Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Surgery Pub Date : 2022-09-01 DOI:10.1177/10225536221140610
Shih-Hui Peng, Sheng-Hsun Lee, Chun-Chieh Chen, Yu-Chih Lin, Yuhan Chang, Pang-Hsin Hsieh, Hsin-Nung Shih, Steve W N Ueng, Chih-Hsiang Chang
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引用次数: 1

Abstract

Purpose: Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty.

Material and methods: From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement.

Results: Mycobacterium abcessus (n = 6) and Mycobacterium chelonae (n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin.

Conclusions: nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.

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非结核分枝杆菌假体周围关节感染:两期翻修关节置换术的结果分析。
目的:非结核分枝杆菌假体周围关节感染(NTMPJI)是髋关节或膝关节置换术中罕见的并发症。NTMPJI治疗结果的经验仍然有限。本研究的目的是调查髋关节或膝关节非结核性分枝杆菌假体周围关节感染在两期置换术治疗后的结果。材料和方法:从1995年到2020年,我们机构对12例NTMPJI患者进行了两期交换关节置换术。我们收集并分析了包括人口统计学数据、合并症、微生物学数据、治疗结果和骨水泥抗生素配方在内的变量。结果:脓肿分枝杆菌(n = 6)和龟分枝杆菌(n = 2)占多数。早发性PJIs 5例,晚发性PJIs 7例。两期置换关节成形术的成功率为66.7%(8 / 12)。3例感染复发,1例出现软组织损伤并发症。术后抗生素治疗不能提高成功率(6例中4例,66.7%)。体外研究表明,非结核分枝杆菌骨水泥隔离剂中最常用的有效抗生素是阿米卡星。结论:非结核分枝杆菌是PJIs的罕见病因,尤其在免疫功能相对低下的患者中应予以怀疑。关节置换术切除和分期再植是首选的方法。术后再植入术前延长抗生素治疗可能不能提高成功率。可能不需要延迟翻修手术,一旦c反应蛋白水平在药物假期后恢复正常即可进行。
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来源期刊
Journal of Orthopaedic Surgery
Journal of Orthopaedic Surgery ORTHOPEDICS-SURGERY
CiteScore
3.10
自引率
0.00%
发文量
91
审稿时长
13 weeks
期刊介绍: Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. It is the official journal of the Asia Pacific Orthopaedic Association. The journal welcomes and will publish materials of a diverse nature, from basic science research to clinical trials and surgical techniques. The journal encourages contributions from all parts of the world, but special emphasis is given to research of particular relevance to the Asia Pacific region.
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