臨床整形外科55巻4号

2020年04月発行

特集 人工関節周囲感染の現状と展望　国際コンセンサスを踏まえて

人工関節周囲感染(PJI)の患者リスク因子—第2回国際コンセンサスを踏まえて

著者： 井上大輔¹ 加畑多文¹ 楫野良知¹ 大森隆昭¹ 上野琢郎¹ 吉谷純哉¹ 上岡顕¹ 山室裕紀¹ 土屋弘行¹

所属機関： ¹金沢大学整形外科

ページ範囲：P.321 - P.327

　人工関節周囲感染(periprosthetic joint infection：PJI)は，いったん発生すると治療に難渋する病態である．PJIの発症を予防するためには，どのような患者リスク因子が存在しているのかを，さまざまなガイドラインを参考にしながら，把握しておく必要がある．なぜなら，対策を講じることでPJI発症のリスクを減じることが可能な場合があるからである．2018年に第2回International Consensus Meeting(ICM)が開催され，それに伴いガイドラインが改正された．改正に伴い，PJIにおける患者リスク因子に関する項目も増加している．本稿では，第2回ICMで議論された内容をもとに，PJI発症における代表的な患者リスク因子を概説する．

参考文献

1) Global guidelines on the prevention of surgical site infection (WHO). http://www.who.int/infection-prevention/publication/ssi-guideline/en/

2) Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 2017;152(8):784-91.

3) Proceeding of the Second International Consensus Meeting (ICM) on Musculoskeletal infection https://icmphilly.com/

4) 日本整形外科学会，日本骨・関節感染症学会(監)．日本整形外科学会診療ガイドライン委員会(編)．骨・関節術後感染予防ガイドライン2015．改訂第2版．東京：南江堂；2015．

5) Kunutsor SK, Whitehouse MR, Blom AW, et al. Patientrelated risk factors for periprosthetic joint infection after total joint arthroplasty:a systematic review and meta-analysis. PLoS One 2016;11(3):e0150866.

6) Inoue D, Xu C, Yazdi H, et al. Age alone is not a risk factor for periprosthetic joint infection. J Hosp Infect 2019;103(1):64-8.

7) Kerkhoffs GM, Servien E, Dunn W, et al. The influence of obesity on the complication rate and outcome of total knee arthroplasty:a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012;94(20):1839-44.

8) Lübbeke A, Zingg M, Vu D, et al. Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty. Acta Orthop 2016;87(2):132-8.

9) Wagner ER, Kamath AF, Fruth K, et al. Effect of body mass index on reoperation and complications after total knee arthroplasty. J Bone Joint Surg Am 2016;98(24):2052-60.

10) Shohat N, Fleischman A, Tarabichi M et al. Weighing in on body mass index and infection after total joint arthroplasty:is there evidence for a body mass index threshold? Clin Orthop Relat Res 2018;476(10):1964-9.

11) Shohat N, Tarabichi M, Tan TL, et al. 2019 John Insall Award:Fructosamine is a better glycaemic marker compared with glycated haemoglobin (HbA1C) in predicting adverse outcomes following total knee arthroplasty:a prospective multicentre study. Bone Joint J 2019;101-B(7_Supple_C):3-9.

12) Johnson RN, Metcalf PA, Baker JR. Fructosamine:a new approach to the estimation of serum glycosylprotein. An index of diabetic control. Clin Chim Acta 1983;127(1):87-95.

13) Ban KA, Minei JP, Laronga C, et al. Executive Summary of the American College of Surgeons/Surgical Infection Society Surgical Site Infection Guidelines-2016 Update. Surg Infect (Larchmt) 2017;18(4):379-82.

14) Tokarski AT, Deirmengian CA, Lichstein PM, et al. Medicare fails to compensate additional surgical time and effort associated with revision arthroplasty. J Arthroplasty 2015;30(4):535-8.

15) Kao FC, Hsu YC, Chen WH, et al. Prosthetic joint infection following invasive dental procedures and antibiotic prophylaxis in patients with hip or knee arthroplasty. Infect Control Hosp Epidemiol 2017;38(2):154-61.

16) Singh JA, Houston TK, Ponce BA, et al. Smoking as a risk factor for short-term outcomes following primary total hip and total knee replacement in veterans. Arthritis Care Res (Hoboken) 2011;63(10):1365-74.

17) American Academy of Orthopaedic Surgeons. Clinical Practice Guideline and Systematic Review Methodology. https://www.aaos.org/globalassets/quality-and-practice-resources/methodology/cpg-methodology-v.03-october-2019-3.pdf

18) Erkocak OF, Yoo JY, Restrepo C, et al. Incidence of infection and inhospital mortality in patients with chronic renal failure after total joint arthroplasty. J Arthroplasty 2016;31(11):2437e41.

19) Shrader MW, Schall D, Parvizi J, et al. Total hip arthroplasty in patients with renal failure:a comparison between transplant and dialysis patients. J Arthroplasty 2006;21(3):324e9.

20) Inoue D, Yazdi H, Goswami K, et al. Comparison of postoperative complications and survivorship of total hip and knee arthroplasty in dialysis and renal transplantation patients. J Arthroplasty 2019;pii:S0883-5403(19)31015-0. doi:10.1016/j.arth.2019.10.038. [Epub ahead of print]