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Prosthetic joint infection caused by gram-negative organisms
Benjamin Zmistowski1, Catherine J Fedorka, Eoin Sheehan
1Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
Abstract:
Traditionally, periprosthetic joint infections (PJIs) due to gram-negative organisms are considered more difficult to manage; however, little literature exists with regard to outcome of PJI caused by gram-negative organisms. We identified 277 patients with 282 culture-positive PJI receiving surgical treatment. Thirty-one joints were treated for gram-negative PJI. The gram-negative group was then compared with the gram-positive and polymicrobial PJI. A single debridement and retention of prosthesis were successful in 70% (7/10) of isolated gram negative compared with 33.3% (13/39) of methicillin-sensitive gram positive, 48.9% (23/47) of methicillin-resistant gram positive, and 57.1% (4/7) of polymicrobial. Of those patients undergoing a planned 2-stage exchange, a successful reimplantation was performed in 52% (12/23) of gram-negative, 51% (52/103) of methicillin-resistant gram-positive, 69% (65/94) of methicillin-sensitive gram-positive, and 0% (0/8) of polymicrobial PJI cases. These results indicate that PJI due to gram-negative pathogens, although less common, is difficult to treat and is associated with limited success.
Insights
Periprosthetic joint infections (PJIs) caused by gram-negative bacteria are challenging to treat. Outcomes for gram-negative PJI are often less successful compared to gram-positive or polymicrobial infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infections (PJIs) are serious complications following joint replacement surgery.
- Gram-negative bacterial infections are often perceived as more challenging to manage than gram-positive infections.
- Limited literature exists on the specific outcomes of gram-negative PJI.
Purpose of the Study:
- To evaluate and compare the treatment outcomes of periprosthetic joint infections (PJIs) caused by gram-negative organisms.
- To compare the success rates of different surgical management strategies for gram-negative PJI against gram-positive and polymicrobial PJI.
Main Methods:
- Retrospective analysis of 282 culture-positive periprosthetic joint infections (PJIs) in patients undergoing surgical treatment.
- Comparison of treatment outcomes between a cohort of 31 gram-negative PJI cases and cohorts of gram-positive (methicillin-sensitive and methicillin-resistant) and polymicrobial PJI cases.
- Evaluation of success rates for single-stage debridement and retention of prosthesis, and two-stage exchange procedures.
Main Results:
- Single debridement and retention of prosthesis had a higher success rate for isolated gram-negative PJI (70%) compared to methicillin-sensitive gram-positive (33.3%), methicillin-resistant gram-positive (48.9%), and polymicrobial (57.1%) PJI.
- For two-stage exchange, successful reimplantation rates were 52% for gram-negative PJI, 51% for methicillin-resistant gram-positive PJI, 69% for methicillin-sensitive gram-positive PJI, and 0% for polymicrobial PJI.
- Gram-negative PJI demonstrated lower success rates in certain treatment scenarios, particularly in two-stage exchange procedures.
Conclusions:
- Periprosthetic joint infections (PJIs) caused by gram-negative pathogens are less common but present significant treatment challenges.
- The outcomes for gram-negative PJI indicate limited success, especially when compared to gram-positive PJI, across various surgical interventions.
- Further research is warranted to optimize treatment strategies for gram-negative periprosthetic joint infections.
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