生物传感器早期诊断假体周围关节感染

假体周围感染(periprosthetic joint infection, PJI)是关节置换术后非常严重的并发症,早诊断、早治疗可改善患者预后。由于血清学诊断和关节液生物标记物检测等方法的灵敏性和特异性都略显不足,PJI的早期诊断仍面临巨大挑战。在PJI的早期诊断上,细菌检测越来越受到重视。近年来,电化学生物传感器因其检测迅速、特异性高等优点在细菌检测领域受到研究者广泛关注。本文对关节置换术后PJI的诊断进行文献分析,并探讨目前生物传感器在细菌检测中的应用,提出其在PJI早期诊断中的应用可能。     

人工关节假体感染诊治的研究进展

人工关节假体感染(PJI)是关节置换术后灾难性的并发症。PJI的危险因素包括免疫缺陷,肥胖,糖尿病等。PJI的临床诊断仍是一个挑战,主要方法包括组织培养,血清标记物,组织病理和滑液穿刺分析等。PJI的治疗方法包括单纯药物治疗;清创保留关节假体;一期翻修;二期翻修等。PJI的致病机理主要在于早期细菌生物膜的形成以及假体/组织界面宿主免疫能力的缺乏。本专栏聚焦PJI的预防、诊断和治疗,介绍国内外学者在该领域所开展的卓有成效的研究,以促进PJI诊治工作进一步的发展。     

噬菌体疗法防治关节假体周围感染研究进展

关节假体周围感染（PJI）指人体关节植入的假体和假体周围存在病原微生物而导致的感染。PJI是髋、膝关节置换术后灾难性的并发症,治疗过程漫长且充满挑战,预后具有不确定性和高风险性。噬菌体是感染细菌、真菌、藻类、放线菌或螺旋体等微生物的病毒的总称,因部分能引起宿主菌的裂解,故称为噬菌体。噬菌体疗法在国外已有较多报道,临床效果显著。该文就噬菌体疗法防治PJI进行综述。     

髋膝关节置换术后假体周围感染焦点问题

自1984年感染假体的生物膜理论被首次提出以来,从预防、诊断到治疗,针对人工髋膝关节置换术后假体周围感染(PJI)的研究始终是骨科医师关注的焦点。目前,对PJI的预防由局部风险因素扩展至全身系统。诊断上除了宏观的临床及影像学表现,特异性病原菌生物膜分子机制及敏感的生物标记物开始进入人们的视野。此外,假体设计及骨水泥技术在PJI治疗中的重要性也同样引起关注。尽管目前PJI无法根除,但通过近几十年的努力,术后PJI的发生率有了明显改善。相信通过每一个医学工作者的不断努力与探索,定会使关节疾病的患者获得更加满意的疗效。     

肘关节假体周围感染诊治进展

肘关节假体周围感染(PJI)是全肘关节置换术后最严重的并发症之一。新型诊断技术如关节滑液聚合酶链反应(PCR)和蛋白分析、超声波法或涡旋法取样行微生物培养等对肘关节PJI有较好的敏感性和特异性,术中冰冻组织切片法是非常可靠的诊断手段。而脱氧葡萄糖-正电子发射断层扫描(FDG-PET)等影像学检查不推荐应用于肘关节PJI的诊断。肘关节PJI治疗主要为抗感染治疗和手术治疗,二期假体置换术是最佳术式,保留假体清创术适用于假体功能良好的急性非表皮葡萄球菌肘关节PJI,一期假体置换术在肘关节PJI治疗中效果不佳,骨重建可应用于肘关节PJI合并关节周围严重骨丢失。该文就肘关节PJI诊治进展作一综述。     

髋关节抗生素骨水泥占位器的研究进展

感染可能是外科植入体如人工假体、髓内针、钢板的严重并发症。尽管围手术期给予适当的抗生素,但仍有相当数量患者术后发生假体周围感染(PJI)。感染的结果导致过度使用抗生素、假体移除、再手术和可能的截肢。当前,PJI通常很难预测、诊断和治疗,二期翻修术是治疗PJI的合理选择。本文仅对髋关节临时占位器(spacer)的有关研究进展作一综述。     

多重病原感染合并髋臼严重骨缺损假体周围感染二期翻修术1例报道并文献复习

假体周围感染(periprosthetic joint infection,PJI)是关节置换术后的严重并发症之一,其发病率为1%~3%,严重影响患者的生活质量,并带来沉重的经济负担[1,2]。目前,治疗PJI的标准术式为人工关节二期翻修术,包括第一阶段取出人工假体,进行彻底清创、植入含抗生素骨水泥间隔器,并在术后使用敏感抗生素治疗;第二阶段待感染控制后,植入新的人工关节[3]。本文报道1例多重感染合并髋臼严重骨缺损患者的诊治过程,针对PJI的病原诊断和重建骨缺损等治疗难点进行探讨。     

关节假体周围感染预防的研究进展

目的总结关节假体周围感染(prosthetic joint infection,PJI)预防的研究进展,为临床工作提供参考。方法查阅近年来国内外PJI相关文献,进行综合分析及归纳总结。结果 PJI的预防涉及人工关节置换术前、术中及术后各阶段,目前临床以多种方法综合治疗为主。结论对于人工关节置换术患者,采用多层面综合治疗方法可有效预防PJI。     

关节假体周围感染研究进展

关节假体周围感染(PJI)是人工关节置换术最严重的并发症之一,病态肥胖、双侧手术、二次手术、住院时间长和异体输血均为危险因素。关节假体超声波降解液培养的敏感度及特异度超过假体周围组织培养。聚合酶链反应技术对检测曾使用抗生素而培养困难的标本有较高成功率。脱氧葡萄糖正电子发射断层扫描技术正发展为新的PJI诊断技术。抗PJI治疗主要针对培养结果选择抗生素,一般采用利福平联合利奈唑胺、万古霉素和替考拉宁均有较好效果。目前的观点认为,一期彻底清创、非骨水泥型假体更换联合短期抗生素疗法是治疗PJI的较好方法 。     

保留假体清创治疗急性假体周围感染

[目的]探讨保留假体清创治疗急性假体周围感染(PJI)的临床效果与炎性指标的早期变化.[方法]2010年1月～2017年8月,对28例髋/膝关节置换术后急性PJI患者采用保留假体清创联合抗生素治疗,设为感染组.随机选取同期初次髋/膝关节置换患者40例为非感染组.比较两组患者围手术期、随访与实验室检验结果.[结果]两组患...     

人工关节置换术后假体周围感染的临床分类

假体周围感染(PJI)是关节外科领域临床处理上最为棘手的问题之一。PJI的发生可以出现在关节置换术后任何时期,并且有着复杂多样的临床表现。同时PJI的病情迁延难愈,严重时可以导致截肢甚至危及生命。在针对PJI的治疗中,合理的临床分类能够帮助医生迅速判断病情,搭建对病情综合性评估的框架,进而做出合理化治疗方案选择。目前国际上关于PJI的临床分类还没有足够清晰的划分。毫无疑问,明确的临床分期和分型会对PJI的治疗有重大的意义。本综述旨在总结文献中PJI的不同临床分类角度,常见的临床分类,探讨其合理性,并进一步归纳其与治疗的关系,为PJI的临床分类及治疗策略选择提供参考。     

The role of microbial biofilms in prosthetic joint infections

Abstract — Prosthetic joint infection (PJI) still remains a significant problem. In line with the forecasted rise in joint replacement procedures, the number of cases of PJI is also anticipated to rise. The formation of biofilm by causative pathogens is central to the occurrence and the recalcitrance of PJI. The subject of microbial biofilms is receiving increasing attention, probably as a result of the wide acknowledgement of the ubiquity of biofilms in the natural, industrial, and clinical contexts, as well as the notorious difficulty in eradicating them. In this review, we discuss the pertinent issues surrounding PJI and the challenges posed by biofilms regarding diagnosis and treatment. In addition, we discuss novel strategies of prevention and treatment of biofilm-related PJI.     

No differences in short-term outcomes between patients with anaerobic and aerobic culture positive prosthetic joint infection

BackgroundProsthetic joint infection (PJI) is a devastation complication of total joint arthroplasty that can result in poor patient outcomes. Anaerobic organisms make up a small proportion of PJI cases and are much less studied. Studies comparing patient outcomes in anaerobic PJI to outcomes in aerobic PJI are sparse. The purpose of this study was to compare the clinical presentation, duration of antibiotics, type of treatment provided, and final outcome between PJI patients with anaerobic infection and those with aerobic infection.MethodsThis was a retrospective study of 26 patients who underwent treatment for PJI at a tertiary referral center. Eight patients with anaerobic PJI were compared to 18 patients with aerobic PJI in terms of clinical presentation, laboratory values, treatment duration, and functional outcome. Statistical analysis was performed on continuous variables of interest.ResultsThe results of our study showed that there are no differences in short term clinical outcomes between PJI patients with cultures positive for anaerobic vs aerobic organisms (38.9% vs 50% successfully treated). Inflammatory markers were higher in the aerobic group and patients in the anaerobic group tended to have fewer medical comorbidities.ConclusionPJI caused by anaerobic organisms results in poor patient outcomes similar to infection caused by aerobic organisms. There are some differences in clinical presentation between the two groups that can be explained by the fact that anaerobic organisms are of low virulence and result in indolent infections causing longstanding symptoms.     

Application of the ICM diagnostic criteria for shoulder periprosthetic joint infection

BackgroundDiagnosis for shoulder periprosthetic infection (PJI) is a challenge in shoulder arthroplasty. The 2018–2019 International Consensus Meeting (ICM) on Orthopedic Infections created a scoring system with minor and major criteria for shoulder PJI. The purpose of this study was to apply these criteria in a cohort of suspected shoulder PJI cases and assess their treatment course.MethodsAn institutional database was used to query TSA patients from January 2013 to May 2019. Patients for revision shoulder arthroplasty were stratified into groups based on the ICM criteria with four main groups: unlikely PJI, possible PJI, probable PJI, and definite PJI. Each patient included was assessed for baseline demographics, Elixhauser co-morbidities (ECM), prior hardware, timing of infection, treatment type, reinfection incidence at one-year, length of hospitalization and 90-day readmission.ResultsA total of 43 patients were identified. After applying ICM criteria for diagnosis of shoulder PJI, there were 16 cases of unlikely PJI, 15 cases of possible PJI, 5 cases of probable PJI and 7 cases of definite PJI. Comparison of baseline characteristics including age (p = 0.23), BMI (p = 0.62), ASA (p = 0.53) reveled no significant differences between each ICM group. C. acnes was not found in any case of definite PJI. Definite PJI had the highest LOS at 2.6 days, p = 0.04. Revision for PJI that was classified as definite infection demonstrated the highest rate of reinfection at 1-year (28.6%) (p = 0.02).ConclusionICM criteria represent an accurate and reliable tool for defining shoulder PJI. Moreover, the criteria appear to demonstrate a higher risk of reinfection in the definite PJI group. Based on these findings, we recommend careful consideration of treatment strategies due to higher risk for reinfectionLevel of evidenceLevel IV; Retrospective Cohort.     

Fungal periprosthetic joint infection: Rare but challenging problem

Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcus aureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%–2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.     

Risk Factors for Failure and Optimal Treatment of Total Joint Arthroplasty for Septic Arthritis

BackgroundPatients with native joint septic arthritis are one of the highest risk groups for developing complications following total joint arthroplasty (TJA), especially periprosthetic joint infection(PJI). There is a paucity of information on the risk factors for developing PJI and the optimal treatment modality of the native septic joint that can mitigate that risk. This multicenter study aimed to determine these risk factors, including prior treatment.MethodsA retrospective study of 233 TJAs performed, following prior septic arthritis at five institutions, was conducted. Comorbidities, organism profile, prior surgery, etiology of septic arthritis, and other relevant variables were reviewed. The primary outcome was the development of PJI, defined by Musculoskeletal Infection Society criteria. Bivariate and multivariate analyses were performed to identify risk factors for PJI.ResultsOverall, the PJI rate was 12.4% in patients who underwent TJA after native septic arthritis. Predisposing risk factors for PJI included antibiotic-resistant organisms, male gender, diabetes, and a postsurgical cause of septic arthritis eg open reduction internal fixation. When controlling for potential confounders, multivariate analysis revealed that male gender, diabetes, and a postoperative etiology were predictors of PJI. The definitive treatment modality for the septic joint did not affect the rate of PJI for both arthroscopy vs irrigation and debridement (I&D), and two-stage exchange vs single-stage procedure.DiscussionThis study has identified several risk factors for developing PJI in patients with prior septic joint arthritis, some of which are modifiable. The initial treatment modality of the native septic joint has no bearing on the development of PJI after TJA.     

二代测序技术在假体周围感染诊断中的应用

假体周围感染(PJI)是人工关节置换术后灾难性的并发症。在PJI的治疗中,早期及时诊断PJI和明确致病微生物仍然是治疗成功的关键。然而,现有的细菌培养技术仍然存在诸多不足,二代测序技术因其具有快速、准确、全面地诊断致病微生物等特点,逐渐被应用于PJI的诊断之中。然而,目前临床上大多数关节外科医师对于二代测序技术及其在诊断PJI中的应用仍缺乏了解和认识,本文对该问题作一综述。     

Rates and Outcomes of Periprosthetic Joint Infection in Persons Who Inject Drugs

BackgroundThe risk of periprosthetic joint infection (PJI) is higher in persons who inject drugs (PWID) after total joint arthroplasty (TJA), though reported rates vary widely. This study was designed to assess outcomes of TJA in PWID and to describe factors associated with improved PJI outcomes among PWID.MethodsA retrospective matched cohort study was performed using a 1:4 match among those with and those without a history of injection drug use (IDU) undergoing TJA. Demographic, surgical, and outcome variables were compared in multivariate logistic regressions to determine PJI predictors. Kaplan-Meier analyses were constructed to characterize the difference in survival of patients who did not have PJI or undergo joint explantation between PWID and the matching cohort.ResultsPWID had a 9-fold increased risk of PJI compared to the matched cohort (odds ratio 9.605, 95% CI 2.781-33.175, P < .001). Ten of 17 PWID whose last use was within 6 months (active use) of primary TJA had a PJI, while 7 of 41 PWID who did not have active use developed a PJI. Of PWID with PJI, treatment failure was seen in 15 of 17, while in patients who did not have an IDU history, 5 of 8 with PJI had treatment failure.ConclusionIDU is a significant risk factor for PJI following TJA. Future work investigating the effect of a multidisciplinary support team to assist in cessation of IDU and to provide social support may improve outcomes and reduce morbidity in this vulnerable population.     

Debridement,antibiotics and implant retention in management of infected total knee arthroplasty: A systematic review

Total knee arthroplasty is a life changing operation. Although a rare complication, periprosthetic joint infection (PJI) can be a devastating event for patient and can be a challenging experience for the treating department. Management of the PJI is generally operative combined with extensive antibiotic therapy. The primary aim of treatment is to restore a functioning joint, either with debridement and retaining the well-fixed implants or with revision of part or all of the components. Whilst two stage revision arthroplasty has been considered as optimal treatment for PJI by many surgeons, Debridement, Antibiotics and Implant Retention (DAIR) could be considered as an alternative option in a selected group of patients.In this study, we review the recent literature to explore the efficacy and outcome of DAIR in PJI. We included all recent studies, which have used DAIR in PJI around total knee arthroplasty and assess for factors that would be either positive or negative towards the outcome. We particularly wanted to review role of timing of surgery and infecting organisms in outcomes of the treatment. We have also tried to identify whether patients have better functional outcome following DAIR in comparison to revision surgeries.