■关节假体周围感染(PJI)是一种描述不佳的感染综合征。先前的研究包括多微生物感染的病例。这个系列描述了临床特征,管理,和单抗菌棒杆菌PJI的结果。
■我们向MayoClinicTotalJointRegistry查询了2010年至2019年成年人(年龄≥18岁)的膝关节和髋关节PJI单抗菌棒状杆菌病例。
■在2067例PJI病例中,共有20例(1%)符合我们的纳入标准。大多数是男性(55%),中位年龄为64岁.70%有慢性症状(>4周)。PJI延迟至晚期(>3个月后)达90%。确定了三个物种:纹状体梭菌(70%),C.jeikeium(20%),和淀粉样C.colatum(10%)。所有测试的分离株对万古霉素(100%)和利奈唑胺(100%)敏感,大多数达托霉素的最低抑制浓度≤0.06mcg/mL(75%)。其他特工不太可靠,对常用的口服药物具有较高的抵抗力。19例患者接受治疗:37%清创术和植入物保留(DAIR),47%两阶段交换,16%的切除而不进行再植入。其中,故障发生在29%,11%,0%,分别。
■棒状杆菌PJIs由于有限的抗菌医疗设备和不确定的最佳手术干预措施而提出了治疗挑战。万古霉素和利奈唑胺仍然是最可靠的治疗药物。DAIR可用于急性PJI,但是验证持久的慢性抑制方案对于这种方法至关重要。
UNASSIGNED: Corynebacterium periprosthetic joint infection (PJI) is a poorly described infectious syndrome. Prior studies included cases of polymicrobial infections. This series describes the clinical characteristics, management, and outcomes of monomicrobial Corynebacterium PJI.
UNASSIGNED: We queried the Mayo Clinic Total Joint Registry for cases of monomicrobial Corynebacterium knee and hip PJI in adults (age ≥18 years) between 2010 and 2019.
UNASSIGNED: A total of 20 (1%) out of 2067 PJI cases met our inclusion criteria. Most were males (55%), and the median age was 64 years. Seventy percent had chronic symptoms (>4 weeks). PJI was delayed to late (>3 months postimplantation) in 90%. Three species were identified: C. striatum (70%), C. jeikeium (20%), and C. amycolatum (10%). All tested isolates were susceptible to vancomycin (100%) and linezolid (100%), and most had a minimum inhibitory concentration ≤0.06 mcg/mL to daptomycin (75%). Other agents were less reliable, with high resistance to oral agents commonly used for suppression. Nineteen patients were treated: 37% debridement and implant retention (DAIR), 47% 2-stage exchange, and 16% resection without reimplantation. Of these, failure occurred in 29%, 11%, and 0%, respectively.
UNASSIGNED: Corynebacterium PJIs pose a therapeutic challenge due to limited antimicrobial armamentarium and undefined optimal surgical intervention. Vancomycin and linezolid remain the most reliable agents for treatment. DAIR may be attempted for acute PJI, but verification of durable chronic suppression options will be critical for this approach.