Microbiological Profiles of Patients with Periprosthetic Joint Infection of the Hip or Knee

Abstract

Periprosthetic joint infections (PJI) are one of the most devastating consequences after total joint arthroplasty. We sought to analyze the causative pathogens of patients with PJI to get better insights and improve treatment. We performed a retrospective study of all patients with PJI of the hip and knee with microbiological detection of a causative pathogen at a tertiary endoprothetic referral center between January 2016 and March 2021. A total of 432 cases with PJI (hip: n = 250; knee: n = 182) were included. The most common causative pathogen were coagulase-negative staphylococci (n = 240; 44.2%), of which Staphylococcus epidermidis (n = 144; 26.7%) was the most frequently detected, followed by S. aureus (n = 77; 14.3%) and enterococci (n = 49; 9%). Gram-negative pathogens and fungi could be detected in 21% (n = 136) and 2.4% (n = 13) of all cases. Overall, 60% of all coagulase-negative staphylococci were oxacillin-resistant, while none of these displayed to be vancomycin-resistant. In summary, the majority of pathogens in cases of PJI could be identified as coagulase-negative staphylococci. For empirical therapy vancomycin might provide the highest antimicrobial coverage in case of an unknown pathogen.

Efficacy of surgical skin preparation solutions in hip arthroplasty: a prospective randomized trial

“…The clinical significance of this finding is unclear, as periprosthetic infections from M. luteus are relatively rare. 18 …”

Microbiological Trends and Antibiotic Susceptibility Patterns in Patients with Periprosthetic Joint Infection of the Hip or Knee over 6 Years

“…Although previous studies have shown that Gram-positive cocci are the most frequently detected pathogens in patients with PJI, the literature is not consistent regarding the role of S. aureus and coagulase-negative staphylococci [ 3 , 12 ]. While Tsai et al identified S. aureus as the most common pathogen with a detection rate of 26%, more recent studies by Hu et al and Stevoska et al identified coagulase-negative staphylococci with detection rates of 38.1 to 56.6% as more common [ 12 , 15 , 17 ].…”

“…While Bjerke-Kroll et al could not detect a difference in the identified species in patients with PJI of the hip or knee, Stevoska et al described a significantly higher rate of Gram-negative bacteria in patients with PJI of the hip [ 14 , 17 ]. As our previous studies did not detect an overall difference in causative pathogens between patients with PJI of the hip and the knee, we did not evaluate this topic [ 3 ].…”

“…To date, empirical antibiotic therapy with ampicillin-sulbactam or amoxicillin-clavulanic acid is often recommended as a first-line therapy [ 19 ]. As recommendations differ between countries, only the knowledge of the local microbiological spectrum might allow the best possible choice [ 2 , 3 ]. Our main findings for Gram-positive cocci are that coagulase-negative staphylococci display in the majority of the isolates an oxacillin resistance, while being in almost one-quarter of all isolates resistant to rifampicin.…”

“…The best possible treatment of a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) has become a major focus of orthopaedic research [ 1 , 2 , 3 ]. An essential part of a successful treatment with eradication of infection is knowledge of the causative pathogens and their antibiotic susceptibility patterns, as reinfection still remains a major problem after reimplantation of THA and TKA [ 2 , 4 , 5 , 6 , 7 ].…”