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Archives of Orthopaedic and Trauma Surgery

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01-11-2021 | Joint Infection | Knee Revision Surgery

Comparative analysis of pathogen structure in patients with PJI after primary total hip and knee arthroplasty

Authors: Petr Preobrazhensky, Svetlana Bozhkova, Andrey Kochish, Rashid Tikhilov, Alexander Kazemirsky

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2021

Abstract

Background

Microbiological profile of pathogens causing periprosthetic joint infection (PJI) after primary total hip (THA) and knee (TKA) arthroplasty varies in different regions, clinics and even departments. The objective of this study was to analyze the pathogen structure in patients with PJI after primary THA and TKA and its influence on the effectiveness of the infection eradication after two-stage reimplantation.

Materials and methods

We collected the retrospective data of 364 patients—161 with PJI after primary TKA (113 treated in two stages 48 with failure after spacer implantation) and 203 patients with infected THA (127 after successful two-stage reimplantation and 76 with PJI recurrence after the first stage) within the time period from January 2012 to December 2017, treated with two-stage protocol in the single center. A comparative analysis of pathogen structure was performed between cohorts of patients with hip and knee PJI. A subanalysis was made between the subsets comprised from patients with successful two-stage treatment and the subsets with failure to treat the infection.

Results

Staphylococcus epidermidis was the most commonly identified pathogen in the full hip and knee cohorts: 30.1% and 32.5%, respectively. However, the percentage of methicillin-resistant Staphylococcus epidermidis (MRSE) among all S. epidermidis isolates was higher in the hip cohort—50% compared with 35% in the knee cohort (p = 0.073). Other coagulase-negative Staphylococci were more common to patients with PJI after primary TKA—10.3% compared with 5% (p < 0.02). Streptococcus sp. caused hip PJI in a larger percentage of cases than in knee PJI (p < 0.01)—7% and 2%, respectively (p < 0.01).

Polymicrobial associations were significantly more common in hip PJI compared to knee PJI: 45.3% and 14% of cases, respectively (p < 0.001). The presence of polymicrobial infection significantly raised the risk of PJI recurrence [OR 2 (95% CI from 1.24 to 3.24)] in knee PJI patients and reduced the effectiveness of infection eradication from 73.9% to 47.8%.

Conclusion

Comparative analysis showed significant differences in the structure of PJI pathogens in the hip and knee. These findings are useful when choosing treatment strategies and empirical antibiotics regimens, in the management of patients with PJIs after primary hip and knee arthroplasty.

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Title: Comparative analysis of pathogen structure in patients with PJI after primary total hip and knee arthroplasty
Authors: Petr Preobrazhensky
Svetlana Bozhkova
Andrey Kochish
Rashid Tikhilov
Alexander Kazemirsky
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Joint Infection
Hip-TEP
Hip-TEP
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2021
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-04139-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparative analysis of pathogen structure in patients with PJI after primary total hip and knee arthroplasty

Abstract

Background

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

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