老年关节假体周围慢性感染病原菌特点调查

Investigation of bacterial characteristics of chronic periprosthetic-joint infection in elderly

摘要:

目的 探讨老年慢性关节假体周围感染(PJI)的细菌谱及细菌耐药特点,为临床防治老年慢性PJI提供参考。方法 回顾性分析广州市第一人民医院关节外科2013年1月至2018年10月收治的行初次和翻修人工髋膝关节置换术的老年PJI患者76例,通过法国生物梅里埃公司的VITEK2-Compact全自动细菌鉴定及药敏分析仪对感染细菌及其耐药进行分析。结果 76例患者中初次置换术后感染64例,翻修术后感染12例。18例为混合感染(至少合并两种细菌感染),58例为单一细菌感染。其中行膝关节置换术51例,髋关节置换术23例,股骨头置换术2例。共分离出细菌108株,其中革兰氏阳性菌72.22%(78/108),以金黄色葡萄球菌及表皮葡萄球菌为主。革兰氏阴性菌27.78%(30/108),以大肠埃希菌及铜绿假单胞杆菌为主。不同细菌对抗菌药物耐药情况有差异。金黄色葡萄球菌及表皮葡萄球菌对克林霉素、红霉素、庆大霉素、青霉素耐药率＞60%,对万古霉素、利奈唑胺、替加环素、奎诺普汀/达福普汀的耐药率＜5%。大肠埃希菌与铜绿假单胞杆菌对头孢唑林钠、头孢他啶、复方新诺明、氨苄青霉素耐药率＞70%；对哌拉西林/他唑巴坦、亚胺培南耐药率＜15%。结论 老年慢性PJI主要致病菌为金黄色葡萄球菌与表皮葡萄球菌,慢性感染细菌谱与急性感染不同,应根据药敏实验合理选用抗菌药物。

Abstract:

Objective To investigate the bacterial spectrum and drug resistance of chronic periprosthetic-joint infection (PJI) in the elderly and to provide reference for its clinical prevention and treatment. Methods A retrospective analysis was made of 76 elderly patients with PJI who underwent hip and knee arthroplasty in Guangzhou First people′s Hospital from January 2013 to October 2018. The bacterial spectrum and drug resistance were analyzed using French Automated Microbial Identification and Susceptibility Test System (VITEK2-Compact, BioMérieux, France). Results Among 76 patients, 64 were infected for the first time after the initial replacement and 12 after revision, 18 being mixed infection (with at least two bacteria) and 58 being single infection. Knee arthroplasty were performed in 51 patients, hip arthroplasty in 23, and femoral head replacement in 2. A total of 108 strains of bacteria were isolated, of which 72.22%(78/108) were gram-positive, mainly Staphylococcus aureus and Staphylococcus epidermidis, and 27.78%(30/108) gram-negative, mainly Escherichia coli and Pseudomonas aeruginosa. Bacteria varied in their resistance to antimicrobial agents. Over 60% Staphylococcus aureus and Staphylococcus epidermidis were resistant to clindamycin, erythromycin, gentamicin and penicillin, and less than 5% to vancomycin, linezolid, tigecycline, quinupeptine/dafolopin; over 70% Escherichia coli and Pseudomonas aeruginosa were resistant to cefazolin sodium, ceftazidime, compound sulfamide and ampicillin and less than 15% to piperacillin/tazobactam and imipenem. Conclusion Staphylococcus aureus and Staphylococcus epidermidis are the main pathogens of chronic PJI in the elderly, the bacterial spectrum of chronic infection different from that of acute infection, and antibiotics should be selected based on the results of drug sensitivity test.