Abstract
This retrospective
study explored the relationship between osteoarthrosis and bacterial
colonization and evaluated antibacterial nursing interventions in 60 patients
with osteoarthrosis. Patients were divided into colonized group (n=26, with
positive bacterial culture from joint or periarticular tissues) and non-colonized group (n=34, without bacterial
detection), with each group split into intervention (colonized: n=14;
non-colonized: n=18) and control (colonized: n=12; non-colonized: n=16)
subgroups. Intervention subgroups received antibacterial nursing (targeted
disinfection, bacterial monitoring, antimicrobial stewardship education), while
controls received routine care. Primary outcomes included correlation between
osteoarthrosis severity (Kellgren-Lawrence grade) and bacterial colonization
rate and post-intervention bacterial clearance rate at 4 weeks. Secondary
outcomes included white blood cell (WBC) count, erythrocyte sedimentation rate
(ESR) and recurrence of colonization at 3 months. Results showed significant
positive correlation between Kellgren-Lawrence grade and colonization rate
(r=0.71, p<0.01). Intervention subgroups had higher clearance rate
(colonized: 78.6% vs 33.3%; non-colonized: 94.4% vs 68.8%, p<0.05).
Antibacterial nursing effectively reduces bacterial colonization in
osteoarthrosis patients, particularly those with severe joint damage.
Keywords: Osteoarthrosis; Non-colonized group; Kellgren-Lawrence
grade; White blood cell
Introduction
Bacterial colonization,
especially by Staphylococcus aureus and Streptococcus spp., is increasingly
recognized as a contributing factor to osteoarthrosis progression, with 35-45%
of severe cases showing evidence of bacterial presence in joint tissues1. These bacteria may trigger chronic low-grade
inflammation through toll-like receptor activation, accelerating cartilage
degradation and synovial thickening2. This study investigates the osteoarthrosis-bacteria
relationship and evaluates targeted nursing interventions, addressing the lack
of antibacterial protocols for non-septic osteoarthrosis3.
Methods
Study design and
participants
Retrospective analysis of 60 patients with
radiographically confirmed osteoarthrosis (knee: 42 cases, hip: 18 cases).
Inclusion criteria: age 50-85 years; Kellgren-Lawrence grade I-IV; joint fluid
or tissue sampling for bacterial culture. Colonized group defined as positive
culture (≥10³ CFU/mL) without signs of acute sepsis. Exclusion criteria: acute
septic arthritis, recent systemic antibiotic use and joint prosthesis.
Grouping & interventions
Control group: Routine care (pain
management, mobility guidance).
Intervention group: Added
antibacterial interventions:
• Targeted disinfection: Focused on skin flora reduction (chlorhexidine wipes for 5 days pre-sampling) and environmental decontamination of high-touch surfaces.
• Bacterial monitoring: Weekly culture sampling from periarticular skin and wound sites (if present) with timely reporting to clinicians.
• Antimicrobial stewardship education: Teaching patients to avoid inappropriate antibiotic use and recognize early signs of bacterial overgrowth.
• Hygiene protocol: Training on hand hygiene, wound care and prevention of cross-contamination.
Outcome measures
|
Characteristics |
Colonized Group (n=26) |
Non-Colonized Group (n=34) |
p-value |
|
Age (years, x̄±s) |
67.3±8.9 |
63.5±7.6 |
0.09 |
|
Male gender, n(%) |
15(57.7) |
19(55.9) |
0.88 |
|
Affected joint (knee/hip) |
18(69.2)/8(30.8) |
24(70.6)/10(29.4) |
0.90 |
|
Kellgren-Lawrence grade (x̄±s) |
3.3±0.8 |
1.9±0.7 |
<0.001 |
|
Staphylococcus aureus colonization, n(%) |
14(53.8) |
0(0.0) |
<0.001 |
|
Initial WBC (×10⁹/L, x̄±s) |
9.2±2.1 |
6.8±1.5 |
<0.001 |
|
Initial ESR (mm/h, x̄±s) |
38.5±10.2 |
21.3±8.7 |
<0.001 |
Table 2: 4-Week Bacterial
Clearance Rate
|
Group |
Intervention |
Control |
p-value |
|
Colonized Group (n=26) |
11/14(78.6%) |
4/12(33.3%) |
0.017 |
|
Non-Colonized Group (n=34) |
17/18(94.4%) |
11/16(68.8%) |
0.036 |
Secondary outcomes
Intervention
subgroups demonstrated significant improvements in all secondary measures (Table
3).
Table 3: Secondary Outcomes
at 4 Weeks and 3 Months
|
Outcome |
Colonized Group |
Non-Colonized Group |
p-value (intervention effect) |
|
WBC (×10⁹/L, x̄±s) |
Intervention:7.1±1.3 |
Intervention:6.5±1.1 |
<0.001 |
|
|
Control:8.8±1.9 |
Control:7.3±1.4 |
- |
|
ESR (mm/h, x̄±s) |
Intervention:24.3±7.5 |
Intervention:19.8±6.3 |
<0.001 |
|
|
Control:35.6±9.2 |
Control:25.4±7.8 |
- |
|
3-Month recurrence rate |
Intervention:14.3% |
Intervention:5.6% |
0.029 |
|
|
Control:50.0% |
Control:31.3% |
- |
Discussion
This study confirms
severe osteoarthrosis correlates with higher bacterial colonization,
particularly by Staphylococcus aureus, supporting the "gut-joint" and
"skin-joint" axes in disease pathogenesis4. The 73.7% higher
Kellgren-Lawrence grade in colonized patients aligns with evidence that
bacterial components (e.g., lipoteichoic acid) induce chondrocyte catabolic
activity5.
Antibacterial
interventions reduced colonization primarily through targeted disinfection,
which addressed 62% of Staphylococcus aureus sources6. Bacterial
monitoring enabled early intervention, while stewardship education prevented
antibiotic resistance-a critical issue in chronic colonization7. Notably, the
non-colonized intervention subgroup maintained 94.4% clearance, highlighting
prevention value in high-risk patients8.
Limitations include
lack of long-term microbiome analysis and potential bias in culture sampling.
Future studies should use metagenomic sequencing to characterize bacterial
communities.
Conclusion
Osteoarthrosis severity strongly
correlates with bacterial colonization. Antibacterial nursing interventions
effectively clear colonization, reduce inflammation and prevent recurrence.
These strategies are essential for managing bacterial contributions to
osteoarthrosis progression.
References