Abstract：
BACKGROUND: A sinus tract is an abnormal channel that communicates between the skin and the joint and meets one of the major criteria that is diagnostic of periprosthetic joint infection (PJI). The purpose of this study was to compare the risk factors and the microorganism profile of PJI of the knee with an overlying sinus tract to PJI without a sinus tract.
METHODS: This was a retrospective case-control study of PJI following TKA with and without the presence of an overlying sinus tract from 1996 to 2020. There were 2,685 unique cases of chronic PJI following TKA, of which 405 cases (15.1%) had a sinus tract and 2,280 cases (84.9%) did not. Univariate and multivariate analyses were performed to evaluate risk factors and the microorganism profiles of the two groups. Odds ratios (OR) with 95% confidence intervals (CI) were reported.
RESULTS: After adjusting for potential confounders in the multivariate analysis, the presence of a sinus tract was associated with a history of severe liver disease (P = 0.039, OR 1.99, 95% CI 1.04 to 3.84). Polymicrobial infections comprised 41.7% of PJI in the sinus tract group, compared to 29.1% in patients who did not have a sinus tract (P < 0.001). Of the monomicrobial PJI, Staphylococcus aureus (P < 0.001), Enterococcus faecalis (P < 0.001), Enterobacter cloacae (P = 0.002), Corynebacterium species (P = 0.037), Proteus mirabilis (P = 0.028), coagulase-negative Staphylococci (P = 0.019), and Candida albicans (P = 0.029) were more common in patients who had a sinus tract.
CONCLUSIONS: The microbiology profile is significantly different in patients who have PJI of the knee with a sinus tract. These findings can guide the surgeon with surgical planning and selecting the appropriate antibiotic-loaded bone cement and empiric antibiotic treatment.
METHODS: This was a retrospective case-control study of PJI following TKA with and without the presence of an overlying sinus tract from 1996 to 2020. There were 2,685 unique cases of chronic PJI following TKA, of which 405 cases (15.1%) had a sinus tract and 2,280 cases (84.9%) did not. Univariate and multivariate analyses were performed to evaluate risk factors and the microorganism profiles of the two groups. Odds ratios (OR) with 95% confidence intervals (CI) were reported.
RESULTS: After adjusting for potential confounders in the multivariate analysis, the presence of a sinus tract was associated with a history of severe liver disease (P = 0.039, OR 1.99, 95% CI 1.04 to 3.84). Polymicrobial infections comprised 41.7% of PJI in the sinus tract group, compared to 29.1% in patients who did not have a sinus tract (P < 0.001). Of the monomicrobial PJI, Staphylococcus aureus (P < 0.001), Enterococcus faecalis (P < 0.001), Enterobacter cloacae (P = 0.002), Corynebacterium species (P = 0.037), Proteus mirabilis (P = 0.028), coagulase-negative Staphylococci (P = 0.019), and Candida albicans (P = 0.029) were more common in patients who had a sinus tract.
CONCLUSIONS: The microbiology profile is significantly different in patients who have PJI of the knee with a sinus tract. These findings can guide the surgeon with surgical planning and selecting the appropriate antibiotic-loaded bone cement and empiric antibiotic treatment.
摘要：
背景：窦道是在皮肤和关节之间连通的异常通道，符合诊断假体周围感染（PJI）的主要标准之一。这项研究的目的是比较具有上覆窦道的膝关节PJI与没有窦道的PJI的危险因素和微生物特征。
方法：这是一项回顾性病例对照研究，对1996年至2020年TKA术后有或没有上覆窦道的PJI进行了研究。TKA后有2685例慢性PJI的独特病例，其中405例（15.1%）有窦道，2280例（84.9%）无窦道。进行单因素和多因素分析以评估两组的危险因素和微生物概况。报告了赔率比(OR)和95%置信区间(CI)。
结果：在多变量分析中调整潜在的混杂因素后，窦道的存在与严重肝病史相关(P=0.039,OR1.99,95%CI1.04~3.84).多微生物感染占窦道组PJI的41.7%，没有窦道的患者为29.1%(P<0.001)。在单抗微生物PJI中，金黄色葡萄球菌(P<0.001),粪肠球菌(P<0.001),阴沟肠杆菌(P=0.002),棒状杆菌属(P=0.037),奇异变形杆菌（P=0.028），凝固酶阴性葡萄球菌(P=0.019),和白色念珠菌（P=0.029）在有窦道的患者中更为常见。
结论：膝关节PJI伴窦道患者的微生物学特征有显著差异。这些发现可以指导外科医生进行手术计划，选择合适的抗生素负载骨水泥和经验性抗生素治疗。
方法：这是一项回顾性病例对照研究，对1996年至2020年TKA术后有或没有上覆窦道的PJI进行了研究。TKA后有2685例慢性PJI的独特病例，其中405例（15.1%）有窦道，2280例（84.9%）无窦道。进行单因素和多因素分析以评估两组的危险因素和微生物概况。报告了赔率比(OR)和95%置信区间(CI)。
结果：在多变量分析中调整潜在的混杂因素后，窦道的存在与严重肝病史相关(P=0.039,OR1.99,95%CI1.04~3.84).多微生物感染占窦道组PJI的41.7%，没有窦道的患者为29.1%(P<0.001)。在单抗微生物PJI中，金黄色葡萄球菌(P<0.001),粪肠球菌(P<0.001),阴沟肠杆菌(P=0.002),棒状杆菌属(P=0.037),奇异变形杆菌（P=0.028），凝固酶阴性葡萄球菌(P=0.019),和白色念珠菌（P=0.029）在有窦道的患者中更为常见。
结论：膝关节PJI伴窦道患者的微生物学特征有显著差异。这些发现可以指导外科医生进行手术计划，选择合适的抗生素负载骨水泥和经验性抗生素治疗。
