Prevalence and Risk Factors for Superinfection with a Difficult-to-Treat Pathogen in Periprosthetic Joint Infections

Area of Science:

• Orthopedics
• Infectious Diseases
• Surgical Infections

Background:

• Periprosthetic joint infections (PJIs) are severe complications following total joint arthroplasty.
• Difficult-to-treat (DTT) pathogens pose significant challenges in PJI management.
• Understanding the prevalence and risk factors for DTT PJI and superinfections is critical.

Purpose of the Study:

• To evaluate the prevalence of PJI caused by DTT pathogens.
• To assess the incidence of PJI with DTT pathogen superinfection.
• To identify risk factors associated with DTT PJI and superinfections.

Main Methods:

• Retrospective observational single-center study of 169 PJI patients.
• Categorization of PJIs into DTT, DTT superinfection, non-DTT, and superinfection groups.
• Analysis of patient demographics, clinical parameters (BMI, CRP, ASA, CCI), and infection characteristics.

Main Results:

• 46.2% of PJIs were caused by DTT pathogens; 30.8% involved superinfections.
• Elevated CRP (≥92.1 mg/L) significantly increased DTT PJI likelihood (OR 6.981).
• Hip joint involvement (OR 3.478), ≥3 revision surgeries (OR 1.288), and chronic PJI (OR 3.449) were associated with higher DTT PJI/superinfection risks.

Conclusions:

• High prevalence of DTT pathogens and superinfections in PJI cases.
• Elevated CRP, hip involvement, multiple revisions, and chronic infection are key risk factors.
• Emphasizes the need for early high-risk patient identification and tailored management strategies for DTT PJIs.