The Challenge of Emerging Resistant Gram-Positive Pathogens in Hip and Knee Periprosthetic Joint Infections

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Increasing prevalence of antibiotic-resistant bacterial pathogens over the past four decades.
• Periprosthetic joint infection (PJI) poses a significant challenge in orthopedic surgery.
• The need for optimized diagnostic and therapeutic strategies to combat resistant infections.

Purpose of the Study:

• To provide recommendations for the prevention and management of periprosthetic joint infections (PJI).
• To address the growing issue of bacterial resistance in the context of orthopedic procedures.
• To highlight the importance of appropriate microbiological techniques and antimicrobial stewardship.

Main Methods:

• Review of current literature and guidelines on PJI prevention and treatment.
• Emphasis on careful patient selection and risk factor modification prior to elective surgery.
• Recommendation of specific microbiological methods, including those for Cutibacterium acnes detection.

Main Results:

• Advocates for appropriate selection and judicious duration of antimicrobial agents to prevent resistance.
• Recommends molecular diagnostic methods (PCR, 16S sequencing, whole-genome sequencing) for culture-negative PJI cases.
• Stresses the value of infectious disease specialist consultation for optimal patient management.

Conclusions:

• Proactive measures, including patient optimization and precise microbiological diagnosis, are crucial for PJI management.
• Antimicrobial stewardship and advanced molecular diagnostics are essential to combat resistant pathogens.
• Multidisciplinary collaboration, including infectious disease specialists, improves outcomes in PJI patients.