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Positive Blood Cultures Decrease the Treatment Success in Acute Hematogenous Periprosthetic Joint Infection Treated

Feng-Chih Kuo1, Karan Goswami2, Mitchell R Klement2

  • 1Rothman Orthopaedic Institute, Philadelphia, PA; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

The Journal of Arthroplasty
|August 5, 2019
PubMed
Abstract

Insights

Positive blood cultures significantly decrease treatment success for acute hematogenous periprosthetic joint infection (PJI) treated with debridement, antibiotics, and implant retention (DAIR). Patients with more comorbidities require more aggressive treatment for better outcomes.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Acute hematogenous periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
  • Debridement, antibiotics, and implant retention (DAIR) is a common surgical approach for managing PJI.
  • The impact of positive blood cultures on DAIR treatment success in PJI is not well understood.

Purpose of the Study:

  • To evaluate the influence of positive blood cultures on the treatment success of DAIR for acute hematogenous PJI.
  • To identify factors associated with positive blood cultures and treatment success in PJI patients.

Main Methods:

  • Retrospective chart review of 49 patients with acute hematogenous PJI treated with DAIR from 2005-2016.
  • Analysis of blood culture data, Elixhauser comorbidity index, and treatment outcomes defined by Delphi criteria.
  • Multivariate logistic regression and Kaplan-Meier survival analysis were employed.

Main Results:

  • 44.9% of blood cultures were positive.
  • Positive blood culture was the sole significant predictor of treatment failure (OR, 3.94; P=.026).
  • Infection-free implant survivorship at 1 year was significantly lower in patients with positive blood cultures (36.4%) compared to those with negative cultures (66.7%).

Conclusions:

  • Positive blood cultures are associated with reduced treatment success for DAIR in acute hematogenous PJI.
  • Patients with increased comorbidities may necessitate more aggressive management strategies for improved PJI treatment outcomes.
Keywords:
acute hematogenousarthroplastyblood cultureperiprosthetic joint infectiontreatment

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