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初次人工全膝关节置换术后假体周围感染的微生物学及药敏分析

The microbiology and antimicrobial susceptibility of the infected knee arthroplasty

摘要:

目的 对初次人工全膝关节置换术(TKA)后假体周围感染的微生物学谱及药敏结果进行调查,为该并发症的诊治提供参考.方法 回顾性研究1995年1月至2011年12月诊治的TKA术后假体周围感染的29例患者资料,男性6例,女性23例;术后诊断感染的时间为1周至10年,平均24.3个月.记录患者的一般资料、放射学结果及感染分期.对获得的细菌学种类、数量及药敏结果进行分析.结果 29例患者中共有19例患者(65.5%)获得阳性微生物学培养结果,均为单一细菌感染,其中革兰染色阳性球菌14例、革兰染色阴性杆菌2例、分枝杆菌2例及真菌1例.14例革兰染色阳性球菌中凝固酶阴性葡萄球菌感染7例,其中甲氧西林敏感的表皮葡萄球菌4例,耐甲氧西林凝固酶阴性葡萄球菌3例;金黄色葡萄球菌感染5例,其中甲氧西林敏感的金黄色葡萄球菌2例,甲氧西林耐药的金黄色葡萄球菌3例;链球菌感染2例.耐药菌及罕见病原菌均出现在Ⅳ型感染.结论 初次TKA术后假体周围感染革兰染色阳性球菌仍为主要病原菌,需警惕耐药菌和罕见菌的产生.应当根据药敏结果针对用药,结果回报前可经验性选用万古霉素.

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abstracts:

Objectives To describe the microbiology,antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) and to provide reference for the diagnosis and treatment of this complication.Methods The medical data of the patients with infected knee arthroplasty,who were managed with revision surgery between January 1995 to December 2011 were reviewed.Twenty-nine cases were identified and majority of the patients were female(23/29).Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months).The microbiology and antimicrobial susceptibility were analyzed.Results The overall positive rate of cultures was 65.5%(19/29).The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19)and Staphylococcus Aureus (SA) (5/19).Rare pathogens of Mycobacterium (2/19) and fungi(1/19) were also identified.Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type Ⅳ infection.Conclusions Gram-positive bacterias are the main pathogen,resistant and rare pathogens should be payed attention to.Antibiotic treatment for infected TKA should be based on the results of drug susceptibility.Vancomycin allows infected knee arthroplasties before the result.

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