142例人工全髋关节置换术后假体周围感染的病原菌分布和耐药性分析

Analysis of pathogen distribution and drug resistance of 142 cases of periprosthetic infection after total hip arthroplasty

摘要:

目的 研究分析人工全髋关节置换术后感染的病原菌分布及其耐药情况。方法 回顾性分析陆军军医大学第二附属医院 2015年1月至2022年3月诊治的142例人工髋关节置换术后感染病例，取伤口分泌物、术中病灶组织进行细菌种类鉴定和耐药性分析。结果 142例人工全髋关节置换术后感染患者共分离出病原菌156株，混合感染患者11例，比例为7.75%。致病菌以革兰阳性菌为主，占64.10%（100株），其中金黄色葡萄球菌和表皮葡萄球菌为主，分别占33.33%、16.67%；革兰阴性菌共占33.98%，其中以铜绿假单胞菌和大肠埃希菌为主，分别占14.74%、10.26%。革兰阳性菌中金黄色葡萄球菌和表皮葡萄球菌主要对青霉素、氨苄西林、苯唑西林、红霉素、阿莫西林/克拉维酸具有非常高的耐药性（均超过50%），对喹奴普汀/达福普汀、万古霉素和利奈唑烷等敏感；革兰阴性菌中铜绿假单胞菌对头孢哌酮、头孢呋辛、哌拉西林等抗菌药物均表现为敏感，而大肠埃希菌对四环素、氨苄西林、环丙沙星和庆大霉素耐药率较高（均超过50%），对头孢哌酮/舒巴坦、米诺环素、替加环素、氨曲南、复方新诺明和亚胺培南等敏感。结论 对于人工全髋关节置换术后感染以包括金黄色葡萄球菌和表皮葡萄球菌在内的革兰阳性菌感染为主，这些病原菌对喹奴普汀/达福普汀、万古霉素和利奈唑烷等药物敏感，可将其作为经验性治疗人工全髋关节置换术后感染的首选药物。

Abstract:

Objective To study and analyze the pathogen distribution and drug resistance of infection after total hip arthroplasty.Methods A total of 142 cases of infection after artificial hip arthroplasty in Xinqiao Hospital，Army Medical University from January 2015 to March 2022 were analyzed retrospectively. The wound secretions and focus tissues were taken for bacterial species identification and drug resistance analysis.Results A total of 156 strains of pathogenic bacteria were isolated from 142 patients with infection after total hip arthroplasty and there were 11 patients with mixed infection，accounting for 7.75%. Gram-positive bacteria accounted for 64.10%（100 strains），of which Staphylococcus aureus and Staphylococcus epidermidis accounted for 33.33% and 16.67%，respectively. Gram-negative bacteria accounted for 33.98%，of which Pseudomonas aeruginosa and Escherichia coli accounted for 14.74% and 10.26%，respectively. Staphylococcus aureus and Staphylococcus epidermidis in gram-positive bacteria were highly resistant to penicillin，ampicillin，oxacillin，erythromycin，amoxicillin/clavulanic acid（all more than 50%）and sensitive to quinoloptin/daptidine，vancomycin and linazolidine. Pseudomonas aeruginosa in gram-negative bacteria was sensitive to antibiotics such as cefoperazone，cefuroxime and piperacillin，while Escherichia coli was highly resistant to tetracycline，ampicillin，ciprofloxacin and gentamicin（all more than 50%），and sensitive to cefoperazone/sulbactam，minocycline，tetracycline，aztreonam，sulfamethoxazole and imipenem.Conclusion Gram-positive bacteria，including Staphylococcus aureus and Staphylococcus epidermidis，are the main infections after total hip arthroplasty. Quinuprotin/daptidine，vancomycin and linezolid can be used as the first choice for empirical treatment of infection after total hip arthroplasty.