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

Abstract

We sought to analyze trends of the causative pathogens and their antibiotic susceptibility patterns in patients with periprosthetic joint infections (PJI) of the hip and knee to get better insights and improve treatment. Retrospective evaluation of all consecutive patients with microbiological detection of a causative pathogen at a tertiary endoprothetic referral center between January 2016 and December 2021 in Germany was performed. Overall, 612 different microorganisms could be detected in 493 patients (hip: n = 293; knee: n = 200). Evaluation did not show a change in the relative abundance of pathogens detected, with coagulase-negative staphylococci (n = 275; 44.9%) found frequently, followed by S. aureus (n = 86; 14.1%), Enterococcus species (n = 57; 9.3%), Streptococcus species (n = 48; 7.8%), and Gram-negative bacteria (n = 80; 13.1%). Evaluation of the antibiotic susceptibilities showed increasing rates of oxacillin-resistant coagulase-negative staphylococci (60.4%; 46.8–76.7%) and piperacillin-tazobactam-resistant Gram-negative bacteria (26.5%; 0–57.1%), although statistically not significant. Resistance of Gram-positive bacteria to vancomycin (<1%) and Gram-negative microorganisms to meropenem (1.25%) remained an exception. In summary, coagulase-negative staphylococci, as the most frequent pathogen, displayed a continuously high rate of oxacillin resistance. For the highest antimicrobial coverage in the case of an empiric therapy/unknown pathogen, vancomycin might be chosen. Level of evidence: IV.

Incidence of Rifampicin Resistance in Periprosthetic Joint Infection: A Single-Centre Cohort Study on 238 Patients

“…Rifampicin is one of the most important drugs used in the treatment of PJI; thus, resistance to rifampicin is a threat to the management of PJI. Fröschen et al [21] reported a stable average rifampicin resistance per year of 24.4% in PJIs caused by CoNS in the last 6 years (2016-2021) in Germany. Contrary to these results and the global trend of increasing antibiotic resistance, we found a decreasing trend of PJIs caused by rifampicin-resistant bacteria in the last decade.…”

Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin

“…Given the pivotal role of rifampicin in PJI treatment and the concerning rise in rifampicin resistance in recent decades, it has become imperative to address this issue [69,70]. A study outlining the occurrence of rifampicin-resistant bacteria isolated from PJI patients reported a consistent 24% level of rifampicin resistance in PJI-associated bacteria over a 6-year period [71]. In contrast, a more recent study spanning two decades at our unit unveiled a declining trend in PJIs caused by rifampicin-resistant bacteria when comparing the time frames of 2011-2015 and 2016-2020 [67].…”