关节置换术后假体周围感染病原菌分布特点及治疗

 目的 分析关节置换术后假体周围感染(PJI)病原菌分布特点、耐药情况及治疗, 为临床合理选择抗菌药物提供依据。方法 回顾性收集2019年1月—2021年11月某院收治的关节PJI患者临床资料, 统计分析PJI病原菌分布、药敏试验结果以及患者抗菌药物使用情况。结果 研究共纳入96例PJI患者, 分离获得112株病原菌, 革兰阳性菌株占80.36%, 以葡萄球菌属细菌为主。药敏试验结果显示, 表皮葡萄球菌对青霉素、苯唑西林耐药率分别为96.30%、81.48%, 大肠埃希菌对庆大霉素、复方磺胺甲口恶唑、氨苄西林耐药率均为100%。PJI患者住院期间抗菌药物使用主要以联合用药为主, 其中万古霉素联合美罗培南占26.04%;骨水泥中人工添加抗生素也以万古霉素和美罗培南为主。结论 关节置换术后PJI主要病原菌为表皮葡萄球菌, 其对青霉素、苯唑西林等普遍耐药, 抗感染治疗以万古霉素联合美罗培南为主。

Distribution characteristics of pathogens and treatment of peri-prosthetic joint infection after artificial joint replacement

Objective To analyze the distribution characteristics of pathogens, antimicrobial resistance and treatment of peri-prosthetic joint infection (PJI) after artificial joint replacement, and provide basis for clinical rational choice of antimicrobial agents. Methods Clinical data of patients with PJI and admitted to a hospital from January 2019 to November 2021 were collected retrospectively, distribution characteristics of pathogens, antimicrobial susceptibility testing results and antimicrobial use of patients were statistically analyzed. Results A total of 96 patients with PJI were included in the study, 112 strains of pathogenic bacteria were isolated, 80.36% of which were Gram-positive strains, mainly Staphylococcus spp.. Antimicrobial susceptibility testing results showed that resistance rate of Staphylococcus epidermidis to penicillin and oxacillin were 96.30% and 81.48% respectively, resistance rates of Escherichia coli to gentamicin, compound sulfamethoxazole and ampicillin were all 100%. Antimicrobial use in PJI patients during hospitalization period was mainly combination, vancomycin combined with meropenem accounted for 26.04%; vancomycin and meropenem were also the main antimicrobial agents artificially added to bone cement. Conclusion The main pathogen of PJI after joint replacement is Staphylococcus epidermidis, which is ge-nerally resistant to penicillin and oxacillin, anti-infection treatment is mainly vancomycin combined with meropenem.