Etiology of implant orthopedic infections: A survey on 1027 clinical isolates
Etiology of implant orthopedic infections: A survey on 1027 clinical isolates
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DOI：
10.1177/039139880502801106
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发表时间：
2005-11-01
影响因子：
1.7
通讯作者：
Montanaro, L
中科院分区：
文献类型：
--
作者：
Arciola, CR;An, YH;Montanaro, L
尽管现代预防方案取得了最新成就，但骨科手术感染仍然频繁得令人无法接受，特别是考虑到脓毒症并发症的破坏性结局。本文探讨了骨科感染中最常涉及的细菌的谱和患病率，特别是与植入物生物材料相关的感染，这些感染根据器械类型进行了分组。在30个月期间（2000年9月至2003年4月），1027微生物菌株连续分离699例患者接受翻修手术在Rizzoli骨科研究所。其中葡萄球菌属775株（75.5%），肠杆菌科82株（8%），假单胞菌属75株（7.3%），肠球菌属54株（5.3%），链球菌属20株（1.9%）。虽然证实了葡萄球菌作为最广泛的感染原因的重要性，但我们的数据表明，葡萄球菌的患病率出乎意料地高。感染的髋关节和膝关节假体上的表皮，分别为42%和44%。感染骨折内固定器械或骨折外固定器械的细菌谱似乎与髋关节和膝关节假体的细菌谱不同，更类似于与医疗器械无关的感染，其特征是金黄色葡萄球菌（超过40%）和铜绿假单胞菌的患病率相对较高。肠杆菌科以及链球菌属和棒状杆菌属的成员经常与在会阴附近进行手术切口的植入物相关，确定了完全改变的谱。
In spite of the recent achievements derived from modem protocols of prophylaxis, orthopedic surgical infections still remain unacceptably frequent, especially in light of the often devastating outcomes of septic complications. The spectrum and the prevalence of the bacteria most frequently involved in orthopedic infections are here explored, with particular reference to those infections associated to implant biomaterials, which were grouped based on device typology. During a 30 months period (from September 2000 to April 2003), 1027 microbial strains were consecutively isolated from 699 patients undergoing revision surgery at the Rizzoli Orthopedic Institute. 775 (75.5%) of all these microorganisms were identified as belonging to the Staphylococcus genus, 82 (8%) to the Enterobacteriaceae family, 75 (7.3%) to the Pseudomonas genus, 54 (5.3%) to the Enterococcus genus and 20 (1.9%) to the Streptococcus genus. While confirming the importance of staphylococci as the most diffuse cause of infection, our data indicate an unexpectedly high prevalence of S. epidermidis on infected hip and knee arthroprostheses, respectively of 42% and 44%. The spectrum of bacteria infecting either internal or external fracture fixation devices appears to differ from that of hip and knee arthroprostheses and more closely resembles that of infections non-associated to medical devices, being characterized by a relatively higher prevalence of Staphylococcus aureus (over 40%) and Pseudomonas aeruginosa. Enterobacteriaceae and members of the Streptococcus and Corynebacterium genera are frequently associated with implants in which surgical incisions were made near the perineum, determining a completely altered spectrum.