Baertl Susanne, Lovasz David, Kees Martin G, Walter Nike, Schindler Melanie, Li Jing, Reinhard Jan, Alt Volker, Rupp Markus
Regensburg University Medical Center, Department of Trauma Surgery, Regensburg, Germany.
Regensburg University Medical Center, Department of Cardiac Surgery, Regensburg, Germany.
J Arthroplasty. 2025 Jul;40(7):1827-1835. doi: 10.1016/j.arth.2024.11.062. Epub 2024 Dec 19.
This study investigated the epidemiology, risk factors, and outcomes of sepsis, a life-threatening complication, in the context of periprosthetic joint infections (PJIs) of the hip and knee.
Sepsis was determined using the sepsis-1 criteria. The cohort with PJI and sepsis was compared to patients who had PJI without sepsis. Analyzed risk factors were patient characteristics, microbiological findings, and comorbidities. Outcome parameters were mortality, length of hospital stay, and intensive care unit stay. Among 108 PJIs (48 hips and 60 knees), 40.6% met the sepsis criteria.
In hip PJI, the sepsis group had a higher Charlson Comorbidity Index (4.0 versus 1.0; P ≤ 0.001) with Staphylococcus aureus infections more common in septic cases (9 of 17 versus 6 of 31; P = 0.04). Renal (odds ratio (OR) 16.9; P ≤ 0.001) and cardiac (OR 12.5; P = 0.02) disease increased sepsis risk. Sepsis correlated with prolonged hospital stays (54 versus 24 days; P = 0.002) and increased mortality (23.5 versus 3.2%; P = 0.047). In knee PJI cases, septic patients had more Staphylococcus aureus PJI (14 of 28 versus 8 of 32; P = 0.04). Atrial fibrillation (OR 3.3; P = 0.04) and renal disease (OR 4.0; P = 0.02) were associated with sepsis. Sepsis cases had longer hospital stays (48 versus 29.5 days; P = 0.01) and higher intensive care unit admissions (67.9 versus 34.4%; P = 0.02). In-hospital mortality was 10-fold higher in the sepsis cohort (25.0 versus 3.3%; OR 10.3, P = 0.02).
In a considerable number of patients, PJI can lead to a septic course associated with increased mortality. This underscores the need for close monitoring to prevent overlooking these patients' deteriorating clinical conditions. Timely interventions, akin to the "every hour counts" approach in sepsis management, might help reduce morbidity and mortality in these patients.
本研究在髋和膝关节假体周围感染（PJI）的背景下，调查了脓毒症（一种危及生命的并发症）的流行病学、危险因素和结局。
使用脓毒症-1标准确定脓毒症。将患有PJI和脓毒症的队列与未患脓毒症的PJI患者进行比较。分析的危险因素包括患者特征、微生物学检查结果和合并症。结局参数为死亡率、住院时间和重症监护病房住院时间。在108例PJI（48例髋关节和60例膝关节）中，40.6%符合脓毒症标准。
在髋关节PJI中，脓毒症组的查尔森合并症指数更高（4.0对1.0；P≤0.001），金黄色葡萄球菌感染在脓毒症病例中更常见（17例中的9例对31例中的6例；P = 0.04）。肾脏疾病（比值比（OR）16.9；P≤0.001）和心脏疾病（OR 12.5；P = 0.02）增加了脓毒症风险。脓毒症与住院时间延长相关（54天对24天；P = 0.002）和死亡率增加（23.5%对3.2%；P = 0.047）。在膝关节PJI病例中，脓毒症患者的金黄色葡萄球菌PJI更多（28例中的14例对32例中的8例；P = 0.04）。心房颤动（OR 3.3；P = 0.04）和肾脏疾病（OR 4.0；P = 0.02）与脓毒症相关。脓毒症病例的住院时间更长（48天对29.5天；P = 0.01），重症监护病房收治率更高（67.9%对34.4%；P = 0.02）。脓毒症队列的院内死亡率高出10倍（25.0%对3.3%；OR 10.3，P = 0.02）。
在相当数量的患者中，PJI可导致脓毒症病程并增加死亡率。这强调了密切监测的必要性，以防止忽视这些患者不断恶化的临床状况。及时干预，类似于脓毒症管理中的“分秒必争”方法，可能有助于降低这些患者的发病率和死亡率。
