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Updated: Aug 27, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Changes in microbiological spectrum and antibiotic susceptibility in two-stage exchange for periprosthetic shoulder
Paul Siegert1,2, Bernhard J H Frank3, Sebastian Simon3
11st Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria. paul.siegert@oss.at.
Background:
Periprosthetic joint infections (PJI) are a major concern in shoulder arthroplasty, which in some cases require two-stage exchange. While it was shown that low-virulence bacteria are the most isolated pathogens in shoulder PJI, little is known about changes in microbiological spectrum and resistance patterns during two-stage revision.
Methods:
This retrospective study included all patients (n = 25) who received a two-stage revision from January 2011 to December 2020 for shoulder PJI in one institution. Microbiological spectrum, antimicrobial resistance patterns, and re-revision rates of culture positive first- and second-stage procedures were analyzed. The mean follow-up time was 29.7 months (range 8; 115 months). At final follow-up, subjective shoulder value (SSV) and visual analog scale (VAS) score for pain and satisfaction with the surgery were assessed.
Results:
In 25 patients, a total of 54 2-stage exchange procedures were performed and positive cultures were obtained in 36 of these surgeries (66.7%). A total of 7 out of 25 patients (28.0%) showed a positive microbiological culture at first and second stages. In those patients, the mean time between first and second stages was 30.9 weeks (range 6; 70). Three out of those seven patients (42.9%) had a polymicrobial spectrum with one microorganism persistent at stage two, including Cutibacterium acnes (n = 1) and Staphylococcus epidermidis (MRSE) (n = 2). In all these cases, antimicrobial resistance patterns changed. All cultures with monomicrobial spectrum (n = 4) at first stage showed a changed spectrum. Patients with positive first- and second-stage revisions showed a mean SSV of 49.3% ± 23.5 versus 52.9% ± 29.5 in single positive patients (p = 0.76). Re-revision was performed in five cases, two of those in patients with positive first- and second-stage cultures.
Conclusion:
There is a high rate of changes in microbiological spectrum and resistance patterns between culture positive first- and second-stage procedures as well as subsequent re-revisions. Intraoperative samples during reimplantation should be taken and resistance reconsidered in case of re-revision.
Insights
Periprosthetic joint infections (PJI) in shoulder arthroplasty revision show significant changes in bacterial spectrum and antimicrobial resistance between stages. Re-evaluating resistance is crucial for managing persistent infections and reducing re-revision rates.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infections (PJI) are a significant complication following shoulder arthroplasty, often necessitating two-stage exchange procedures.
- Low-virulence bacteria are commonly implicated in shoulder PJI, yet the evolution of microbial profiles and resistance during staged revision remains underexplored.
Purpose of the Study:
- To investigate the changes in microbiological spectrum and antimicrobial resistance patterns during two-stage revision for shoulder PJI.
- To analyze re-revision rates in relation to microbiological findings in staged procedures.
Main Methods:
- A retrospective analysis of 25 patients undergoing two-stage revision for shoulder PJI between 2011 and 2020.
- Evaluation of microbiological cultures, antimicrobial resistance, and re-revision rates from both first and second stages.
- Assessment of patient outcomes including Subjective Shoulder Value (SSV) and Visual Analog Scale (VAS) scores.
Main Results:
- Positive cultures were obtained in 66.7% of the 54 procedures. 28% of patients had positive cultures at both stages, with mean time between stages of 30.9 weeks.
- Polymicrobial infections were observed in 42.9% of patients with positive cultures at both stages, often with one persistent microorganism (e.g., Cutibacterium acnes, MRSE).
- Antimicrobial resistance patterns frequently changed between stages. Re-revision occurred in five cases, two of which involved patients with positive cultures at both stages.
Conclusions:
- Significant shifts in microbiological spectrum and antimicrobial resistance occur between the first and second stages of shoulder PJI revision.
- Intraoperative sampling during reimplantation is recommended to guide appropriate antibiotic selection.
- Reconsidering antimicrobial resistance is essential in cases requiring re-revision to improve treatment efficacy.
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