培养阴性假体周围感染的临床特征、诊断及治疗

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摘要假体周围感染(prosthetic joint infection，PJI)是关节置换术的灾难性并发症，尽管已采取多项措施预防，初次髋、膝关节置换术后假体周围感染的发生率仍分别高达1%~4%和1%~2%。随着人口老龄化、关节置换患者数量的逐年增长、假体生存期的延长及患者预期寿命的提高，假体周围感染的患者数量也将不断增加。假体周围感染的诊断需结合详细的病史、体格检查、血清学、微生物学、组织病理学及影像学等检查结果，明确引起感染的病原菌对于假体周围感染的准确诊断与恰当治疗具有重要的指导意义，但约有7.0%~42.1%的假体周围感染患者，在整个治疗过程中均无法找到病原学证据，即培养阴性假体周围感染(culture-negative prosthetic joint infection，CN PJI)。由于无法明确病原菌，不仅给诊断带来不确定性，也给患者带来极大的困惑。临床医师在治疗过程中也将面临严峻的挑战，常常导致不恰当的治疗，继而增加治疗失败率，带来灾难性的后果。为此，本文对培养阴性假体周围感染的临床特征、诊断标准及治疗策略做一综述，以期能指导临床医师准确诊断，避免漏诊或误诊给患者带来不良后果，同时分析提高病原菌检出率的措施、手术方式及抗感染方案的选择策略，以提高治疗成功率。

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	陈志 1
	林佳俊 1
	刘文革 1*
	周宗科 2
	沈彬 2
	杨静 2
	康鹏德 2
	裴福兴 2

基金资助:卫生部卫生行业科研专项(201302007)

通讯作者: 刘文革

作者简介: 陈志(1988－ )，男，医师，福建医科大学附属协和医院，350000。

引用本文:

陈志 1，林佳俊 1，刘文革 1*，周宗科 2，沈彬 2，杨静 2，康鹏德 2，裴福兴 2. 培养阴性假体周围感染的临床特征、诊断及治疗[J]. 实用骨科杂志, 2019, 25(12): 1106-1109.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I12/1106

［1］Parvizi J，Walinchus L，Adeli B.Molecular diagnostics in periprosthetic joint infection［J］.Int J Artif Organs，2011，34(9)：847-855.
［2］Kurtz SM，Lau E，Watson H，et al.Economic burden of periprosthetic joint infection in the United States［J］.J Arthroplasty，2012，27(8)：61-65.
［3］陈志，周宗科.髋、膝关节置换术后假体周围感染的诊治进展［J］.实用骨科杂志，2017，23(3)：247-251.
［4］Reisener M，Perka C.Do culture-negative periprosthetic joint infections have a worse outcome than culture-positive periprosthetic joint infections? A systematic review and Meta-analysis［J］.Biomed Res Int，2018，2018：6278012.
［5］Yoon HK，Cho SH，Lee DY，et al.A Review of the literature on culture-negative periprosthetic joint infection：epidemiology，diagnosis and treatment［J］.Knee Surg Relat Res，2017，29(3)：155-164.
［6］Parvizi J，Zmistowski B，Berbari EF，et al.New definition for periprosthetic joint infection：from the workgroup of the musculoskelet al infection dociety［J］.Clin Orthop Relat Res，2011(469)：2992-2994.
［7］Choi HR，Kwon YM，Freiberg AA，et al.Periprosthetic joint infection with negative culture results：Clinical characteristics and treatment outcome［J］.J Arthroplasty，2013，28(6)：899-903.
［8］Berbari EF，Marculescu C，Sia I，et al.Culture-negative prosthetic joint infection［J］.Clin Infect Dis，2007，45(9)：1113-1119.
［9］Trampuz A，Piper KE，Jacobson MJ.Sonication of removedhip and knee prostheses for diagnosis of infection［J］.N Engl J Med，2007，357(7)：654-663.
［10］McLawhom AS，Nawabi DH，Ranawat AS.Management of resistant，atypical and culture-negative periprosthetic joint infections after hip and knee arthroplasty［J］.Open Orthop J，2016，30(10)：615-632.
［11］Malekzadeh D，Osmon DR，Lahr BD，et al.Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection［J］.Clin Orthop Relat Res，2010(468)：2039-2045.
［12］Della Valle C，Parvizi J，Bauer TW，et al.American academy of orthopaedic durgeons.American scademy of orthopaedic surgeons clinical practice guideline on：the diagnosis of periprosthetic joint infections of the hip and knee［J］.J Bone Joint Surg (Am)，2011，93(14)：1355-1357.
［13］Larsen LH，Lange J，Xu Y，et al.Optimizing culture methods for diagnosis of prosthetic joint infections：a summary of modifications and improvements reported since 1995［J］.J Med Microbiol，2012，61(Pt 3)：309-316.
［14］Font-Vizcarra L，García S，Martínez-Pastor JC，et al.Blood culture flasks for culturing synovial fluid in prosthetic joint infections［J］.Clin Orthop Relat Res，2010(468)：2238-2243.
［15］Valshva R，Sardana R，Butta H，et al.Laboratory diagnosis of prosthetic joint infections：Current concepts and present status［J］.J Clin Orthop Trauma，2019，10(3)：560-565.
［16］Shahi A，Parvizi J，Kazarian GS，et al.The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration［J］.Clin Orthop Relat Res，2016(474)：1610-1615.
［17］Chen MF，Chang CH，Yang LY，et al.Synovial fluid interleukin-16，interleukin-18，and CRELD2 as novel biomarkers of prosthetic joint infections［J］.Bone Joint Res，2019，8(4)：179-188.
［18］Valshva R，Sardana R，Butta H，et al.Laboratory diagnosis of Prosthetic Joint Infections：Current concepts and present status［J］.J Clin Orthop Trauma，2019，10(3)：560-565.
［19］Shahi A，Kheir MM，Tarabichi M，et al.Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation［J］.J Bone Joint Surg (Am)，2017，99(17)：1419-1427.
［20］Li R，Shao HY，Hao LB，et al.Plasma fibrinogen exhibits better performance than plasma D-dimer in the diagnosis of periprosthetic joint infection：A multicenter retrospective study［J］.J Bone Joint Surg (Am)，2019，101(7)：613-619.
［21］Li H，Ni M，Li X，et al.Two-stage revisions for culture-negative infected total knee arthroplasties：a five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases［J］.J Orthop Sci，2017，22(2)：306-312.
［22］Mortazavi SM，Vegari D，Ho A，et al.Two-stage exchange arthroplasty for infected total knee arthroplasty：predictors of failure［J］.Clin Orthop Relat Res，2011，469(11)：3049-3054.
［23］陈志，周宗科，沈彬，等.急性、迟发性、慢性假体周围感染的病原学特征及疗效分析［J］.实用骨科杂志，2019，25(4)：26-29.
［24］Gehrke T，Alijanipour P，Parvizi J.The management of an infected total knee arthroplasty［J］.Bone Joint J，2015，97 (10 Supple A)：20-29.
［25］Tan TL，Kheir MM，Shohat N，et al.Culture-negative periprosthetic joint infection：An update on what to expect［J］.JBJS Open Access，2018，3(3)：e0060.
［26］Kim YH，Kulkarni SS，Park JW，et al.Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected totalknee arthroplasty［J］.J Orthop，2015，12(Suppl 1)：37-43.
［27］Huang R，Hu CC，Adeli B，et al.Culture-negative periprosthetic joint infection does not preclude infection control［J］.Clin Orthop Relat Res，2012(470)：2717-2723.
［28］Parikh MS，Antony S.A comprehensive review of the diagnosis and management of prosthetic joint infections in the absence of positive cultures［J］.J Infect Public Health，2016，9(5)：545-556.
［29］Parvizi J，Azzam K，Ghanem E，et al.Periprosthetic infection due to resistant staphylococci：serious problems on the horizon［J］.Clin Orthop Relat Res，2009(467)：1732-1739.
［30］Parvizi J，Erkocak OF，Della Valle CJ.Culture-negative periprosthetic joint infection［J］.J Bone Joint Surg(Am)，2014，96(5)：430-436.
［31］Santoso A，Park KS，Shin YR.Two-stage revision for periprosthetic joint infection of the hip：culture-negative versus culture-positive infection［J］.J Orhtop，2018，15(2)：391-395.