Chinese Journal of Tissue Engineering Research ›› 2022, Vol. 26 ›› Issue (36): 5837-5843.doi: 10.12307/2022.799
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Jiang Xu, Cao Fuyang, Xiong Ao, Yang Meng, Tan Jun, Yu Yang, Zhang Shaokun, Xu Jianzhong
Received:
2021-12-04
Accepted:
2022-01-13
Online:
2022-12-28
Published:
2022-04-27
Contact:
Xu Jianzhong, MD, Chief physician, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
About author:
Jiang Xu, Master candidate, Department of Orthopedics, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
CLC Number:
Jiang Xu, Cao Fuyang, Xiong Ao, Yang Meng, Tan Jun, Yu Yang, Zhang Shaokun, Xu Jianzhong. Distribution, drug resistance, and clinical characteristics of pathogenic bacteria in 102 cases of periprosthetic joint infection[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(36): 5837-5843.
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2.1 假体周围感染患者基本资料 纳入102例明确诊断为假体周围感染的病例资料,66例患者病原菌培养阳性,36例患者病原菌培养阴性,培养阳性率为64.7%,每例患者2次培养结果均一致。患者平均年龄为(66.3±10.6)岁;男性45例(44.1%),女性57例(55.9%);患有高血压45例(44.1%)、糖尿病25例(24.5%)。感染部位:膝关节71例(69.6%),髋关节31例(30.4%)。存在与感染关节相通窦道者21例(20.6%)。感染分期:早期感染者46例(45.1%),迟发感染者20例(19.6%),晚期感染者36例(35.3%)。治疗方式有:保留假体清创术17例(16.7%),一期翻修例26例(25.5%),二期翻修例59例(57.8%)。术后至少12个月的随访,102例患者中11例(10.8%)术后1年内出现感染症状复发。 2.2 假体周围感染患者病原菌种类及分布 66例培养阳性病例,共计检出71株病原菌,其中5例患者为混合感染,分别为阴沟肠杆菌+铜绿假单胞菌、大肠埃希菌+金黄色葡萄球菌、人葡萄球菌亚种+表皮葡萄球菌、大肠埃希菌+猪霍乱沙门菌、表皮葡萄球菌+粪肠球菌。 全部病原菌中,革兰阳性菌41株,占比57.8%,其中表皮葡萄球菌(21.1%)和金黄色葡萄球菌(15.5%)最常见;革兰阴性菌21株,占比29.6%,其中大肠埃希菌(12.7%)最常见;真菌9株,占比12.7%,其中近平滑念珠菌(5.6%)最常见。 在膝关节中,革兰阳性菌占比60%(27/45),革兰阴性菌占比22.2%(10/45),真菌占比17.8%(8/45);在髋关节中,革兰阳性菌占比53.8%(14/26),革兰阴性菌占比42.3%(11/26),真菌占比3.8%(1/26)。膝、髋病原菌分布比较差异无显著性意义(P=0.087),见表1。 "
2.3.3 真菌耐药情况 药敏试验未发现耐药菌株。 2.4 假体周围感染患者不同病原菌培养结果间的特征差异 排除5例混合感染病例后,其余97例以病原菌培养结果分为革兰阳性菌36例、革兰阴性菌16例、真菌9例及培养阴性36例共4组,4组在年龄、部位、高血压、糖尿病、窦道、D-二聚体、感染时间、感染控制情况等方面比较差异无显著性意义(P > 0.05)。此外Fisher精确检验结果显示,4组在治疗方式(清创/一期/二期)选择上存在统计学差异(P < 0.05),但采用Bonferroni调整后分析显示,4组在治疗方式(清创/一期/二期)选择上组间成对比较差异无显著性意义(P > 0.05)。4组在炎症指标(白细胞、血沉、C-反应蛋白)方面比较差异有显著性意义(P < 0.05),进一步分析(组间成对比较,用Bonferroni法校正显著性水平)结果:①C-反应蛋白:革兰阳性菌组C-反应蛋白水平高于病原菌培养阴性组(调整后P=0.000),其余组间比较差异无显著性意义(P > 0.05);②血沉:革兰阴性菌组血沉大于病原菌培养阴性组(调整后P=0.008),其余组间比较差异比较无显著性意义(P > 0.05);③白细胞计数:革兰阴性菌组白细胞计数大于病原菌培养阴性组(调整后P=0.029),其余组间比较差异无显著性意义(P > 0.05),见表4。"
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