背景:全髋关节置换术无疑是骨科的主要选择性手术,有助于显著改善骨关节炎患者的生活质量。该手术最具潜在破坏性的并发症之一是假体周围关节感染。免疫功能低下的患者可能会受到常规程序通常无法检测到的罕见低毒力生物的折磨。因此,采用先进的识别方法,例如骨科植入物的间接超声处理,可能对处理此类案件至关重要。
方法:我们介绍了一例因纹状体棒状杆菌引起的慢性假体周围髋关节感染的72岁女性患者的特殊病例。病原体仅在对提取的植入物进行严格的超声处理后才被鉴定。这个案子的整体管理非常严格,主要是因为病人的免疫系统受损,并最终在我们的机构进行了两阶段的修订。
方法:尽管关于治疗假体周围髋关节感染的文献很多,对于患有罕见低毒力微生物的多发病率或免疫功能低下患者的此类感染,目前尚无具体的指南.因此,诊断工作,必须确定抗生素治疗和适当的修订时间表。提取的植入物的超声处理可能是诊断库中的强大工具,因为它可以帮助识别稀有微生物,如棒状杆菌属。基于抗菌分析和适当的最终翻修手术时机的相关抗生素治疗是有效治疗此类感染的支柱。
结论:在过去十年中,纹状体棒状杆菌越来越被认为是假体周围髋关节感染的新原因。在COVID-19大流行后,在多发性或免疫受损的患者中观察到此类报告的显着上升。该病例是仅在对提取的植入物进行超声处理后诊断出的纹状体棒状杆菌假体周围髋关节感染的第一份报告。本文旨在提高对棒状杆菌属周围的认识。假肢关节感染,同时突出了进一步适当研究的领域。
BACKGROUND: Total hip arthroplasty is indubitably a dominant elective surgery in orthopaedics, contributing to prodigious improvement in the quality of life of patients with osteoarthritis. One of the most potentially devastating complications of this operation is periprosthetic joint infection. Immunocompromised patients might be afflicted by infrequent low-virulence organisms not typically detected with conventional procedures. Consequently, employing advanced identification methods, such as the circumstantial sonication of orthopaedic implants, could be crucial to managing such cases.
METHODS: We present a peculiar case of a 72-year-old female patient suffering from a chronic periprosthetic hip infection due to Corynebacterium striatum. The pathogen was only identified after rigorous sonication of the extracted implants. The overall management of this case was immensely exacting, primarily because of the patient\'s impaired immune system, and was finally treated with two-stage revision in our Institution.
METHODS: Although copious literature exists concerning managing periprosthetic hip infections, no concrete guidelines are available for such infections in multimorbid or immunocompromised patients with rare low-virulence microorganisms. Hence, a diagnostic work-up, antibiotic treatment and appropriate revision timeline must be determined. Sonication of extracted implants could be a powerful tool in the diagnostic arsenal, as it can aid in identifying rare microbes, such as Corynebacterium spp. Pertinent antibiotic treatment based on antibiogram analysis and apposite final revision-surgery timing are the pillars for effective therapy of such infections.
CONCLUSIONS: Corynebacterium striatum has been increasingly recognized as an emerging cause of periprosthetic hip infection in the last decade. A conspicuous rise in such reports has been observed in multimorbid or immunocompromised patients after the COVID-19 pandemic. This case is the first report of Corynebacterium striatum periprosthetic hip infection diagnosed solely after the sonication of extracted implants. This paper aims to increase awareness surrounding Corynebacterium spp. prosthetic joint infections, while highlighting the fields for further apposite research.