Dragosloveanu Serban, Birlutiu Rares-Mircea, Neamtu Bogdan, Birlutiu Victoria
Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 021382 Bucharest, Romania.
Microorganisms. 2025 May 21;13(5):1168. doi: 10.3390/microorganisms13051168.
This study examines temporal patterns in pathogens isolated from prosthetic joint infection (PJI) cases and antimicrobial resistance patterns at a Romanian orthopedic center. We have conducted a retrospective cohort study that included 674 patients undergoing hip or knee replacement revision surgery between January 2016 and December 2023. From these, 102 confirmed PJI cases requiring surgical intervention were selected for analysis. We isolated 27 microorganisms from acute PJI cultures and 82 from chronic PJIs. (33 cases, 30.3%; 95% CI 22.0-40.3) was the predominant pathogen, with coagulase-negative (22 cases, 20.18%; 95% CI 0.9-41.3) and Enterobacteriaceae (13 cases, 11.9%; 95% CI 6.4-18.3) also prevalent. Methicillin resistance was identified in 43.6% of coagulase-negative staphylococci and 45.5% of isolates. All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Among Gram-negative bacilli, and showed resistance to third-generation cephalosporins, with phenotypic profiles suggestive of extended-spectrum β-lactamase (ESBL) production. All , spp., and strains were fully susceptible to tested agents, while exhibited reduced susceptibility to ciprofloxacin, aztreonam, and imipenem. Among the isolated strains, 47 were multidrug-resistant (MDR), with accounting for the highest MDR count, including methicillin resistance. The distribution of microorganism types and MDR strains remained consistent throughout the study period, with no significant association between infection type and MDR strain presence or between infection site and microorganism presence except for a strong association between MDR strains and the type of microorganism ( < 0.05). The microbial profile and resistance patterns in PJIs have remained stable over eight years. Our observations do not suggest that MDR PJIs are more commonly acute cases, contrary to what has been highlighted in previous reports. The ongoing prevalence of MDR strains underscores the importance of targeted antimicrobial treatments based on local susceptibility profiles.
本研究调查了罗马尼亚一家骨科中心从人工关节感染（PJI）病例中分离出的病原体的时间模式以及抗菌药物耐药模式。我们进行了一项回顾性队列研究，纳入了2016年1月至2023年12月期间接受髋关节或膝关节置换翻修手术的674例患者。其中，102例确诊需要手术干预的PJI病例被选作分析对象。我们从急性PJI培养物中分离出27种微生物，从慢性PJI中分离出82种。（33例，30.3%；95%置信区间22.0 - 40.3）是主要病原体，凝固酶阴性菌（22例，20.18%；95%置信区间0.9 - 41.3）和肠杆菌科细菌（13例，11.9%；95%置信区间6.4 - 18.3）也较为常见。在凝固酶阴性葡萄球菌中，43.6%被鉴定为耐甲氧西林，在分离株中45.5%耐甲氧西林。所有革兰氏阳性分离株对万古霉素、利奈唑胺和替加环素仍敏感。在革兰氏阴性杆菌中， 和 对第三代头孢菌素耐药，其表型特征提示产超广谱β-内酰胺酶（ESBL）。所有 、 属和 菌株对测试药物均完全敏感，而 对环丙沙星、氨曲南和亚胺培南的敏感性降低。在分离出的菌株中，47株为多重耐药（MDR），其中 导致的MDR数量最多，包括耐甲氧西林。在整个研究期间，微生物类型和MDR菌株的分布保持一致，感染类型与MDR菌株的存在之间或感染部位与微生物的存在之间均无显著关联，但MDR菌株与微生物类型之间存在强关联（ < 0.05）。PJI中的微生物谱和耐药模式在八年内保持稳定。与之前报告中所强调的情况相反，我们的观察结果并不表明MDR PJI更常见于急性病例。MDR菌株的持续流行凸显了根据当地药敏谱进行针对性抗菌治疗的重要性。
