Significant Difference in Antimicrobial Resistance of Coagulase Negative Periprosthetic Joint Infection in Septic Revision Total Knee Arthroplasty Between Two Major Orthopedic Centers

Stevoska, Stella; Himmelbauer, Felix; Stiftinger, Julian; Stadler, Christian; Gotterbarm, Tobias; Heyse, Thomas J.; Klasan, Antonio

doi:10.1016/j.arth.2021.11.017

Cited by 12 publications

(9 citation statements)

References 30 publications

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“…Second, the causative organisms involved in the septic revision TKAs varied among the included studies, and some of the studies did not report the causative organisms. Although the virulence and resistance profiles of the causative organism can affect the success rates and clinical outcomes for revision TKAs 38 , we were not able to account for this source of heterogeneity. Third, the causes of aseptic revision TKAs also varied among the included studies, and this heterogeneity would have affected the results for the aseptic revision TKAs in the individual studies.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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Background: Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis. Methods: The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted. Results: Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], −6.86; 95% CI, −11.80 to −1.92; p = 0.006). However, the Knee Society Function Score (MD, −1.84; 95% CI, −7.84 to 3.80; p = 0.52) and range of motion (MD, −6.96°; 95% CI, −16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs. Conclusions: Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Kim,

Bae

2023

Journal of Bone and Joint Surgery

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“…Our study showed a significant diversity of practice and in many cases a lack of guidance regarding prophylactic antibiotics. The difficulty in establishing such guidelines lies in differences in antibiotic strains over time [ 22 ], between geographic regions and centres [ 23 ] and even hip and knee arthroplasty [ 24 ]. Contribution to guidelines was also heterogenous with only six (35%) explicitly stating multidisciplinary involvement.…”

Section: Discussionmentioning

confidence: 99%

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

et al. 2022

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(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.

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“…The antimicrobial resistance profile of coagulase-negative staphylococci isolated from cases of PJI after TKA was found to differ significantly between tertiary referral centers, even ones in geographic proximity to one another 53 . As a result, continuous antibiotic susceptibility testing is essential to optimize antibiotic therapy and stewardship.…”

Section: Antibiotic Therapymentioning

confidence: 96%

What’s New in Musculoskeletal Infection

Otero

Brown

Courtney

et al. 2023

Journal of Bone and Joint Surgery

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Significant Difference in Antimicrobial Resistance of Coagulase Negative Periprosthetic Joint Infection in Septic Revision Total Knee Arthroplasty Between Two Major Orthopedic Centers

Cited by 12 publications

References 30 publications

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

What’s New in Musculoskeletal Infection

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