Abstract
Clinical and microbiological characteristics of patients with Bacteroides prosthetic joint infection (PJI) have not been well described in the literature. The aim of this retrospective cohort study was to assess the outcome of patients with Bacteroides PJI and to review risk factors associated with failure of therapy. Between 1/1969 and 12/2012, 20 episodes of Bacteroides PJI in 17 patients were identified at our institution. The mean age of the patients in this cohort at the time of diagnosis was 55.6 years; 59% (n=10) had knee involvement. Twenty four percent (n=4) had diabetes mellitus, and 24% had a history of either gastrointestinal (GI) or genitourinary (GU) pathology prior to the diagnosis of PJI. Thirty five percent (n=6) were immunosuppressed. The initial medical/surgical strategy was resection arthroplasty (n=9, 50%) or debridement and implant retention (n=5, 28%). Thirty seven percent (n=7) were treated with metronidazole. Eighty percent (n=4) of patients that failed therapy had undergone debridement and retention of their prosthesis, as compared to none of those treated with resection arthroplasty. Seventy percent (n=14) of patient episodes were infection free at their last date of follow up. In conclusion, a significant proportion of patients with Bacteroides PJI are immunosuppressed and have an underlying GI or GU tract pathology. Retention and debridement of the prosthesis is associated with a higher risk of treatment failure.
Highlights
Prosthetic joint infections (PJI) are the most common cause of failure of total joint arthroplasty, resulting in additional procedures, increased health care costs, and increased morbidity for the patient [1,2,3]
Four patients (24%) had a history of gastrointestinal/ genitourinary (GI/GU) pathology at the time of PJI diagnosis
A significant proportion (35%) of patients with Bacteroides PJI had underlying immunosuppression, with a significant number of patients in this study presenting either with diabetes mellitus (24%), and rheumatoid arthritis or the use of immunosuppressive therapy (35% for each)
Summary
Prosthetic joint infections (PJI) are the most common cause of failure of total joint arthroplasty, resulting in additional procedures, increased health care costs, and increased morbidity for the patient [1,2,3]. The Infectious Disease Society of America published guidelines in 2012 to help guide clinicians in the diagnosis and management of PJI. These guidelines primarily focus on the management of common pathogens associated with PJI, namely staphylococci and streptococci, and do not comprehensively address less commonly encountered organisms associated with PJI. More common pathogens, these organisms have the potential to create significant morbidity among patients, resulting in increased health care costs and prolonged hospital stay. Despite the ability to produce significant patient morbidity, there are few data available on the http://www.jbji.net medical and surgical management of Bacteroides PJI [11]
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