Abstract
Periprosthetic infection is one of the most serious complications after primary endoprosthetics. Infection with gram-negative bacteria is particularly difficult to treat. Aim: to conduct a comparative analysis of the clinical efficacy of the sanitizing stage of a 2-stage method for the treatment of patients with chronic PJI (hip joint) caused by gram-negative pathogens using a combination of highly dispersed silver, aztreonam and vancomycin for additional impregnation of an antimicrobial spacer. Materials and methods. The study is based on an analysis of the treatment outcomes of 44 patients with PJI caused by gram-negative bacteria, who received antimicrobial spacers of various compositions during the rehabilitation stage. In group 1 (n=17), bone cement was additionally impregnated with vancomycin and highly dispersed silver, in group 2 (n=27), aztreonam was added to the impregnation composition. The follow-up period was 6 months. The nonparametric Mann Whitney test was used to analyze the intergroup differences in quantitative parameters, and the Fisher test was used for relative indicators. The differences were considered significant at р <0.05. Results. The groups did not differ by gender or age of the patients. In group 2, a pronounced normalization of CRP was observed in the postoperative period (р <0.05). The leading pathogens in both groups were Pseudomonas aeruginosa and Klebsiella pneumoniae, which accounted for more than 75% of the pathogen spectrum. About 40% of cases were represented by polymicrobial infection. The recurrence rate of PJIs in groups 1 and 2 was 35.3% and 14.8%, respectively (p=0.115). Conclusion. The conducted study demonstrated the clinical effectiveness of using a combination of vancomycin, aztreonam and highly dispersed silver as part of bone cement and can be considered as a local etiotropic antibacterial therapy in the treatment of chronic PJI, including those caused by gram-negative pathogens and microbial associations.