假体周围感染培训ppt课件

假体周假体周围感染感染假体周围感染1什么是什么是PJI关 节 假 体 周 围 感 染（Periprosthetic joint infection，PJI），发生于关节置换术后，以膝关节（2%）、髋关节（0.45-0.57%）多见。Two-stage Revision for Periprosthetic Hip and Knee Joint Infections.The open orthropaedics journal.2017Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.The Open Orthopaedics Journal,20162假体周围感染什么是PJI关节假体周围感染（Periprosthetic 2存在于假体相通的窦道受累人工关节部位2处组织或关节液样本中分离出同一病原体以下4条满足3条或以上ESR或CRP水平升高滑膜或关节液白细胞升高滑膜或关节液中性粒细胞百分比升高组织或关节液单次细菌培养阳性PJI诊断断标准（准（AAOS标准）准）*Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty:Current Concepts.JAAOS-D-15-00017,2016 3假体周围感染存在于假体相通的窦道PJI诊断标准（AAOS标准）*Pri3PJI临床表床表现红肿热痛，切口不愈合红肿热痛，切口不愈合急性急性慢性慢性PJI夜间痛，休息痛夜间痛，休息痛窦道形成窦道形成脓液流出脓液流出Two-stage Revision for Periprosthetic Hip and Knee Joint Infections.The open orthropaedics journal.2017Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.The Open Orthopaedics Journal,20164假体周围感染PJI临床表现红肿热痛，切口不愈合急性慢性PJI夜间痛，休息4PJI常常见病原菌病原菌*初次人工全膝关节置换术后假体周围感染的病原菌分布及药敏分析.Chinese Journal of Reparative and Reconstructive Surgery.2014、类感染金黄色葡萄球菌类感染凝固酶隐性葡萄球菌病原菌主要病原菌主要来源于血液来源于血液及皮肤及皮肤5假体周围感染PJI常见病原菌*初次人工全膝关节置换术后假体周围感染的病原5生物膜生物膜-PJI药物治物治疗的关的关键病原体基质多糖聚合物蛋白DNABiofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.The Open Orthopaedics Journal,2016The role of microbial biofilms in prosthetic joint infections A review.Acta Orthopaedica 2015普遍存在难以清除6假体周围感染生物膜-PJI药物治疗的关键病原体Biofilm and t6抗生素抗生素抗体抗体生物膜内生物膜内容物聚集容物聚集生物膜生物膜DNADNA片段片段骨骨 科科 内内 植植 物物细菌细菌吞噬细胞吞噬细胞Correlationbetweeninvivo&invitroefficacyofantimicrobialagentagainstforeignbodyinfection,Rev Infect Dis.江荣林院长授课摘录江荣林院长授课摘录7假体周围感染抗生素抗体生物膜内容物聚集生物膜DNA片段骨 科 内 植 物7Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.The Open Orthopaedics Journal,2016The role of microbial biofilms in prosthetic joint infections A review.Acta Orthopaedica 20158假体周围感染Biofilm and the Role of Antibi8PJI分期分期早期感染：24个月*An update on surgical and antimicrobial therapy for acute periprosthetic joint infection:new challenges for the present and the future.Expert Rev Anti Infect Ther.2015.根据术后PJI发生的时间，可分为早期感染、迟发感染、晚期感染。行清创术是否行清创术视具体情况而定9假体周围感染PJI分期早期感染：65岁伴有严重基础疾病术后引流手术切口开裂常见病原体金黄色葡萄球菌肠球菌需氧G-杆菌（铜绿）Themanagementofaninfectedtotalkneearthroplasty.Bone Joint J,2015An update on surgical and antimicrobial therapy for acute periprosthetic joint infection:new challenges for the present and the future.Expert Rev Anti Infect Ther.2015.18假体周围感染多重感染高危因素常见病原体The management of18培养阴性的感染培养阴性的感染培养阴性的原因1.取样备前使用抗生素2.培养基选取不当3.培养时间过短（2周）抗生素使用原则覆盖范围足够广革兰阳性菌革兰阴性菌耐药菌（MASA）厌氧菌使用时间足够长至少2周监测WBC及CRP联合用药Themanagementofaninfectedtotalkneearthroplasty.Bone Joint J,2015An update on surgical and antimicrobial therapy for acute periprosthetic joint infection:new challenges for the present and the future.Expert Rev Anti Infect Ther.2015.19假体周围感染培养阴性的感染培养阴性的原因抗生素使用原则The manag19病原体病原体静脉用静脉用药备选方案方案后后续口服用口服用药新青新青敏感葡萄球菌敏感葡萄球菌新青新青或氯唑西林或氯唑西林或头孢唑林或头孢唑林万古霉素或替考拉宁万古霉素或替考拉宁或达托霉素或或达托霉素或利奈利奈唑胺胺左氧氟沙星左氧氟沙星+利福平利福平克林霉素克林霉素/复方新复方新诺明明夫西地酸或夫西地酸或利奈利奈唑胺胺耐新青耐新青葡萄球菌葡萄球菌万古霉素万古霉素达托霉素或达托霉素或替考拉宁或替考拉宁或利奈利奈唑胺胺克林霉素克林霉素/复方新复方新诺明明夫西地酸或夫西地酸或利奈利奈唑胺胺青霉素敏感青霉素敏感肠球菌球菌青霉素青霉素G或氨或氨苄西林西林万古霉素万古霉素/替考拉宁替考拉宁或或利奈利奈唑胺胺，或，或氨氨苄西林西林+头孢曲松曲松利奈利奈唑胺胺氨氨苄西林西林耐青霉素耐青霉素肠球菌球菌万古霉素万古霉素替考拉宁或替考拉宁或利奈利奈唑胺胺利奈利奈唑胺胺-溶血性溶血性链球菌球菌青霉素青霉素G或或头孢曲松曲松万古霉素或替考拉宁或万古霉素或替考拉宁或利利奈奈唑胺胺阿莫西林或阿莫西林或利奈利奈唑胺胺一般一般肠内杆菌内杆菌环丙沙星丙沙星厄他培南厄他培南环丙沙星丙沙星或或头孢类/复方新复方新诺明明某些特殊某些特殊肠内杆菌内杆菌环丙沙星丙沙星厄他培南或厄他培南或头孢吡吡肟环丙沙星丙沙星铜绿假假单胞菌胞菌头孢他他啶/环丙沙星丙沙星美美罗培南培南/环丙沙星丙沙星环丙沙星丙沙星厌氧菌氧菌阿莫西林克拉阿莫西林克拉维酸或酸或哌拉拉西林他西林他唑巴坦或碳青霉巴坦或碳青霉烯克林霉素克林霉素/甲硝甲硝唑克林霉素克林霉素/甲硝甲硝唑清创术+抗生素+假体保留药物推荐*An update on surgical and antimicrobial therapy for acute periprosthetic joint infection:new challenges for the present and the future.Expert Rev Anti Infect Ther.2015.20假体周围感染病原体静脉用药备选方案后续口服用药新青敏感葡萄球菌新青万20G+所致的PJI，后续口服用药推荐利奈唑胺。21假体周围感染G+所致的PJI，后续口服用药推荐利奈唑胺。21假体周围感染21抗生素药物含量最大血药浓度（mg/ml）半衰期（小时）每日剂量青霉素G3g130-2350.5-0.6720-24万单位，q4h或持续阿莫西林2/0.2g110/141.0-1.52g/8h氟氯西林1g130-2101.0-1.52g/4h头孢唑林1g1881.5-2.02g/8h头孢曲松1g2008.02g/24h头孢他啶1g902.0-2.52g/8h头孢吡肟1g1631.02g/8h利奈唑胺0.6g21.24.260.6g/12h美罗培南0.5g521.02g/8h万古霉素-4.0-6.015 mg/kg/12h替考拉宁400mg7050-7010-12 mg/kg/day达托霉素350mg1408-96-10 mg/kg/day环丙沙星400mg4.64400 mg/12h常用抗生素剂量及用法*An update on surgical and antimicrobial therapy for acute periprosthetic joint infection:new challenges for the present and the future.Expert Rev Anti Infect Ther.2015.22假体周围感染抗生素药物含量最大血药浓度（mg/ml）半衰期（小时）每日剂22总结1.PJI明确病原体，根据培养及药敏结果选择合适的抗生素2.手术+抗生素联合治疗，单纯抗生素治疗效果不佳3.术后抗生素覆盖范围足够广，时间足够长，必要时多种抗生素或利福平联合用药（SAT除外）。23假体周围感染总结1.PJI明确病原体，根据培养及药敏结果选择合适的抗生23谢谢24假体周围感染谢谢24假体周围感染24