Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections

Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty. In the course of a PJI, superinfections with pathogens that do not match the primary infecting micro-organism may occur. To our knowledge, there are no published data on the outcome of such infections in the literature. The aim of this study was to assess the outcome of PJI with superinfections with a difficult-to-treat (DTT) pathogen. Data of 169 consecutive patients with PJI were retrospectively analyzed in this single-center study. Cases were categorized into: Group 1 including non-DTT-PJI without superinfection, Group 2 DTT-PJI without superinfection, Group 3 non-DTT-PJI with DTT superinfection, and Group 4 non-DTT-PJI with non-DTT superinfection. Group 3 comprised 24 patients and showed, after a mean follow-up of 13.5 ± 10.8 months, the worst outcome with infection resolution in 17.4% of cases (p = 0.0001), PJI-related mortality of 8.7% (p = 0.0001), mean revision rate of 6 ± 3.6 (p < 0.0001), and duration of antibiotic treatment of 71.2 ± 45.2 days (p = 0.0023). PJI caused initially by a non-DTT pathogen with a superinfection with a DTT pathogen is significantly associated with the worst outcome in comparison to non-DTT-PJI, PJI caused initially by a DTT pathogen, and to non-DTT-PJI with a non-DTT superinfection.

[1]  E. Schwarz,et al.  Distinct vasculotropic versus osteotropic features of S. agalactiae versus S. aureus implant‐associated bone infection in mice , 2020, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[2]  T. Schildhauer,et al.  Microbial findings and the role of difficult-to-treat pathogens in patients with periprosthetic infection admitted to the intensive care unit , 2020, Orthopedic reviews.

[3]  F. Schildberg,et al.  Difficult-to-treat pathogens significantly reduce infection resolution in periprosthetic joint infections. , 2020, Diagnostic microbiology and infectious disease.

[4]  Lauren N. Pearson,et al.  Letter to the Editor on "The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria". , 2020, The Journal of arthroplasty.

[5]  M. Faschingbauer,et al.  Difficult to treat: are there organism-dependent differences and overall risk factors in success rates for two-stage knee revision? , 2020, Archives of Orthopaedic and Trauma Surgery.

[6]  C. Perka,et al.  Biofilm-active antibiotic treatment improved the outcome of knee periprosthetic joint infection: Results from a 6-year prospective cohort. , 2020, International journal of antimicrobial agents.

[7]  C. Beck,et al.  Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model , 2020, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[8]  C. Perka,et al.  Enterococcal periprosthetic joint infection: clinical and microbiological findings from an 8-year retrospective cohort study , 2019, BMC Infectious Diseases.

[9]  O. Borens,et al.  Periprosthetic joint infection: current concepts and outlook , 2019, EFORT open reviews.

[10]  C. Perka,et al.  Management of Chronically Infected Total Knee Arthroplasty With Severe Bone Loss Using Static Spacers With Intramedullary Rods. , 2019, The Journal of arthroplasty.

[11]  W. Khan,et al.  Single-Stage Revision Surgery in Infected Total Knee Arthroplasty: A PRISMA Systematic Review , 2019, Journal of clinical medicine.

[12]  D. Albala,et al.  Management of , 2018, Basic Urological Management.

[13]  A. Trampuz,et al.  Management of Periprosthetic Joint Infection , 2018, Springer Berlin Heidelberg.

[14]  C. Perka,et al.  Orthopedic implant-associated infections caused by Cutibacterium spp. – A remaining diagnostic challenge , 2018, PloS one.

[15]  J. Parvizi,et al.  Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection. , 2018, The Journal of arthroplasty.

[16]  M. Queiroz,et al.  Risk Factors and Treatment Options for Failure of a Two-Stage Exchange , 2018, Current Reviews in Musculoskeletal Medicine.

[17]  J. Parvizi,et al.  The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. , 2018, The Journal of arthroplasty.

[18]  C. Perka,et al.  Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study , 2017, Archives of Orthopaedic and Trauma Surgery.

[19]  T. Peel,et al.  Prosthetic Joint Infections , 2018, Springer International Publishing.

[20]  J. Parvizi,et al.  Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes. , 2017, The Journal of arthroplasty.

[21]  F. Haddad,et al.  Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections , 2016, The open orthopaedics journal.

[22]  H. Kremers,et al.  Multi‐disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee , 2016, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[23]  M. Whitehouse,et al.  Re-Infection Outcomes Following One- And Two-Stage Surgical Revision of Infected Knee Prosthesis: A Systematic Review and Meta-Analysis , 2015, PloS one.

[24]  D. Murray,et al.  One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[25]  C. Perka,et al.  Current failure mechanisms after knee arthroplasty have changed: polyethylene wear is less common in revision surgery. , 2015, The Journal of bone and joint surgery. American volume.

[26]  Theresa Lamagni,et al.  Epidemiology and burden of prosthetic joint infections. , 2014, The Journal of antimicrobial chemotherapy.

[27]  A. Liddle,et al.  Single- or Two-stage Revision for Infected Total Hip Arthroplasty? A Systematic Review of the Literature , 2014, Clinical orthopaedics and related research.

[28]  Á. Soriano,et al.  Prosthetic joint infections due to methicillin-resistant and methicillin-susceptible staphylococci treated with open debridement and retention of the prosthesis. , 2013, Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia.

[29]  P. Foguet,et al.  A systematic review of the evidence for single stage and two stage revision of infected knee replacement , 2013, BMC Musculoskeletal Disorders.

[30]  A. Del Arco,et al.  The Diagnosis of Periprosthetic Infection , 2013, The open orthopaedics journal.

[31]  J. Parvizi,et al.  Success After Treatment of Periprosthetic Joint Infection: A Delphi-based International Multidisciplinary Consensus , 2013, Clinical orthopaedics and related research.

[32]  P. Choong,et al.  Cost analysis of debridement and retention for management of prosthetic joint infection. , 2013, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[33]  J. Parvizi,et al.  Periprosthetic joint infection: Current concept , 2013, Indian journal of orthopaedics.

[34]  O. Borens,et al.  [Ten errors to avoid while dealing with infected total joint arthroplasties]. , 2012, Revue medicale suisse.

[35]  W. Zimmerli,et al.  Pathogenesis and treatment concepts of orthopaedic biofilm infections. , 2012, FEMS immunology and medical microbiology.

[36]  S. Kurtz,et al.  Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. , 2012, The Journal of bone and joint surgery. American volume.

[37]  J. Parvizi,et al.  New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society , 2011, Clinical orthopaedics and related research.

[38]  J. Parvizi,et al.  Prosthetic joint infection caused by gram-negative organisms. , 2011, The Journal of arthroplasty.

[39]  D. Viemann,et al.  Staphylococcus aureus small-colony variants are adapted phenotypes for intracellular persistence. , 2010, The Journal of infectious diseases.

[40]  I. Sia,et al.  Efficacy and safety of rifampin containing regimen for staphylococcal prosthetic joint infections treated with debridement and retention , 2010, European Journal of Clinical Microbiology & Infectious Diseases.

[41]  Á. Soriano,et al.  Antibiotic resistance in orthopaedic surgery: acute knee prosthetic joint infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae , 2010, European Journal of Clinical Microbiology & Infectious Diseases.

[42]  Javad Parvizi,et al.  Two-stage Exchange Knee Arthroplasty: Does Resistance of the Infecting Organism Influence the Outcome? , 2010, Clinical orthopaedics and related research.

[43]  J. Parvizi,et al.  Revision Hip Arthroplasty: Infection is the Most Common Cause of Failure , 2010, Clinical orthopaedics and related research.

[44]  J. Esteban,et al.  Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty , 2010, Clinical orthopaedics and related research.

[45]  Daniel Berry,et al.  Prosthetic Joint Infection Risk after TKA in the Medicare Population , 2010, Clinical orthopaedics and related research.

[46]  Steven M. Kurtz,et al.  The Epidemiology of Revision Total Knee Arthroplasty in the United States , 2009, Clinical orthopaedics and related research.

[47]  Jukka Lumio,et al.  Incidence of prosthetic joint infections after primary knee arthroplasty. , 2010, The Journal of arthroplasty.

[48]  Mel S. Lee,et al.  Gram-negative prosthetic joint infections: risk factors and outcome of treatment. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[49]  J. Parvizi,et al.  The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. , 2009, The Journal of arthroplasty.

[50]  S. Kurtz,et al.  Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. , 2009, The Journal of arthroplasty.

[51]  Javad Parvizi,et al.  Periprosthetic Infection Due to Resistant Staphylococci: Serious Problems on the Horizon , 2009, Clinical orthopaedics and related research.

[52]  Antti Malmivaara,et al.  Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach , 2009, Acta orthopaedica.

[53]  L. Frommelt,et al.  Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[54]  S. Kurtz,et al.  Infection burden for hip and knee arthroplasty in the United States. , 2008, The Journal of arthroplasty.

[55]  J. McCabe,et al.  Surgical site infection with methicillin-resistant Staphylococcus aureus after primary total hip replacement. , 2008, The Journal of bone and joint surgery. British volume.

[56]  S. Kurtz,et al.  Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. , 2007, The Journal of bone and joint surgery. American volume.

[57]  Chuan‐Mu Chen,et al.  Surgical Débridement and Parenteral Antibiotics in Infected Revision Total Knee Arthroplasty , 2007, Clinical orthopaedics and related research.

[58]  L. Frommelt,et al.  Proposal for a histopathological consensus classification of the periprosthetic interface membrane , 2006, Journal of Clinical Pathology.

[59]  W. Zimmerli,et al.  Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. , 2006, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[60]  R. Proctor,et al.  Staphylococcus epidermidis Polysaccharide Intercellular Adhesin Production Significantly Increases during Tricarboxylic Acid Cycle Stress , 2005, Journal of bacteriology.

[61]  T. Ono,et al.  Synovectomy, debridement, and continuous irrigation for infected total knee arthroplasty , 2005, International Orthopaedics.

[62]  J. Lonner,et al.  Limited success with open debridement and retention of components in the treatment of acute Staphylococcus aureus infections after total knee arthroplasty. , 2003, The Journal of arthroplasty.

[63]  W. Zimmerli,et al.  Management of Infection Associated with Prosthetic Joints , 2003, Infection.

[64]  P. Holtom,et al.  Periprosthetic Total Hip Infection: Outcomes Using a Staging System , 2002, Clinical orthopaedics and related research.

[65]  B. Levine,et al.  Use of Blood Culture Vial Specimens in Intraoperative Detection of Infection , 2001, Clinical orthopaedics and related research.

[66]  N. Athanasou,et al.  Histological and microbiological findings in non-infected and infected revision arthroplasty tissues , 2000, Archives of Orthopaedic and Trauma Surgery.

[67]  A. Hanssen,et al.  Infection after total hip arthroplasty. Past, present, and future. , 1995, The Journal of bone and joint surgery. American volume.

[68]  A. Gristina,et al.  Current concepts review. Total joint replacement and sepsis. , 1983, The Journal of bone and joint surgery. American volume.