The Therapeutic Effect Of Streptococcal Periprosthetic Joint Infection

Background and objective: Periprosthetic joint infection is a serious complication after total joint replacements.Staphylococcus aureus and coagulase negative staphylococci are the most common pathogens.The proportion of streptococcus infections has increased in recent years.Because streptococcus is sensitive to antibiotics,resistant strains are rare,it is generally believed that there is a good cure rate,but some studies have reported that the treatment of streptococcal periprosthetic joint infection is poor,so the purpose of this study is to evaluate the therapeutic effect of streptococcal periprosthetic joint infection,and to compare whether there is a difference in the therapeutic effect between streptococcus and other single bacteria caused by periprosthetic joint infection.Methods: From January 2010 to December 2016,a retrospective case-control study was carried out in two tertiary hospitals in fuzhou,fujian province.Inclusion criteria: consistent with the diagnostic criteria of Musculoskeletal Infection Society,and for single bacterial Infection,according to Tsukayama parting,type will Ⅱ infection(early postoperative infection,within 1 month after the first replacement)and type Ⅲ infection(acute blood-borne infections,symptom duration of 4 weeks)as an acute infection and treated by debridement,antibiotics and implant retention,type Ⅳ infection(more than 1 month after joint replacement only symptoms of infection,or acute illnesses out more than four weeks of blood-borne infection infection)for chronic infection,namely the treatment was two-stage revision.exclusion criteria: long-term immunosuppressive therapy,unable to cooperate with treatment and follow-up,culture negative or mixed infection,special bacteria methicillin-resistant staphylococcus aureus or skin of methicillin-resistant staphylococcus infection;Combine chronic disease or malignancy,diabetes mellitus,but not follow the doctor’s advice to control blood sugar.Cases will met inclusion and exclusion criteria,according to the treatment group of patients’ age,sex,body mass index,bacterial culture results,treatment and therapeutic effect were compared.Results: There were 185 cases of periprosthetic joint infection that met the diagnostic criteria in the two hospitals,and 99 cases were included in the inclusion and exclusion criteria.Among them,19 cases of streptococcus infection(19.20%)were followed up from3 months to 50 months,and the median follow-up time was 23 months,2 cases had relapses,17 had no infection,and the survival rate was 89.5%(95%CI 0.641 to 0.973).In the group of debridement,antibiotics and implant retention,12 cases of streptococcus infection,3 male and 9 female,1 hip 11 knee,average age of 68.25 years,followed up from march to 50 months,median follow-up time of 23.5 months,2 cases of infection recurrence,10 cases without infection,1 year without infection survival rate of 83.3%(95%CI 0.482 to 0.956);infection of non-streptococcus is 20 case,11 male 9 female,6 hip 14 knee,average age 63.80 years,that follow-up period is from 14 month to 50 month,median follow up time 25 months,5 infection recurrence,15 case no infection survival rate,1 year no infection survival rate is 78.9%(95% CI 0.532 ~ 0.915),the difference between the non-infected survival curve is not statistically significant(P > 0.05).In the group of two-stage revision,7 cases of streptococcus Infection,2 male and 5 female,4 hip 3 knee,average age 64.86 years,that follow-up period is 13 months to 33 months,the median follow up 23 month,7 case no infection survival rate,1 year no infection survival rate is 100%;There were 60 cases of non-streptococcus infection,29 male and 31 female,30 hips 30 knee,average age of 64.68 years,that follow-up period is 1 months to 84 months(median follow-up time in 16 months),15 cases of infection recurrence,45 cases without infection survival,1 year without infection survival rate of 75.0%(95%CI 0.620 to 0.841),the difference of survival curves was not statistically significant(P > 0.05).Conclusion: streptococcal artificial joint infection is well treated with timely and appropriate treatment(89.5% without infection for 1 year),and is similar to the therapeutic effect of other single bacteria.