<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With ...<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Between January 2011 and December 2012</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we retrospectively examined adult patients who met PJI-SIRS criteria. Medi</span><span style="font-family:Verdana;">cal history search for patients’ anamnesis, surgical times, laborato</span><span style="font-family:Verdana;">ry-microbiological findings and success rates was performed. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the </span><span style="font-family:Verdana;">cases. A sickness sensation and pain were the most common prodromal</span><span> </span><span style="font-family:Verdana;">symp</span><span style="font-family:Verdana;">toms found 4.9 days before the admission to the hospital. In 85.7% of the</span><span style="font-family:Verdana;"> cases the etiological agent was identified, with </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> as the most common. Two</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">stage surgery treatment was performed with a time interval between admission and the first operation of 5.45</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">h. The mean time during the first and second operation was of 23 minutes and 117 minutes respectively. A reduction on microbiological positive cultures was found after </span><span><span style="font-family:Verdana;">the first rapid operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0038). Serum CRP levels and fever </span></span><span style="font-family:Verdana;">disappearance were the first parameters which indicated a favorable disease evolution </span><span><span style="font-family:Verdana;">after the first operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0137) and (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0181) respectively. A</span></span><span style="font-family:Verdana;"> successful </span><span><span style="font-family:Verdana;">management was possible in 90% of the cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Sepsis in patients with PJI announces itself early through the leading symptoms of feel</span></span><span style="font-family:Verdana;">ing sick and pain in the affected joint. This time interval should be used</span><span style="font-family:Verdana;"> therapeutically</span><span style="font-family:Verdana;"> and diagnostically to prevent the complication of a life-threatening</span><span style="font-family:Verdana;"> sepsis at best.</span></span>展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:'';font-size:10pt;"><span style=&q...<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;"> Low-grade PJI remains a diagnostic dilemma in the medical community. It is mainly caused by low-virulent bacteria that cause chronic infection. This is mainly due to the formation of biofilms on the implant surface. This biofilm formation poses a diagnostic challenge that causes difficulties in the microbiological diagnosis of the infection by conventional culture methods. Sonication culture of implants has proven to be useful for biofilm forming bacteria. Therefore, we examined the evaluation of low-grade PJI using sonication culture methods and searched for influencing factors. </span><b><span style="font-family:Verdana;font-size:12px;">The methods:</span></b><span style="font-family:Verdana;font-size:12px;"> Between October 2016 and November 2019 we retrospectively examined adult patients with suggestive clinical and laboratory findings of low-grade PJI. The patient's medical history, demographic information, prosthesis type, laboratory findings and length of hospital stay were collected. The results of the microbiological culture were divided into the results of the conventional preoperative and intraoperative culture method and the results of the sonication. In addition, laboratory chemical diagnostics of the joint punctures and CRP determination were performed. Additionally, the influence of prosthesis design and fixation technique, with and without cement, was investigated. </span><b><span style="font-family:Verdana;font-size:12px;">The Results:</span></b><span style="font-family:Verdana;font-size:12px;"> Fifty-two patients with a mean age of 70.5 years were included in this study. The female population was more frequently affected. The most frequently affected joints were hip and knee. A higher percentage of pathogen detection was found at sonication with 60% of positive cultures, compared to 52% of intraoperative </span></span><span style="line-height:1.5;font-family:Verdana;">and 40% of preoperative </span><span style="line-height:1.5;font-family:Verdana;">conventional positive culture findings. The majority of patients were monomicrobial infections, with Staphylococcus epidermidis being the most frequently detected etiologic pathogen. The sonication culture was best able to detect a polymicrobial infection in 14% of cases compared to 6% of intraoperative and 4% of preoperative conventional cultures. Patients with a polymicrobial infection showed higher CRP values (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0172) and longer hospitalization (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0017) than monomicrobial infected patients. The results of the intraoperative conventional culture showed the highest congruence with the results of the sonication culture (concordance of 79%) compared to the preoperative culture. An infectious histopathological classification confirmed the microbiological ultrasound findings in 69% of cases with an infectious category. Cemented fixation showed a trend towards less positive microbiological findings, and total hip arthroplasty showed the highest detection of bacteria by sonication culture compared to bicondylar surface knee replacement (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0072). </span><b style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">Conclusion:</span></b><span style="line-height:1.5;font-family:Verdana;"> The sonication culture proved to be an important microbiological diagnostic tool, especially for the detection of polymicrobial infections in cases of low-grade PJI. This method has an established place in the diagnosis of low-grade PJI. The prosthesis design and the cemented fixation technique seem to have an influence on the detection of bacteria.展开更多
目的系统评价全关节置换手术(TJA)术后假体周围感染(PJI)风险预测模型的研究进展,分析当前研究的局限性并提出优化建议。方法系统检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库(SinoMed)、万方数据库...目的系统评价全关节置换手术(TJA)术后假体周围感染(PJI)风险预测模型的研究进展,分析当前研究的局限性并提出优化建议。方法系统检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库(SinoMed)、万方数据库、维普数据库和中国知网(CNKI)等中英文数据库,检索时限从各数据库建库至2024年8月31日。两名研究者独立进行文献筛选,采用CHARMS清单提取数据,并使用PROBAST工具评价纳入研究的偏倚风险。结果本研究共纳入14项研究,涉及17个预测模型。最常见的预测因子包括糖尿病史、肥胖[身体质量指数(BMI)≥30 kg/m^(2)]、高龄(≥65岁)、创伤性骨折史及手术时间延长(≥2 h)等。所有纳入研究均存在较高偏倚风险,主要源自研究对象选择偏倚(如单中心样本)及统计分析偏倚(如未校正混杂因素)。结论当前已发表的TJA术后PJI风险预测模型多数展现出良好的预测效能,但研究设计存在显著局限性,特别是偏倚风险控制不足。未来研究需重点改进方法学设计,包括采用前瞻性多中心研究、标准化预测变量定义及充分校正混杂因素。展开更多
文摘<b><span style="font-family:Verdana;">Introduction</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;">: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Between January 2011 and December 2012</span></span><span style="font-family:Verdana;">,</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> we retrospectively examined adult patients who met PJI-SIRS criteria. Medi</span><span style="font-family:Verdana;">cal history search for patients’ anamnesis, surgical times, laborato</span><span style="font-family:Verdana;">ry-microbiological findings and success rates was performed. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the </span><span style="font-family:Verdana;">cases. A sickness sensation and pain were the most common prodromal</span><span> </span><span style="font-family:Verdana;">symp</span><span style="font-family:Verdana;">toms found 4.9 days before the admission to the hospital. In 85.7% of the</span><span style="font-family:Verdana;"> cases the etiological agent was identified, with </span><i><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="font-family:Verdana;"> as the most common. Two</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">stage surgery treatment was performed with a time interval between admission and the first operation of 5.45</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">h. The mean time during the first and second operation was of 23 minutes and 117 minutes respectively. A reduction on microbiological positive cultures was found after </span><span><span style="font-family:Verdana;">the first rapid operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0038). Serum CRP levels and fever </span></span><span style="font-family:Verdana;">disappearance were the first parameters which indicated a favorable disease evolution </span><span><span style="font-family:Verdana;">after the first operation (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0137) and (</span><i><span style="font-family:Verdana;">P</span></i><span style="font-family:Verdana;"> = 0.0181) respectively. A</span></span><span style="font-family:Verdana;"> successful </span><span><span style="font-family:Verdana;">management was possible in 90% of the cases. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Sepsis in patients with PJI announces itself early through the leading symptoms of feel</span></span><span style="font-family:Verdana;">ing sick and pain in the affected joint. This time interval should be used</span><span style="font-family:Verdana;"> therapeutically</span><span style="font-family:Verdana;"> and diagnostically to prevent the complication of a life-threatening</span><span style="font-family:Verdana;"> sepsis at best.</span></span>
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:'';font-size:10pt;"><span style="font-family:Verdana;font-size:12px;"> Low-grade PJI remains a diagnostic dilemma in the medical community. It is mainly caused by low-virulent bacteria that cause chronic infection. This is mainly due to the formation of biofilms on the implant surface. This biofilm formation poses a diagnostic challenge that causes difficulties in the microbiological diagnosis of the infection by conventional culture methods. Sonication culture of implants has proven to be useful for biofilm forming bacteria. Therefore, we examined the evaluation of low-grade PJI using sonication culture methods and searched for influencing factors. </span><b><span style="font-family:Verdana;font-size:12px;">The methods:</span></b><span style="font-family:Verdana;font-size:12px;"> Between October 2016 and November 2019 we retrospectively examined adult patients with suggestive clinical and laboratory findings of low-grade PJI. The patient's medical history, demographic information, prosthesis type, laboratory findings and length of hospital stay were collected. The results of the microbiological culture were divided into the results of the conventional preoperative and intraoperative culture method and the results of the sonication. In addition, laboratory chemical diagnostics of the joint punctures and CRP determination were performed. Additionally, the influence of prosthesis design and fixation technique, with and without cement, was investigated. </span><b><span style="font-family:Verdana;font-size:12px;">The Results:</span></b><span style="font-family:Verdana;font-size:12px;"> Fifty-two patients with a mean age of 70.5 years were included in this study. The female population was more frequently affected. The most frequently affected joints were hip and knee. A higher percentage of pathogen detection was found at sonication with 60% of positive cultures, compared to 52% of intraoperative </span></span><span style="line-height:1.5;font-family:Verdana;">and 40% of preoperative </span><span style="line-height:1.5;font-family:Verdana;">conventional positive culture findings. The majority of patients were monomicrobial infections, with Staphylococcus epidermidis being the most frequently detected etiologic pathogen. The sonication culture was best able to detect a polymicrobial infection in 14% of cases compared to 6% of intraoperative and 4% of preoperative conventional cultures. Patients with a polymicrobial infection showed higher CRP values (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0172) and longer hospitalization (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0017) than monomicrobial infected patients. The results of the intraoperative conventional culture showed the highest congruence with the results of the sonication culture (concordance of 79%) compared to the preoperative culture. An infectious histopathological classification confirmed the microbiological ultrasound findings in 69% of cases with an infectious category. Cemented fixation showed a trend towards less positive microbiological findings, and total hip arthroplasty showed the highest detection of bacteria by sonication culture compared to bicondylar surface knee replacement (</span><i style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">P</span></i><span style="line-height:1.5;font-family:Verdana;"> = 0.0072). </span><b style="font-family:'';font-size:10pt;line-height:1.5;"><span style="font-family:Verdana;font-size:12px;">Conclusion:</span></b><span style="line-height:1.5;font-family:Verdana;"> The sonication culture proved to be an important microbiological diagnostic tool, especially for the detection of polymicrobial infections in cases of low-grade PJI. This method has an established place in the diagnosis of low-grade PJI. The prosthesis design and the cemented fixation technique seem to have an influence on the detection of bacteria.
