Li Yicheng, Wuermanbieke Shalitanati, Wang Fei, Mu Wenbo, Ji Baochao, Guo Xiaobin, Zou Chen, Chen Yanyang, Zhang Xiaogang, Cao Li
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Department of Sports Medicine, Karamay Hospital of People's Hospital of Xinjiang Uygur Autonomous Region, Karamay, China.
Bone Joint Res. 2024 Oct 4;13(10):546-558. doi: 10.1302/2046-3758.1310.BJR-2024-0119.R1.
The optimum type of antibiotics and their administration route for treating Gram-negative (GN) periprosthetic joint infection (PJI) remain controversial. This study aimed to determine the GN bacterial species and antibacterial resistance rates related to clinical GN-PJI, and to determine the efficacy and safety of intra-articular (IA) antibiotic injection after one-stage revision in a GN pathogen-induced PJI rat model of total knee arthroplasty.
A total of 36 consecutive PJI patients who had been infected with GN bacteria between February 2015 and December 2021 were retrospectively recruited in order to analyze the GN bacterial species involvement and antibacterial resistance rates. Antibiotic susceptibility assays of the GN bacterial species were performed to screen for the most sensitive antibiotic, which was then used to treat the most common GN pathogen-induced PJI rat model. The rats were randomized either to a PJI control group or to three meropenem groups (intraperitoneal (IP), IA, and IP + IA groups). After two weeks of treatment, infection control level, the side effects, and the volume of antibiotic use were evaluated.
was the most common pathogen in GN-PJI, and meropenem was the most sensitive antibiotic. Serum inflammatory markers, weightbearing activity, and Rissing score were significantly improved by meropenem, especially in the IA and IP + IA groups ( p < 0.05). Meropenem in the IA group eradicated from soft-tissue, bone, and prosthetic surfaces, with the same effect as in the IP + IA group. Radiological results revealed that IA and IP + IA meropenem were effective at relieving bone damage. Haematoxylin and eosin staining also showed that IA and IP + IA meropenem improved synovial inflammation and bone destruction. No pathological changes in the main organs or abnormal serum markers were observed in any of the meropenem-treated rats. The IA group required the lowest amount of meropenem, followed by the IP and IP + IA groups.
IA-only meropenem with a two-week treatment course was effective and safe for PJI control following one-stage revision in a rat model, with less meropenem use.
治疗革兰阴性（GN）人工关节周围感染（PJI）的最佳抗生素类型及其给药途径仍存在争议。本研究旨在确定与临床GN-PJI相关的GN细菌种类和抗菌耐药率，并在全膝关节置换术的GN病原体诱导的PJI大鼠模型中，确定一期翻修术后关节内（IA）注射抗生素的疗效和安全性。
回顾性纳入2015年2月至2021年12月期间连续36例感染GN细菌的PJI患者，以分析GN细菌种类及抗菌耐药率。对GN细菌种类进行抗生素敏感性试验，筛选出最敏感的抗生素，然后用于治疗最常见的GN病原体诱导的PJI大鼠模型。将大鼠随机分为PJI对照组或三个美罗培南组（腹腔内（IP）、IA和IP + IA组）。治疗两周后，评估感染控制水平、副作用和抗生素使用量。
是GN-PJI中最常见的病原体，美罗培南是最敏感的抗生素。美罗培南可显著改善血清炎症标志物、负重活动和Rissing评分，尤其是在IA组和IP + IA组（p < 0.05）。IA组的美罗培南可清除软组织、骨骼和假体表面的 ，效果与IP + IA组相同。影像学结果显示，IA组和美罗培南IP + IA组可有效缓解骨损伤。苏木精和伊红染色还显示，IA组和美罗培南IP + IA组可改善滑膜炎和骨破坏。在任何接受美罗培南治疗的大鼠中，均未观察到主要器官的病理变化或异常血清标志物。IA组所需的美罗培南量最低，其次是IP组和IP + IA组。
在大鼠模型中，仅采用IA途径给予美罗培南并进行为期两周的治疗疗程，对一期翻修术后的PJI控制有效且安全，美罗培南用量较少。
