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Published on: December 3, 2017
Trends of Prosthetic Joint Infection Organisms and Recurrence for a Single High-Volume Arthroplasty Surgeon Over 20
Caleb M Yeung1, Vincentius J Suhardi1, Nathan H Varady1
1Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Background:
Prosthetic joint infection (PJI) is a morbid complication following total joint arthroplasty (TJA). PJI diagnosis and treatment has changed over time, and patient co-management with a high-volume musculoskeletal infectious disease (MSK ID) specialist has been implemented at our institution in the last decade.
Methods:
We retrospectively evaluated all consecutive TJA patients treated for PJI between 1995 and 2018 by a single high-volume revision TJA surgeon. Microbial identities, antibiotic resistance, prior PJI, and MSK ID consultation were investigated.
Results:
In total, 261 PJI patients (median age 66 years, interquartile range 57-75) were treated. One-year and 5-year reinfection rates were 15.8% (95% confidence interval [CI] 11.6-20.7) and 22.1% (95% CI 17.0-27.7), respectively. Microbial identities and antibiotic resistances did not change significantly over time. Despite seeing more prior PJI patients (53.3% vs 37.6%, P = .012), MSK ID-managed patients had similar infection rates as non-MSK ID-managed patients (hazard ratio [HR] 1.02, 95% CI 0.6-1.75, P = .93). Prior PJI was associated with higher reinfection risk (HR 2.39, 95% CI 1.39-4.12, P = .002) overall and in patients without MSK ID consultation, specifically (HR 2.78, 95% CI 1.37-5.65, P = .005). This risk was somewhat lower and did not reach significance in prior PJI patients with MSK ID consultation (HR 1.97, 95% CI 0.87-4.48, P = .106).
Conclusion:
We noted minimal differences in microbial/antibiotic resistances for PJI over 20 years in a single institution, suggesting current standards of PJI treatment remain encouragingly valid in most cases. MSK ID involvement was not associated with lower reinfection risk overall; however, in patients with prior PJI, the risk of reinfection appeared to be somewhat lower with MSK ID involvement.
Level Of Evidence:
Level IV-Case Series.
Insights
Prosthetic joint infection (PJI) treatment has remained consistent over 20 years, with no significant changes in microbes or antibiotic resistance. Musculoskeletal infectious disease (MSK ID) specialist involvement showed a trend toward lower reinfection risk in patients with prior PJI.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Prosthetic joint infection (PJI) is a significant complication of total joint arthroplasty (TJA).
- Diagnosis and treatment strategies for PJI have evolved.
- Co-management with musculoskeletal infectious disease (MSK ID) specialists has been implemented at some institutions.
Purpose of the Study:
- To evaluate trends in microbial identities and antibiotic resistance in PJI over a 20-year period.
- To assess the impact of MSK ID specialist consultation on PJI reinfection rates.
- To identify risk factors for reinfection in patients with PJI.
Main Methods:
- Retrospective review of 261 TJA patients treated for PJI between 1995 and 2018.
- Analysis of microbial identities, antibiotic resistance patterns, history of prior PJI, and MSK ID consultation.
- Statistical analysis including hazard ratios to compare reinfection rates.
Main Results:
- One-year and 5-year reinfection rates were 15.8% and 22.1%, respectively.
- Microbial identities and antibiotic resistance showed no significant changes over time.
- Prior PJI was associated with a higher reinfection risk (HR 2.39), particularly in patients without MSK ID consultation (HR 2.78).
- MSK ID-managed patients with prior PJI had a non-significant trend toward lower reinfection risk (HR 1.97).
Conclusions:
- Current PJI treatment standards appear effective, with minimal changes in microbial profiles or antibiotic resistance over two decades.
- While overall reinfection rates were similar, MSK ID involvement may offer a benefit for patients with a history of PJI.
- Prior PJI remains a significant risk factor for reinfection after TJA.
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