Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Laboratory of Microbiology and GMP Quality Control, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
Clin Microbiol Infect. 2023 Nov;29(11):1431-1436. doi: 10.1016/j.cmi.2023.07.018. Epub 2023 Jul 28.
The aim of this study was to investigate the clinical relevance of an isolated positive sonication fluid culture (SFC) in patients who underwent revision surgery of a prosthetic joint. We hypothesized that cases with a positive SFC have a higher rate of infection during follow-up compared with controls with a negative SFC.
This retrospective multicentre observational study was performed within the European Study Group of Implant-Associated Infections. All patients who underwent revision surgery of a prosthetic joint between 2013 and 2019 and had a minimum follow-up of 1 year were included. Patients with positive tissue cultures or synovial fluid cultures were excluded from the study.
A total of 95 cases (positive SFC) and 201 controls (negative SFC) were included. Infection during follow-up occurred in 12 of 95 cases (12.6%) versus 14 of 201 controls (7.0%) (p = 0.125). In all, 79.8% of cases were with treated with antibiotics (76/95). Of the non-treated cases, 89% (17/19) had a positive SFC with a low virulent microorganism. When solely analysing patients who were not treated with antibiotics, 16% of the cases (3/19) had an infection during follow-up versus 5% of the controls (9/173) (p = 0.08).
Although not statistically significant, infections were almost twice as frequent in patients with an isolated positive SFC. These findings require further exploration in larger trials and to conclude about the potential benefit of antibiotic treatment in these cases.
本研究旨在探讨在接受人工关节翻修手术的患者中，单纯阳性超声液培养（SFC）的临床意义。我们假设与阴性 SFC 对照组相比，SFC 阳性的病例在随访期间感染率更高。
这是一项在欧洲植入物相关感染研究组内进行的回顾性多中心观察性研究。纳入 2013 年至 2019 年间接受人工关节翻修手术且随访时间至少 1 年的所有患者。排除有阳性组织培养或关节液培养的患者。
共纳入 95 例（SFC 阳性）和 201 例（SFC 阴性）对照组患者。95 例中有 12 例（12.6%）在随访期间发生感染，201 例对照组中有 14 例（7.0%）（p=0.125）。共有 79.8%的病例接受了抗生素治疗（76/95）。未接受治疗的病例中，89%（17/19）的 SFC 阳性且微生物毒力低。仅分析未接受抗生素治疗的患者，16%的病例（3/19）在随访期间发生感染，而对照组为 5%（9/173）（p=0.08）。
尽管没有统计学意义，但 SFC 阳性患者的感染率几乎是对照组的两倍。这些发现需要在更大规模的试验中进一步探索，以确定在这些病例中抗生素治疗的潜在获益。
