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Multiflora and Gram-Negative Microorganisms Predominate in Infections Affecting Pelvic Endoprostheses Following Tumor

P T J Sanders1, M P A Bus1, H Scheper1

  • 1Departments of Orthopedic Surgery (P.T.J.S., M.P.A.B., R.J.P.v.d.W., M.A.J.v.d.S., and P.D.S.D.) and Infectious Diseases (H.S. and M.G.J.d.B.), Leiden University Medical Center, Leiden, the Netherlands.

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Summary

Periprosthetic infections after pelvic reconstruction are often polymicrobial and gram-negative, differing from typical joint infections. This suggests a need to re-evaluate current treatment and prophylaxis strategies for pelvic endoprostheses.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Oncology

Background:

  • Periprosthetic infections following pelvic reconstruction are a significant complication, with high reported incidence rates.
  • Management is challenging, often requiring multiple surgeries and implant removal, yet epidemiology and outcomes remain poorly understood.

Purpose of the Study:

  • To investigate the causative microorganisms and clinical outcomes of infections in patients with pelvic endoprostheses after tumor resection.

Main Methods:

  • A retrospective, multicenter cohort study identified patients with periacetebular tumor resection and subsequent infection between 2003 and 2017.
  • Data collected included isolated microorganisms, number of reoperations, antimicrobial strategies, and treatment outcomes.

Main Results:

  • Of 70 patients, 18 (26%) developed infections, predominantly polymicrobial (78%) and gram-negative (62%).
  • Enterobacteriaceae and microorganisms associated with intestinal flora were common pathogens.
  • At follow-up, 50% retained their original implant, while 50% required implant removal, with varied secondary reconstruction outcomes.

Conclusions:

  • Pelvic endoprosthetic infections are typically polymicrobial and gram-negative, potentially linked to intestinal flora, unlike common gram-positive periprosthetic joint infections.
  • These findings suggest a distinct pathogenesis and highlight the need to reassess current prophylaxis and empiric treatment protocols.