Related Experiment Video
Updated: Nov 10, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A
Raquel Bandeira da Silva1, Mauro José Salles2,3
1Department of Internal Medicine, Hospital São Francisco de Assis, Belo Horizonte 30360-290, Brazil.
Abstract:
Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan-Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.
Insights
Multidrug-resistant Gram-negative bacteria (MDR-GNB) are a growing cause of prosthetic joint infection (PJI). Previous surgery and local complications increase MDR-GNB PJI risk, while comorbidities and resistant strains lead to treatment failure.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Prosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
- The increasing prevalence of multidrug-resistant Gram-negative bacteria (MDR-GNB) complicates PJI management.
Purpose of the Study:
- To identify independent risk factors (RFs) associated with MDR-GNB PJI.
- To evaluate the influence of these factors on treatment outcomes in PJI patients.
Main Methods:
- Retrospective observational study of hip and knee PJI cases diagnosed between January 2014 and July 2018.
- Bivariate and multivariate analyses were used to determine RFs for MDR-GNB PJI.
- Kaplan-Meier analysis assessed treatment outcomes.
Main Results:
- Revision arthroplasty, postoperative hematoma, previous orthopedic infection, and early infection were independent RFs for MDR-GNB PJI.
- Extensively drug-resistant GNB and patient comorbidities were independently associated with treatment failure.
- MDR-GNB PJI was linked to prior surgery, local complications, and pre-existing infections.
Conclusions:
- MDR-GNB PJI is associated with specific patient and surgical factors, including prior orthopedic interventions and local complications.
- Treatment failure in MDR-GNB PJI is exacerbated by extensively drug-resistant strains and patient comorbidities.
- Findings suggest a potential role for antibiotic selective pressure in bacterial skin colonization contributing to MDR-GNB PJI.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:18Endocarditis III: Medical Management