Prosthetic joint infection caused by gram-negative organisms

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.