The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms.

Natividad Benito,Alberto Bahamonde,Javier Ariza,Gorane Euba,Isabel Mur,Julia Praena,Alba Ribera,Javier Cobo,Dolors Rodríguez-Pardo,Jaime Esteban,Xavier Crusi,Laura Morata,Alfredo Jover-Sáenz,Carles Pigrau,Carlos Dueñas,Melchor Riera,Marta Fernández-Sampedro,Pere Coll,Laura Guío,Beatriz Sobrino,Luisa Sorlí,María Dolores Del Toro ,Juan Pablo Horcajada ,Josu Mirena Baraia‐Etxaburu ,Jesús Román Martínez-Álvarez ,Álex Soriano ,António Ramos ,Clinical Microbiolo

doi:10.3390/jcm8050673

Abstract

The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)—including multidrug-resistant organisms (MDRO)—by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama’s scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and “positive intraoperative cultures” (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: <1 month, 2–3 months, 4–12 months, >12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.

Highlights

While the risk of prosthetic infection in patients undergoing joint replacement could be considered low, the high frequency of these procedures converts the combination of low risks into a substantial burden of infection [1]
2524 episodes of prosthetic joint infections (PJIs) were diagnosed during the study period in 19 participating hospitals located in eight of the 17 administrative regions of Spain
In spite of significant differences between the coagulase-negative staphylococci (CoNS) species [43], we found that isolates of CoNS species behaved in a similar way, it should be remembered that a substantial percentage of CoNS were not identified to the species level

Summary

Introduction

While the risk of prosthetic infection in patients undergoing joint replacement could be considered low (hips: 0.2–1.5%, knees: 0.4–1.5%, shoulders: 0.8–2%), the high frequency of these procedures converts the combination of low risks into a substantial burden of infection [1]. Biofilm formation when microorganisms attach to the surface of prosthetic devices plays a crucial role in the pathogenesis of PJI [2]. This poses a challenge for the diagnosis of biofilm-embedded microorganisms, and antimicrobial therapy in biofilm-associated pathogens is of limited efficacy [3]. A significant number of patients (5–35%) have negative cultures [8] In this situation, empirical antimicrobial therapy is even more important, but more difficult to decide on, taking into consideration that the patient will have to receive it for the several weeks to months that it takes to cure a PJI [4,8]

Objectives

Methods

Results