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Updated: May 22, 2025
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Microbiologic features of prosthetic joint infections at a tertiary referral orthopaedic unit
Stephen Christopher Murphy1,2, Shane P Russell3,4,5, James A Harty3,4,5
1Cork University Hospital, Cork, Ireland. Sfmurphy101@gmail.com.
Background:
Prosthetic joint infections (PJI) are a potential devasting consequence of arthroplasty surgery. Knowledge of the causative organism and antimicrobial sensitivity increases eradication success rates for PJI.
Aims:
This study aimed to: 1) Observe the PJI microbiome at a tertiary referral arthroplasty unit; 2) Make comparison to similar published observations; and; 3) Establish empiric local antibiotic PJI guidelines.
Methods:
All patients with positive tissue cultures for PJIs over a 4 year period were included. An electronic microbiology laboratory database search was performed to identify isolated microorganisms, sensitivities and resistances. Time from index procedure to PJI onset was recorded. The identified PJI microbiome was compared to current literature.
Results:
86 patients involving 88 joints were included. 56% (n = 49) related to hip, 42% (n = 37) to knee and 2% (2) to shoulder arthroplasty procedures. Coagulase Negative Staphylococci (CoNS) were isolated in 32% of cases, Staphylococcus aureus (SA) in 23%, Enterococcus species and Streptococcus species in 9.0%. 19% of case occurred within 3 months of index surgery, 17% from 3-12 months and 64% after 12 months. The microbiome identified varied comparable studies.
Conclusion:
This study describes a local PJI microbiome with contrasting results from comparable studies. Empiric antibiotic guidelines have been established to target treatment and a local PJI register has since been established to improve patient outcomes and antimicrobial stewardship in an era of antibiotic resistance.
Insights
Prosthetic joint infections (PJI) are a serious complication of joint replacement surgery. This study identified the local PJI microbiome and established new antibiotic guidelines to improve treatment outcomes and combat resistance.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Prosthetic joint infections (PJI) pose a significant challenge following arthroplasty surgery.
- Understanding the causative microorganisms and their antimicrobial sensitivities is crucial for successful PJI eradication.
Purpose of the Study:
- To characterize the PJI microbiome at a specialized arthroplasty unit.
- To compare local findings with existing literature on PJI microbiomes.
- To develop evidence-based, empiric antibiotic guidelines for PJI treatment.
Main Methods:
- A retrospective analysis of patients with positive PJI tissue cultures over four years.
- Utilized an electronic microbiology database to identify microorganisms, sensitivities, and resistances.
- Recorded the time interval between the index arthroplasty procedure and PJI onset.
Main Results:
- 88 joints across 86 patients were included, predominantly hip (56%) and knee (42%) arthroplasties.
- Coagulase-negative Staphylococci (32%) and Staphylococcus aureus (23%) were the most common pathogens.
- The majority of PJIs (64%) occurred more than 12 months post-surgery, with a distinct microbiome profile compared to literature.
Conclusions:
- The study delineates a unique local PJI microbiome, differing from previously published data.
- New empiric antibiotic guidelines were established to optimize PJI management.
- A local PJI registry was created to enhance patient outcomes and antimicrobial stewardship amidst rising antibiotic resistance.
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