为有效预防及治疗感染，研究髋膝关节置换术后假体周围感染的病原菌构成与耐药率的变化趋势，评价抗感染方案的治疗效果。

收集华西医院骨科自2010年至2015年收治的初次髋、膝关节置换术后假体周围感染病例的相关资料。统计培养阳性率、病原菌构成与耐药率，分析病原菌构成与耐药率的变化趋势及不同抗感染方案的治疗效果。

共146例纳入研究，髋、膝关节置换术后假体周围感染分别为111例和35例，培养阳性率为73.97%，病原菌以革兰阳性菌为主，占55.48%，其中表皮葡萄球菌及金黄色葡萄球菌所占比例最高，分别为25.34%及15.07%；革兰阴性菌占13.01%，其中阴沟肠杆菌、铜绿假单胞菌及大肠埃希菌分别占4.79%、3.42%及2.05%。革兰阳性菌对利福平、利奈唑胺、万古霉素等较敏感，革兰阴性菌对阿米卡星、亚胺培南及头孢吡肟有较高的敏感性，但病原菌对β-内酰胺类、庆大霉素、克林霉素及部分喹诺酮类抗菌药物的耐药率较高。经验性抗感染方案多选择静脉使用万古霉素联合头孢菌素、左氧氟沙星或克林霉素，续以口服头孢克洛或头孢克洛联合利福平。对于培养阳性的病例，则根据药敏结果使用敏感抗菌药物。

目前假体周围感染的培养阴性率较高，应规范术前抗菌药物使用及标本的采集与培养，以提高检出率。病原菌谱复杂，以革兰阳性菌为主，病原菌对多种抗菌药物具有较高耐药性。经验性抗感染方案的抗菌谱应覆盖革兰阳性菌，尤其是葡萄球菌，待病原菌明确后需根据药敏结果制定个体化的抗感染方案。

To explore the microbiology and antibiotic susceptibility of bacteria isolated from infected joint after total hip arthroplasty and total knee arthroplasty and assess the antibiotic treatment options for prosthetic joint infection.

The microbiology, antimicrobial susceptibility and antibiotic treatment data of prosthetic hip and knee infection patients in West China Hospital between January 1, 2010 and December 31, 2015 were retrospective reviewed and analyzed.

A total of 146 patients were identified, 111 cases were prosthetic hip infection and 35 cases were prosthetic knee infection, and the prevalence of culture negative was 26.03%. Gram-positive bacteria were the main pathogen, encountered 55.48%. The most common organisms were staphylococcus epidermidis (25.34%) and staphylococcus aureus (15.07%). Gram-negative isolates encountered 13.01%, and Escherichia coli (6.85%) was the most common causative organism, followed by enterobacter cloacae (4.79%) and pseudomonas aereginasa (3.42%). The results of antibiotic susceptibility showed gentamicin, clindamycin, beta-lactanm antibiotics were poorly susceptibe to gram-positive isolates, but they were sensitive to antibiotic such as rifampin, linezolid, furantoin, quinupristin and vancomycin. Antibiotic such as amikacin and imipenem were sentive to Gram-negative bacteria, but gentamicin, tobramycin and cephalosporins had high resistance rate. Empirical antibiotic treatment should combined vancomycin and ceftriaxone, fluroquinolone or clindamycin. When the pathogen was confirmed, the treatment should be individualized.

The prevalence of culture negative was still very high. The dominate pathogen was Gram-positive bacteria, and the most common organisms were Staphylococcus Epidermidis and Staphylococcus Aureus. The empirical antibiotic should cover the Gram-positive isolate, especially the staphyloccus. When the pathogen was confirmed, the treatment should be individualized, taking into account the infection organism and results of antibiotic susceptibility.