Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Abstract

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

Cost of off-label antibiotic therapy for bone and joint infections: a 6-year prospective monocentric observational cohort study in a referral centre for management of complex osteo-articular infections

“…Unfortunately, these results do not represent what is has been achieved in other countries. In Switzerland, the proportion of prescriptions filled with generic drugs is only about 17 % to 23 %, while in France it is about 30 % to 40 % -far from Germany and Great Britain, with 80 % to 82 % and 83 % to 85 %, respectively (Wouters et al, 2017;Decollogny et al, 2011; Organisation for Economic Co-Operation and Development (OECD), 2019). Nevertheless, without the generic molecules of daptomycin and linezolid, the costs associated with ETs during the study period could not have been stable and would have increased dramatically, especially in 2019 with the use of tedizolid, ceftolozane-tazobactam, and ceftazidime-avibactam.…”

The Analysis of Polyethylene Hip Joint Endoprostheses Strength Parameters Changes after Use inside the Human Body

“…Osteoarthritis (OA) affects over 30% of the general population over the age of 30 and over 65% over the age of 65 [1,2]. Joint arthroplasty is an expensive procedure, depending on the area of operation, age and weight of the patient, the extent of the procedure, type of prosthesis and components used, however in most cases it is the only way to effectively and completely cure disability in millions of people around the world [3][4][5]. Despite the dynamic development in the field of materials engineering, it was not possible to develop an artificial friction node that would be universal and sufficiently failure-free to be implanted in all patients.…”

Higher Reinfection Rate after Two-stage Revision Arthroplasty in Patients with Refractory Diabetes Mellitus: A retrospective analysis with a minimum ten-year follow up

“…Meanwhile, we also found that E. coli was signi cantly more frequently cultured in Group 2 than in Group 1. The prevalence of E. coli PJI is approximately 8% [24], and this resistant strain is highly related to poor outcomes in two-stage revision arthroplasty [25]. However, for DM patients with E. coli PJI, our study is the rst to identify the relative risk.…”