McCulloch Robert A, Adlan Amirul, Jenkins Neil, Parry Michael, Stevenson Jonathan D, Jeys Lee
Bone Infection Service, The Royal Orthopaedic Hospital, Birmingham, UK.
Department of Infectious Diseases and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK.
J Bone Jt Infect. 2022 Aug 8;7(4):177-182. doi: 10.5194/jbji-7-177-2022. eCollection 2022.
: this study compared the patient and microbiological profile of prosthetic joint infection (PJI) for patients treated with two-stage revision for knee arthroplasty with that of lower-limb endoprostheses for oncological resection. : a total of 118 patients were treated with two-stage revision surgery for infected knee arthroplasty and lower-limb endoprostheses between 1999 and 2019. A total of 74 patients had two-stage revision for PJI of knee arthroplasty, and 44 had two-stage revision of oncology knee endoprostheses. There were 68 men and 50 women. The mean ages of the arthroplasty and oncology cohorts were 70.2 years (range of 50-89) and 36.1 years (range of 12-78) respectively ( .01). Patient host and extremity criteria were categorized according to the Musculoskeletal Infection Society (MSIS) host and extremity staging system. The patient microbiological culture, the incidence of polymicrobial infection, and multidrug resistance (MDR) were analysed and recorded. : polymicrobial infection was reported in 16 % (12 patients) of knee arthroplasty PJI cases and in 14.5 % (8 patients) of endoprostheses PJI cases ( .783). There was a significantly higher incidence of MDR in endoprostheses PJI, isolated in 36.4 % of cultures, compared with knee arthroplasty PJI (17.2 %, .01). Gram-positive organisms were isolated in more than 80 % of cultures from both cohorts. Coagulase-negative (CoNS) was the most common Gram-positive organism, and was the most common Gram-negative organism in both groups. According to the MSIS staging system, the host and extremity grades of the oncology PJI cohort were significantly worse than those for the arthroplasty PJI cohort ( .05). : empirical antibiotic prophylaxis against PJI in orthopaedic oncology is based upon PJI in arthroplasty, despite oncology patients presenting with worse host and extremity staging. CoNS was the most common infective organism in both groups; however, pathogens showing MDR were significantly more prevalent in oncological PJI of the knee. Therefore, empirical broad-spectrum treatment is recommended in oncological patients following revision surgery.
本研究比较了接受膝关节置换二期翻修术治疗的假体关节感染（PJI）患者与接受肿瘤切除下肢假体植入术患者的患者情况和微生物学特征。1999年至2019年间，共有118例患者接受了感染性膝关节置换和下肢假体的二期翻修手术。其中，74例患者因膝关节置换术后PJI接受二期翻修，44例因肿瘤性膝关节假体接受二期翻修。患者中男性68例，女性50例。关节置换组和肿瘤组的平均年龄分别为70.2岁（范围50 - 89岁）和36.1岁（范围12 - 78岁）（P <.01）。患者宿主和肢体标准根据肌肉骨骼感染学会（MSIS）宿主和肢体分期系统进行分类。分析并记录患者的微生物培养情况、多微生物感染发生率和多重耐药（MDR）情况。膝关节置换术后PJI病例中有因多微生物感染报告的占16%（12例），假体植入术后PJI病例中有因多微生物感染报告的占14.5%（8例）（P =.783）。与膝关节置换术后PJI（17.2%）相比，假体植入术后PJI中MDR的发生率显著更高，在36.4%的培养物中分离出MDR（P <.01）。两组超过80%的培养物中分离出革兰氏阳性菌。凝固酶阴性葡萄球菌（CoNS）是最常见的革兰氏阳性菌，两组中大肠杆菌是最常见的革兰氏阴性菌。根据MSIS分期系统，肿瘤性PJI组的宿主和肢体分级明显比关节置换术后PJI组差（P <.05）。尽管肿瘤患者的宿主和肢体分期较差，但骨科肿瘤中针对PJI的经验性抗生素预防是基于关节置换术后的PJI情况。CoNS是两组中最常见的感染病原体；然而，表现出MDR的病原体在膝关节肿瘤性PJI中明显更为普遍。因此，建议对肿瘤患者在翻修手术后进行经验性广谱治疗。
