二硫苏糖醇对假体周围感染细菌检出的影响△

Effect of dithiothreitol on bacteria detection in chronic periprosthetic joint infection

摘要:

[目的] 探讨二硫苏糖醇 (dithiothreitol, DTT) 是否可提高关节置换术后假体周围感染 (prosthetic joint infection, PJI) 患者病原微生物的检出率。[方法] 2020 年 3 月 1 日—2021 年 10 月 30 日本科收治的 46 例慢性 PJI 患者纳入此前瞻性研究。清创术取出病变组织分为 3 份，1 份直接进行细菌培养(直接组)，1 份用生理盐水浸泡滑膜 15 min，用浸泡液行细菌培养 (盐水组)，另 1 份使用 1 mg/ml 浓度的 DTT 液体浸泡滑膜 15 min 后，用浸泡液行细菌培养(DTT 组)。比较三种培养结果。[结果]总体检出率由高至低依次为：DTT 组 32/46(69.57%)，直接组 20/46(43.38%)，盐水组 17/46(36.96%)，差异有统计学意义(P＜0.05)；DTT 组病原微生物检出率显著高于直接组(P=0.011)及盐水组(P=0.001)，而直接组与盐水组病原微生物检出率的差异无统计学意义(P=0.529)。46 例的 138 份送检标本共检出 69 株细菌，3 种标本处理各主要菌种检出率的差异均无统计学意义(P＞0.05)。46 例中，术前使用抗生素治疗的 28 例患者检出率 DTT 组为 16/28(57.14%)，直接组 10/28(35.71%)，盐水组 8/ 28 (28.57%)，差异无统计学意义 (P=0.079)。术前未使用抗生素的 18 例检出率为 DTT 组 16/18 (88.89%)，直接组 10/18 (55.56%)，盐水组 9/18(50.00%)，差异有统计学意义(P＜0.05)。两两比较发现 DTT 组检出率显著高于盐水组(P=0.014)，但与直接组检出率相比差异不具有统计学意义。[结论]使用 DTT 浸泡病变组织可提高 PJI 患者病原微生物的检出阳性率。

Abstract:

[Objective] To investigate whether dithiothreitol (DTT) can improve the detection rate of pathogenic microorganisms in peri- prosthetic joint infection (PJI) secondary to joint replacement. [Methods] A prospective study was conducted on 46 patients who admitted to our department from March 2020 to October 2021 for chronic PJI. The tissue samples harvested from debridement were divided into 3 parts. One part was directly cultured for bacteria (direct group), the other part was soaked with normal saline for 15 minutes and then cultured with soaking solution (saline group) , while the last part was soaked with 1mg/ mL DTT solution for 15 minutes and then cultured with soaking so- lution (DTT group) . The bacterial culture results were compared among the three groups. [Results] The overall bacterial detection rate ranked up-down was 32/46 (69.57%) in DTT group, 20/46 (43.38%) in direct group and 17/46 (36.96%) in saline group, with a statistically significant difference among them (P<0.05) . In term of pairwise comparison, the DTT group had significantly higher detection rate than the direct group (P=0.011) and saline group (P=0.001) , nevertheless there was no significant difference between direct group and saline group (P=0.529) . A total of 69 bacterial strains were detected in 138 samples from 46 patients without significant differences in the detection rate of major bacterial species among the three sample treatments (P>0.05) . Among the 46 patients, the detection rate of 28 patients who were treated with antibiotics before surgery was 16/28 (57.14%) in the DTT group, 10/28 (35.71%) in the direct group and 8/28 (28.57%) in the sa- line group, with no statistical significance (P=0.079) . However, the detection rate of 18 patients who had no antibiotics before operation was 16/18 (88.89%) in the DTT group, 10/18 (55.56%) in the direct group, and 9/18 (50.00%) in the saline group, which was statistically signifi- cant (P<0.05) . Pairwise comparison showed that the detection rate of DTT group was significantly higher than that of saline group (P= 0.014) , but not significantly different between DTT group and direct group. [Conclusion] Soaking pathological tissues with DTT does im- prove the detection rate of pathogenic microorganisms in PJI.