急性、迟发性、慢性假体周围感染的病原学特征及疗效分析

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摘要目的回顾性分析华西医院骨科收治的髋、膝关节置换术后假体周围感染的微生物培养及药敏等数据，比较急性、迟发性及慢性感染病原菌构成与耐药性的特征，分析不同治疗方案的治疗效果。方法收集我院骨科自2010年1月1日至2015年12月31日收治的初次髋、膝关节置换术后假体周围感染病例的相关资料，共146例患者，其中男性77例，女性69例；年龄29~89岁，平均(57.37±14.74)岁。全髋关节置换术(total hip arthroplasty，THA)术后假体周围感染111例，全膝关节置换术(total knee arthroplasty，TKA)术后假体周围感染35例。根据感染持续时间划分为急性、迟发性及慢性感染三组，其中急性、迟发性及慢性感染分别为19例，20例，107例。统计各组的培养阳性率、病原菌构成与耐药率，分析不同治疗方案的治疗效果。结果革兰阳性菌是各个类型感染的主要病原菌，在急性、迟发性、慢性感染中分别占57.89%、60.00%及54.21%，以表皮葡萄球菌及金黄色葡萄球菌所占比例最高。革兰阴性菌所致感染以阴沟肠杆菌、铜绿假单胞菌及大肠埃希菌为主。病原菌对利福平、利奈唑胺、呋喃妥因、替加环素及万古霉素具有较高的敏感性，但对庆大霉素、克林霉素、β-内酰胺类及喹诺酮类抗菌药物的耐药率较高。迟发性与慢性感染的病原菌对多种抗菌药物的耐药率高于急性感染的病原菌。二期翻修是主要的手术方式，占89.72%，扩创保留假体与一期翻修分别占5.48%和4.79%。结论假体周围感染的病原菌谱广且复杂，病原菌以革兰阳性菌为主，其中以葡萄球菌占比最高，病原菌对多种抗菌药物有较高的耐药性，且耐药率随感染时间的延长而增加。抗感染方案及手术方式的制定应个体化，充分评估，准确把握各种术式的适应证。

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关键词 ：关节成形术, 假体周围感染, 耐药性, 抗生素

Abstract：Objective To analyze the microbiology and antibiotic susceptibility of bacteria isolated from infected hip and knee joint，compareorganism profile and antibiotic susceptibilitybetween the acute，delayed and late infection patientsand to assess the antibiotic and surgery treatment outcome of prosthetic joint infection. Methods The microbiology and antimicrobial susceptibility data of prosthetic hip and knee infection patients between January 1，2010 and December 31，2015 were retrospective reviewed and analyzed.A total of 146 patients were identified.111 cases were prosthetic hip infection and 35 cases were prosthetic knee infection，with a mean age of (57.37±14.74)(range，29~89 ).The patients were divided into the acute，delayed and late infection groups.There were 19 cases in the acute group，20 cases in the delayed group and 107 in the lateinfection group.The organism profile，antibiotic susceptibility and treatment outcome were compared.Results Gram-positive bacteria wasthe main pathogen，whichwas found in 57.89% cases of the acute group，60.00% of the delayed group and 54.21%of thelate infection group.The most common organisms were Staphylococcus Epidermidis and Staphylococcus Aureus.The infections caused by Gram-negative bacteria were mainly enterobacter cloacae，pseudomonas aereginasa and escherichia coli.The results of antibiotic susceptibility showed bacteria were sensitive to antibiotic such as rifampin，linezolid，furantoin，quinupristin and vancomycin，but Gentamicin，tobramycin and cephalosporins had high resistance rate.And，with the increase of the infection time，the resistance of pathogen increased gradually.Two-stage revision was the most common surgical approach，encountered 89.72%，followed by irrigation and debridement (5.48%) and one-stage revision (4.79%).Conclusion The pathogen spectrum of prosthetic joint infectionis wide and complex，the dominate pathogen is Gram-positive bacteria，and the most common organisms is Staphylococcus.The antibiotic resistance rate is high，and with the increase of the infection time，the resistance rate increased gradually.So the antibiotic treatment and surgical approach should be individually and fully evaluated.

Key words： arthroplaty prosthetic related infection drug resistance antibiotic

基金资助:卫生部卫生行业科研专项(201302007)

通讯作者: 周宗科

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

引用本文:

陈志 1，周宗科 2*，沈彬 2，杨静 2，康鹏德 2，裴福兴 2. 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): 313-316.
Chen Zhi 1，Zhou Zongke 2*，Shen Bin 2，et al. Analyses of Microbiology and Outcome in Early，Delayed and Late Prosthetic Joint Infection. sygkzz, 2019, 25(4): 313-316.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2019/V25/I4/313

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