Periprosthetic Joint Infection and Concomitant Sepsis: Unveiling Clinical Manifestations, Risk Factors, and Patient...

Area of Science:

• Orthopedics
• Infectious Diseases
• Critical Care Medicine

Background:

• Periprosthetic joint infection (PJI) is a severe complication following hip and knee replacement surgery.
• Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, can arise from PJIs.

Purpose of the Study:

• To investigate the epidemiology, risk factors, and outcomes of sepsis in patients with hip and knee periprosthetic joint infections (PJIs).

Main Methods:

• Sepsis diagnosis utilized the sepsis-1 criteria.
• A cohort of patients with PJI and sepsis was compared to those with PJI alone.
• Risk factors (patient characteristics, microbiology, comorbidities) and outcomes (mortality, hospital/ICU stay) were analyzed.

Main Results:

• 40.6% of 108 PJIs met sepsis criteria. Hip PJI with sepsis showed higher comorbidity (CCI 4.0 vs 1.0) and Staphylococcus aureus prevalence. Renal and cardiac diseases increased sepsis risk.
• Knee PJI with sepsis also had higher S. aureus rates. Atrial fibrillation and renal disease were associated with sepsis. Septic cases experienced longer hospital stays and higher ICU admissions.
• In-hospital mortality was significantly higher in the sepsis cohort for both hip (23.5% vs 3.2%) and knee (25.0% vs 3.3%) PJIs.

Conclusions:

• A significant proportion of PJIs develop into sepsis, leading to substantially increased mortality.
• Close patient monitoring is essential to identify deteriorating conditions promptly.
• Timely, sepsis-like interventions are critical to reduce morbidity and mortality in PJI patients.