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首页> 外文期刊>Antimicrobial agents and chemotherapy. >Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis.
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Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis.

机译：开放性清创术和保留假体治疗的革兰氏阴性杆菌引起的急性假体关节感染的结果。

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The aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJIs) due to gram-negative bacilli (GNB) treated without implant removal. Patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, comorbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy, and outcome were recorded. Classification and regression tree analysis, the Kaplan-Meier survival method, and the Cox regression model were applied. Forty-seven patients were included. The mean age was 70.7 years, and there were 15 hip prostheses and 32 knee prostheses. The median number of days from the time of arthroplasty was 20. The most frequent pathogens were members of the Enterobacteriaceae family in 41 cases and Pseudomonas spp. in 20 cases. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin. The median durations of intravenous and oral antibiotic treatment were 14 and 64 days, respectively. A total of 35 (74.5%) patients were in remission after a median follow-up of 463 days (interquartile range, 344 to 704) days. By use of the Kaplan-Meier survival curve, a C-reactive protein (CRP) concentration of < or = 15 mg/dl (P = 0.03) and receipt of a fluoroquinolone, when all GNB isolated were susceptible (P = 0.0009), were associated with a better outcome. By use of a Cox regression model, a CRP concentration of < or = 15 mg/dl (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.05 to 12.5; P = 0.043) and receipt of a fluoroquinolone (OR, 9.09; 95% CI, 1.96 to 50; P = 0.005) were independently associated with better outcomes. Open debridement without removal of the implant had a success rate of 74.5%, and the factors associated with good prognosis were a CRP concentration at the time of diagnosis < or = 15 mg/dl and treatment with a fluoroquinolone.
机译：我们研究的目的是评估未经治疗的革兰氏阴性杆菌（GNB）导致的急性假体关节感染（PJI）的结果。前瞻性登记了2000年至2007年诊断为GNB的急性PJI患者。记录人口统计学，合并症，植入物类型，微生物学数据，手术治疗，抗菌治疗和结局。应用分类和回归树分析，Kaplan-Meier生存方法以及Cox回归模型。包括四十七名患者。平均年龄为70.7岁，有15个髋关节假体和32个膝关节假体。从关节置换术开始算起，平均天数为20天。最常见的病原体是41例肠杆菌科和假单胞菌属。在20个案例中。在肠杆菌科中，有14株对环丙沙星耐药，而所有铜绿假单胞菌分离株均对环丙沙星敏感。静脉和口服抗生素治疗的中位时间分别为14天和64天。中位随访463天（四分位间距344至704天）后，共有35例（74.5％）患者缓解。使用Kaplan-Meier生存曲线，当所有分离出的GNB都易感时（P = 0.0009），C反应蛋白（CRP）浓度<或= 15 mg / dl（P = 0.03）并收到氟喹诺酮，与更好的结果相关。通过使用Cox回归模型，CRP浓度<或= 15 mg / dl（几率[OR]为3.57; 95％置信区间[CI]为1.05至12.5; P = 0.043），并且收到了氟喹诺酮（ OR为9.09; 95％CI为1.96至50; P = 0.005）分别与较好的预后相关。未清除植入物的开放性清创术的成功率为74.5％，与良好预后相关的因素是诊断时CRP浓度≤15 mg / dl并用氟喹诺酮治疗。

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