Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study
Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study
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DOI：
10.1111/1469-0691.12649
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发表时间：
2014-11-01
影响因子：
14.2
通讯作者：
Ariza, J.
中科院分区：
文献类型：
--
作者：
Rodriguez-Pardo, D.;Pigrau, C.;Ariza, J.
我们的目的是评估革兰氏阴性人工关节感染（GN-PJI）的流行病学和结果，采用清创、抗生素和植入物保留（DAIR）治疗，确定失败的预测因素，并确定环丙沙星的使用对预后的影响。我们对2003年至2010年在16家西班牙医院诊断的GN-PJI进行了回顾性、多中心、观察性研究。我们将失败定义为随访期间炎性关节体征的持续或复发，导致计划外手术或重复清创术> 30天，与手术相关的死亡，或抑制性抗菌治疗。用考克斯回归模型分析预测失败的参数。共研究了242例患者（33%为男性;中位年龄76岁，四分位距（IQR）68-81），共发生242次GN-PJI。植入物包括150个（62%）髋关节、85个（35%）膝关节、5个（2%）肩关节和2个（1%）肘关节假体。有189例（78%）急性感染。致病微生物为肠杆菌科（78%）、假单胞菌属（78%）。革兰阴性杆菌占20%，其他革兰阴性杆菌占2%。总体而言，19%的分离株对环丙沙星耐药。DAIR用于174例（72%）病例，总体成功率为68%，在用环丙沙星治疗的环丙沙星敏感GN-PJIs中位随访25个月后增加至79%。环丙沙星治疗显示出独立的保护作用（校正风险比（aHR）0.23; 95%CI，0.13-0.40; p
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement >30days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p