培养阴性感染在全膝关节置换术后感染性并发症中的作用

Q3 Medicine Genij Ortopedii Pub Date : 2023-08-31 DOI:10.18019/1028-4427-2023-29-4-402-409
L. Lyubimova, S. Bozhkova, N. N. Pchelova, E. V. Preobrazhenskaya, E. A. Lyubimov
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A favorable outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, “life with a spacer” without signs of infection.Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. 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引用次数: 0

摘要

慢性假体周围关节感染(PJI)的诊断是困难的,因为假体周围炎症的临床症状显示生物材料中没有微生物的生长。培养阴性的感染率可达42.1%。该研究的目的是分析慢性膝关节PJI的两阶段治疗的结果,这取决于感染过程的病因。材料和方法对103例患者的结果进行回顾性分析:I组(n=30)未发现微生物生长,II组(n= 73)发现病原体正生长。根据2018年ICM标准诊断膝关节PJI。一个有利的结果表明,在重新植入假体,关节融合术,“生活与间隔”后至少两年内没有复发,没有感染迹象。结果培养阴性感染占29.1% (n = 30)。该组患者入院前接受抗生素治疗的可能性是II组的1.5倍,CRP、ESR和关节白细胞计数的平均水平比II组低1.5-2倍。第二组主要病原菌为葡萄球菌(69.8%)和MRSE(75%)。ⅰ组感染复发率为3.4%,ⅱ组为16.9% (p = 0.0928),两期治疗成功率分别为96.7%和74% (p = 0.0064)。微生物在生物材料中缺乏生长的原因包括以前的抗生素治疗、伤口引流、违反生物材料取样规则、缺乏非典型微生物生长的培养基以及微生物在种植体表面形成生物膜的能力。在手术过程中,在不确定的情况下,对受影响组织进行紧急组织学检查是可行的。一项荟萃分析(2023)的结果显示,与清创和保留种植体相比,更换感染的假体对于治疗培养阴性感染更有效。结论培养阴性感染组在2年随访期间采用种植体置换术和广谱经用性抗生素治疗两期PJI的成功率较高。该组微生物学结果阴性可能与PJI诊断前使用抗菌药物有关。
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The role of culture-negative infection among infectious complications after total knee arthroplasty
Introduction Diagnosis of chronic periprosthetic joint infection (PJI) is difficult with the clinical signs of periprosthetic inflammation showing no growth of microorganism in the biomaterial. The frequency of culture-negative infection can reach 42.1 %. The objective of the study was to analyze outcomes of two-stage treatment of chronic PJI of the knee joint depending on the etiology of the infectious process.Material and methods A retrospective analysis of outcomes was produced for 103 patients: group I (n=30) showing no growth of microorganisms and group II (n = 73) demonstrating positive growth of pathogens. Knee PJI was diagnosed according to the 2018 ICM criteria. A favorable outcome suggested absence of recurrence for at least two years after reimplantation of endoprosthesis, arthrodesis, “life with a spacer” without signs of infection.Results Culture-negative infection was detected in 29.1 % (n = 30). Patients in the group were 1.5 times more likely to receive antibiotic therapy prior to admission and had average levels of CRP, ESR and articular leukocyte count being 1.5-2 times less than those in group II. Staphylococci (69.8 %) including MRSE (75 %) was the leading pathogen in group II. Recurrence of infection was 3.4 % in group I and 16.9 % in group II (p = 0.0928), the two-stage treatment was successful in 96.7 % and 74 %, respectively (p = 0.0064).Discussion Causes for the lack of growth of microorganisms in biological materials included previous antibiotic therapy, wound drainage, violations of the rules for sampling of biological material, absence of media for the growth of atypical microorganisms and the ability of microorganisms to form biofilms on implant surfaces. An emergency histological examination of the affected tissues was practical during surgery in doubtful situations for adequate surgical approach. The results of a meta-analysis (2023) showed that the replacement of an infected endoprosthesis was more effective for the treatment of a culture-negative infection compared to debridement and preservation of implant.Conclusion The culture-negative infection group in our series showed better success rate of a two-stage treatment of PJI using implant replacement and broad-spectrum empiric antibiotic therapy at a two-year follow-up period. The negative microbiological result in the group could be caused by antibacterial drugs administered prior to diagnosis of PJI.
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来源期刊
Genij Ortopedii
Genij Ortopedii Medicine-Surgery
CiteScore
0.70
自引率
0.00%
发文量
104
审稿时长
12 weeks
期刊介绍: Journal’s main goal is to contribute to the development of the contemporary medical science via presentation of fundamental and applied original scientific studies to the scientific and practical medical community that would widen and deepen the understanding of the most important problems in the field of traumatology, orthopaedics, and related specialties. Our journal provides a direct open access to its content which is based on the principle that the open access option promotes global exchange of knowledge and experience. Journal’s strategy: -Development of the journal as a scientific platform for researchers, doctors, post-graduates and residents -Attraction of highly-cited authors to publish their studies -Selection of manuscripts of scientific interest for readers that will impact on journal citation index in RINC -Increase in the portion of publications submitted by foreign authors and studies conducted in association with foreign scientists; growth of citations in the journals that are included into global systems of indexing and reputable databases -Improvement of the Journal’s web site in two languages for a greater accessibility by authors and readers -Introduction of the Journal into global indexing systems
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