Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.
Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review.
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DOI：
10.4081/or.2015.5623
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发表时间：
2015-03-03
影响因子：
2.1
通讯作者：
Gebauer M
中科院分区：
文献类型：
--
作者：
Jakobs O;Schoof B;Klatte TO;Schmidl S;Fensky F;Guenther D;Frommelt L;Gehrke T;Gebauer M
真菌假体周围关节感染（PJI）是全膝关节置换术（TKA）后一种罕见但具有破坏性的并发症。目前缺乏准确治疗膝关节置换术这一严重并发症的标准化程序。在本次系统评价中，我们收集了 36 项研究的数据，共报告了 45 例 TKA 并发真菌 PJI 病例。随后，对术前、术中和术后期间的诊断、药物和手术程序进行了分析。念珠菌属约占真菌 PJI 的 80%（45 例中的 36 例），因此是最常报告的病原体。除一名患者外，所有患者均接受全身抗真菌治疗，而局部抗真菌治疗，例如局部抗真菌治疗。使用浸渍垫片的相关性较低。切除关节成形术延迟再植入（两阶段翻修）是首选的手术治疗方法。然而，在所有报告的病例中，50% 的手术治疗是异质的。联合治疗的结果为中等，其中 11 名患者出现复发性真菌 PJI，5 名患者随后出现细菌性 PJI 作为主要并发症。总之，本系统评价整合了最新 45 例 TKA 真菌 PJI 报告病例的数据。根据现有文献，讨论了全膝关节置换术后这种破坏性并发症的治疗策略。
Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.