背景:GeneXpert®MRSA/SASSTI(耐甲氧西林金黄色葡萄球菌/金黄色葡萄球菌皮肤和软组织感染)PCR测试可以早期检测葡萄球菌中的甲氧西林耐药性。该测试是针对皮肤感染开发的,并已针对人工关节感染进行了评估,但是,根据我们的知识,尚未评估关节置换术以外的硬件感染。此外,我们在非假体接骨术患者中进行了一项回顾性研究,目的是:1)确定PCR检测与常规培养物相比的诊断价值,以及由此产生的适当抗生素治疗的比率.2)识别假阴性(FN)结果的比率,3)识别和比较感染性治疗的失败率(FN与其他)4)以搜索PCR测试的FN的危险因素。
目的:PCR检测允许早期和适当靶向抗生素治疗。
方法:比较了4年(2012-2016年)非假体硬件骨关节感染的PCR测试结果和常规培养结果,以确定使用常规培养结果作为参考的诊断价值和适当抗生素治疗的比率。比较了FN组和其他组的结果之间的感染管理失败,并确定了与PCR测试FN相关的变量。
结果:对419个PCR测试的分析使我们建立了42.86%的灵敏度,特异性为96.82%,阳性预测值为60%,阴性预测值为93.83%。利用PCR检测结果对术后抗生素治疗的靶向性,它适合90.94%的葡萄球菌覆盖率(381/419).FN组与其他患者之间感染治疗失败的患者率没有显着差异(20.8%对17.7%,分别;危险比=1.12(95CI0.47-2.69,p=0.79))。初始创伤期间的皮肤开放(p=0.005)和多微生物感染与PCR测试的FN风险显着相关(p<0.001)。
结论:PCR检测可以减少在骨缝合硬件感染治疗期间经验性广谱抗生素治疗的持续时间,但导致9.06%的病例缺乏抗生素覆盖率。
方法:III;诊断性病例对照研究。
BACKGROUND: The GeneXpert® MRSA/SA SSTI (Methicillin Resistant Staphylococcus aureus/S. aureus skin and soft tissue infection) PCR test allows early detection of methicillin resistance in staphylococci. This test was developed for skin infections and has been evaluated for prosthetic joint infections but, to our knowledge, has not been evaluated for hardware infections outside of arthroplasties. Furthermore, we conducted a retrospective study in patients with non-prosthetic osteosynthesis hardware aiming: (1) to identify the diagnostic values of the PCR test compared to conventional cultures and the resulting rate of appropriate antibiotic therapy; (2) to identify the rate of false negative (FN) results; (3) to identify and compare the rates of failure of infectious treatment (FN versus others); (4) to search for risk factors for FN of the PCR test.
OBJECTIVE: The PCR test allowed early and appropriate targeting of antibiotic therapy.
METHODS: The results of PCR tests and conventional cultures for osteoarticular infections of non-prosthetic hardware over four years (2012-2016) were compared to identify the diagnostic values of using the results of conventional culture as a reference and the rate of appropriate antibiotic therapies. Infectious management failures between the results of the FN group and the others were compared, and variables associated with a FN of the PCR test were identified.
RESULTS: The analysis of 419 PCR tests allowed us to establish a sensitivity of 42.86%, a specificity of 96.82%, a positive predictive value of 60% and a negative predictive value of 93.83%. Using the results of the PCR test for the targeting of postoperative antibiotic therapy, it was suitable for staphylococcal coverage in 90.94% (381/419). The rates of patients for whom infectious treatment failed were not significantly different between the FN group and the other patients (20.8% versus 17.7%, respectively; Hazard Ratio=1.12 (95%CI 0.47-2.69, p=0.79)). A skin opening during the initial trauma (p=0.005) and a polymicrobial infection were significantly associated with a risk of FN from the PCR test (p<0.001).
CONCLUSIONS: The PCR test makes it possible to reduce the duration of empirical broad-spectrum antibiotic therapy during the treatment of an infection of osteosynthesis hardware but causes a lack of antibiotic coverage in 9.06% of cases.
METHODS: III; diagnostic case control study.