Periprosthetic joint infection following total knee arthroplasty: its bacteriological characteristics and treatment strategies

doi:10.3969/j.issn.2095-4344.2017.35.024

Abstract

Abstract:

BACKGROUND: Periprosthetic infection after total knee arthroplasty (TKA) has become the most serious complication. However, there is still a lack of clinical study on the distribution of pathogenic bacteria. Therefore, understanding the distribution characteristics of the main pathogenic bacteria is critical for preventing and treating postoperative infection.

OBJECTIVE: To analyze the bacteriological characteristics in the patients with periprosthetic joint infection following TKA, so as to provide reference for early prevention and treatment.

METHODS: CNKI, VIP, WanFang and PubMed databases were retrieved for the literature concerning periprosthetic infection following TKA published before 2016. The incidence of periprosthetic joint infection after TKA was statistically analyzed.

RESULTS AND CONCLUSION: (1) 103 articles were included, involving 1 399 patients. (2) The main pathogenic bacteria were Staphylococcus aureus, coagulase negative Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Streptococcus and Enterococcus. There is no significant difference in the distribution of bacteria at home and abroad. Treatment strategies are divided into conservative and surgical treatments. (3) The key for successfully preventing and treating periprosthetic infection after TKA lies in the multiple disciplinary team collaboration, understanding the distribution of bacteria, early diagnosis and active preventive measurements, as well as rational treatment strategies.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Arthroplasty, Replacement, Knee, Prosthesis Implantation, Infection, Bacteria, Tissue Engineering

CLC Number:

R318

Cui Ke-ke, Yang Wei-yi, Liu Jun, Pan Jian-ke, Zhang Bao-qing, Cao Xue-wei. Periprosthetic joint infection following total knee arthroplasty: its bacteriological characteristics and treatment strategies [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(35): 5721-2576.

Figures/Tables 2

2.1 文献检索情况检索国内外数据库初步得到1 100篇目标文献，其中国内文献67篇，国外文献1 033篇，根据入选标准和排除标准手动筛选、智能检索，最终纳入103篇，其中外文88篇，中文15篇。文献中采取数据样本1980至2016年，得到全膝关节置换术后假体周围感染1 399例，并对全膝关节置换术后假体周围感染细菌分情况及特点，及临床中采用的治疗策略进行系统描述。 2.2 细菌分布情况本次研究以全膝关节置换术后发生感染为主，检索文献及临床研究涉及国内外膝关节置换术后假体周围感染细菌培养结果阳性共1 399例，涉及菌株53种，其中革兰阳性菌共1 017例，革兰阴性菌267例，真菌44例，分支杆菌42例，其他29例，见图1及表1。革兰阳性菌中金黄色葡萄球菌共515例，占革兰阳性菌比重50.6%，占总细菌比重36.7%；凝血酶阴性金黄色葡萄球菌189例，占革兰阳性菌比重18.6%，占总细菌比重13.5%；表皮葡萄球菌156例，占革兰阳性菌15.3%，占总细菌比重11.2%；链球菌64例，占革兰阳性菌比重6.3%，占总细菌比重4.6%；肠球菌属57例，占革兰阳性比重5.6%，占总细菌比重4.1%；革兰阳性菌中还包含其他菌属，占细菌比重较小，详见图2。革兰阴性菌共267例，其中大肠埃希菌共93例，占革兰阴性菌比重34.8%，占总细菌比重6.7%；铜绿假单胞菌37例，占革兰阴性菌比重13.9%，占总细菌比重2.6%；鲍曼不动杆菌、肠杆菌属各29例，占革兰阴性菌比重10.9%，占总细菌比重2.1%；阴沟肠杆菌23例，占革兰阴性菌8.6%，占总细菌比重1.6%；革兰阴性菌中还含有其他菌属，由于发生概率低，详见图3。真菌共44例，占总细菌比重3.1%，见图4。分支杆菌共39例，占总细菌比重3.0%。其他菌属29例，占总细菌比重2.1%，见图5。由此可见，全膝关节置换术后假体周围感染以革兰阳、阴性菌为主，集中于金黄色葡萄球菌、凝固酶阴性葡萄球菌、表皮葡萄球菌、大肠埃希菌、链球菌、肠球菌、铜绿假单胞菌等为主。有文献报道，在膝关节假体周围感染中金黄色葡萄球菌(52.15%)高于凝固酶阴性葡萄球菌(24.48%)[14]。 2.3 统计分析数据录入SPSS 19.0，分别对比不同菌种国内外的发生率，分析国内外全膝关节置换术后细菌分布特点之间有无差异性。其中革兰阳性菌(G+)国内、外细菌发生率χ2=3.3817，P=0.065 9 > 0.05，差异无显著性意义；革兰阴性菌(G-)国内、外细菌发生率 χ2=3.528 0，P=0.060 3 > 0.05，差异无显著性意义；真菌国内、外细菌发生率χ2=2.184 3，P=0.139 4 > 0.05，差异无显著性意义；分枝杆菌国内、外细菌发生率χ2检验(Fisher)确切概率法：P=0.000 7 < 0.05，统计分析差异有显著性意义，考虑与国内关于分支杆菌相关的文献报道较少，文献数据纳入较少相关。结果提示，国内外全膝关节置换术后细菌总的分布情况差异无显著性意义，细菌分布多集中于革兰阳性菌。 "

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