Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

Abstract

Background: Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. Methods: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. Results: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05). Conclusion: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

The efficacy and safety of tranexamic acid in rheumatoid arthritis patients undergoing simultaneous bilateral total knee arthroplasty: a multicenter retrospective study

“…It was reported that RA patients presented higher risk of infection following TKA [ 39 ]. Some recent studies have proved that the routine use of TXA could decrease the risk of injection in total joint arthroplasty [ 40 , 41 ].…”

The Use of Oral Antibiotics After Total Joint Arthroplasty

“…Carender et al 67 noted that patients who received treatment with EOA after TJA had higher rates of resistance in coagulase-negative staphylococci infections and Gram-negative organisms than patients who received standard prophylaxis. Antimicrobial-resistant organisms have also been noted for higher rates of PJI treatment failure 68,69 . Resistance additionally poses a risk of society as a whole.…”

Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection

“…The surgical operative methods were determined by the degree, time and even the specific location of the infection 11,12 . DAIR showed a good success rate in cases of early acute infection by multidrug‐sensitive bacteria, but it is not suitable for patients with bacterial resistance 13 . Immunocompetent patients with healthy soft tissues, only mild or moderate bone loss, confirmed infection microorganisms and its sensitivity, can be treated with one‐stage revision 14 .…”