符合髋关节置换术条件的肥胖患者和非肥胖患者腹股沟区皮肤微生物群培养的定性比较

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-10-12 DOI:10.1016/j.artd.2024.101483
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引用次数: 0

摘要

背景随着肥胖症发病率的上升,外科医生经常面临通过关节成形术(全髋关节成形术)治疗严重肥胖患者髋关节骨性关节炎的问题。为了减少手术影响,通常会选择微创方法。因此,直接前路方法越来越受欢迎,但被怀疑会导致肥胖患者出现更多伤口并发症,尤其是革兰氏阴性病原体。方法对计划通过直接前路进行全髋关节置换术的患者进行筛选。研究组定义为体重指数≥35 且切口部位有腹部肿块的患者,而非肥胖患者为对照组。使用平板和棉签在髂前上棘远端和外侧 2-3 厘米处采集微生物组样本。研究组有 28 名患者,对照组有 36 名患者。两组患者皮肤上最常见的潜在病原体均为表皮葡萄球菌。肥胖患者的微生物群显示,肠杆菌科革兰氏阴性菌的感染率明显更高。研究组的伤口并发症发生率更高,但无统计学意义。对于这类特殊患者,应考虑对抗生素使用方法和切口进行调整。
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Qualitative Comparison of Cultured Skin Microbiota From the Inguinal Region of Obese and Nonobese Patients Eligible for Hip Arthroplasty

Background

With the rising prevalence of obesity, surgeons are frequently confronted with the problem of treating osteoarthritis of the hip via arthroplasty (total hip arthroplasty) in severely obese patients. To reduce the surgical impact, minimal-invasive approaches are often chosen. For this reason, the direct anterior approach has gained popularity but is suspected of leading to more wound complications in obese patients, especially by Gram-negative pathogens. Causative differences of the skin microbiome have been suspected but not yet proven.

Methods

Patients scheduled for total hip arthroplasty via direct anterior approach were screened for inclusion. The study group was defined as patients with a body mass index ≥35 and an abdominal pannus hanging over the incision site, whereas nonobese patients served as the control group. Samples of the microbiome were taken 2-3 cm distal and lateral to the superior anterior iliac spine using plates and swabs. Species identification was carried out by mass spectrometric analysis.

Results

The study group consisted of 28 patients, the control group of 36 patients. The most frequent potential pathogen on the skin was Staphylococcus epidermidis in both the groups. Microbiota found in obese patients showed significantly higher prevalence of Gram-negative bacteria from the order Enterobacterales. Wound complications were more frequent in the study group, but this was not statistically significant.

Conclusions

Obese patients with abdominal pannus present higher rates of colonization with Enterobacterales at the incision site of the direct anterior approach. Modifications of the antibiotic regime and the incision should be considered in this special patient population.
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来源期刊
Arthroplasty Today
Arthroplasty Today Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
258
审稿时长
40 weeks
期刊介绍: Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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