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The risk factors of polymicrobial periprosthetic joint infection: a single-center retrospective cohort study
Hao Li1,2, Jun Fu2, Erlong Niu2
1Medical School of Chinese PLA, Beijing, People's Republic of China.
Background:
Periprosthetic joint infection is a serious complication after total joint arthroplasty and polymicrobial PJI which compose a subtype of PJI often indicate worse outcomes compared to monomicrobial periprosthetic joint infection. However, a literature review suggested that there were limited number studies evaluating the risk factors of polymicrobial PJI.
Materials And Methods:
Between 2015 January and 2019 December, a total of 64 polymicrobial PJI patients and 158 monomicrobial PJI patients in a tertiary center were included in this study and corresponding medical records were scrutinized. The diagnosis of PJI was based on 2014 MSIS criteria. Logistic regression was used to identify the association between various variables and polymicrobial PJI and ROC curve was used to identify their efficiency.
Results:
The prevalence of polymicrobial PJI is 28.3% in our cohorts. After adjusting for the presence of sinus, previous and knee infection, isolation of enterococci (OR, 3.025; 95%CI (1.277,7.164) p = 0.012), infection with atypical organisms (OR, 5.032;95%CI: (1.470,17.229) p = 0.01), infection with gram-negative organisms (OR, 2.255; 95%CI (1.011,5.031) p = 0.047), isolation of streptococcus spp. (OR, 6; 95%CI (2.094,17.194) p = 0.001), and infection with CNS (OfR, 2.183;95%CI (1.148,4.152) p = 0.017) were risk factors of polymicrobial PJI compared to monomicrobial PJI. However, knee infection is related to a decreased risk of polymicrobial PJI with an adjusted OR = 0.479 (p = 0.023).
Conclusion:
This study demonstrated that the prevalence of polymicrobial PJI is 28.3% in PJI patients. Moreover, the presence of sinus tract and previous joint revisions were risk factors for identifying different bacterial species in the intraoperative specimens. Therefore, in these PJI cases, it is necessary to examine multiple specimens of both intraoperative tissue and synovial fluid for increasing the detection rate and obtaining resistance information.
Insights
Polymicrobial periprosthetic joint infection (PJI) affects 28.3% of PJI cases and is linked to specific bacterial types and prior joint issues. Early identification of risk factors like sinus tracts and previous revisions is crucial for better outcomes.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty.
- Polymicrobial PJI, a subtype of PJI, is associated with poorer outcomes than monomicrobial PJI.
- Limited research exists on the risk factors contributing to polymicrobial PJI.
Purpose of the Study:
- To identify the prevalence of polymicrobial PJI.
- To determine the risk factors associated with polymicrobial PJI compared to monomicrobial PJI.
Main Methods:
- A retrospective study included 64 polymicrobial PJI and 158 monomicrobial PJI patients between January 2015 and December 2019.
- The 2014 Musculoskeletal Infection Society (MSIS) criteria were used for PJI diagnosis.
- Logistic regression and Receiver Operating Characteristic (ROC) curve analysis were employed to identify risk factors and their predictive efficiency.
Main Results:
- The prevalence of polymicrobial PJI was 28.3%.
- Risk factors for polymicrobial PJI included the presence of a sinus tract, previous joint revisions, and isolation of specific bacteria such as Enterococci, atypical organisms, Gram-negative organisms, Streptococcus spp., and Coagulase-Negative Staphylococci (CNS).
- Knee infection was associated with a decreased risk of polymicrobial PJI (adjusted OR = 0.479, p = 0.023).
Conclusions:
- Polymicrobial PJI accounts for 28.3% of PJI cases.
- Sinus tracts and prior joint revisions are significant risk factors for polymicrobial PJI.
- Comprehensive analysis of multiple intraoperative tissue and synovial fluid specimens is recommended for improved detection rates and antibiotic resistance profiling in PJI management.
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