Analysis Of Pathogens Characteristics Of Periprosthetic Infection After Knee And Hip Arthroplasty

Background and objectiveArtificial joint replacement is recognized as the most effective treatment for terminal bone lesions of the knee and hip joint,which can effectively help different patients to restore joint function and eliminate pain,thus improving the overall quality of life of patients.With the rapid development of medical technology in recent decades,people’s movement and lifestyle change,more and more patients have undergone knee and hip replacement.Related literature reports also show that the number of joint replacement operations at home and abroad has been on the rise.But at the same time,as a complicated complication after artificial joint replacement,periprosthetic infection is also a major problem that clinicians need to pay attention to.Some current studies show that periprosthetic infections after knee replacement are about 1%to 2%,and periprosthetic infections after hip replacement are about 1%.This proportion for older,underlying diseases and other weak,low immunity of patients,the proportion is often higher.In addition,due to different pathogen types,different infection time and individual differences,in addition to the typical manifestations of general infection of redness,swelling,heat and pain,there may also be atypical or early hidden characteristics that affect the diagnosis and treatment process of the disease.Today for artificial joint replacement prosthesis after clinical infection of the means of diagnosis of pathogenic bacteria culture positive results or positive symptoms in combination with inspecting index into account,so for different types of prosthetic infection of patients with systematic study,to explore the pathogenic characteristics,clinical features,treatment methods and effect can help clinical early diagnosis and treatment work,Reduce patient pain and unnecessary waste of medical resources.Current research on periprosthetic infection after artificial joint replacement is not sufficient and complete,and more studies are needed to supplement it.On this basis,102 cases of periprosthetic infection after artificial joint replacement in our hospital were analyzed by pathogens and the clinical characteristics of different pathogens were compared,in order to provide reference for clinical diagnosis and treatment.MethodsA total of 102 patients with periprosthetic infection after artificial joint replacement treated in the orthopedic ward of our hospital from September 2013 to September 2020 were included,including 45 males and 57 females,with an average age of 66.3±10.6 years.Knee joint 71 cases,hip joint 31 cases;Early infection 46 cases,late infection 20 cases,late infection 36 cases;According to the results of pathogen culture,infection time,local tissue condition of joint and physical differences of patients,different surgical methods(prosthesis reserving debridement,primary revision and secondary revision)were comprehensively considered for treatment.Basic personal information,basic diseases,infection time after joint replacement,surgical joint location,existence of sinus tract,first routine test indicators after admission(serum C-reactive protein,ESR,D-dimer,blood routine),pathogen culture results and drug sensitivity results of patients were recorded.Patients were followed up more than 12 months after the operation,and the degree of infection control was comprehensively evaluated based on relevant signs,imaging examination and related test results.SPSS 25.0 was used for statistical analysis of relevant data to compare the distribution and drug resistance of different pathogens.The culture results of pathogenic bacteria were divided into groups(culture negative bacteria,Gram positive bacteria,Gram negative bacteria and fungi)to compare the difference of characteristics between different pathogenic bacteria groups.P<0.05 indicated statistical significance.Results(1)A total of 71 strains of pathogenic bacteria were detected in all cases of periprosthetic infection in this study.Forty-one strains(57.8%)of Gram-positive bacteria were cultured,of which 35 strains(49.3%)were staphylococcus.Twenty-one strains(29.6%)of Gram-negative bacteria were cultured,and the highest proportion of escherichia coli was 9 strains(12.7%).Nine strains(12.7%)of fungi were isolated,all of which were candida.The proportion of staphylococcus aureus in knee joint was 30.8%higher than that in hip joint(6.7%).(2)Gram-positive bacteria had higher drug resistance rate to erythromycin,clindamycin,oxacillin,penicillin and other antibiotics,but showed no drug resistance to tigecycline,linezolid,vancomycin.The resistance rate of gram-negative bacteria to cefazolin,gentamicin,quinolones,ampicillin and other antibiotics was higher.Fungal susceptibility tests did not show resistance.(3)There were no significant differences in age,gender,underlying diseases,infection types,surgical site,sinus tract,surgical method selection and prognosis among the negative,gram-positive,gram-negative and fungal groups(P>0.05).At the early stage of infection,the c-reactive protein level of Gram-positive bacteria was higher than that of culture negative group,and the white blood cell count and erythrocyte sedimentation rate of gram-negative bacteria were higher than that of culture negative group(P<0.05).ConclusionStaphylococcus is still the main bacteria causing periprosthetic infection after knee and hip arthroplasty,and the increasing proportion of fungal infection needs to be paid attention to;More pathogens have high resistance to common antibiotics.The application of sensitive antibiotics should be adjusted with reference to drug sensitivity test and short-term treatment effect.In the early stage of infection,Gram-positive bacteria and Gram-negative bacteria often have more significant inflammatory index levels than those with negative culture.