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Staphylococcus aureus versus Staphylococcus epidermidis in periprosthetic joint infection-Outcome analysis of

G T Hischebeth1, T M Randau2, M M Ploeger2

  • 1Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany.

Diagnostic Microbiology and Infectious Disease
|September 30, 2018
PubMed

Insights

Periprosthetic joint infections (PJIs) are challenging. Two-stage therapy shows high eradication for Staphylococcus aureus and coagulase-negative staphylococci, but methicillin-resistant S. epidermidis (MRSE) poses significant challenges.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Periprosthetic joint infections (PJIs) are a significant complication following total joint arthroplasty.
  • Staphylococcus aureus and coagulase-negative staphylococci are the primary causative agents of PJIs.

Purpose of the Study:

  • To evaluate the efficacy of a 2-stage therapy algorithm in eradicating Staphylococcus aureus and S. epidermidis.
  • To compare eradication rates based on methicillin susceptibility and resistance profiles.

Main Methods:

  • Retrospective analysis of 74 patients diagnosed with PJI.
  • Inclusion criteria: PJI caused by MRSA, MRSE, MSSA, or MSSE.
  • Follow-up of at least 2 years to assess infection-free status.

Main Results:

  • Overall, 75.7% of patients were definitively free of infection after 2 years.
  • Eradication rates varied by pathogen: MSSA (92.6%), MSSE (95.2%), MRSA (80%), and MRSE (54.2%).
  • Methicillin-resistant S. epidermidis (MRSE) demonstrated significantly lower eradication rates compared to MSSA, MSSE, and MRSA.

Conclusions:

  • The 2-stage therapy algorithm is effective for most PJI pathogens but shows limitations with MRSE.
  • Further research is needed to optimize treatment strategies for MRSE periprosthetic joint infections.
  • Pathogen-specific antibiotic resistance significantly impacts treatment outcomes in PJI management.
Keywords:
ArthroplastyHipKneeMRSAMRSEPJIPeriprosthetic joint infection

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