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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 5/2010

01-05-2010 | Symposium: Current Issues in Knee Reconstruction

Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

Authors: José Cordero-Ampuero, MD, PhD, Jaime Esteban, MD, PhD, Eduardo García-Rey, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 5/2010

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Abstract

Background

Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied.

Questions/purposes

This study compared the results of treatment of knee arthroplasty infections by single versus polymicrobial isolates, Gram-positive versus Gram-negative, and methicillin-resistant versus -sensitive Staphylococci.

Methods

We prospectively followed 47 patients with late knee arthroplasty infections. The mean age was 72 years (range, 20–87 years). The treatment protocol included two-stage exchange and a combination of two oral antibiotics given for 6 months. Minimum followup was 1 year (average, 4.8 ± 3 years; range, 1–12 years). Control of the infection was judged by absence of clinical, serologic, and radiologic signs of infection. The functional outcome was evaluated by Knee Society score at the last followup.

Results

Infection was controlled in all 15 patients with polymicrobial and in 28 of 32 (88%) with monomicrobial infections, in eight of nine patients with Gram-negative and in 35 of 38 (92%) with Gram-positive isolates. Control was also achieved in 22 of 25 patients (88%) infected by methicillin-resistant Staphylococci and in 14 of 14 by methicillin-sensitive Staphylococci. The Knee Society scores averaged 81-63 in patients with polymicrobial infections and were higher than in monomicrobial infections (75-52). The mean KSS was 85-59 in Gram-negative infections compared to 75-55 in Gram-positive infections. The mean KSS was similar in methicillin-resistant (78-54) and methicillin-sensitive Staphylococci (73-56) infections.

Conclusions

Polymicrobial and Gram-negative infections can be controlled in late knee arthroplasty infections. On the other hand, infections by methicillin-resistant Staphylococci are less likely to be controlled by the regimens we used.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Metadata
Title
Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty
Authors
José Cordero-Ampuero, MD, PhD
Jaime Esteban, MD, PhD
Eduardo García-Rey, MD, PhD
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 5/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-009-1224-9

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