摘要目的 分析人工髋膝关节置换术后假体周围感染(PJI)患者的微生物培养结果、药物敏感性实验结果及手术治疗方法.方法 收集2014-2016年北京市9家医院收治的髋、膝关节置换术后诊断为PJI的318例患者资料,其中髋关节置换术后患者148例(148髋),膝关节置换术后患者170例(170膝),患者年龄(62.3±13.1)岁(范围:21～86岁),男性145例,女性173例,体重指数(25.6±3.8) kg/m 2(范围:15.6～38.1 kg/m2).结果 318例患者关节腔穿刺液和(或)关节腔内组织微生物培养结果示革兰阳性菌209例(65.7％),革兰阴性菌29例(9.1％),真菌10例(3.1％),非结核分枝杆菌3例(0.9％),培养阴性72例(22.6％),甲氧西林耐药菌69例(21.7％);抗菌药物的药物敏感性实验结果示青霉素、头孢呋辛、阿莫西林+棒酸总体耐药率较高,分别为79.9％、69.9％、68.1％;美罗培南、万古霉素、利奈唑胺耐药率均为0.髋、膝关节置换术后PJI患者的手术治疗方式中,二期翻修术分别占72.9％(108/148)和64.1％(109/170),一期翻修术占21.6％(32/148)和7.6％(13/170)、开放清创术占4.7％(7/148)和26.4％(45/170).结论 革兰阳性菌为髋、膝关节置换术后PJI的主要病原菌,需警惕耐药菌和罕见菌的产生,本组病例中二期翻修术仍是PJI的主要手术治疗方式.

abstractsObjective To investigate the microbiological test,antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.Methods A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology,antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3 ± 13.1) years old (range:21-86 years old),including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m 2 (range:15.6-38.1 kg/m2).Results In total,318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture,209 cases (65.7％) had Gram-positive bacteria,29 cases (9.1％) had Gram-negative bacteria,10 cases (3.1％) had fungi,3 cases (0.9％) had non-tuberculous mycobacteria,72 cases (22.6％) were negative,69 cases (21.7％) had methicillin-resistant bacteria.The antibiotic sensitivity results showed that the overall resistance rate of penicillin,cefuroxime,amoxicillin+clavulanic acid was 79.9％,69.9％,and 68.1％,respectively;meropenem,vancomycin,and linezolid resistance rate was 0.For the treatment methods of hip and knee PJI,two-stage revision surgery acounted for 72.9％ (108 / 148) and 64.1％ (109/170),respectively.One-stage revision surgery accounted for 21.6％ (32/148) and 7.6％ (13/170),and open debridement surgery accounted for 4.7％(7/148) and 26.4％ (45/170).Conclusions Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to.The Majority of hip and knee PJI cases were treated by two-stage revision surgery.