Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis.
Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis.
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DOI：
10.1155/2018/6278012
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发表时间：
2018
影响因子：
--
通讯作者：
Perka C
中科院分区：
文献类型：
--
作者：
Reisener M;Perka C
培养阴性假体周围关节感染（CN PJI）尚未得到很好的研究，由于对PJI缺乏共识，特别是培养阴性感染，存在相当大的不确定性。由于CN PJI具有挑战性的临床问题，本系统综述的目的是根据目前关于CN PJI的文献描述发病率、诊断和治疗结果。本综述旨在评估髋关节和膝关节CN PJI与培养阳性患者相比预后较差的正式假设。这是系统评价，证据水平为3。EMBASE、MEDLINE和Cochrane图书馆于2018年1月进行了电子检索。所有以英语或德语发表的至少10例患者的有关髋关节或膝关节CN PJI的研究均被纳入。随后，作者对诊断和治疗结果进行了描述性分析。8项研究符合纳入标准。髋关节或膝关节CN PJI的发生率从7%到42%不等。根据随机效应模型，对纳入的研究进行汇总，得出总发病率估计为11%[95%置信区间（CI）： 10-12]。283例患者中最常见的手术干预是两期假体修复。术后，大多数患者接受万古霉素作为抗生素治疗，单独或与其他抗生素联合使用。在所有纳入的研究中，成功治疗感染的比率从85%到95%不等。基于治疗后5年无感染生存率为95%，两期置换关节置换术的结果最好。我们得出结论，CN PJI具有与培养阳性感染相同甚至更好的结果。尽管如此，对于CN PJI的标准化诊断方案和循证治疗策略应该得到进一步的研究。
Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI. The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones. It is systematic review with level of evidence 3. EMBASE, MEDLINE, and the Cochrane Library were searched electronically in January 2018. All studies regarding CN PJI of the hip or knee published in English or German with a minimum of 10 patients were included. Afterwards, the authors performed a descriptive analysis of diagnosis and treatment outcome. Eight studies were identified that met the inclusion criteria. The incidence of CN PJI in the hip or knee ranged from 7% to 42 %. The included studies were pooled to give an overall incidence rate estimate of 11 % [95% confidence interval (CI): 10-12] based on a random-effects model. The most common surgical intervention was the two-stage revision of prosthesis with 283 patients. Postoperatively, the majority of patients received vancomycin as the antibiotic treatment, alone or in combination with other antibiotics. The rate of succesfully treated infections varied from 85% to 95 % in all included studies. The two-stage exchange arthroplasty had the best outcome, based on the infection-free survival rate of 95%, five years after treatment. We conclude that CN PJI have the same or even better results than culture-positive infections. Nonetheless, a standardized diagnostic protocol and evidence-based treatment strategies for CN PJI should be implemented for further studies.
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DOI：
10.1302/0301-620x.100b1.bjj-2017-0626.r1
发表时间：
2018-01
期刊：
The bone & joint journal
影响因子：
--
作者：
Ibrahim MS;Twaij H;Haddad FS
通讯作者：
Haddad FS
影响因子：
4.2
作者：
Jenny, Jean-Yves;Barbe, Bruno;Argenson, Jean-Noel
通讯作者：
Argenson, Jean-Noel
影响因子：
2.1
作者：
Jakobs O;Schoof B;Klatte TO;Schmidl S;Fensky F;Guenther D;Frommelt L;Gehrke T;Gebauer M
通讯作者：
Gebauer M
影响因子：
28.2
作者：
Eugenia Portillo, Maria;Salvado, Margarita;Pablo Horcajada, Juan
通讯作者：
Pablo Horcajada, Juan
影响因子：
1.5
作者：
Kim, Young-Hoo;Kulkarni, Sourabh S.;Rastogi, Devarshi
通讯作者：
Rastogi, Devarshi