Stimolo Davide, Budin Maximilian, De Mauro Domenico, Suero Eduardo, Gehrke Thorsten, Citak Mustafa
Helios ENDO-Klinik, Holstenstrasse 2, 22767, Hamburg, Germany.
Musculoskeletal Oncology Unit, Department of Orthopedics, University of Florence, Largo Palagi 1, 50135, Florence, Italy.
J Orthop Traumatol. 2024 Dec 19;25(1):67. doi: 10.1186/s10195-024-00806-x.
Patients affected by chronic kidney disease (CKD) are at increased risk of periprosthetic joint infection (PJI) after total hip arthroplasty (THA). This patient population has a higher risk of recurrent infections and hospitalization. The aim of this study is to compare the profile of microorganisms in patients with CKD and PJI of the hip versus controls and to individuate potentially unusual and drug-resistant microorganisms among the causative bacteria.
A total of 4261 patients affected by PJI of the hip were retrospectively studied. Patients affected by CKD in this population were identified and compared with a control group of patients with PJI but without CKD. Data on patient characteristics and comorbidities were collected. The microorganisms responsible for PJI were identified and compared between both groups.
The CKD group included 409 patients, 54.3% male, mean age of 73.8 ± 8.9 years, a higher body mass index (BMI) than the general population (29.88 ± 5.90 kg/m), and higher age-adjusted CCI of 6.15 ± 2.35. Overall, 70 different isolates of microorganisms were identified, including 52 Gram-positive spp., 28 Gram-negative spp., 3 fungi, and 1 mycobacterium. Polymicrobial infections were more common in CKD group than controls (47.9% versus 30.9%; p < 0.0001). Staphylococcus spp. were the most common bacteria in both groups, followed by Gram-negative Enterobacteriaceae and Streptococcus spp. CKD group showed a higher risk of developing infections caused by Staphylococcus aureus (p = 0.003), Gram-negative bacteria, and Candida (p = 0.035).
Renal failure exposes patients who undergo THA to PJI caused by microorganisms that are potentially more drug resistant, leading to a higher risk of treatment failure. Knowing in advance the different microorganism profiles could help to plan a different surgical strategy.
慢性肾脏病（CKD）患者在全髋关节置换术（THA）后发生假体周围关节感染（PJI）的风险增加。该患者群体发生反复感染和住院的风险更高。本研究的目的是比较CKD合并髋关节PJI患者与对照组患者的微生物谱，并在致病细菌中确定潜在的不常见和耐药微生物。
对4261例髋关节PJI患者进行回顾性研究。确定该人群中受CKD影响的患者，并与一组无CKD的髋关节PJI患者对照组进行比较。收集患者特征和合并症数据。确定两组中导致PJI的微生物并进行比较。
CKD组包括409例患者，男性占54.3%，平均年龄73.8±8.9岁，体重指数（BMI）高于一般人群（29.88±5.90kg/m²），年龄校正后的CCI更高，为6.15±2.35。总体而言，共鉴定出70种不同的微生物分离株，包括52种革兰氏阳性菌、28种革兰氏阴性菌、3种真菌和1种分枝杆菌。CKD组的混合感染比对照组更常见（47.9%对30.9%；p<0.0001）。葡萄球菌属是两组中最常见的细菌，其次是革兰氏阴性肠杆菌科和链球菌属。CKD组发生由金黄色葡萄球菌（p=0.003）、革兰氏阴性菌和念珠菌（p=0.035）引起感染的风险更高。
肾衰竭使接受THA的患者面临由潜在耐药性更强的微生物引起的PJI风险，导致治疗失败的风险更高。提前了解不同的微生物谱有助于制定不同的手术策略。
