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Published on: December 3, 2017
Effective Treatment of Single-Stage Revision Using Intra-Articular Antibiotic Infusion for Polymicrobial
Yicheng Li1, Xiaogang Zhang1, Xiaobin Guo1
1Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Background:
The treatment of polymicrobial periprosthetic joint infection (PJI) confronted distinct challenges. No reports have assessed the efficacy of local antibiotic delivery combined with 1-stage exchange in polymicrobial PJI.
Methods:
Between January 2013 and December 2018, we retrospectively analyzed the data of 126 patients, including 19 polymicrobial PJIs and 107 monomicrobial PJIs, who underwent single-stage revision using intra-articular antibiotic infusion. The risk factors, microbiology, infection control rate, and clinical outcomes were compared between the 2 groups.
Results:
Higher body mass index, presence of a sinus tract, and prior revisions were the risk factors for polymicrobial PJI. Isolation of Staphylococcus epidermidis, Streptococcus, Enterococcus, and Gram-negative pathogens was highly associated with polymicrobial PJI. Of the 19 polymicrobial PJIs, only 2 patients occurred infection recurrence, which is similar with the result of 6 of 107 patients in the monomicrobial PJI (P = .225). The Harris Hip Score of the polymicrobial group showed no difference from that of the monomicrobial group (78 vs 80; P = .181). Nevertheless, the polymicrobial group exhibited inferior Hospital for Special Surgery knee score relative to the monomicrobial group (77 vs 79; P = .017).
Conclusion:
With rational and targeted use of antibiotics, single-stage revision can effectively control polymicrobial infections, and achieve favorable outcomes similar to that in monomicrobial patients. However, this regimen is still needed to be further confirmed, especially in the infections with different microbial species simultaneously. Additionally, obese patients with a sinus tract and those who had prior revisions had a greater risk of polymicrobial PJI.
Insights
Single-stage revision with local antibiotics effectively treats polymicrobial periprosthetic joint infection (PJI), showing similar recurrence rates to monomicrobial PJI. Risk factors for polymicrobial PJI include obesity and prior revisions.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Polymicrobial periprosthetic joint infection (PJI) presents unique treatment challenges.
- No prior studies have evaluated single-stage exchange with local antibiotic delivery for polymicrobial PJI.
Purpose of the Study:
- To assess the efficacy and outcomes of single-stage revision with intra-articular antibiotic infusion for polymicrobial PJI.
- To compare risk factors, microbiology, and clinical outcomes between polymicrobial and monomicrobial PJI cases.
Main Methods:
- Retrospective analysis of 126 patients (19 polymicrobial, 107 monomicrobial PJI) undergoing single-stage revision.
- Comparison of risk factors, infection control rates, and functional scores (Harris Hip Score, HSS knee score).
Main Results:
- Higher body mass index, sinus tract, and prior revisions were risk factors for polymicrobial PJI.
- Similar infection recurrence rates between polymicrobial (2/19) and monomicrobial (6/107) PJI.
- No significant difference in Harris Hip Score; however, polymicrobial PJI showed inferior HSS knee scores.
Conclusions:
- Single-stage revision with targeted antibiotics is effective for polymicrobial PJI, yielding outcomes comparable to monomicrobial infections.
- Obesity, sinus tract presence, and prior revisions increase the risk of polymicrobial PJI.
- Further confirmation is needed for this regimen, especially in complex polymicrobial infections.
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