Gibert Charles, Marchetti Camille, Guery Benoît, Steinmetz Sylvain, Ferry Tristan, Lamoth Frederic
Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Institut des Sciences Pharmaceutiques et Biologiques, Université Claude Bernard Lyon 1, Villeurbanne, France.
Open Forum Infect Dis. 2025 May 14;12(6):ofaf281. doi: 10.1093/ofid/ofaf281. eCollection 2025 Jun.
prosthetic joint infections (CPJI) are serious complications, for which optimal surgical management and antifungal therapy remain unclear. This systematic review and meta-analysis aimed at defining the outcome predictors of CPJI.
A systematic literature review was performed in PubMed, Medline, Embase, and Web of Science until July 2024. Articles (cohorts, case-series or case reports) reporting individual data of adult patients with CPJI were included. Data about underlying conditions, characteristics of infection, and outcomes were collected. Outcome predictors were assessed in univariate analysis. Significant variables were included in a multivariate model using logistic regression with a binomial link function. Multicollinearity among the independent variables was assessed using the variance inflation factor.
A total of 385 CPJI (including 204 hip and 152 knee infections) from 110 publications were included. Polymicrobial infections accounted for 33% cases. (47.2%) was the predominant species followed by (28.6%). In multivariate analysis, independent predictors of failure were co-infection with (odds ratio, 0.4; 95% confidence interval, 0.18-0.92; = .032) and debridement/retention of the prosthesis (0.25; 0.11-0.55; < .001), whereas first-line therapy with amphotericin B was associated with success (3.18; 1.25-9.87; = .014). No difference according to the type of prosthesis exchange procedure (1, 2, or 3 stages) was found. Use of local antifungal therapy (eg, antifungal drug-impregnated spacers) had no significant impact on outcome.
This study confirms the importance of complete hardware removal in CPJI. Most importantly, it provides evidence supporting the use of amphotericin B as initial antifungal therapy.
人工关节感染（CPJI）是严重的并发症，其最佳手术管理和抗真菌治疗仍不明确。本系统评价和荟萃分析旨在确定CPJI的预后预测因素。
截至2024年7月，在PubMed、Medline、Embase和Web of Science上进行了系统的文献综述。纳入报告成年CPJI患者个体数据的文章（队列研究、病例系列或病例报告）。收集有关基础疾病、感染特征和结局的数据。在单因素分析中评估预后预测因素。使用具有二项式链接函数的逻辑回归将显著变量纳入多变量模型。使用方差膨胀因子评估自变量之间的多重共线性。
纳入了来自110篇出版物的385例CPJI（包括204例髋关节感染和152例膝关节感染）。多微生物感染占33%的病例。（47.2%）是主要菌种，其次是（28.6%）。在多变量分析中，失败的独立预测因素是与（比值比，0.4；95%置信区间，0.18 - 0.92； = .032）合并感染和假体清创/保留（0.25；0.11 - 0.55； < .001），而两性霉素B一线治疗与成功相关（3.18；1.25 - 9.87； = .014）。未发现根据假体置换程序类型（1、2或3期）有差异。使用局部抗真菌治疗（如抗真菌药物浸渍间隔物）对结局无显著影响。
本研究证实了在CPJI中彻底去除硬件的重要性。最重要的是，它提供了支持使用两性霉素B作为初始抗真菌治疗的证据。
