Pathogenic And Drug Sensitivity Analysis Of Periprosthetic Joint Infection After Arthroplasty

Background:Total hip arthroplasty（THA）can effectively improve the hip joint function of patients with end-stage osteoarthritis,femoral neck fracture,intertrochanteric fracture and developmental dysplasis of the hip,eliminate the pain of hip joint and correct hip joint deformity.Total knee arthroplasty（TKA）can effectively improve the knee joint function of patients with end-stage osteoarthritis,traumatic arthritis,rheumatoid arthritis,hemophiliac arthritis,correct the knee joint deformity,and eliminate the patients’knee joint pain and discomfort and other phenomena.So as to improve the quality of life of patients with important operation,joint arthroplastyt surgery has developed rapidly in recent years^[1],but with the popularity of artificial joint arthroplasty in clinic,PJI number of cases also showed a trend of increased year by year^[2],joint prosthesis infection（periprosthetic be infection,PJI）is the important reason for the failure of surgery,line is the most common cause of secondary revision^[3].According to statistics,The incidence of PJI after joint arthroplasty is about 1%^[4],PJI will seriously affect the operation effect,and to give patients and their families bring huge economic pressure and burden in the heart,and leading to the extension of treatment time,medical resource consumption,patient satisfaction rate drop,also brought a huge challenge to surgeons.Due to factors such as biofilm（BF）^[5],bacteria are not easy to be removed,and the difficulty in cultivating pathogenic bacteria,the enhancement of bacterial drug resistance,and the continuous emergence of multi-drug resistant bacteria bring great difficulties to the treatment of PJI.Therefore,timely understanding of the microbiology and drug sensitivity characteristics of PJI is of great significance to the prevention and treatment of PJI.However,there are few related investigations in China,and there is still a lack of complete PJI microbiological analysis results in the province.Therefore,this study retrospectively studied the clinical data of PJI patients and analyzed their microbiology and drug sensitivity characteristics,so as to provide reference for the clinical treatment and prevention of PJI.Objective:This topic statistical PJI after artificial hip knee arthroplasty cases data,analysis of THA and TKA prostheses infection of the relevant information,and then understand PJI patients after artificial hip knee arthroplasty,composition,distribution of the pathogen,etc,summarize the drug resistance and multiple drug resistance,so as to guide targeted in the clinical use of antibiotics,reducing the generation of drug-resistant strains,the period for PJI provides the basis for the diagnosis and treatment and prevention to provide the reference.Method:Clinical data of 95 patients with PJI after knee and hip replacement admitted by henan provincial people’s hospital from May 2012 to December 2018 were retrospectively analyzed,including 38 males（40.0%）and 57 females（60.0%）.Ratio of male to female:0.67:1.The patients were aged from 30 to 86 years old with an average age of（58.58±11.49）years old.The distribution area,primary disease,primary operation,operation area,fever,sinus tract,white blood cells（WBC）,leukocyte neutral ratio（LNR）,C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）of PJI patients were statistically analyzed.bacterial distribution,drug resistance,multi-drug resistance and other characteristics.Result:1.After 95 cases of total hip and knee arthroplasty PJI joints in patients with puncture or pus culture,a total of 18 species of bacteria detection were cultivated 43 strains of bacteria,cultivate positive rate（45.26%,43/95）,including gram-positive bacteria（G+）for a total of 22 strains（51.16%,22/43）,and gram-negative bacteria（G-）for a total of 17strains（39.53%,17/43）,fungus is 4 strains（9.30%,4/43）.Of G+bacteria staphylococcus aureus as the main bacteria detection,and including 14 strains of staphylococcus aureus to after 2 strains,followed by hemolysis staphylococcus epidermis staphylococcus aureus,staphylococcus aureus,staphylococcus aureus,slow,in enterococcus excrement enterococcus,1 strain of enterococcus,heidegger and G-bacteria e.coli bacteria as the main detection,4 strains,followed by pneumonia klebsiella after 3 strains of bacteria,pseudomonas aeruginosa,acinetobacter baumannii,sewer singular each 2 strains of proteus,enterobacter,conglobation enterobacter,serratia marcescens each 1 strain,while including smooth candida fungus,2 strains of candida albicans.2.Of the 43 cases of PJI patients after total hip and knee arthroplasty,27（62.79%,27/43）were multi-drug resistance,and 16（37.21%,16/43）were not multi-drug resistance.Among the 43 patients,1 patient was found resistant to linezolid,2 patients were resistant to carbapenems,and no vancomycin resistant strain was found.Conclusion:1.The pathogenic bacteria of 43 patients with PJI after total hip and knee arthroplasty were mainly G+bacteria,followed by G-bacteria and fungi.Staphylococcus aureus was the main bacteria in G+bacteria,and escherichia coli was the main bacteria in G-bacteria,which gradually increased.2.Among the 43 cases of PJI patients after total hip and knee arthroplasty,27 cases were multi-drug resistance,and the rate of multi-drug resistance was gradually increasing.Among the 43 patients,1 patient was found resistant to linezolid,2 patients were resistant to carbapenems,and no vancomycin resistant strain was found.After artificial joint replacement,PJI should be actively prevented.For PJI patients,antibiotic treatment should be standardized,and bacterial culture and drug sensitivity test should be conducted for several times,and corresponding adjustments should be made according to the results of drug sensitivity test.