Held Michael E, Stambough Jeffery B, McConnell Zachary A, Mears Simon C, Barnes C Lowry, Stronach Benjamin M
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Orthopaedic Surgery, University of Florida, Gainesville, Florida.
J Arthroplasty. 2025 Apr;40(4):1021-1027. doi: 10.1016/j.arth.2024.09.034. Epub 2024 Sep 26.
Infective endocarditis (IE) and periprosthetic joint infections (PJI) occur due to hematogenous bacterial spread, theoretically increasing the risk for concurrent infections. There is a scarcity of literature investigating this specific association. We aimed to assess the prevalence, comorbidities, and clinical presentation of patients who have simultaneous PJI and IE.
We retrospectively identified 655 patients (321 men, 334 women; 382 total hip arthroplasty, 273 total knee arthroplasty) who developed a PJI from July 1, 2015, to December 31, 2020, at one institution. There were two groups created: patients diagnosed with PJI with IE (PJI + IE) and PJI patients who did not have IE (PJI). We analyzed clinical outcomes and comorbidities.
There were nine patients who had PJI with IE (1.4% of PJI patients). The C-reactive protein (170.9 versus 78, P = 0.026), Elixhauser comorbidity score (P = 0.002), length of hospital stay (10.9 versus 5.7 days, P = 0.043), and the 2-year postdischarge mortality rate (55.6 versus 9.0%, P = 0.0007) were significantly greater in the PJI + IE group. Comorbidities such as iron deficiency anemia (P = 0.03), coagulopathy (P = 0.02), complicated diabetes mellitus (P = 0.02), electrolyte disorders (P = 0.01), neurologic disease (P = 0.004), paralysis (P = 0.04), renal failure (P = 0.0001), and valvular disease (P = 0.0008) occurred more frequently in the PJI + IE group. Modified Duke's criteria were met for possible or definite IE in eight of the nine patients.
Concurrent PJIs and IE, although rare, are a potentially devastating disease state with increased length of hospital stay and 2-year mortality rates. This emphasizes the need for appropriate IE workups in patients who have a PJI. The modified Duke's criteria are effective in establishing a diagnosis for IE in this scenario.
感染性心内膜炎（IE）和人工关节周围感染（PJI）是由血源性细菌传播引起的，理论上会增加并发感染的风险。目前关于这种特定关联的文献较少。我们旨在评估同时患有PJI和IE的患者的患病率、合并症及临床表现。
我们回顾性地确定了2015年7月1日至2020年12月31日在一家机构发生PJI的655例患者（321例男性，334例女性；382例行全髋关节置换术，273例行全膝关节置换术）。将患者分为两组：诊断为PJI合并IE的患者（PJI + IE）和未患IE的PJI患者（PJI）。我们分析了临床结局和合并症。
有9例患者患有PJI合并IE（占PJI患者的1.4%）。PJI + IE组的C反应蛋白（170.9对78，P = 0.026）、埃利克斯豪泽合并症评分（P = 0.002）、住院时间（10.9对5.7天，P = 0.043）以及出院后2年死亡率（55.6%对9.0%，P = 0.0007）均显著更高。PJI + IE组缺铁性贫血（P = 0.03）、凝血功能障碍（P = 0.02）、复杂性糖尿病（P = 0.02）、电解质紊乱（P = 0.01）、神经系统疾病（P = 0.004）、瘫痪（P = 0.04）、肾衰竭（P = 0.0001）和瓣膜病（P = 0.0008）等合并症更为常见。9例患者中有8例符合改良杜克标准中可能或确诊IE的标准。
PJI和IE同时存在虽然罕见，但却是一种潜在的毁灭性疾病状态，住院时间和2年死亡率均增加。这强调了对患有PJI的患者进行适当IE检查的必要性。在这种情况下，改良杜克标准对于确立IE诊断是有效的。
