Ergin Musa, Budin Maximilian, Canbaz Sebati B, Ciloglu Osman, Salber Jochen, Gehrke Thorsten, Citak Mustafa
ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany; Department of Orthopedics and Traumatology, Cihanbeyli State Hospital, Konya, Turkey.
ENDO-Klinik Hamburg Department of Orthopaedic Surgery, Hamburg, Germany.
J Arthroplasty. 2025 Feb;40(2):494-498. doi: 10.1016/j.arth.2024.08.030. Epub 2024 Aug 24.
Periprosthetic joint infection (PJI) is a major complication following hip arthroplasty, leading to prolonged hospital stays, increased health care costs, and major morbidity. Diabetes mellitus is a prevalent comorbidity among hip arthroplasty patients, contributing to an increased risk of surgical complications, including infections. However, limited evidence exists regarding the microbial profiles of PJIs in diabetic patients compared to nondiabetic counterparts.
We conducted a retrospective cohort study to investigate the microbial diversity of PJIs in diabetic and nondiabetic patients following hip arthroplasty. Medical records of patients who underwent hip arthroplasty procedures between 1996 and 2021 were reviewed. Patients diagnosed with PJI, based on the international consensus meeting, were included in the study. Microbiological data, including culture results, and risk factors were collected and analyzed. A total of 4,261 culture-positive patients diagnosed with PJI following hip arthroplasty were included in the analysis.
Microbiological analysis revealed a diverse spectrum of microbial pathogens, with Staphylococcus species being the most commonly isolated pathogen. Comparison between diabetic and nondiabetic patients revealed differences in the microbial profiles of PJIs, with diabetic patients more likely to be infected with specific pathogens, including Candida albicans (P = 0.01 odds ratio (OR) 2.8, confidence interval (CI) 1.2 to 6.2), Klebsiella pneumoniae (P = 0.03 OR 2.4, CI 1.0 to 5.6), Staphylococcus aureus (P = 0.04 OR 1.3, CI 1.0 to 1.8), Staphylococcus epidermidis (P < 0.001 (R 1.7, CI 1.4 to 2.2), Polymicrobial infections (P < 0.001 OR 1.5, CI 1.2 to 1.8), and Clostridium perfringens (P = 0.04 OR 5.9, CI 1.0 to 33.1).
Our study provides valuable insights into the microbial diversity of PJIs in diabetic and nondiabetic patients following hip arthroplasty. The identification of a tendency to different microbial profiles in diabetic patients underscores the need for tailored approaches to infection prevention and management in this high-risk population. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve patient outcomes.
人工关节周围感染（PJI）是髋关节置换术后的一种主要并发症，会导致住院时间延长、医疗费用增加以及严重的发病率。糖尿病是髋关节置换术患者中常见的合并症，会增加包括感染在内的手术并发症风险。然而，与非糖尿病患者相比，关于糖尿病患者PJI微生物谱的证据有限。
我们进行了一项回顾性队列研究，以调查髋关节置换术后糖尿病和非糖尿病患者PJI的微生物多样性。回顾了1996年至2021年间接受髋关节置换手术患者的病历。根据国际共识会议诊断为PJI的患者纳入研究。收集并分析微生物学数据，包括培养结果和危险因素。共有4261例髋关节置换术后诊断为PJI的培养阳性患者纳入分析。
微生物学分析显示微生物病原体种类多样，葡萄球菌属是最常分离出的病原体。糖尿病患者和非糖尿病患者之间的比较显示，PJI的微生物谱存在差异，糖尿病患者更易感染特定病原体，包括白色念珠菌（P = 0.01，优势比（OR）2.8，置信区间（CI）1.2至6.2）、肺炎克雷伯菌（P = 0.03，OR 2.4，CI 1.0至5.6）、金黄色葡萄球菌（P = 0.04，OR 1.3，CI 1.0至1.8）、表皮葡萄球菌（P < 0.001，OR 1.7，CI 1.4至2.2）、混合感染（P < 0.001，OR 1.5，CI 1.2至1.8）以及产气荚膜梭菌（P = 0.04，OR 5.9，CI 1.0至33.1）。
我们的研究为髋关节置换术后糖尿病和非糖尿病患者PJI的微生物多样性提供了有价值的见解。糖尿病患者中不同微生物谱倾向的识别强调了针对这一高危人群进行感染预防和管理的定制方法的必要性。需要进一步研究以阐明潜在机制并开发针对性干预措施以改善患者预后。
