Analysis Of Pathogen Distribution And Drug Resistance Of Acute,Delayed And Chronic Periprosthetic Joint Infection

Objective: To retrospectively analysis on the pathogen culture and drug sensitivity results of patients with infection after artificial hip and knee replacement in the department of Joint Surgery,The First Affiliated Hospital of Xinjiang Medical University.To compare the distribution and drug resistance of pathogenic bacteria in acute,delayed and chronic periprosthetic infections,so as to provide reference for the diagnosis and treatment of serious postoperative complications.Methods: Data of patients with periprosthetic joint infection after primary hip and knee joint replacement in joint surgery department of our hospital from August 2010 to August 2020 were collected,including a total of 316 patients,including 146 males and 170 females.There were 161 cases of periprosthetic joint infection after total hip arthroplasty(THA)and 155 cases of periprosthetic joint infection after total knee arthroplasty(TKA).According to the time of postoperative infection,the patients were divided into three groups: acute,delayed and chronic PJI,which were 65 cases,83 cases and 168 cases respectively.The differences of general data,pathogen types,quantity,composition ratio,culture positive rate and drug sensitivity test results were recorded and compared among the three groups.Results: Gram-positive bacteria were the main pathogenic bacteria of PJI,accounting for 32.84%,50.00% and 48.90% respectively in the three groups of PJI,mainly Staphylococcus epidermidis and Staphylococcus aureus.Gramnegative bacteria were mainly Escherichia coli and Enterobacter cloacae.Gram-positive bacteria showed good sensitivity to quinolones and rifampicin.The sensitivity to linezolid,vancomycin and tigecycline was 100%.Gram-negative bacteria showed high sensitivity to carbapenems antibiotics.The drug resistance rate of acute PJI to rifampin,ciprofloxacin and erythromycin was significantly higher than that of delayed and chronic PJI,with statistically significant difference(P=0.001,P=0.002,P=0.010).The drug resistance of acute PJI to levofloxacin,clindamycin and tetracycline was significantly higher than that of chronic PJI,the difference was statistically significant(P=0.005,P=0.027,P=0.027).The drug resistance rate of ampicillin/sulbactam in acute infection(60.00%)was significantly higher than that of chronic PJI(16.67%),the difference was statistically significant(P=0.040).Conclusion:The drug resistance rate of pathogenic bacteria causing acute PJI was higher than that of late-onset and chronic PJI.Gram-positive bacteria are still the main pathogenic bacteria of PJI,but fungal and rare pathogenic bacteria infection should be warned.