Periprosthetic joint infections treated with two-stage revision over 14 years: an evolving microbiology profile

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Late periprosthetic joint infection (PJI) affects 0.3%-1.9% of total hip and knee arthroplasties.
• Effective PJI treatment requires surgical intervention and targeted antibiotics.

Purpose of the Study:

• To analyze temporal trends of causative organisms in PJI over 14 years at a single institution.
• To identify shifts in bacterial prevalence contributing to late PJI.

Main Methods:

• Retrospective analysis of PJI cases over a 14-year period.
• Statistical analysis using a Poisson regression model to assess infection rate trends.
• Identification and categorization of bacterial organisms responsible for PJI.

Main Results:

• A significant linear increase in PJI rates was observed for Methicillin-resistant Staphylococcus aureus (MRSA) (IRR=1.11, P=0.019).
• Incidence rate ratios also increased for Streptococcus viridans (IRR=1.18, P=0.002) and Propionibacterium acnes (IRR=1.21, P=0.024).
• These specific bacteria showed a concerning rise as primary causative agents in PJI.

Conclusions:

• The increasing prevalence of MRSA, S. viridans, and P. acnes in PJI warrants re-evaluation of current management protocols.
• Consideration should be given to pre-surgical MRSA screening and empiric antibiotic regimens covering MRSA.
• Extended incubation periods for bacterial culture and dental prophylaxis against S. viridans may be beneficial.