Different microbial and resistance patterns in primary total knee arthroplasty infections - a report on 283 patients from Lithuania and Sweden
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Sujeesh Sebastian1, Erdem Aras Sezgin2, Justinas Stučinskas3
1Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden. sujeesh.sebastian@med.lu.se.
Background:
The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement.
Methods:
Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision.
Results:
The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41).
Conclusions:
The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.
Insights
Microbial profiles and resistance patterns in infected knee replacements differ between Sweden and Lithuania. Lithuania shows higher rates of methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, suggesting societal and hospital factors influence outcomes.
Area of Science:
- Orthopedic surgery
- Infectious disease microbiology
- Public health epidemiology
Background:
- Infections following total knee arthroplasty (TKA) present varied microbial and susceptibility profiles influenced by demographics, antimicrobial stewardship, and surgical practices.
- Understanding these variations is crucial for effective treatment strategies and infection control.
Purpose of the Study:
- To compare the recent microbial landscape and antimicrobial resistance patterns in cases of infected TKAs undergoing revision surgery in Sweden and Lithuania.
- To investigate the influence of patient-related, societal, and local hospital factors on bacteriology and resistance patterns.
Main Methods:
- Nationwide data from Sweden (2018) and a single revision center in Lithuania (2011-2020) were used, identifying 202 TKAs in Sweden and 84 in Lithuania revised for infection.
- Culture reports were analyzed to determine microorganism types and their antimicrobial resistance patterns at the time of revision surgery.
Main Results:
- Early prosthetic joint infections (PJIs) were more common in Sweden (44%), while late-type PJIs predominated in Lithuania (52%).
- Gram-positive bacteria were prevalent in both countries (Sweden 55%, Lithuania 80%), with Staphylococcus aureus being the most frequent isolate.
- Lithuania exhibited higher rates of methicillin resistance in Staphylococcus aureus (4/28) and coagulase-negative staphylococci (19/29) compared to Sweden (1/42 and 9/41, respectively). Polymicrobial infections were more frequent in Sweden (16%) than in Lithuania (6%).
Conclusions:
- Significant differences exist in infection types, microbial profiles, and antimicrobial resistance patterns between Sweden and Lithuania.
- Emerging resistance in Lithuania is likely attributable to societal and local hospital factors.
- The study highlights the need for comprehensive microbiology data on prosthetic joint infections within national implant registries to facilitate cross-country comparisons and improve data aggregation.
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