Achatz Veronika, Mitterer Jennyfer A, Huber Stephanie, Akcicek Ece, Tobudic Selma, Sebastian Sujeesh, Hofstaetter Jochen G
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria.
AUVA Trauma Center Vienna Meidling, Vienna, Austria.
J Bone Jt Infect. 2025 Aug 11;10(4):265-275. doi: 10.5194/jbji-10-265-2025. eCollection 2025.
: While Gram-negative periprosthetic joint infections (PJIs) are generally known for their poor outcome, few data on species exist. Therefore, we investigated the prevalence, clinical characteristics, microbial spectrum, outcomes, antimicrobial treatment, and surgical procedures of -species-associated PJIs. : We retrospectively evaluated 1776 culture-positive revision hip and knee arthroplasties (hereafter rTHA and rTKA, respectively) from a single institution between 2008 and 2024. The European Bone and Joint Infection Society and International Consensus Meeting criteria were used for classification. The Charlson comorbidity score and tier classification were used for evaluating risk factors and success and failure rates. Statistical analysis was performed using the chi-square test and binary logistic regression. : Among 1776 culture-positive revision arthroplasties, we identified 26 (1.5 %) -species-associated PJIs. The majority were observed in rTHA, mostly in chronic (65.4 %) and polymicrobial (57.7 %) infections. Chronic PJIs were associated with polymicrobial infections ( ), resulting in a higher failure rate ( ). Among polymicrobial infections (15 of 26 cases), (5 of 15), (4 of 15), and (3 of 15) were most frequently observed. The most frequently used surgical approach was a two-stage revision (46.2 %), with a success rate of 25 % (3 of 12). -species-associated PJIs were mainly treated with fluoroquinolone, especially ciprofloxacin showed higher success rates ( ). The reinfection-free survival rate was 48.5 % after 12 months and 22.6 % after 40 months. : species represent a rare group of pathogens and are predominantly found in chronic and polymicrobial PJIs, with a higher occurrence in rTHA than rTKA. Despite an overall high clinical failure rate, ciprofloxacin showed promising antimicrobial treatment efficacy.
虽然革兰氏阴性假体周围关节感染(PJI)通常因其预后不良而闻名,但关于相关菌种的数据却很少。因此,我们调查了与菌种相关的PJI的患病率、临床特征、微生物谱、预后、抗菌治疗及外科手术情况。我们回顾性评估了2008年至2024年间来自单一机构的1776例培养阳性的髋关节和膝关节翻修置换术(以下分别简称rTHA和rTKA)。采用欧洲骨与关节感染协会和国际共识会议标准进行分类。使用Charlson合并症评分和分级分类来评估危险因素以及成功率和失败率。采用卡方检验和二元逻辑回归进行统计分析。在1776例培养阳性的翻修置换术中,我们识别出26例(1.5%)与菌种相关的PJI。大多数病例见于rTHA,主要为慢性感染(65.4%)和多微生物感染(57.7%)。慢性PJI与多微生物感染相关( ),导致更高的失败率( )。在多微生物感染(26例中的15例)中, (15例中的5例)、 (15例中的4例)和 (15例中的3例)最为常见。最常用的手术方式是两阶段翻修(46.2%),成功率为25%(12例中的3例)。与菌种相关的PJI主要用氟喹诺酮治疗,尤其是环丙沙星显示出更高的成功率( )。12个月后的无再感染生存率为48.5%,40个月后为22.6%。菌种是一类罕见的病原体,主要见于慢性和多微生物PJI,在rTHA中的发生率高于rTKA。尽管总体临床失败率较高,但环丙沙星显示出有前景的抗菌治疗效果。