Etiology of surgical site infections after primary total joint arthroplasties

Abstract

We sought to characterize the causative pathogens of surgical site infections (SSIs) following primary total joint arthroplasties and to evaluate trends in the microbial etiology. We analyzed the etiology of SSIs following 2,632 total hip arthroplasty and knee arthroplasty procedures performed at our institution from 2004 through 2010. We calculated the annual proportion of SSIs accounted for each of the most common organisms and evaluated trends using the x 2 test for trend. SSIs were identified in 111 procedures (4.2%). The annual incidence of SSIs did not change significantly during the study period. Staphylococci were the most common cause of infection (59.6%) and most of infections were monomicrobial (82.8%). From 2004 to 2010, the annual proportion of infections due to gram-negative bacilli (GNB) increased from 21.4% to 66.7% (p ¼ 0.085 for trend). This increase was accompanied by a decline in the proportion of SSIs from coagulase-negative staphylococci (p ¼ 0.003). Additionally, we found an increase in the percentage of polymicrobial infections (from 7.1% in 2004 to 41.7% in 2010, p ¼ 0.014). Multivariate analysis corroborated these trends. Our study reports an emergence of GNB as a cause of SSIs after primary total joint arthroplaties and an increase of polymicrobial infections.

Multi‐disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee

“…In addition to Staphylococcus , many PJI‐causing bacteria can form biofilms, which are particularly resistant to treatments because they often require genus‐specific modes of eradication . Although biofilm structures vary, multiple species can coexist within one biofilm, which facilitates conjugation and could confer antibiotic resistance .…”

“…Among PJIs, polymicrobial infections occur in approximately, 7–17% of cases overall (Table ) and are often most difficult to treat. Strikingly, though, Benito et al reported a fivefold increase in the yearly occurrence of polymicrobial infections from 7.1 to 41.7% over a period of 6 years from 2004 to 2010, and an equally alarming increase in the yearly proportion of infections caused by gram‐negative bacteria (21.4–66.7% over the same period). Of these, Enterobacteriaceae are challenging because they resist a wide range of antibiotics .…”

Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection

“…Importantly, the prevalence of methicillin-resistant S. aureus (MRSA) in PJI is increasing, especially in the USA [12]. In addition, polymicrobial infections can occur in up to 15% of cases [13] despite the fact that some authors reported a substantial increase in the yearly occurrence of polymicrobial infections over the period of six years (2004 to 2010) with a greater increase in the proportion of gram-negative bacteria during the same period [14]. …”

Trends in surgical site infections following orthopaedic surgery

“…A single-centre study from France reported a small change in Enterobacteriaceae as causative pathogens in osteoarticular infections from 13% in 2002 to 15% in 2011 [20]. A further single-site study from Spain based on primary total joint arthroplasties reported a nonsignificant but marked increase in Gram-negative infections, from 21% in 2004 to 67% in 2010 [21].…”