The microbial profile of infected endoprosthetic reconstructions after wide excision for patients with
Rishi Trikha1, Danielle Greig1, Troy Sekimura1
1Department of Orthopaedic Surgery at the University of California, Santa Monica, California, USA.
Background And Objectives:
Periprosthetic infection is a devastating complication following endoprosthetic reconstruction. This study utilized a large database of endoprostheses to describe the incidence, risk factors, and microbial profile of such infections to better catalogue and understand these catastrophic events.
Methods:
A retrospective review of endoprosthetic reconstructions for an oncologic indication from January 1, 1981 to December 31, 2020 was performed. Demographic, oncologic, procedural and outcome data was analyzed. Multivariable logistic regression was used to identify potential risk factors for infection with significance defined as p < 0.05.
Results:
Forty four out of 712 (6.2%) reconstructions resulted in infection at a mean time of 39.9 ± 44.5 months. Revision surgery (odds ratio [OR] 6.14, p < 0.001) or having a postoperative wound complication (OR 7.67, p < 0.001) were significantly associated with infection. Staphylococcus aureus and Staphylococcus epidermidis were the most commonly cultured organisms at a rate of 34.1% (15/44) and 22.7% (10/44), respectively. Ten infections resulted in amputation; five due to antimicrobial-resistant infections and three due to polymicrobial infections.
Conclusion:
Understanding the microbial profile of patients undergoing endoprosthetic reconstruction is paramount. This study demonstrates a relatively high rate of polymicrobial and antibiotic-resistant infections that portend worse outcomes, thus suggesting that pathogen-specific infectious practices may be warranted.
Level Of Evidence:
Retrospective cohort study, level III.
Insights
Periprosthetic infections after endoprosthetic reconstruction occur in 6.2% of cases. Revision surgery and wound complications are key risk factors for these infections, often caused by Staphylococcus species.
Area of Science:
- Orthopedic Surgery
- Oncology
- Infectious Diseases
Background:
- Periprosthetic infection is a severe complication following endoprosthetic reconstruction.
- Understanding infection incidence, risk factors, and microbial profiles is crucial.
Purpose of the Study:
- To describe the incidence, risk factors, and microbial profile of periprosthetic infections after oncologic endoprosthetic reconstruction.
- To identify factors associated with these infections to improve patient outcomes.
Main Methods:
- Retrospective review of 712 endoprosthetic reconstructions for oncologic indications (1981-2020).
- Analysis of demographic, oncologic, procedural, and outcome data.
- Multivariable logistic regression to identify infection risk factors (p < 0.05).
Main Results:
- Infection occurred in 6.2% (44/712) of reconstructions at a mean of 39.9 months post-surgery.
- Revision surgery (OR 6.14) and postoperative wound complications (OR 7.67) were significant risk factors.
- Staphylococcus aureus (34.1%) and S. epidermidis (22.7%) were most common; 10 infections led to amputation, including antimicrobial-resistant and polymicrobial cases.
Conclusions:
- A significant rate of periprosthetic infections, including polymicrobial and antibiotic-resistant types, was observed.
- These infections are associated with worse outcomes, including amputation.
- Pathogen-specific infectious practices may be warranted for endoprosthetic reconstructions.
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