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Antibiotic resistance in early periprosthetic joint infection
Saiprasad Ravi1, Mark Zhu2, Christopher Luey3
1School of Medicine, The University of Auckland, Auckland, New Zealand.
Background:
Prophylactic antibiotics significantly reduce prosthetic joint infection (PJI) rates after hip and knee arthroplasty. However, rising antibiotic resistance has raised concerns over the adequacy of conventional prophylaxis. This study aimed to identify organisms causing PJIs in hip and knee arthroplasty secondary to perioperative contamination and their susceptibility to current prophylactic antibiotics.
Methods:
We performed a retrospective audit of 4009 primary hip and knee arthroplasties (1852 hips and 2157 knees) at three tertiary referral hospitals. PJIs were identified according to the Infectious Diseases Society of America definition, and patients were followed-up for 2 years. For patients with confirmed PJIs, causative bacteria and their antibiotic susceptibilities were identified.
Results:
Thirty-five PJI cases were identified (13 hips and 22 knees). The overall definite PJI rate was 0.87% (0.7% for hips, 1.0% for knees). Ninety-six percent of patients with PJI received cefazolin prophylaxis. Culture information was available for 30 cases. The most common infecting organisms were coagulase-negative staphylococci (CoNS), causing 35% of infections. Ninety-two percent of CoNS strains were cefazolin-resistant. Twenty-five percent of patients were infected with Staphylococcus aureus, 9.1% of which were methicillin-resistant. Overall, 53% of infecting organisms were cefazolin-resistant.
Conclusions:
The majority of bacteria causing early PJI are resistant to cefazolin. Whilst many organisms cultured were susceptible to vancomycin, there is currently insufficient evidence to justify its routine use as a prophylactic. However, when treating PJI in the early postoperative period, surgeons should be aware that most organisms will be methicillin-resistant, and the choice of empirical antibiotic treatment should reflect this.
Insights
Most bacteria causing early prosthetic joint infections (PJI) are resistant to cefazolin. Surgeons should consider methicillin-resistant organisms when choosing empirical PJI treatment.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Prophylactic antibiotics are crucial for reducing prosthetic joint infection (PJI) rates after hip and knee arthroplasty.
- Rising antibiotic resistance challenges the efficacy of conventional antibiotic prophylaxis.
- This study investigates organisms causing PJIs from perioperative contamination and their susceptibility to current prophylactic agents.
Purpose of the Study:
- To identify common bacterial pathogens responsible for early prosthetic joint infections (PJIs) following hip and knee arthroplasty.
- To assess the susceptibility of these causative organisms to standard prophylactic antibiotics, particularly cefazolin.
- To inform empirical antibiotic treatment strategies for early PJI.
Main Methods:
- A retrospective audit of 4009 primary hip and knee arthroplasties was conducted across three tertiary hospitals.
- Prosthetic joint infections (PJIs) were identified using the Infectious Diseases Society of America criteria, with a 2-year follow-up.
- Causative bacteria and their antibiotic susceptibility profiles were analyzed for confirmed PJI cases.
Main Results:
- Thirty-five PJI cases (0.87% overall rate) were identified: 13 hip and 22 knee infections.
- Ninety-six percent of PJI patients received cefazolin prophylaxis.
- Coagulase-negative staphylococci (CoNS) were the most frequent pathogens (35%), with 92% demonstrating cefazolin resistance. Staphylococcus aureus accounted for 25% of infections, with 9.1% being methicillin-resistant. Overall, 53% of infecting organisms were cefazolin-resistant.
Conclusions:
- The majority of bacteria causing early prosthetic joint infections exhibit resistance to cefazolin.
- While vancomycin showed susceptibility against many cultured organisms, routine prophylactic use is not currently supported by evidence.
- Empirical antibiotic selection for early PJI management must account for the high prevalence of methicillin-resistant organisms.
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