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Polymicrobial Prosthetic Joint Infections: Risk Factors and Outcome

  • Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society
  • Published:
Clinical Orthopaedics and Related Research

Abstract

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.

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Acknowledgments

We thank Drs. Harry A. Demos, MD and H. Del Schutte Jr, MD from the Department of Orthopedic Surgery at the Medical University of South Carolina for their surgical expertise.

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Authors and Affiliations

  1. Division of Infectious Diseases, Medical University of South Carolina, 100 Doughty Street, Suite 210, BA/IOP South, PO Box 250752, Charleston, SC, 29425, USA

    Camelia E. Marculescu MD, MSCR & J. Robert Cantey MD

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  1. Camelia E. Marculescu MD, MSCR
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  2. J. Robert Cantey MD
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Correspondence to Camelia E. Marculescu MD, MSCR.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case report and that all investigations were conducted in conformity with ethical principles of research.

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Marculescu, C.E., Cantey, J.R. Polymicrobial Prosthetic Joint Infections: Risk Factors and Outcome. Clin Orthop Relat Res 466, 1397–1404 (2008). https://doi.org/10.1007/s11999-008-0230-7

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  • DOI: https://doi.org/10.1007/s11999-008-0230-7

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