1887

Abstract

Purpose. Periprosthetic joint infection (PJI) is a devastating complication that leads to enormous economic and health care complaints from affected patients. The aim of this study is to identify the causative pathogens responsible for PJI, evaluate temporal trends concerning the pathogen pattern and identify potential risk factors for PJI.

Methodology. This was a retrospective study analysing a total of 937 patients suffering PJI of the hip or knee joint between 2003 and 2011.

Results. In total, 394 patients (42.0 %) with total knee arthroplasty (TKA), 477 patients (50.9 %) with total hip arthroplasty (THA) and 64 patients (6.8 %) receiving a dual-head prosthesis had to be hospitalised due to PJI. In two cases (0.2 %), a simultaneous infection of TKA and THA occurred. The mean age of the study cohort was 70.85±11.68 years. The mean body mass index (BMI) was 28.53±5.7. According to the Charlson comorbidity index, 2.99 % of the patients were classified as severity Grade 1, 13.98 % Grade 2, 40.02 % Grade 3 and 43.0 % Grade 4. Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative Staphylococcus (CoNS), Streptococcus, and Enterococcus were the pathogens mainly responsible. An increase in high-resistance pathogens, such as MRSE, extended-spectrum beta-lactamase bacteria (ESBL), ampicillin-resistant Enterococcus, Acinetobacter spp. and vancomycin-resistant Enterococcus (VRE), was found during the study period. Only MRSA showed a declining tendency in a regression model.

Conclusion. Patients suffering PJI present a certain risk profile with many comorbidities, e.g. high age and obesity. The observed microbiological pattern demonstrates the rise of high-resistance pathogens.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000835
2018-09-12
2024-04-16
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/11/1608.html?itemId=/content/journal/jmm/10.1099/jmm.0.000835&mimeType=html&fmt=ahah

References

  1. Wengler A, Nimptsch U, Mansky T. Hip and knee replacement in Germany and the USA: analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Dtsch Arztebl Int 2014; 111:407–416 [View Article][PubMed]
    [Google Scholar]
  2. Bjerke-Kroll BT, Christ AB, McLawhorn AS, Sculco PK, Jules-Elysée KM et al. Periprosthetic joint infections treated with two-stage revision over 14 years: an evolving microbiology profile. J Arthroplasty 2014; 29:877–882 [View Article][PubMed]
    [Google Scholar]
  3. Garvin KL, Hanssen AD. Infection after total hip arthroplasty. Past, present, and future. J Bone Joint Surg Am 1995; 77:1576–1588 [View Article][PubMed]
    [Google Scholar]
  4. Parvizi J, Azzam K, Ghanem E, Austin MS, Rothman RH. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res 2009; 467:1732–1739 [View Article][PubMed]
    [Google Scholar]
  5. Nelson CL, Evans RP, Blaha JD, Calhoun J, Henry SL et al. A comparison of gentamicin-impregnated polymethylmethacrylate bead implantation to conventional parenteral antibiotic therapy in infected total hip and knee arthroplasty. Clin Orthop Relat Res 1993; 295:96–101 [View Article][PubMed]
    [Google Scholar]
  6. Ascherl R. Infection management of megaimplants. Orthopade 2010; 39:980–993 [View Article][PubMed]
    [Google Scholar]
  7. Militz M, Bühren V. Replacement of infected knee and hip endoprostheses. Chirurg 2010; 81:310–320 [View Article][PubMed]
    [Google Scholar]
  8. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998; 27:1247–1254 [View Article][PubMed]
    [Google Scholar]
  9. Wu C, Qu X, Liu F, Li H, Mao Y et al. Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients. PLoS One 2014; 9:e95300 [View Article][PubMed]
    [Google Scholar]
  10. Lenz M, Hofmann GO, Mückley T. Diagnosis and treatment of periprosthetic infections. Unfallchirurg 2012; 115:496–502 [View Article][PubMed]
    [Google Scholar]
  11. Hozack WJ, Parvizi J. New definition for periprosthetic joint infection. J Arthroplasty 2011; 26:1135–1138 [View Article][PubMed]
    [Google Scholar]
  12. Parvizi J, Gehrke T. International Consensus Group on Periprosthetic Joint Infection Definition of periprosthetic joint infection. J Arthroplasty 2014; 29:1331 [View Article][PubMed]
    [Google Scholar]
  13. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K et al. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty 2008; 23:984–991 [View Article][PubMed]
    [Google Scholar]
  14. Ruchholtz S, Täger G, Nast-Kolb D. The infected hip prosthesis. Unfallchirurg 2004; 107:307–319 [View Article][PubMed]
    [Google Scholar]
  15. Aggarwal VK, Bakhshi H, Ecker NU, Parvizi J, Gehrke T et al. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 2014; 27:399–406 [View Article][PubMed]
    [Google Scholar]
  16. Geipel U, Herrmann M. The infected implant: bacteriology. Unfallchirurg 2005; 108:961–975[PubMed]
    [Google Scholar]
  17. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466:1710–1715 [View Article][PubMed]
    [Google Scholar]
  18. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med 2004; 351:1645–1654 [View Article][PubMed]
    [Google Scholar]
  19. Spiegl U, Pätzold R, Friederichs J, Militz M, Bühren V. Risk factors for failed cleansing following periprosthetic delayed hip prosthesis infection. Orthopade 2012; 41:459–466 [View Article][PubMed]
    [Google Scholar]
  20. Fridkin SK, Edwards JR, Courval JM, Hill H, Tenover FC et al. The effect of vancomycin and third-generation cephalosporins on prevalence of vancomycin-resistant enterococci in 126 U.S. adult intensive care units. Ann Intern Med 2001; 135:175–183 [View Article][PubMed]
    [Google Scholar]
  21. Renner L, Perka C, Trampuz A, Renz N. Treatment of periprosthetic infections. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizin 2016; 87:831–838
    [Google Scholar]
  22. Renz N, Perka C, Trampuz A. Management of periprosthetic infections of the knee. Der Orthopade 2016; 45:65–71
    [Google Scholar]
  23. Portillo ME, Salvadó M, Trampuz A, Siverio A, Alier A et al. Improved diagnosis of orthopedic implant-associated infection by inoculation of sonication fluid into blood culture bottles. J Clin Microbiol 2015; 53:1622–1627 [View Article][PubMed]
    [Google Scholar]
  24. Renz N, Cabric S, Janz V, Trampuz A. Sonication in the diagnosis of periprosthetic infections. Significance and practical implementation. Der Orthopade 2015; 44:942–945
    [Google Scholar]
  25. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med Overseas Ed 2007; 357:654–663 [View Article]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000835
Loading
/content/journal/jmm/10.1099/jmm.0.000835
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error