Non-elective and revision arthroplasty are independently associated with hip and knee prosthetic joint infection caused by Acinetobacter baumannii: a Brazilian single center observational cohort study of 98 patients

Abstract

Background Prosthetic joint infection (PJI) caused by Acinetobacter baumannii (Ab) has become a growing concern due to its overwhelming ability to express resistance to antibiotics and produce biofilm. Aim This study aimed to identify independent risk factors (RFs) associated with Ab-associated PJI and their role in the treatment outcome. Methods This was a single-centre, retrospective cohort study of PJI patients diagnosed between January 2014 and July 2018. A PJI diagnosis was made based upon the MSIS 2018 criteria. To estimate RFs associated with Ab-associated PJI, multivariate analyses with a level of significance of p < 0.05 were performed. To evaluate treatment failure, Kaplan–Meier analysis and log-rank test were performed. Results Overall, 98 PJI cases were assessed, including 33 with Ab-associated PJI and 65 with PJI involving other microorganisms (non–Ab-associated PJI). Independent RFs associated with Ab-associated PJI were revision arthroplasty [odds ratio (OR) = 3.01; 95% confidence interval (CI) = 1.15–7.90; p = 0.025] and nonelective arthroplasty (OR = 2.65; 95% CI = 1.01–7.01; p = 0.049). Ab-associated PJI was also more likely than non–Ab-associated PJI to be classified as a chronic late infection (OR = 5.81; 95% CI = 2.1–16.07; p = 0.001). Ab-associated PJI was not associated with treatment failure (p = 0.557). Conclusions Late chronic infections, surgical revision and nonelective arthroplasty are well-known predictors of PJI but were also independently associated with Ab-associated PJI. Infections caused by Ab and surgical treatment with debridement, antibiotics and implant retention were not associated with PJI treatment failure. Trial registration Study data supporting our results were registered with the Brazilian Registry of Clinical Trials (https://www.ensaiosclinicos.gov.br/rg/RBR-6ft5yb/), an open-access virtual platform for the registration of studies on humans performed in Brazil. Registration no.RBR-6ft5yb.

Epidemiology and Risk Factors for Revision Total Knee Arthroplasty in Chinese Patients: A Retrospective Study in Changchun, Jilin Province, China

“…The reason for the high frequency of periprosthetic joint infection (PJI) in single/multi-center studies might be that TKA revisions related to PJI are generally considered extremely complicated and expensive [ 22 , 23 ]. Meanwhile, revisions related to aseptic loosening and other mechanical drawbacks might be considered “simple” revisions and tend to be performed in local hospitals, whereas PJI-related revisions are more frequently referred to specialized orthopedic centers with experience and sufficient resources [ 20 , 24 ]. This also explains why the proportion of patients with PJI in the present study was higher than that reported in some other studies.…”

Promising applications of D-amino acids in periprosthetic joint infection

“…174,267,268 Infections caused by A. baumannii represent ~2% of all healthcare-associated infections in the U.S. and Europe, 269 and globally, ~45% of all A. baumannii isolates are multidrug resistant, further complicating clinical outcomes. 270,271 The rate of orthopedic implant-associated A. baumannii infections range from 0.6%-28.7%, [272][273][274] with a mortality rate of 30.7%, 274,275 and these infections are an increasingly common cause of osteomyelitis and delayed healing in soldiers with orthopedic battlefield wounds. [276][277][278] Furthermore, recent study by Choe et al 268 showed that A. baumannii inhibited implant osseointegration when investigated in a murine model of infection.…”