Atkins B L, Bowler I C
Department of Medical Microbiology, John Radcliffe Hospital, Oxford, UK.
J Hosp Infect. 1998 Dec;40(4):263-74. doi: 10.1016/s0195-6701(98)90302-4.
The microbial aetiology of large joint sepsis is changing now that joint replacement therapy is becoming common place. The clinical history and examination may give important clues about the likelihood of infection and the possible involvement of unusual organisms. Newly introduced technology to improve the sensitivity of tests for the presence of micro-organisms in synovial fluid has not yet made a significant contribution to routine management. New imaging techniques such as magnetic resonance imaging are likely to improve patient management, but their utility is still under assessment. Arthroscopic biopsy to obtain material for culture and histology is particularly important in suspected chronic septic arthritis. Prosthetic joint infections present a particular challenge to microbiologists since the organisms involved are often found in small numbers and are common skin contaminants. Optimal microbiological management involves the taking of multiple (> or = 5) samples, careful processing to resuscitate organisms whilst avoiding contamination, and careful interpretation of results in the light of the clinical and histological picture.
随着关节置换治疗变得越来越普遍，大关节脓毒症的微生物病因正在发生变化。临床病史和检查可能会提供有关感染可能性以及不常见病原体可能参与情况的重要线索。新引入的提高滑膜液中微生物检测敏感性的技术尚未对常规管理做出重大贡献。诸如磁共振成像等新的成像技术可能会改善患者管理，但其效用仍在评估中。在疑似慢性化脓性关节炎中，通过关节镜活检获取用于培养和组织学检查的材料尤为重要。人工关节感染对微生物学家来说是一个特殊的挑战，因为所涉及的病原体数量通常很少，而且是常见的皮肤污染物。最佳的微生物学管理包括采集多个（≥5个）样本，进行仔细处理以复苏病原体同时避免污染，并根据临床和组织学情况仔细解读结果。
