Orthopaedic Department, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2951-2958. doi: 10.1007/s00402-022-04489-z. Epub 2022 Jun 27.
Periprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for "aseptic" causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics.
Medical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated.
A total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33-86) years were included. At an average follow-up of 67 ± 33 (24-127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively.
Infection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspiration should not rule out a C. acnes PJI, especially in the presence of clinical correlates of infection.
Retrospective case-control study, Level III.
Kantonale Ethikkommission Zürich, BASEC Nr.:2017-00567.
假体周围关节感染（PJI）是全关节置换（TJR）后的一种破坏性并发症。痤疮丙酸杆菌（C. acnes）是一种低毒皮肤共生菌，通常在 TJR 翻修手术中因“无菌”原因而被发现。本研究的目的是报告在 TJR 治疗中，伴有 C. acnes 污染或感染的患者，采用翻修手术加假体置换加延长（≥8 周）术后抗生素治疗的治疗结果。
回顾性评估 2005 年 1 月至 2014 年 12 月期间，至少有一次 C. acnes 培养阳性的术中组织样本或 TJR 翻修手术中的超声液的患者的医疗记录。主要终点是根据 Delphi 标准消除感染。还研究了术前 TJR 抽吸术对 C. acnes PJI 诊断的准确性。
共纳入 52 名患者（35 名男性，17 名女性）的 52 个 TJR（28 个肩部，17 个髋关节，7 个膝关节），平均年龄为 63±11（33-86）岁。平均随访 67±33（24-127）个月后，无论手术治疗或给予延长术后抗生素，C. acnes PJI 的感染清除率均为 97%。意外 C. acnes PJI 的发生率为 28.8%。术前关节抽吸术检测 C. acnes PJI 的灵敏度和特异性分别为 59%和 88%，而阳性预测值和阴性预测值分别为 83%和 67%。
至少随访 24 个月时，C. acnes PJI 的感染清除率非常高，表明 C. acnes PJI 可以通过翻修手术和延长术后抗生素联合治疗得到充分治疗。术前诊断 C.acnes PJI 可能具有挑战性，超过四分之一的患者没有怀疑 C.acnes PJI。对于单个阳性培养物的适当治疗仍不清楚。TJR 抽吸术阴性不应排除 C.acnes PJI，尤其是在存在感染临床相关性的情况下。
回顾性病例对照研究，III 级。
苏黎世州伦理委员会，BASEC Nr：2017-00567。
