Şahin Rıfat, Budin Maximilian, Suero Eduardo M, Gehrke Thorsten, Çıtak Mustafa
Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany; Department of Orthopaedics and Traumatology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey.
Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany.
J Arthroplasty. 2025 Apr;40(4):1034-1039. doi: 10.1016/j.arth.2024.12.029. Epub 2025 Jan 3.
Periprosthetic joint infections (PJIs) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients?
Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups as follows: patients those who had and those who did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson Comorbidity Index scores (P < 0.001).
Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were as follows: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), methicillin-resistant Staphylococcus aureus (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06).
Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and methicillin-resistant Staphylococcus aureus. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.
人工关节周围感染（PJI）是全膝关节置换术（TKA）最严重的并发症之一。慢性肾脏病（CKD）患者更容易发生PJI。我们旨在回答以下问题：1）CKD患者TKA术后PJI中常见的病原体有哪些，与非CKD患者的病原体有差异吗？2）CKD患者TKA术后PJI的危险因素有哪些？
回顾性纳入因TKA慢性PJI接受手术的患者。患者分为两组：有CKD的患者和无CKD的患者。记录患者的人口统计学数据和合并症。根据活检结果确定导致PJI的微生物，并对两组进行比较。CKD组有331例患者，对照组有2238例患者。有CKD的患者年龄显著更大（P<0.001），Charlson合并症指数得分更高（P<0.001）。
二元逻辑回归在CKD组中确定了多种微生物。PJI中最常见的微生物如下：表皮葡萄球菌（比值比[OR]1.38；P=0.030；95%置信区间[CI]1.03至1.86）、金黄色葡萄球菌（OR 1.88；P<0.001；95%CI 1.36至2.61）、粪肠球菌（OR 2.39；P<0.001；95%CI 1.44至3.94）、大肠埃希菌（OR 1.76；P=0.028；95%CI 1.06至2.94）、耐甲氧西林金黄色葡萄球菌（OR 3.04；P=0.024；95%CI 1.15至8.02）、多微生物感染（OR 1.52；P<0.001；95%CI 1.12至2.06）。
患有PJI和CKD的患者特定微生物感染的发生率更高，包括葡萄球菌、肠球菌、革兰氏阴性菌和耐甲氧西林金黄色葡萄球菌。为降低CKD患者发生PJI的高风险，建议基于这种微生物谱制定治疗方案，并在TKA术前对CKD合并症进行多学科评估。
