Factors related to outcome of early and delayed prosthetic joint infections
Factors related to outcome of early and delayed prosthetic joint infections
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DOI：
10.1016/j.jinf.2014.07.008
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发表时间：
2015-01-01
影响因子：
28.2
通讯作者：
Esposito, S.
中科院分区：
文献类型：
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作者：
Ascione, T.;Pagliano, P.;Esposito, S.
在这项前瞻性研究中，我们评估的影响，坚持诊断和治疗协议对假体关节感染（PJI）的诊断准确性和outcome.Patients和方法：患者早期或延迟PJI提到超过5年的时间。诊断是基于特征性的临床体征，影像学表现和微生物证据。抗生素的微生物的结果的基础上，选择和药物活性对甲氧西林耐药葡萄球菌的管理，如果没有微生物的证据已被obtained.Results：入选标准符合159例（中位年龄64岁，男性45%）。早期感染56例，迟发感染103例。99例（62%）病例报告了合并症。122/159例（77%）获得阳性培养物，20%培养凝固酶阴性葡萄球菌，28%培养金黄色葡萄球菌，7%培养铜绿假单胞菌。早期感染经清创及抗生素治疗后治愈率达80%。在延迟感染中，两阶段交换后的治愈率为85%。在28例接受抗生素治疗而未手术的迟发性感染患者中，仅8例（29%）感染在治疗停止后48周得到抑制。结论：适当的诊断和外科手术和微生物驱动的抗生素治疗，包括利福平，以提高诊断的准确性和结果。(C)2014年，英国传染病协会。由爱思唯尔有限公司出版。保留所有权利。
In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome.Patients and methods: Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained.Results: Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome.Conclusion: Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome. (C) 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.