Department of Clinical Pharmacy, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
Department of Clinical Laboratory, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
Int Wound J. 2023 Oct;20(8):3315-3323. doi: 10.1111/iwj.14212. Epub 2023 Apr 25.
To assist orthopaedic surgeons in choosing appropriate antibiotics, this study attempted to identify the common microorganisms that cause periprosthetic joint infection (PJI) and their respective drug resistance spectrums. The clinical data of 202 patients with PJI after primary hip and knee arthroplasty between January 2017 and December 2021 were retrospectively analysed. There were 84 males and 118 females, aged (63.03 ± 13.10) years (range: 24-89 years). A total of 102 and 100 patients underwent total hip and total knee arthroplasty, respectively. Based on the time of postoperative infection, the patients were divided into acute (25 cases), delayed (91 cases), and chronic (86 cases) PJI groups. The results of pathogen species, composition ratio, and drug susceptibility tests were collected. Gram-positive bacteria were the primary causative pathogens of PJI (58.91%, 119/202), and their culture-positive rates in patients with acute, delayed, and chronic PJI were 32.00% (8/25), 62.64% (57/91), and 62.79% (54/86), respectively. Staphylococcus epidermidis and Staphylococcus aureus were the major gram-positive bacteria detected, followed by gram-negative bacteria (29/202, 14.36%), and fungi (4/202, 1.98%). Gram-positive bacteria showed higher resistance to penicillin (81.25%), oxacillin (63.33%), erythromycin (61.17%), and clindamycin (48.35%) and 100% sensitivity to linezolid, vancomycin, daptomycin, and tigecycline. In gram-negative bacteria, the drug resistance rates to cefazolin, gentamicin, furantoin, cefuroxime, ticacillin/clavulanic acid, ceftriaxone, ciprofloxacin, and tobramycin were >50%. However, no vancomycin-resistant bacteria were discovered in the current study. The drug resistance rate to carbapenems was low, ranging from 0% to 3.57%. Gram-positive bacteria are the main causative pathogens of PJI, and the resistance rate of pathogens of chronic PJI is higher than those of delayed and acute PJI. Use of cefuroxime and clindamycin in patients with PJIs should proceed with caution because of the high drug resistance rate. Vancomycin can be used as a first-line antibiotic against gram-positive bacteria. Carbapenems can be used as the first choice against gram-negative bacteria because of to their high sensitivity.
为了帮助矫形外科医生选择合适的抗生素，本研究试图确定引起假体周围关节感染（PJI）的常见微生物及其各自的药物耐药谱。回顾性分析了 2017 年 1 月至 2021 年 12 月期间初次髋关节和膝关节置换术后发生 PJI 的 202 例患者的临床资料。其中男 84 例，女 118 例，年龄（63.03±13.10）岁（范围：24-89 岁）。102 例患者行全髋关节置换术，100 例患者行全膝关节置换术。根据术后感染时间，将患者分为急性（25 例）、延迟（91 例）和慢性（86 例）PJI 组。收集病原菌种类、构成比和药敏试验结果。革兰阳性菌是 PJI 的主要病原体（58.91%，119/202），急性、延迟和慢性 PJI 患者的培养阳性率分别为 32.00%（8/25）、62.64%（57/91）和 62.79%（54/86）。表皮葡萄球菌和金黄色葡萄球菌是主要的革兰阳性菌，其次是革兰阴性菌（29/202，14.36%）和真菌（4/202，1.98%）。革兰阳性菌对青霉素（81.25%）、苯唑西林（63.33%）、红霉素（61.17%）和克林霉素（48.35%）的耐药率较高，对利奈唑胺、万古霉素、达托霉素和替加环素的耐药率为 100%。革兰阴性菌对头孢唑林、庆大霉素、呋喃妥因、头孢呋辛、替卡西林/克拉维酸、头孢曲松、环丙沙星和妥布霉素的耐药率>50%。然而，目前的研究中未发现耐万古霉素的细菌。碳青霉烯类药物的耐药率较低，为 0%至 3.57%。革兰阳性菌是 PJI 的主要病原体，慢性 PJI 的病原体耐药率高于延迟和急性 PJI。由于高耐药率，应谨慎使用头孢呋辛和克林霉素治疗 PJI 患者。万古霉素可作为治疗革兰阳性菌的一线抗生素。由于对革兰阴性菌的高敏感性，碳青霉烯类药物可作为首选药物。
