Predictors of Reinfection in Prosthetic Joint Infections Following Two-Stage Reimplantation

Hartman, Curtis W.; Daubach, Eric C.; Richard, Brian T.; Lyden, Elizabeth; Haider, Hani; Kildow, Beau J.; Konigsberg, Beau S.; Garvin, Kevin L.

doi:10.1016/j.arth.2022.03.017

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…Petis et al revealed that a previous revision operation was a risk factor for reinfection [ 2 ]. Hartman et al reported elevated CRP levels at the time of diagnosis and methicillin-sensitive Staphylococcus aureus infection were associated with the reinfection rate [ 43 ]. Logroscino et al revealed obesity (BMI > 25) and multiple previous procedures as risks [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate

Chang

Yen

et al. 2023

JCM

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Background: Antibiotic-loaded bone cement (ALBC) spacers are used in the first stage when treating periprosthetic joint infection (PJI). This study aimed to investigate whether a spacer made from commercial ALBC or plain bone cement with additional antibiotics could affect the spacer exchange rate before reimplantation. Methods: Patients undergoing two-stage exchange arthroplasty due to chronic PJI from January 2014 to August 2021 were retrospectively reviewed. The exclusion criteria included arthroplasty in the setting of septic arthritis, megaprosthesis, atypical pathogen infection, spacer placement unrelated to PJI, and spacer exchange due to mechanical complications. The patient demographics, brand of cement, and microbiology were recorded manually. The primary outcome was the incidence of spacer exchange due to persistent infection and the secondary outcome was the incidence of reinfection after reimplantation. A multivariate logistic regression analysis and Chi-square test were conducted to identify the effect of cement type on the spacer exchange. Results: A total of 334 patients underwent two-stage exchange arthroplasty for PJI. The spacer exchange rates in the commercial and non-commercial ALBC groups were 6.4% and 25.1%, respectively (p = 0.004). After controlling for confounding factors, there were significant differences between the commercial group and non-commercial groups in the spacer exchange rate (adjusted OR = 0.25; 95% CI = 0.72–0.87, p = 0.029). The use of commercial ALBC was not associated with a lower reinfection rate after reimplantation (p = 0.160). Conclusions: In a two-stage exchange arthroplasty scenario, the spacer comprised of commercial ALBC resulted in a lower spacer exchange rate than the plain bone cement, both of which had additional antibiotics. However, the use of commercial ALBC was not associated with a lower incidence of reinfection following reimplantation.

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Section: Discussionmentioning

confidence: 99%

Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate

Chang

Yen

et al. 2023

JCM

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“…Hartman et al in 2022 reported on a retrospective cohort of 158 patients with hip and knee PJI that underwent both stages with mainly articulating spacers (33). The overall reinfection rate was reported as 19.6% (31/158) and the median TTR in the group with reinfection was 141 days compared to 109 days in the group without reinfection, although not statistically significant (p = 0.055).…”

Section: Reinfection After Two-stage Revision Arthroplasty and Time T...mentioning

confidence: 99%

Is long time to reimplantation a risk factor for reinfection in two-stage revision for periprosthetic infection? A systematic review of the literature

Puetzler

Schulze²,

Gosheger³

et al. 2023

Front. Surg.

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The two-stage revision arthroplasty is a common treatment option for chronic periprosthetic infection (PJI). The time to reimplantation (TTR) reported in the literature varies substantially from a few days to several hundred days. It is hypothesized that longer TTR could be associated with worse infection control after second stage. A systematic literature search was performed according to Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in Pubmed, Cochrane Library and Web of Science Core Collection in clinical studies published until January 2023. Eleven studies investigating TTR as a potential risk factor for reinfection met the inclusion criteria (ten retrospective and one prospective study, published 2012–2022). Study design and outcome measures differed notably. The cutoff points above which TTR was regarded as “long” ranged from 4 to 18 weeks. No study observed a benefit for long TTR. In all studies, similar or even better infection control was observed for short TTR. The optimal TTR, however, is not yet defined. Larger clinical studies with homogeneous patient populations and adjustment for confounding factors are needed.

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“…In this cohort, MRSA was the second most common infectious organism and MRSE was the third most common. The prevalence of resistance in PJIs has persisted 12,13 .…”

Section: Historical Perspectivementioning

confidence: 99%

The Challenge of Emerging Resistant Gram-Positive Pathogens in Hip and Knee Periprosthetic Joint Infections

Garvin

Kildow

Hewlett

et al. 2023

Journal of Bone and Joint Surgery

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An increase in resistant bacterial pathogens has occurred over the last 4 decades.Careful patient selection and improving or correcting risk factors for periprosthetic joint infection (PJI) before elective surgical treatment are strongly recommended.Appropriate microbiological methods, including those used to detect and grow Cutibacterium acnes, are recommended.Antimicrobial agents used in the prevention or management of infection should be selected appropriately and the duration of therapy should be carefully considered in order to mitigate the risk of developing bacterial resistance.Molecular methods including rapid polymerase chain reaction (PCR) diagnostics, 16S sequencing, and/or shotgun and/or targeted whole-genome sequencing are recommended in culture-negative cases of PJI.Expert consultation with an infectious diseases specialist (if available) is recommended to assist with the appropriate antimicrobial management and monitoring of patients with PJI.

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Predictors of Reinfection in Prosthetic Joint Infections Following Two-Stage Reimplantation

Cited by 21 publications

References 17 publications

Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate

Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate

Is long time to reimplantation a risk factor for reinfection in two-stage revision for periprosthetic infection? A systematic review of the literature

The Challenge of Emerging Resistant Gram-Positive Pathogens in Hip and Knee Periprosthetic Joint Infections

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