Polymicrobial Prosthetic Joint Infections: Risk Factors and Outcome
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Limited data are available regarding the risk factors and outcome of polymicrobial prosthetic joint infection (PJIs) when compared with monomicrobial PJI. Between January 1998 and November 2006, we retrospectively identified 34 of 174 prosthetic joint infections (19%) were polymicrobial. The 2-year cumulative probability of success of treating polymicrobial and monomicrobial PJIs was 63.8% and 72.8%, respectively. Twenty-six percent, 38%, and 29% of PJIs were treated with two-stage exchange, débridement and retention, or resection arthroplasty, respectively, and the 2-year survival rate free of treatment failure in each group was 77.7% (95% confidence interval, 42.8%–94.2%), 52.7% (95% confidence interval, 28.4%–75.9%), and 64.2% (95% confidence interval, 28.7%–88.9%). Methicillin-resistant Staphylococcus aureus (26.4% versus 7.1%) and anaerobes (11.7% versus 2.8%) were more common in polymicrobial PJIs. Polymicrobial PJIs occurred in patients with a soft tissue defect/dehiscence (23.5% versus 2.8%), drainage (79.4% versus 39.2%), or prior local irradiation (8.8% versus 0.71%). We found the following factors associated with polymicrobial prosthetic joint infections: the presence of a soft tissue defect/wound dehiscence (odds ratio, 5.9), drainage (odds ratio, 5.0), and age 65 years or older (odds ratio, 2.8).
Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
- Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998;27:1247–1254. CrossRef
- Cierny G, DiPasquale D. Periprosthetic total joint infections:staging, treatment and outcomes. Clin Orthop Relat Res. 2002;402:23–28. CrossRef
- Gallo J, Kolar M, Koukalova D, Sauer P, Loveckova Y, Dendis M, Kesselova M, Petrzelova J, Yapletalova J. Bacterial pathogens of periprosthetic infections and diagnostic possibilities [in Russian]. Klinicka Mikrobiologie a Infekcni Lekarstvi. 2006;12:117–123.
- Gavet F, Tournadre A, Soubrier M, Ristori JM, Dubost JJ. Septic arthritis in patients aged 80 and older: a comparison with younger adults. J Am Geriatr Soc. 2005;53:1210–1213. CrossRef
- Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect. 1999;48:11–22.
- Hirakawa K, Stulberg BN, Wilde AH, Bauer TW, Secic M. Results of 2-stage reimplantation for infected total knee arthroplasty. J Arthroplasty. 1998;13:22–28. CrossRef
- Jackson WO, Schmalzried TP. Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements. Clin Orthop Relat Res. 2000;381:101–105. CrossRef
- Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997;56:470–475. CrossRef
- Lentino JR. Prosthetic joint infections: bane of orthopedists, challenge for infectious disease specialists. Clin Infect Dis. 2003;36:1157–1161. CrossRef
- Lidgren L, Knutson K, Stefansdottir A. Infection and arthritis. Infection of prosthetic joints. Best Pract Res Clin Rheumatol. 2003;17:209–218. CrossRef
- McPherson EJ, Tontz W Jr., Patzakis M, Woodsome C, Holtom P, Norris L, Shufelt C. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop. 1999;28:161–165.
- Moran E, Masters S, Berendt AR, McLardy-Smith P, Byren I, Atkins BL. Guiding empirical antibiotic therapy in orthopedics: the microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention. J Infect. 2007;55:1–7. CrossRef
- Poss R, Thornhill TS, Ewald FC, Thomas WH, Batte NJ, Sledge CB. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res. 1984;182:117–126.
- Salgado CD, Dash S, Robert Cantey J, Marculescu CE. Higher risk of treatment failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res. 2007;461:48–53.
- Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Wilson PD Jr. Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am 1982;64:525–535.
- Sculco TP. The economic impact of infected joint arthroplasty. Orthopedics. 1995;18:871–873.
- Steckelberg JM, Osmon DR. Prosthetic joint infections. In: Bisno AL, Waldwogel FA, eds. Infections of Indwelling Prosthetic Devices. Washington DC: ASM; 2000:173–209.
- Tan ESL, Lennox HM, Doig GJ, Snyman RF. Polymicrobial deep joint replacement infection temporally associated with building construction: a case series. Inf Contr Hosp Epidemiol. 2005;26:430–432. CrossRef
- Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 1996;78:512–523.
- Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003;85(Suppl 1):S75–80.
- Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee-replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg 1990;72:878–883.
- Polymicrobial Prosthetic Joint Infections: Risk Factors and Outcome
Clinical Orthopaedics and Related Research
Volume 466, Issue 6 , pp 1397-1404
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