Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes

Charalambous, Lefko T; Kim, Billy; Schwartz, Andrew M.; Case, Andrew D.; Seidelman, Jessica; Hendershot, Edward F.; Bolognesi, Michael P.; Seyler, Thorsten M.; Jiranek, William A.

doi:10.1016/j.arth.2022.02.050

Cited by 11 publications

(7 citation statements)

References 61 publications

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“…Analysis of PJI microbiological patterns in a large cohort containing 997 patients with PJI and 180 (18.1%) of them were detected with MRCoNS [ 24 ]. Charalambous et al [ 25 ] reported a poor rate of success in treating CoNS PJI, which was likely due to the interaction of inherent virulence through biofilm formation and decreased antibiotic efficacy. Regarding fungal infections, C. albicans were detected more frequently in the PJI cohort, with a prevalence of 8.0%.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

Lyu

et al. 2023

BMC Musculoskelet Disord

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Background The purpose of this study is to investigate the microbial patterns of periprosthetic joint infection (PJI) and fracture-related infection (FRI), and guide for the formulation of more accurate empirical antimicrobial regimens based on the differences in pathogen distribution. Methods A comparative analysis of pathogen distribution was conducted between 153 patients (76 with PJI and 77 with FRI). Predicted analyses against isolated pathogens from two cohorts were conducted to evaluate the best expected efficacy of empirical antimicrobial regimens (imipenem + vancomycin, ciprofloxacin + vancomycin, and piperacillin/tazobactam + vancomycin). Results Our study found significant differences in pathogen distribution between the PJI and FRI cohorts. Staphylococci (61.3% vs. 31.9%, p = 0.001) and Gram-negative bacilli (GNB, 26.7% vs. 56.4%, p < 0.001) were responsible for the majority of infections both in the PJI and FRI cohorts, and their distribution in the two cohorts showed a significant difference (p < 0.001). Multi-drug resistant organisms (MDRO) were more frequently detected in the FRI cohort (29.3% vs. 44.7%, p = 0.041), while methicillin-resistant coagulase-negative Staphylococci (MRCoNS, 26.7% vs. 8.5%, p = 0.002) and Canidia albicans (8.0% vs. 1.1%, p = 0.045) were more frequently detected in the PJI cohort. Enterobacter spp. and Acinetobacter baumannii were detected only in the FRI cohort (11.7% and 8.5%, respectively). Conclusions Staphylococci and GNB were responsible for the majority of infections in both PJI and FRI. Empirical antimicrobial therapy should focus on the coverage of Staphylococci in PJI and GNB in FRI, and infections caused by MDROs should be more vigilant in FRI, while the high incidence of MRCoNS in PJI should be noted, which could guide for the formulation of more accurate empirical antimicrobial regimens. Targeted therapy for FRI caused by A. baumannii and PJI caused by C. albicans needs to be further investigated. Our study reports significant differences in pathogen distribution between the two infections and provides clinical evidence for studies on the mechanism of implant-associated infection.

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

Lyu

et al. 2023

BMC Musculoskelet Disord

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“…MRSA has been well-established to have infection recurrence despite appropriate surgical treatment, and although CoNS has recently gained increasing attention for its virulence with rising rates of methicillin-resistance, our cohort highlights MRSA as the pathogen with worse outcomes in the setting of flap reconstruction. 37,38 The relatively lower risk for recurrent infection for CoNS is likely explained by the high occurrence of polymicrobial (n = 8, 18.2%) and enterococcal (n = 6, 13.6%) PJIs in this cohort, which are less common but notorious for high treatment failure rates. 39,40 More importantly, overall outcomes for all patients were dismal with a recurrent or persistent reinfection rate of 52.3%, and the virulence of offending pathogens seen in this cohort emphasize the importance of an intact soft tissue envelope in preventing infections.…”

Section: Discussionmentioning

confidence: 90%

Risk factors for failure after rotational muscle flap coverage for prosthetic knee infections

Kim,

Wixted,

Schwartz

et al. 2024

J Orthop Surg (Hong Kong)

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Introduction Soft tissue defects are a devastating complication of prosthetic joint infections (PJI) after total knee arthroplasty (TKA). Rotational flaps are commonly utilized to address these defects with variable reports of success. This study aimed to identify predictors of poor outcomes in rotational muscle flap placement after prosthetic knee infections. The authors hypothesized that outcomes may vary based on infecting pathogen and treatment characteristics. Methods 44 cases of rotational muscle flaps for prosthetic knee infection were retrospectively evaluated at a tertiary referral hospital from 2007 to 2020. Muscle flap types included 39 medial and four lateral gastrocnemius, and one anterior tibialis. Minimum follow-up was 1 year (median: 3.4 years). Primary outcome was flap-related complications. Secondary outcomes included recurrent infection requiring additional surgery, final joint outcomes, and mortality. Results One-year complication-free flap survivorship was 83.9%, recurrent infection-free survivorship was 65.7%, and amputation-free survivorship was 79%. Multivariable cox regression revealed that rheumatoid arthritis diagnosis (HR: 3.4; p = .028) and methicillin-resistant Staphylococcus aureus-positive culture (HR: 4.0; p = .040) had increased risk, while Coagulase-negative Staphylococcus infections had reduced risk for recurrent or persistent infection (HR: 0.2; p = .023). Final joint outcome was retained TKA implant in 18 (40.9%), amputation in 15 (34.1%) patients, and definitive treatment with articulating spacer in 10 (22.7%). 5-years survivorship from death was 71.4%. Conclusion Rotational muscle flaps for soft tissue coverage of the knee are often performed in limb salvage situations with poor survivorship from flap complications, reinfections, and amputation. When considering surgical options for limb salvage, patients should be counseled on these risks.

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“…However, PJI caused by resistant CoNS is a major concern, although resistance patterns appear to vary tremendously, even in similar geographical regions [ 29 ]. One study on 55 episodes of TKA PJI caused by CoNS found that only around half of the patients, despite the use of long-term systemic antibiotic treatment, remained infection-free after a follow-up period of 29 months [ 30 ]. Compared to the present study, 40% of their patients had undergone treatment for PJI before and in their study, this was associated with a higher risk of reinfection.…”

Section: Discussionmentioning

confidence: 99%

Two-Stage Revision Arthroplasty for Resistant Gram-Positive Periprosthetic Joint Infections Using an Oral Linezolid-Based Antibiotic Regime

Gründer,

Bockholt,

Gosheger

et al. 2023

Antibiotics

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Background: Increasing antibiotic resistance has been reported as an issue in the systemic treatment of periprosthetic joint infection (PJI). Linezolid offers the advantages of high oral bioavailability and little resistance; however, efficacy in the treatment of PJI varies considerably, and studies reporting consistent surgical treatment are scarce. Methods: This is a retrospective, single-center analysis of two-stage revisions performed between 2008 and 2017. We identified 111 patients who met the inclusion criteria. Oral linezolid was given for 28 days following 14 days of intravenous tailored antibiotics in resistant gram-positive PJI. A total of 64% of the patients had methicillin-resistant coagulase-negative staphylococci. The median follow-up was 43 (interquartile range (IQR) 30–57) months. Results: 22% (24/111) of the patients underwent surgery for subsequent infection. The 5-year infection-free survival probability was 77% (95% confidence interval (CI) 69–85). A total of 5% of the patients (6/111) had the same organism at the time of reinfection. The patients with infections caused by other organisms than Coagulase-negative staphylococci tended to have a worse reinfection-free survivorship at five years (70% vs. 81%, p = 0.09). Furthermore, the patients with obesity tended to have reduced reinfection-free survivorship at five years (69% vs. 84%, p = 0.08). Overall, 5% (6/111) of the patients had blood count abnormalities with no treatment discontinuations. Conclusion: Two-stage revision arthroplasty with systemic oral linezolid treatment for resistant gram-positive PJI results in an infection control of 77% at the mid-term.

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Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes

Cited by 11 publications

References 61 publications

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

Risk factors for failure after rotational muscle flap coverage for prosthetic knee infections

Two-Stage Revision Arthroplasty for Resistant Gram-Positive Periprosthetic Joint Infections Using an Oral Linezolid-Based Antibiotic Regime

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