Abstract
BackgroundProsthetic joint infection (PJI) caused by Acinetobacter baumannii (Ab) has become a growing concern due to its overwhelming ability to express resistance to antibiotics and produce biofilm.AimThis study aimed to identify independent risk factors (RFs) associated with Ab-associated PJI and their role in the treatment outcome.MethodsThis was a single-centre, retrospective cohort study of PJI patients diagnosed between January 2014 and July 2018. A PJI diagnosis was made based upon the MSIS 2018 criteria. To estimate RFs associated with Ab-associated PJI, multivariate analyses with a level of significance of p < 0.05 were performed. To evaluate treatment failure, Kaplan–Meier analysis and log-rank test were performed.ResultsOverall, 98 PJI cases were assessed, including 33 with Ab-associated PJI and 65 with PJI involving other microorganisms (non–Ab-associated PJI). Independent RFs associated with Ab-associated PJI were revision arthroplasty [odds ratio (OR) = 3.01; 95% confidence interval (CI) = 1.15–7.90; p = 0.025] and nonelective arthroplasty (OR = 2.65; 95% CI = 1.01–7.01; p = 0.049). Ab-associated PJI was also more likely than non–Ab-associated PJI to be classified as a chronic late infection (OR = 5.81; 95% CI = 2.1–16.07; p = 0.001). Ab-associated PJI was not associated with treatment failure (p = 0.557).ConclusionsLate chronic infections, surgical revision and nonelective arthroplasty are well-known predictors of PJI but were also independently associated with Ab-associated PJI. Infections caused by Ab and surgical treatment with debridement, antibiotics and implant retention were not associated with PJI treatment failure.Trial registrationStudy data supporting our results were registered with the Brazilian Registry of Clinical Trials (https://www.ensaiosclinicos.gov.br/rg/RBR-6ft5yb/), an open-access virtual platform for the registration of studies on humans performed in Brazil.Registration no.RBR-6ft5yb.
Highlights
Worldwide, an increasing number of individuals have undergone joint-replacement surgeries, at the hip and knee, either for elective reasons or following sustained trauma
Infections caused by Acinetobacter baumannii (Ab) and surgical treatment with debridement, antibiotics and implant retention were not associated with Prosthetic joint infection (PJI) treatment failure
This microorganism is ubiquitous in the environment [9] and has become one of the most successful pathogens associated with health care–related infections due to its ability to express a variety of antimicrobial resistance mechanisms and to form biofilms on both biotic and abiotic surfaces [10]
Summary
An increasing number of individuals have undergone joint-replacement surgeries, at the hip and knee, either for elective reasons or following sustained trauma. Due to its ability to spread in health care environments, Acinetobacter baumannii (Ab) is currently the most difficult species to control and eradicate [9] This microorganism is ubiquitous in the environment [9] and has become one of the most successful pathogens associated with health care–related infections due to its ability to express a variety of antimicrobial resistance mechanisms and to form biofilms on both biotic and abiotic surfaces [10]. In several Latin American countries, Ab strains have shown resistance to virtually all classes of antibiotics, including carbapenems. This worrisome microbial epidemiology has been identified at some Brazilian hospitals, where 77% of these isolates have exhibited resistance to carbapenems [13]. Prosthetic joint infection (PJI) caused by Acinetobacter baumannii (Ab) has become a growing concern due to its overwhelming ability to express resistance to antibiotics and produce biofilm
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