Infection:骨科手术术前关节囊滑液培养不能预测引起假体周围关节感染的病原体

2021-09-17 MedSci原创 MedSci原创

因各种原因导致关节置换的患者多少都会出现假体周围关节感染,尽管临床医生在诊断和治疗管理方面取得了相当大的进展,但假体周围关节感染 (PJI) 仍然是一个需要攻克的问题。

      因各种原因导致关节置换的患者多少都会出现假体周围关节感染,尽管临床医生在诊断和治疗管理方面取得了相当大的进展,但假体周围关节感染 (PJI) 仍然是一个需要多学科治疗的棘手问题。术前和术中微生物培养被认为是诊断 PJI 的金标准,然而,滑液培养的敏感性有限,因此不能完全排除 PJI。敏感性差的原因有很多,包括慢性低度感染中的细菌载量低、病原体作为生物膜粘附在植入物表面上、先前的抗菌治疗、运输延迟或样本处理不当。本项研究旨在探究术前病原体检测的价值,并评估了其与培养阳性假体周围关节感染 (PJI) 患者术中培养的一致性。

 

      研究人员前瞻性的收集患者术前(滑液)和术中培养(假体周围组织滑液)关节液,然后进行组织学培养,确定阳性 PJI 事件的发生。最后使用Fisher精确检验比较术前和术中培养物中的病原体检出率并计算它们的一致性。

 

      研究结果显示在 167 次 PJI 阳性事件中,150 次为单一微生物感染,其中凝固酶阴性葡萄球菌 ( n  = 55, 37%)、金黄色葡萄球菌( n  = 34, 23%) 和链球菌 ( n  = 21, 14%) 是最常见的病原体. 17 次阳性培养 (10%) 是多种微生物感染。病原体可在 110 次术前培养和 153 次术中培养中被发现(66% VS 92%,p < 0.001)。对于低毒力病原体(40% VS 94%,p < 0.001)、多种微生物感染(59% VS 100%,p = 0.007)术前病原体检出率低于术中培养。

图:围手术期微生物检测阳性率

      本项研究证实关节置换患者的术前和术中细菌培养的一致性较差(52%)。在 38% 的 PJI 发作中,唯一或额外的病原体仅在术中培养中发现,因此术前滑液培养被认为对 PJI 中的病原体检测并不可靠。

 

原始出处:

Philipp Schulz. Et al. Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection. Infection.2021.

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    2021-09-18 xue8605
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