OBJECTIVES To investigate the diagnostic value of serum D-dimer in patients with periprosthetic joint infection (PJI). Moreover, to provide evidence for the treatment of PJI by investigating distribution of pathogenic bacteria and antibiotic resistance situation among the patients. METHODS A retrospective study of the medical records of all patients undergoing arthroplasty from the Second Xiangya Hospital of Central South University from 2014 to 2018, 40 patients with periprosthetic joint infection, 37 patients with aseptic loosening and 59 patients with extra-articular infection were selected. The results of serum D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were collected. As well as the bacterial types and antimicrobial susceptibility test results from tissue or joint fluid samples around the prosthetic joint of the patients were collected. All the relevant data were analyzed. RESULTS The serum D-dimer, CRP and ESR level were significantly higher in the patients with PJI. The mean D-dimer level was 2.0795 μg/mL in PJI group compared with 0.6854 μg/mL in aseptic loosening group (p = 0.000) and 0.4556 μg/mL in extra-articular infection group (p = 0.000). For diagnosing PJI, the serum D-dimer test demonstrated better sensitivity (87.50%), and better specificity (89.19%); while the serum CRP and ESR had a sensitivity of 80.00% and 82.50% and a specificity of 78.38% and 64.86%, respectively. Moreover, the sensitivity and specificity of ESR and CRP combined was 75.00% and 83.78%, respectively. In addition, 29 strains of pathogens around the prosthesis after arthroplasty were detected, including 22 strains of Gram-positive bacteria, 3 strains of Gram-negative bacteria, and 4 strains of fungi. The staphylococcus was the major pathogen showing high resistance to Cefoxitin and ampicillin. CONCLUSION Patients with PJI have high levels of serum D-dimer, which is a promising marker for the diagnosis of PJI. The Gram-positive bacteria are major pathogen in PJI after arthroplasty, and Staphylococcus aureus is the most common organism. Clinical efficacy is significantly improved by reasonable choice of antibiotics and effective medicine education.

中文翻译：

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血清D-二聚体作为PJI的诊断指标，并对PJI患者的病因进行回顾性分析。

目的探讨血清D-二聚体在人工关节周围感染（PJI）中的诊断价值。此外，通过调查患者中病原菌的分布和抗生素耐药性情况，为治疗PJI提供证据。方法回顾性分析2014年至2018年中南大学湘雅第二医院所有关节置换术患者的病历，选择40例假体周围关节感染，37例无菌性松动患者和59例关节外感染患者。收集血清D-二聚体，C反应蛋白（CRP）和红细胞沉降率（ESR）的结果。以及从患者假肢周围的组织或关节液样本中收集的细菌类型和抗菌药敏试验结果。分析所有相关数据。结果PJI患者的血清D-二聚体，CRP和ESR水平明显升高。PJI组的平均D-二聚体水平为2.0795μg/ mL，而无菌性松动组的平均D-二聚体水平为0.6854μg/ mL（p = 0.000），关节外感染组的平均D-二聚体水平为0.4556μg/ mL（p = 0.000）。对于诊断PJI，血清D-二聚体测试显示出更高的敏感性（87.50％）和更好的特异性（89.19％）；血清CRP和ESR的敏感性分别为80.00％和82.50％，特异性为78.38％和64.86％。此外，ESR和CRP的敏感性和特异性分别为75.00％和83.78％。此外，关节置换术后检出29株病原体，包括22株革兰氏阳性菌，3株革兰氏阴性菌和4株真菌。葡萄球菌是主要的病原体，对头孢西丁和氨苄青霉素具有较高的耐药性。结论PJI患者血清D-二聚体水平高，是诊断PJI的有前途的标志物。革兰氏阳性细菌是关节置换术后PJI的主要病原体，金黄色葡萄球菌是最常见的生物。通过合理选择抗生素和有效的医学教育，可显着提高临床疗效。葡萄球菌是主要的病原体，对头孢西丁和氨苄青霉素具有较高的耐药性。结论PJI患者血清D-二聚体水平高，是诊断PJI的有前途的标志物。革兰氏阳性细菌是关节置换术后PJI的主要病原体，金黄色葡萄球菌是最常见的生物。通过合理选择抗生素和有效的医学教育，可显着提高临床疗效。葡萄球菌是主要的病原体，对头孢西丁和氨苄青霉素具有较高的耐药性。结论PJI患者血清D-二聚体水平高，是诊断PJI的有前途的标志物。革兰氏阳性细菌是关节置换术后PJI的主要病原体，金黄色葡萄球菌是最常见的生物。通过合理选择抗生素和有效的医学教育，可显着提高临床疗效。