Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.
Department of Orthopedics and Traumatology, Cihanbeyli State Hospital, Konya, Turkey.
Int Orthop. 2024 Oct;48(10):2633-2640. doi: 10.1007/s00264-024-06275-5. Epub 2024 Aug 24.
The purpose of this study is to conduct a comparative analysis of the microbiological profiles in periprosthetic joint infections (PJIs) after total knee arthroplasty (TKA) between diabetic and non-diabetic patients. The study aims to address what are the variations in microbial colonization and infection patterns between diabetic and non-diabetic patients undergoing total knee arthroplasty.
A retrospective analysis of 2,569 culture-positive cases of PJIs post-TKA was conducted, comparing outcomes between diabetic (n = 321) and non-diabetic (n = 2,248) patients. Demographic, clinical, and microbiological data were collected and analyzed using descriptive statistics, chi-squared tests, logistic regression, and other statistical tests.
Diabetic patients exhibited distinct microbial colonization patterns, with a higher prevalence of pathogens such as Staphylococcus aureus (p = 0.033), Pseudomonas aeruginosa (p < 0.001), Streptococcus spp. (Streptococcus agalactiae and Streptococcus dysgalactiae; p = 0.010, 0.016 respectively), Candida spp. (p = 0.010), and Corynebacterium spp. (p = 0.024). Additionally, diabetic patients were at increased risk of polymicrobial infections. Comorbidities associated with diabetes, including chronic pulmonary disease, renal insufficiency, and peripheral artery disease, were significantly more prevalent in diabetic patients and further complicated PJI outcomes.
This study underscores the importance of tailored perioperative antimicrobial strategies and vigilant infection control measures in diabetic patients undergoing TKA. Understanding the differential microbial profiles and associated comorbidities can inform targeted interventions to mitigate the risk of PJIs and improve outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for diabetic patients undergoing TKA.
本研究旨在对全膝关节置换术后（TKA）糖尿病和非糖尿病患者的假体周围关节感染（PJI）的微生物谱进行比较分析。本研究旨在探讨糖尿病和非糖尿病 TKA 患者之间微生物定植和感染模式的差异。
对 2569 例 TKA 后培养阳性的 PJI 病例进行回顾性分析，比较糖尿病（n=321）和非糖尿病（n=2248）患者的结局。收集并使用描述性统计、卡方检验、逻辑回归和其他统计检验分析人口统计学、临床和微生物学数据。
糖尿病患者表现出独特的微生物定植模式，金黄色葡萄球菌（p=0.033）、铜绿假单胞菌（p<0.001）、链球菌属（无乳链球菌和停乳链球菌；p=0.010、0.016）、假丝酵母菌属（p=0.010）和棒状杆菌属（p=0.024）等病原体的患病率较高。此外，糖尿病患者发生混合感染的风险增加。与糖尿病相关的合并症，包括慢性肺部疾病、肾功能不全和外周动脉疾病，在糖尿病患者中更为常见，进一步使 PJI 结局复杂化。
本研究强调了在 TKA 中为糖尿病患者制定个体化围手术期抗菌策略和加强感染控制措施的重要性。了解不同的微生物谱和相关合并症可以为针对这一高风险人群的干预措施提供信息，以降低 PJI 的风险并改善结局。需要进一步的研究来阐明糖尿病患者 TKA 患者的潜在机制并优化管理策略。
