A Retrospective Analysis of Differences in Efficacy of Surgical Treatment of Hematogenous versus Non-Hematogenous Periprosthetic Joint Infections and Risk Factors

目的：本文旨在对比血源性假体周围感染(periprosthetic joint infection, PJI)与非血源性PJI外科治疗的疗效，分析造成其疗效差异的原因以及危险因素。方法：回顾分析2001年1月至2022年6月期间在青岛大学附属医院治疗的膝关节或髋关节PJI的患者138例。根据感染途径分为血源性和非血源性PJI，随访3年至18年。结果：138例PJI患者中，血源性PJI (血源组) 54例，非血源性PJI (非血源组) 84例。膝关节感染83例比例明显高于髋关节感染55例(P Objective: This study aims to compare clinical outcomes between hematogenous and non-hematogenous periprosthetic joint infections (PJIs) following surgical treatment, analyze factors contributing to outcome disparities, and identify associated risk factors. Methods: We conducted a retrospective analysis of 138 PJI cases treated at the Affiliated Hospital of Qingdao University from January 2001 to June 2022. Patients were stratified into hematogenous and non-hematogenous groups based on infection etiology, with postoperative surveillance spanning 3~18 years. Results: Among 138 PJI patients, 54 cases were hematogenous PJI (hematogenous group) and 84 cases were non-hematogenous PJI (non-hematogenous group). Knee infections (83 cases) showed significantly higher prevalence than hip infections (55 cases) (P Staphylococcus aureus cases), while 13 cases involved Gram-negative bacteria (including Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, Brucella spp., Klebsiella oxytoca, and Ralstonia pickettii). The hematogenous group showed significantly higher Gram-negative bacterial infections than the non-hematogenous group (P < 0.05). Fungal infections occurred in 8 cases. Treatment failure occurred in 20 hematogenous group patients and 18 non-hematogenous group patients, demonstrating significant intergroup difference (P < 0.05). Univariate analysis identified diabetes mellitus, G+ infections, fungal infections, and debridement with prosthesis retention as significant risk factors for treatment failure. Multivariate analysis revealed G+ infections, fungal infections, and prosthesis retention as independent risk factors for treatment failure, with prosthesis retention being the sole independent risk factor in hematogenous PJI (P < 0.05). Kaplan-Meier survival analysis with Log-rank test demonstrated significantly lower prosthesis survival rates in the hematogenous group compared to the non-hematogenous group at 3, 6, and 12 months post-surgical intervention (P < 0.05). Conclusion: Hematogenous PJIs exhibit significantly higher treatment failure rates compared to non-hematogenous infections. Prosthesis retention during debridement represents the sole independent risk factor for treatment failure in hematogenous PJIs.