Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus
Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus
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DOI：
10.1007/s00264-014-2510-z
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发表时间：
2015-03-01
影响因子：
2.7
通讯作者：
Uckay, Ilker
中科院分区：
文献类型：
--
作者：
Betz, Michael;Abrassart, Sophie;Uckay, Ilker
目的：清创、抗生素和植入物保留（DAIR）手术是人工髋关节感染患者的一种选择，对于这些患者来说，关节置换术的取出是有问题的。不幸的是，一些建议用于决定关节置换术感染的DAIR管理的指南没有考虑到感染病原体的作用。虽然金黄色葡萄球菌和链球菌是髋关节置换术感染的主要原因，方法本回顾性研究包括1996年至2012年期间在日内瓦大学医院住院的所有患者，最初接受DAIR人工髋关节单菌治疗。S.金黄色葡萄球菌或链球菌属（Streptococcus spp.）DAIR治疗的结果在最短随访2年后进行评价。文献检索也进行了检索数据从其他机构的DAIR治疗的情况下，在我们的institutions.Results，38 DAIR治疗髋关节置换术单菌感染的患者进行了至少一次手术清创（中位数2，范围1至5），交换移动的部分，并伴随有针对性的抗生素治疗数周或数月。根据我们的研究标准，文献检索确定了其他机构中52例额外DAIR治疗病例的结局数据。在将我们自己的数据与从其他报告中检索到的数据合并后，我们发现S的失败率为21%，而不是24%。金黄色葡萄球菌感染，DAIR治疗的患者，但没有失败的14链球菌感染的患者。在合并数据中，失败率与S。金黄色葡萄球菌感染显著高于链球菌。(19/90 vs 0/14次; Fisher精确检验，P = 0.07）。金黄色葡萄球菌感染者的预后往往比链球菌感染者差。在未来的指南和建议中应考虑感染病原体的具体影响。
Purpose The debridement, antibiotic and implant retention (DAIR) procedure is an option for patients with prosthetic hip joint infections for whom arthroplasty removal is problematic. Unfortunately, some of the guidelines proposed for deciding on DAIR management of arthroplasty infections fail to take into consideration the role of the infecting pathogen. While Staphylococcus aureus and streptococci are major contributors to infected hip arthroplasties, their respective contributions to treatment success or failure rates with the DAIR procedure have not been thoroughly analysed from a microbiological perspective.Methods This retrospective study included all patients who were hospitalised in Geneva University Hospitals between 1996 and 2012 and were initially treated with DAIR for prosthetic hip joint monomicrobial infection due to S. aureus or Streptococcus spp. The outcome of DAIR treatment was evaluated after a minimal follow-up of two years. A literature search was also performed to retrieve data from additional DAIR-treated cases in other institutions.Results In our institution, 38 DAIR-treated patients with hip arthroplasty monomicrobial infections underwent at least one surgical debridement (median two, range one to five), exchange of mobile parts and concomitant targeted antibiotic therapy for several weeks or months. A literature search identified outcome data in other institutions from 52 additional DAIR-treated cases according to our study criteria. After merging our own data with those retrieved from other reports, we found a failure rate of 21 % instead of 24 % for S. aureus-infected, DAIR-treated patients, but no failure in 14 streptococcal-infected patients. In the pooled data, the failure rate linked with S. aureus infections was significantly higher than that with Streptococcus ssp. (19/90 vs 0/14 episodes; Fisher's exact test, P = 0.07).Conclusions DAIR-treated patients with prosthetic hip joint infections due to S. aureus tended to have worse outcomes than those infected with Streptococcus spp. The specific influence of the infecting pathogen should be considered in future guidelines and recommendations.