Outcomes After Pseudomonas Prosthetic Joint Infections

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Pseudomonas species are difficult-to-treat pathogens in prosthetic joint infections (PJIs).
• Limited antibiotic options and biofilm formation complicate Pseudomonas PJI management.
• This study evaluates single-institution outcomes and reviews existing literature on Pseudomonas PJIs.

Purpose of the Study:

• To assess treatment outcomes for Pseudomonas PJIs at a single institution.
• To compare outcomes of monomicrobial versus polymicrobial Pseudomonas PJIs.
• To review current literature on Pseudomonas PJI management and clearance rates.

Main Methods:

• Retrospective evaluation of 42 patients with hip or knee PJIs caused by Pseudomonas.
• Analysis of infection clearance at 1 year post-treatment.
• Separate analysis for monomicrobial and polymicrobial infections.
• Focused literature review on Pseudomonas PJI outcomes.

Main Results:

• One-year infection clearance was 58% for monomicrobial and 35% for polymicrobial PJIs.
• For monomicrobial PJIs, DAIR had 63% success, and two-stage exchange had 55%.
• Polymicrobial infections were more common (55%) with a 44% mortality rate.
• Antipseudomonal resistance occurred in 16% of cases.

Conclusions:

• Pseudomonas PJIs, often polymicrobial, are difficult to eradicate.
• DAIR demonstrated favorable infection clearance (63-80%) in literature review.
• Two-stage revision showed variable clearance rates (33-83%) in literature review.