Osman ÇİMEN, Alper KÖKSAL, Ali ÖNER, Ferdi DIRVAR, Muhammed MEERT, Cem ALBAY

BİR ÜÇÜNCÜ BASAMAK HASTANESİNDE PRİMER VE REVİZYON DİZ PROTEZİ AMELİYATLARINDAN SONRA İZOLE EDİLEN MİKROORGANİZMALARIN SIKLIĞININ VE ANTİBİYOTİK DİRENÇLERİNİN ZAMAN İÇERİSİNDE DEĞİŞİMİNİN DEĞERLENDİRİLMESİ

AMAÇ: Artmış total diz artroplasti sayısı zaman içerisinde periprostetik eklem enfeksiyonları (PEE) ve diğer komplikasyonların artmasına neden olmuştur. Enfeksiyon ve mikrobiyoloji konusundaki güncel trendlerin anlaşılması PPE’nin tedavisi ve önlenmesi için gereklidir. Bu nedenle çalışmada zaman içerisinde revizyon total diz protezi ameliyatı sonrasında izole edilen bakteri türlerindeki ve bu bakterilerin gösterdiği antibiyotik dirençlerindeki değişimi ortaya koymayı amaçladık.GEREÇ VE YÖNTEM: İki hasta grubu retrospektif olarak değerlendirildi. Birinci grup enfeksiyon gelişimine neden olan ameliyatını 2005 ve 2011, ikinci grup ise 2012 ve 2018 yılları arasında olan hastalardan oluşmaktaydı. İzole edilen mikroorganizma türlerinin ve bu organizmaların antibiyotik dirençlerinin zaman içerisindeki değişimi incelendi. Sefazolin (allerji varlığında da klindamisin) 2005 ile 2018 yıllarında rutin profilakside kullandığımız antibiyotiktir.BULGULAR: Çalışmaya 42 hasta (43 diz eklemi) dahil edildi. En sık izole edilen bakteri Staphylococcus epidermidis idi. Staphylococcus aureus birinci ve ikinci grupta en sık izole edilen ikinci bakteriydi. Zamanla gram-negatif (Pseudomonas aeruginosa) bakteri izolasyon oranlarında artış olduğu gözlendi. Yapılan istatistiksel analize göre siprofloksasine (p=0.0021), gentamisine (p=0.0001), tetrasikline (p=0.043) ve trimetoprim/sulfomethoksazole (p=0.0016) karşı antibiyotik direncinde zaman içerisinde artış olduğu gözlendi. Sefazolin allerjisi durumunda kullandığımız klindamisine karşı (p=0.88) zaman içerisinde artmış bir antibiyotik direnci gözlenmedi. Sefazolin direncinin 2012 ve 2018 yılları arasında belirgin olarak azaldığı gözlendi. Sadece bir hastada vankomisin direnci olduğu görüldü.SONUÇ: Literatür ve bizim sonuçlarımız PEE olan hastalarda gram negatif bakteri izolasyon oranlarında istikrarlı bir artış olduğunu göstermektedir. Bu yüzden, diz artroplastisinde gram negatif bakterileri de kapsayacak antibiyotik protokollerinin kullanılması zamanla daha da gerekli hale gelecektir. Yapılan çalışmada siprofloksasine, gentamisine, tetrasikline ve trimetoprim/sulfomethoksazole karşı antibiyotik direncinde zaman içerisinde artış olduğu gözlenmiştir fakat bu antibiyotikler bizim rutin profilakside kullandığımız antibiyotikler değildir. Profilaksi için tek başına sefazolin veya klindamisin kullanmak yerine bu antibiyotiklerin gentamisinle kombine edilmesi gereklilik arz etmektedir.

Anahtar Kelimeler:

Diz, Artroplasti, Enfeksiyon, Mikroorganizma, Antibiyotik direnci

ASSESSMENT OF THE FREQUENCY OF ISOLATED MICROORGANISMS AND CHANGE OF THEIR ANTIBIOTIC RESISTANCE OVER TIME AFTER PRIMARY AND REVISION KNEE ARTHROPLASTIES AT A TERTIARY REFERRAL HOSPITAL

OBJECTIVE: Increased number of total knee arthroplasty has led to an increases the risk of periprosthetic joint infection (PJI) and other complications over time. Therefore, the current trends in infection and microbiology data are necessary to be understood to prevent and treat knee PJI. For this reason, we aimed to identify the course of bacterial species isolated after revision total knee arthroplasty and to investigate the change of antibiotic resistance over time.MATERIAL AND METHODS: Two groups of patients were evaluated, retrospectively. Group 1 consisted of patients who had surgery that caused the development of infection performed between 2005 and 2011 while group 2 consisted of patients between 2012 and 2018. The variation of isolated microorganisms species and their antibiotic resistances over time were investigated. Cefazolin (clindamycin in case of allergy) was the antibiotic used for routine prophylaxis between 2005 and 2018.RESULTS: Overall, 42 patients (43 knee joints) were included in the study. The most frequently isolated bacterium was Staphylococcus epidermidis while Staphylococcus aureus was the second most isolated bacterium in groups 1 and 2. An increased rate of gram-negative bacteria (Pseudomonas aeruginosa) isolation was observed in time. According to statistical analysis, a significant increase in antibiotic resistance to ciprofloxacin (p=0.0021), gentamicin (p=0.0001), tetracycline (p=0.043) and trimethoprim/sulfamethoxazole (p=0.0016) were observed over time. No increased antibiotic resistance observed over time against clindamycin (p=0.88) which we used in case of cefazoline allergy. Cefazoline resistance significantly decreased during 2012 and 2018 (p<0.0001). Vancomycin resistance was observed in only one patient.CONCLUSIONS: Our results and the literature has showed a steady increase in gram-negative bacteria isolation rates in patients with PJI. Therefore, it will become more necessary to use prophylactic antibiotic regimens including gram-negative bacteria in knee arthroplasty surgery. Although an increased resistance to ciprofloxacin, gentamicin, tetracycline and trimethoprim/sulfamethoxazole was found over time in the current study, these were not the antibiotics we used for routine prophylaxis. Instead of using cefazolin or clindamycin alone for prophylaxis, it is necessary to combine these anatibiotics with gentamicin.

Keywords:

Knee, Arthroplasty, Infection, Microorganism, Antibiotic resistance,

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