作　　者： (王永成）; (牛啸博）; (张新宇）; (李华）; (徐永胜）; (吕龙）;

机构地区： 内蒙古自治区人民医院骨关节科,呼和浩特010017

出　　处： 《中华关节外科杂志（电子版）》 2017年第4期46-49,共4页

摘　　要： 目的分析术前无症状菌尿(ASB)与初次人工关节置换术后假体周围感染(PJI)的相关性,探讨ASB患者发生PJI的风险。方法回顾性分析自2013年6月至2016年9月在内蒙古自治区人民医院骨关节科接受初次人工髋膝关节置换手术患者982例,其中髋关节559例,膝关节423例,所有患者均行尿常规检验及培养尿液样本鉴定ASB,排除既往有泌尿系统疾病或者术前有尿道感染症状的患者,以术后发生PJI为临床结局,计数资料以率或构成比表示,采用卡方检验和Logstic回归模型进行统计分析。结果本组资料ASB患病率为14.15%,女性118例(17.33%),男性21例(6.98%),女性显著高于男性(OR=1.94,Х~2=19.82,P<0.05)。ASB组的PJI发生率明显高于非ASB组(OR=4.18,Х~2=6.35,P<0.05);ASB治疗组(4.51%)和非治疗组(3.92%)发生PJI无差异(OR=0.62;Х~2=1.21,P>0.05)。革兰阴性菌PJI发生率ASB组(2.88%)与非ASB组(0.36%)比较有显著性差异(OR=8.30,Х~2=7.46,P<0.05),但PJI中分离的微生物与所有ASB患者术前尿培养物中的微生物均不一致。ASB对PJI的发生有显著影响[OR=4.18,95%CI:(1.59,11.02),P<0.05],是PJI的独立预测因子。结论 ASB是PJI的独立危险因素,特别是由革兰氏阴性菌引起的感染,术前抗生素治疗ASB并无获益。 Objective To investigate the association between asymptomatic bacteriuria（ ASB）and prosthetic joint infection（ PJI） after arthroplasty,and to explore the risk of PJI in ASB patients.Methods A retrospective analysis was conducted in 982 patients（ 559 hips and 423 knees） who underwent primary hipknee arthroplasty from June 2013 to September 2016. All the patients underwent urine routine examination and culture of urine samples was for ASB identification. Postoperative PJI was set as the clinical outcome and analyzed,excluding the patients with previous urinary system diseases or patients with preoperative symptoms of urinary tract infection. Categorical variables were presented as number of patients and percentages. Chi-square test and Logistic regression model were used for statistical analysis. Results The prevalence of ASB was 14. 15%[118 females（ 17. 33%）,21 males（ 6. 98%） ],the prevalence of the females was significantly higher than that of the males（ OR = 1. 94,Х~2= 19. 82,P 0. 05）. The incidence of PJI in ASB group was significantly higher than that in non ASB group（ OR =4. 18,Х~2= 6. 35,P 0. 05）. There was no significant difference（ OR = 0. 62,Х~2= 1. 21,P 0. 05） in PJI incidence between the ASB treatment group（ 4. 51%） and the non-treatment group（ 3. 92%）. The ASB group（ 2. 88%） presented a significantly higher proportion of PJI due to Gram-negative microorganisms（ OR = 8. 30,Х~2= 7. 45,P 0. 05） than the non-ASB group（ 0. 36%）,but these did not correlate to the isolates from urine cultures. ASB significantly affected the occurrence of PJI（ OR = 4. 18,95% CI： 1. 59-11. 02,P 0. 05）; it was an independent predictor of PJI. Conclusion ASB may be an independent risk factor for PJI,especially the one caused by Gram-negative bacteria. The preoperative antibiotic treatment of ASB shows no benefit.

关 键 词： 细菌尿 关节成形术 感染 危险因素