发生率,微生物学研究,以及在全膝关节整形术后与假肢关节感染相关的因素
Erica J Weinstein1,2, Alisa J Stephens-Shields2, Craig W Newcomb2
1Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA network open
|October 31, 2023
概括
在全膝关节整形术 (TKA) 后的假肢关节感染 (PJIs) 在手术后的早期和晚期更为常见. 了解这些PJI模式和相关的风险因素对于改善患者的治疗结果至关重要.
科学领域:
- 整形外科手术 整形外科手术
- 传染性疾病 传染性疾病
- 流行病学 流行病学
背景情况:
- 膝关节整形术 (TKA) 是一种常见的手术,具有重大临床影响.
- 在TKA之后的假肢关节感染 (PJIs) 是一种严重的并发症,但关于其发生率,微生物学和相关风险因素的知识差距仍然存在.
研究的目的:
- 为了确定PJI发病率发生在初级TKA后的早期,延迟和晚期.
- 为了识别不同手术后期通常从PJI中分离出来的微生物.
- 为了研究与PJI发展相关的患者和外科因素,在不同的术后时间框架.
主要方法:
- 一项使用美国退伍军人事务部 (VA) 企业数据仓库数据的回顾性队列研究.
- 纳入标准包括在1999年10月1日至2019年9月30日期间接受选择性初级TKA的患者,并且至少有1年的VA护理.
- 统计分析包括波桑回归和参数生存模型,以评估早期 (≤3个月),延迟 (>3-12个月) 和晚期 (>12个月) 术后期的发病率和相关风险因素.
主要成果:
- 总共分析了79,367个初级TKA,确定了1,599个 (2.0%) 的PJI.
- 与晚期相比,PJI的发病率在早期 (26.8每10,000人月) 和延迟 (5.4每10,000人月) 期间显著更高,而后期 (1.3每10,000人月).
- 黄金葡萄球菌是整体上最常见的隔离物,但在早期的PJIs中显著的是グラム阴性感染. 肝炎C病毒感染,外周动脉疾病和自身免疫性炎症性关节炎被确定为所有时期的危险因素.
结论:
- 在TKA之后,PJI的发病率在早期和晚期的术后阶段显著增加.
- 根据TKA后发生的时间,与PJIs相关的显著微生物特征和患者特异性风险因素.
- 这些发现支持针对术后抗生素使用的量身定制策略,基于手术后时间的风险分层,以及针对PJI风险因子的修改.
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