血液性急性膝关节和髋关节假体感染的假体保留和高失败率

IF 5 Q3 Medicine
N. Pansu , M. Hamoui , F. Manna , A. Makinson , S. Dufour , D. Morquin , F. Canovas , J. Reynes , V. Le Moing
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引用次数: 4

摘要

目的评价血液性假体关节感染的研究很少。我们的目的是描述这些感染的特征和与管理失败相关的因素。方法选择2004年1月至2015年5月在蒙彼利埃大学医院接受髋关节和膝关节感染治疗的患者记录中,以植入后一年以上出现感染症状为定义的血液病获得性感染。失败的定义是由于假体相关感染导致的死亡,保守治疗时需要移除假体,或新假体感染症状复发。结果共纳入47例假体膝关节感染患者,其中膝关节感染33例,髋关节感染14例。感染原为链球菌(43%)、金黄色葡萄球菌(43%)、革兰氏阴性杆菌(13%)和单核细胞增生李斯特菌(2%)。31例患者最初进行清创和种植体保留,15例进行假体移除(3例一期手术,10例二期手术)。抗生素治疗的中位持续时间为66.5天。总体失败率为52%(24/48),假体保留策略为71%(22/31),假体移除为13%(2/15),金黄色葡萄球菌感染为63%(12/19)。31例患者中有13例(42%)采用保守治疗(在植入良好的假体上进行关节切开术,无窦道且症状出现<21天),但失败率仍高达69%(9/13)。唯一与失败相关的因素是保守的手术治疗。结论血液性假体关节感染的保守治疗失败率高,应考虑假体置换术作为最佳治疗策略,尤其是金黄色葡萄球菌感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implant retention and high rate of treatment failure in hematogenous acute knee and hip prosthetic joint infections

Objectives

Only few studies evaluated hematogenous prosthetic joint infections. We aimed to describe the characteristics of these infections and factors associated with management failure.

Methods

We selected hematogenously-acquired infections, defined by the occurrence of infectious symptoms more than a year after implantation among records of patients treated for hip and knee prosthetic joint infections at Montpellier University Hospital between January 2004 and May 2015. Failure was defined by death due to prosthesis-related infection, need for prosthesis removal in case of conservative treatment, or recurrence of infectious signs on a new prosthesis.

Results

Forty-seven patients with hematogenous prosthetic joint infection were included (33 knee infections and 14 hip infections). Infectious agents were streptococci (43%), Staphylococcus aureus (43%), Gram-negative bacilli (13%), and Listeria monocytogenes (2%). Thirty-one patients were initially treated with debridement and implant retention and 15 with prosthesis removal (three with one-stage surgery, 10 with two-stage surgery). The median duration of antibiotic therapy was 66.5 days. The overall failure rate was 52% (24/48), 71% (22/31) with implant retention strategy, 13% (2/15) with prosthesis removal, and 63% (12/19) in case of Staphylococcus aureus infection. Conservative treatment was appropriate (arthrotomy on a well-implanted prosthesis without sinus tract and symptom onset <21 days) in 13/31 patients (42%) with a failure rate still high at 69% (9/13). The only factor associated with failure was conservative surgical treatment.

Conclusion

The high risk of failure of conservative treatment for hematogenous prosthetic joint infections should lead to considering prosthesis replacement as the optimal strategy, particularly with Staphylococcus aureus.

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来源期刊
Medecine et maladies infectieuses
Medecine et maladies infectieuses 医学-传染病学
CiteScore
1.10
自引率
0.00%
发文量
0
审稿时长
10.7 weeks
期刊介绍: L''organe d''expression de la Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is the official publication of the Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is indexed in the major databases: Medline, Web of Science/Clarivate and Scopus. The journal publishes scientific /research articles, general reviews, short communications and letters, in both English and French. The journal welcomes submissions on the various aspects of infectious pathologies and pathogenic agents. Médecine et Maladies Infectieuses focuses on clinical therapeutics, nosocomial infections, biology, prevention, as well as epidemiology and therapeutics.
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