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[Distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty]
Zhi Chen1, Jia-Jun Lin1, Wen-Ge Liu1
1Department of Orthopaedics, West China Hospital, Sichuan University, Chendu 610041, Sichuan, China.
Objective:
To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty, and to formulate prevention and treatment strategies for drug-resistant bacteria.
Methods:
The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected, including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty. The culture positive rate, pathogenic bacteria composition and drug resistance rate were counted over the years, and the change trend of pathogen distribution and drug resistance was analyzed.
Results:
One hundredand eight strains of pathogenic bacteria were detected in 146 cases, and the positive rate of culture was 73.97%. Gram positive bacteria accounted for 55.48%, Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34% and 15.07% respectively. Gram negative bacteria accounted for 13.01%, including Enterobacter cloacae, Pseudomonas aeruginosa and Escherichia coli. There were 4 cases of Mycobacterium tuberculosis infection and mixed infection. The results of culture over the years showed that the constituent ratio of Gram positive bacteria had an increasing trend, fluctuating from 39.13% to 76.47%. The results of drug sensitivity showed that the pathogens were highly resistant to β-lactams, quinolones, clindamycin and gentamicin, and the drug resistance rate was increasing, but it was still sensitive to rifampicin, nitrofurantoin, tigecycline, linezolid and vancomycin.
Conclusion:
Gram positive bacteria are the main pathogens of periprosthetic infection, and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics, and the resistance rate is still increasing. To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.
Insights
Gram-positive bacteria are increasingly the primary cause of periprosthetic joint infections. These pathogens show rising antibiotic resistance, necessitating enhanced monitoring for effective prevention and treatment strategies.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infections (PJIs) pose a significant challenge after hip and knee arthroplasty.
- Understanding the evolving microbial landscape and antimicrobial resistance patterns is crucial for patient outcomes.
Purpose of the Study:
- To investigate the distribution and antimicrobial susceptibility of pathogens causing PJIs.
- To identify trends in pathogen prevalence and resistance over time.
- To inform the development of targeted prevention and treatment strategies for drug-resistant bacteria.
Main Methods:
- Retrospective analysis of 146 PJI cases following hip and knee arthroplasty (2010-2015).
- Evaluation of culture-positive rates, pathogenic bacteria composition, and antimicrobial resistance patterns.
- Analysis of temporal trends in pathogen distribution and drug resistance.
Main Results:
- Gram-positive bacteria, particularly Staphylococcus epidermidis and Staphylococcus aureus, were the predominant pathogens (55.48%).
- A rising trend in the proportion of Gram-positive bacteria was observed (39.13% to 76.47%).
- Pathogens exhibited high resistance to common antibiotics (e.g., β-lactams, quinolones) but remained sensitive to vancomycin, linezolid, and others.
Conclusions:
- Gram-positive bacteria are the leading cause of PJIs, with a notable increase in their prevalence.
- Increasing antimicrobial resistance among PJI pathogens necessitates continuous surveillance.
- Monitoring pathogen distribution and resistance trends is vital for effective PJI management and antimicrobial stewardship.
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