Roman Mihai Dan, Bocea Bogdan-Axente, Ion Nicolas-Ionut-Catalin, Vorovenci Andreea Elena, Dragomirescu Dan, Birlutiu Rares-Mircea, Birlutiu Victoria, Fleaca Sorin Radu
Faculty of Medicine Sibiu, Lucian Blaga University, Str. Lucian Blaga, Nr. 2A, 550169 Sibiu, Romania.
County Clinical Emergency Hospital, 550245 Sibiu, Romania.
Microorganisms. 2023 Jan 1;11(1):116. doi: 10.3390/microorganisms11010116.
PJIs following total hip and knee arthroplasty represent severe complications with broad implications, and with significant disability, morbidity, and mortality. To be able to provide correct and effective management of these cases, an accurate diagnosis is needed. Classically, acute PJIs are characterized by a preponderance of virulent microorganisms, and chronic PJIs are characterized by a preponderance of less-virulent pathogens like coagulase-negative staphylococci or species. This paper aims to analyze if there are any changes in the causative microorganisms isolated in the last years, as well as to provide a subanalysis of the types of PJIs.
In this single-center study, we prospectively included all retrospectively consecutive collected data from patients aged over 18 years that were hospitalized from 2016 through 2022, and patients that underwent a joint arthroplasty revision surgery. A standardized diagnostic protocol was used in all cases, and the 2021 EBJIS definition criteria for PJIs was used.
114 patients were included in our analysis; of them, 67 were diagnosed with PJIs, 12 were acute/acute hematogenous, and 55 were chronic PJIs. 49 strains of gram-positive aerobic or microaerophilic cocci and 35 gram-negative aerobic bacilli were isolated. Overall, was the most common isolated pathogen, followed by coagulase-negative staphylococci (CoNS). All cases of acute/acute hematogenous PJIs were caused by gram-positive aerobic or microaerophilic cocci pathogens. Both and methicillin-resistant were involved in 91.66% of the acute/acute hematogenous PJIs cases. 21.8% of the chronic PJIs cases were caused by pathogens belonging to the Enterobacterales group of bacteria, followed by the gram-negative nonfermenting bacilli group of bacteria, which were involved in 18.4% of the cases. 12 chronic cases were polymicrobial.
Based on our findings, empiric broad-spectrum antibiotic therapy in acute PJIs could be focused on the bacteria belonging to the gram-positive aerobic or microaerophilic cocci, but the results should be analyzed carefully, and the local resistance of the pathogens should be taken into consideration.
全髋关节和膝关节置换术后的假体周围感染（PJI）是具有广泛影响的严重并发症，会导致严重残疾、发病和死亡。为了能够对这些病例进行正确有效的管理，需要准确的诊断。传统上，急性PJI的特征是致病性微生物占优势，而慢性PJI的特征是致病性较弱的病原体如凝固酶阴性葡萄球菌或其他菌种占优势。本文旨在分析近年来分离出的致病微生物是否有任何变化，并对PJI的类型进行亚分析。
在这项单中心研究中，我们前瞻性地纳入了2016年至2022年期间住院的18岁以上患者以及接受关节置换翻修手术患者的所有回顾性连续收集数据。所有病例均采用标准化诊断方案，并使用2021年EBJIS关于PJI的定义标准。
114例患者纳入我们的分析；其中，67例被诊断为PJI，12例为急性/急性血源性感染，55例为慢性PJI。分离出49株革兰氏阳性需氧或微需氧球菌和35株革兰氏阴性需氧杆菌。总体而言，[具体菌种名称未给出]是最常见的分离病原体，其次是凝固酶阴性葡萄球菌（CoNS）。所有急性/急性血源性PJI病例均由革兰氏阳性需氧或微需氧球菌病原体引起。[具体菌种名称未给出]和耐甲氧西林[具体菌种名称未给出]在91.66%的急性/急性血源性PJI病例中出现。21.8%的慢性PJI病例由肠杆菌科细菌病原体引起，其次是革兰氏阴性非发酵杆菌组细菌，占病例的18.4%。12例慢性病例为多菌种感染。
根据我们的研究结果，急性PJI的经验性广谱抗生素治疗可侧重于革兰氏阳性需氧或微需氧球菌，但应仔细分析结果，并考虑病原体的局部耐药性。
