Bratu Angelica, Cirstoiu Catalin, Popa Mihnea Ioan Gabriel, Popescu Mihai, Dumitrascu Oana Clementina, Agapie Mihaela, Orban Carmen
Department of Anesthesiology and Intensive Care, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.
Department of Orthopedics and Traumatology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Life (Basel). 2025 Apr 21;15(4):674. doi: 10.3390/life15040674.
The management of septic orthopedic patients, particularly those with periprosthetic joint infections (PJIs) and trauma-related sepsis, remains a significant clinical challenge. This retrospective cohort study evaluated 27 patients admitted to the Intensive Care Unit (ICU) at the Emergency University Hospital in Bucharest between 2021 and 2024. Patients presented with either PJIs or polytrauma-related infections requiring critical care interventions. The PJI-TNM classification system was employed to assess infection complexity, comorbidities, and implant stability. Therapeutic strategies included one- or two-stage revision surgeries and targeted antimicrobial therapy, including the use of antibiotic-impregnated calcium sulfate beads. Infection resolution was achieved in 85.2% of patients, with a mean ICU stay of 13 days. The overall ICU mortality rate was 11%, with two deaths occurring within the first 30 days of admission. Elevated SOFA scores (≥10) and poor glycemic control (HbA1c > 8.5%) were significantly associated with prolonged ICU stays and higher complication rates. Statistical analysis revealed significant differences in CRP normalization and bone healing times across glycemic control groups ( < 0.001). Patients requiring mechanical ventilation exhibited longer ICU stays and increased mortality (25%). The PJI-TNM classification showed potential utility for risk stratification and guiding personalized treatment strategies. These findings underscore the importance of multidisciplinary ICU-level care and metabolic control in improving outcomes for septic orthopedic patients. Future multicenter studies are needed to validate these preliminary observations and refine prognostic models for this high-risk population.
脓毒症骨科患者的管理，尤其是假体周围关节感染（PJI）和创伤相关脓毒症患者的管理，仍然是一项重大的临床挑战。这项回顾性队列研究评估了2021年至2024年期间在布加勒斯特紧急大学医院重症监护病房（ICU）住院的27例患者。患者表现为需要重症监护干预的PJI或多发伤相关感染。采用PJI-TNM分类系统评估感染复杂性、合并症和植入物稳定性。治疗策略包括一期或二期翻修手术以及靶向抗菌治疗，包括使用抗生素浸渍硫酸钙珠。85.2%的患者感染得到解决，平均ICU住院时间为13天。ICU总体死亡率为11%，入院后前30天内有2例死亡。序贯器官衰竭评估（SOFA）评分升高（≥10）和血糖控制不佳（糖化血红蛋白>8.5%）与ICU住院时间延长和并发症发生率较高显著相关。统计分析显示，不同血糖控制组的C反应蛋白（CRP）正常化和骨愈合时间存在显著差异（<0.001）。需要机械通气的患者ICU住院时间更长，死亡率更高（25%）。PJI-TNM分类显示出在风险分层和指导个性化治疗策略方面的潜在效用。这些发现强调了多学科ICU水平护理和代谢控制在改善脓毒症骨科患者预后方面的重要性。未来需要多中心研究来验证这些初步观察结果，并完善针对这一高危人群的预后模型。
