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Septic Failure After One-Stage Exchange for Prosthetic Joint Infection of the Hip: Microbiological Implications
Iman Godarzi Bakhtiari1, Georges Vles2, Sophia-Marlene Busch1
1Department of Orhopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany.
Background:
The microbiological implications of septic failure after 1-stage exchange for prosthetic joint infection (PJI) of the hip remain unclear.
Methods:
Information was gathered on comorbidities, previous procedures, preoperative and postoperative microbiology results, methods of detection, and antibiotic resistance patterns, for all patients, who developed septic failure after 1-stage exchange for PJI of the hip performed at our institution during 2001-2017.
Results:
Seventy-seven patients were identified. Septic failure was diagnosed a mean of 1.7 (standard deviation 2.3, range 0-11.8) years later. Although the spectrum of microorganisms was similar to preoperative, in the majority of patients (55%), the initial microorganism(s) was (were) replaced by (a) totally different microorganism(s). Overall, there was a decrease in the number of polymicrobial PJIs. The number of patients with high virulent microorganisms decreased significantly from 52 to 36 (P = .034). The number of PJIs due to gram-negative pathogens remained similar (11 vs 14, P = .491). The number of rifampicin-resistant staphylococci, fluoroquinolone-resistant streptococci, enterococci, and fungi changed from 8 to 15, 0 to 2, 7 to 3, and 1 to 2, respectively, but these changes did not reach statistical significance.
Conclusion:
The majority of reinfections is caused by different infecting bacteria, hence it is essential to perform a new diagnostic workup and not base treatment decisions (solely) on historical cultures. We were furthermore unable to irrefutably prove that, from a microbiological point of view, septic failure after 1-stage exchange comes with increased challenges. Given the time interval to failure, we propose that a longer follow-up of these patients is needed, than previously suggested.
Insights
Septic failure after hip prosthetic joint infection (PJI) treatment often involves new bacteria, necessitating repeat cultures for effective treatment. Microbiological challenges in these cases require further investigation and extended patient follow-up.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Prosthetic joint infection (PJI) management, particularly after 1-stage exchange for hip PJI, has unclear microbiological implications regarding septic failure.
- Understanding the microbial landscape post-treatment is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate the microbiological characteristics and antibiotic resistance patterns in patients experiencing septic failure after 1-stage exchange for hip PJI.
- To determine if septic failure presents unique microbiological challenges compared to initial infections.
Main Methods:
- Retrospective analysis of 77 patients who underwent 1-stage exchange for hip PJI between 2001-2017.
- Collection and analysis of preoperative and postoperative microbiological data, including pathogen identification and antibiotic susceptibility.
- Evaluation of comorbidities, previous procedures, and time to septic failure.
Main Results:
- In 55% of cases, septic failure was associated with a shift to different causative microorganisms compared to the initial infection.
- A significant decrease in the incidence of polymicrobial infections and infections caused by highly virulent microorganisms was observed.
- While changes in specific resistant strains (e.g., rifampicin-resistant staphylococci) and gram-negative pathogens were noted, they did not reach statistical significance.
Conclusions:
- The frequent emergence of different bacterial species in recurrent hip PJI underscores the importance of repeat microbiological analysis for guiding treatment decisions.
- Current data do not conclusively demonstrate increased microbiological complexity in septic failure after 1-stage exchange.
- Extended follow-up periods are recommended for patients with hip PJI to better understand long-term outcomes and potential microbiological shifts.
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