中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
5期
413-416
,共4页
彭慧明%翁习生%翟吉良%边焱焱%林进%金今%钱文伟%赵丽娟
彭慧明%翁習生%翟吉良%邊焱焱%林進%金今%錢文偉%趙麗娟
팽혜명%옹습생%적길량%변염염%림진%금금%전문위%조려연
关节成形术,置换,膝%感染%抗药性,微生物
關節成形術,置換,膝%感染%抗藥性,微生物
관절성형술,치환,슬%감염%항약성,미생물
Arthroplasty,replacement,knee%Infection%Drug resistance,microbial
目的 对初次人工全膝关节置换术(TKA)后假体周围感染的微生物学谱及药敏结果进行调查,为该并发症的诊治提供参考.方法 回顾性研究1995年1月至2011年12月诊治的TKA术后假体周围感染的29例患者资料,男性6例,女性23例;术后诊断感染的时间为1周至10年,平均24.3个月.记录患者的一般资料、放射学结果及感染分期.对获得的细菌学种类、数量及药敏结果进行分析.结果 29例患者中共有19例患者(65.5%)获得阳性微生物学培养结果,均为单一细菌感染,其中革兰染色阳性球菌14例、革兰染色阴性杆菌2例、分枝杆菌2例及真菌1例.14例革兰染色阳性球菌中凝固酶阴性葡萄球菌感染7例,其中甲氧西林敏感的表皮葡萄球菌4例,耐甲氧西林凝固酶阴性葡萄球菌3例;金黄色葡萄球菌感染5例,其中甲氧西林敏感的金黄色葡萄球菌2例,甲氧西林耐药的金黄色葡萄球菌3例;链球菌感染2例.耐药菌及罕见病原菌均出现在Ⅳ型感染.结论 初次TKA术后假体周围感染革兰染色阳性球菌仍为主要病原菌,需警惕耐药菌和罕见菌的产生.应当根据药敏结果针对用药,结果回报前可经验性选用万古霉素.
目的 對初次人工全膝關節置換術(TKA)後假體週圍感染的微生物學譜及藥敏結果進行調查,為該併髮癥的診治提供參攷.方法 迴顧性研究1995年1月至2011年12月診治的TKA術後假體週圍感染的29例患者資料,男性6例,女性23例;術後診斷感染的時間為1週至10年,平均24.3箇月.記錄患者的一般資料、放射學結果及感染分期.對穫得的細菌學種類、數量及藥敏結果進行分析.結果 29例患者中共有19例患者(65.5%)穫得暘性微生物學培養結果,均為單一細菌感染,其中革蘭染色暘性毬菌14例、革蘭染色陰性桿菌2例、分枝桿菌2例及真菌1例.14例革蘭染色暘性毬菌中凝固酶陰性葡萄毬菌感染7例,其中甲氧西林敏感的錶皮葡萄毬菌4例,耐甲氧西林凝固酶陰性葡萄毬菌3例;金黃色葡萄毬菌感染5例,其中甲氧西林敏感的金黃色葡萄毬菌2例,甲氧西林耐藥的金黃色葡萄毬菌3例;鏈毬菌感染2例.耐藥菌及罕見病原菌均齣現在Ⅳ型感染.結論 初次TKA術後假體週圍感染革蘭染色暘性毬菌仍為主要病原菌,需警惕耐藥菌和罕見菌的產生.應噹根據藥敏結果針對用藥,結果迴報前可經驗性選用萬古黴素.
목적 대초차인공전슬관절치환술(TKA)후가체주위감염적미생물학보급약민결과진행조사,위해병발증적진치제공삼고.방법 회고성연구1995년1월지2011년12월진치적TKA술후가체주위감염적29례환자자료,남성6례,녀성23례;술후진단감염적시간위1주지10년,평균24.3개월.기록환자적일반자료、방사학결과급감염분기.대획득적세균학충류、수량급약민결과진행분석.결과 29례환자중공유19례환자(65.5%)획득양성미생물학배양결과,균위단일세균감염,기중혁란염색양성구균14례、혁란염색음성간균2례、분지간균2례급진균1례.14례혁란염색양성구균중응고매음성포도구균감염7례,기중갑양서림민감적표피포도구균4례,내갑양서림응고매음성포도구균3례;금황색포도구균감염5례,기중갑양서림민감적금황색포도구균2례,갑양서림내약적금황색포도구균3례;련구균감염2례.내약균급한견병원균균출현재Ⅳ형감염.결론 초차TKA술후가체주위감염혁란염색양성구균잉위주요병원균,수경척내약균화한견균적산생.응당근거약민결과침대용약,결과회보전가경험성선용만고매소.
Objectives To describe the microbiology,antimicrobial susceptibility of patients proven prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) and to provide reference for the diagnosis and treatment of this complication.Methods The medical data of the patients with infected knee arthroplasty,who were managed with revision surgery between January 1995 to December 2011 were reviewed.Twenty-nine cases were identified and majority of the patients were female(23/29).Diagnosis of PJI after primary TKA was between 1 week and 10 years (average 24.3 months).The microbiology and antimicrobial susceptibility were analyzed.Results The overall positive rate of cultures was 65.5%(19/29).The most common organisms identified were Coagulase-negative Staphylococcus (CNS) (7/19)and Staphylococcus Aureus (SA) (5/19).Rare pathogens of Mycobacterium (2/19) and fungi(1/19) were also identified.Vancomycin was the most effective antibiotics with overall sensitivity rates of 100%.Resistant and rare pathogens were all in type Ⅳ infection.Conclusions Gram-positive bacterias are the main pathogen,resistant and rare pathogens should be payed attention to.Antibiotic treatment for infected TKA should be based on the results of drug susceptibility.Vancomycin allows infected knee arthroplasties before the result.