Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study
Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study
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DOI：
10.1016/j.cmi.2016.05.004
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发表时间：
2016-08-01
影响因子：
14.2
通讯作者：
Ariza, J.
中科院分区：
文献类型：
--
作者：
Benito, N.;Franco, M.;Ariza, J.
了解假体关节感染 (PJI) 的微生物病因谱对于指导经验性治疗和建立关节置换术中的抗菌预防措施非常重要。没有基于大型当代患者队列的可用数据。我们试图描述 PJI 的致病病原体并评估微生物病因学的趋势。我们假设近年来 PJI 中耐药微生物的频率有所增加。我们从 2003 年至 2012 年在西班牙 19 家医院进行了一项队列研究。每两年（2003-2004 年至 2011-2012 年），都会评估引起 PJI 的微生物和多重耐药细菌的发生率。评估了研究期间的时间趋势。我们纳入了 2524 名连续诊断为 PJI 的成年患者。 2288例（90.6%）获得微生物学诊断。葡萄球菌是最常见的感染原因（1492 例，65.2%）。然而，革兰氏阴性杆菌引起的感染比例呈统计上显着的线性上升趋势，主要是由于最近两年的增长（2003-2004年为25%，2011-2012年为33.3%；趋势p=0.024）。没有哪个特定物种对总体增长的贡献不成比例。多重耐药菌PJI的比例从2003-2004年的9.3%增加到2011-2012年的15.8%（p < 0.008），主要是因为多重耐药革兰氏阴性杆菌显着增加（从2003-2004年的5.3%增加到2011-2012年的8.2%；p 0.032）。观察到的趋势对于 PJI 的管理和关节置换的预防具有重要意义。 N. Benito，(C) 2016 年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements. N. Benito, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.