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Updated: Aug 10, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint
Tiancong Ma1,2, Jinyang Lyu1,2, Jingchun Ma1
1Department of Orthopaedic Surgery Huashan Hospital Fudan University, 12Th Wulumuqi Middle Road, Jing'an District, Shanghai, China.
Background:
The purpose of this study is to investigate the microbial patterns of periprosthetic joint infection (PJI) and fracture-related infection (FRI), and guide for the formulation of more accurate empirical antimicrobial regimens based on the differences in pathogen distribution.
Methods:
A comparative analysis of pathogen distribution was conducted between 153 patients (76 with PJI and 77 with FRI). Predicted analyses against isolated pathogens from two cohorts were conducted to evaluate the best expected efficacy of empirical antimicrobial regimens (imipenem + vancomycin, ciprofloxacin + vancomycin, and piperacillin/tazobactam + vancomycin).
Results:
Our study found significant differences in pathogen distribution between the PJI and FRI cohorts. Staphylococci (61.3% vs. 31.9%, p = 0.001) and Gram-negative bacilli (GNB, 26.7% vs. 56.4%, p < 0.001) were responsible for the majority of infections both in the PJI and FRI cohorts, and their distribution in the two cohorts showed a significant difference (p < 0.001). Multi-drug resistant organisms (MDRO) were more frequently detected in the FRI cohort (29.3% vs. 44.7%, p = 0.041), while methicillin-resistant coagulase-negative Staphylococci (MRCoNS, 26.7% vs. 8.5%, p = 0.002) and Canidia albicans (8.0% vs. 1.1%, p = 0.045) were more frequently detected in the PJI cohort. Enterobacter spp. and Acinetobacter baumannii were detected only in the FRI cohort (11.7% and 8.5%, respectively).
Conclusions:
Staphylococci and GNB were responsible for the majority of infections in both PJI and FRI. Empirical antimicrobial therapy should focus on the coverage of Staphylococci in PJI and GNB in FRI, and infections caused by MDROs should be more vigilant in FRI, while the high incidence of MRCoNS in PJI should be noted, which could guide for the formulation of more accurate empirical antimicrobial regimens. Targeted therapy for FRI caused by A. baumannii and PJI caused by C. albicans needs to be further investigated. Our study reports significant differences in pathogen distribution between the two infections and provides clinical evidence for studies on the mechanism of implant-associated infection.
Insights
This study reveals distinct microbial patterns in periprosthetic joint infections (PJI) and fracture-related infections (FRI), guiding tailored empirical antimicrobial strategies. Key differences in Staphylococci and Gram-negative bacilli (GNB) prevalence inform targeted treatment for these implant-associated infections.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Microbiology
Background:
- Periprosthetic joint infection (PJI) and fracture-related infection (FRI) are significant complications following orthopedic procedures.
- Understanding the distinct microbial profiles of PJI and FRI is crucial for effective treatment.
Purpose of the Study:
- To investigate and compare the microbial patterns in PJI and FRI.
- To guide the development of more accurate empirical antimicrobial regimens based on pathogen distribution differences.
Main Methods:
- A comparative analysis of pathogen distribution was performed on 153 patients (76 with PJI, 77 with FRI).
- Predicted efficacy of empirical antimicrobial regimens (imipenem + vancomycin, ciprofloxacin + vancomycin, piperacillin/tazobactam + vancomycin) was evaluated against isolated pathogens.
Main Results:
- Significant differences in pathogen distribution were observed between PJI and FRI cohorts.
- Staphylococci were more prevalent in PJI (61.3%) compared to FRI (31.9%), while Gram-negative bacilli (GNB) were more common in FRI (56.4%) than PJI (26.7%).
- Multi-drug resistant organisms (MDRO) were more frequent in FRI (44.7%), whereas methicillin-resistant coagulase-negative Staphylococci (MRCoNS) and Candida albicans were more common in PJI.
Conclusions:
- Empirical antimicrobial therapy should target Staphylococci in PJI and GNB in FRI.
- Vigilance for MDROs in FRI and MRCoNS in PJI is recommended for optimizing treatment.
- Further research is needed for targeted therapies against specific pathogens like Acinetobacter baumannii in FRI and Candida albicans in PJI.
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