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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2016 | Original Article

Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip

Authors: Svetlana Bozhkova, Rashid Tikhilov, Dmitry Labutin, Alexey Denisov, Igor Shubnyakov, Vadim Razorenov, Vasilii Artyukh, Anna Rukina

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2016

Abstract

Background

The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery.

Materials and methods

A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups—135 with monomicrobial and 54 with polymicrobial infection.

Results

Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m² (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0–10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0–27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18–16.37; p = 0.03).

Conclusions

Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful.

Level of evidence

Level III, therapeutic study.

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Title: Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip
Authors: Svetlana Bozhkova
Rashid Tikhilov
Dmitry Labutin
Alexey Denisov
Igor Shubnyakov
Vadim Razorenov
Vasilii Artyukh
Anna Rukina
Publication date: 01-12-2016
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2016
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-016-0417-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

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