Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study

Abstract

It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.

Bacterial Infection and Implant Loosening in Hip and Knee Arthroplasty: Evaluation of 209 Cases

“…When we compared patients who were treated surgically due to PJI for the first time with patients who had already undergone at least one revision due to PJI, we found that S. epidermidis infections increased in the latter group. Contrary to data by others, Gram-negative bacteria were only rarely detected in our cases of prosthetic joint infection [19]. …”

Staphylococcus aureus Prosthetic Joint Infection Is Prevented by a Fluorine‐ and Phosphorus‐Doped Nanostructured Ti–6Al–4V Alloy Loaded With Gentamicin and Vancomycin

“…The most frequently used antibiotics for loading on titanium nanostructures are gentamicin and vancomycin; though others such as penicillin and streptomycin and antimicrobials like peptides or hydroxypropyltrimethyl ammonium have been used. The use of antibiotic monotherapy has been associated with bacterial antibiotic‐resistant emergence, and dual antibiotic therapy may prevent antibiotic‐resistance in local therapy.…”

“…Though prosthetic joint infection (PJI) occurs infrequently (1‐2% of all cases), it is a nonetheless devastating, due to the high associated morbidity and substantial costs of this complication; indeed, the economic burden of PJI is expected to grow in the coming years with the increase in the number of patients undergoing arthroplasty replacements . The most frequently isolated microorganisms from these infections are Gram‐positive cocci, which represent up to 77% of all infections, the most common of which are Staphylococcus aureus and Staphylococcus epidermidis . After arthroplasty, systemic and prophylactic treatments of PJIs may be ineffective as antibiotics cannot easily reach the prosthesis–tissue interface, particularly if necrotic or avascular tissue remains after surgery; and increases in the antibiotic dose are associated with organ toxicity .…”

Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

“…Diagnosis within the first 2 weeks could enable rapid treatment before formation of resistant biofilms [2,16]. However, chronic infections can be "silent" or culture negative to conventional tests [4], and many patients with immune deficiency do not present with typical symptoms such as fever or elevated neutrophil counts [28], so their pain may be incorrectly attributed to aseptic loosening, instability, or malalignment.…”