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The Most Common Organisms in Periprosthetic Joint Infection: A Survey of the International Orthopaedic Device
Stephen D Graham1, Joseph Serino2, Kayla T Hietpas1
1OrthoCarolina Research Institute, Charlotte, North Carolina.
Background:
Periprosthetic joint infection (PJI) remains a major source of morbidity, mortality, and economic burden, both in the United States and internationally. Understanding regional microbiology profiles in PJI is essential to assist with empiric antibiotic selection. The purpose of this study was to survey an international database to identify and compare the microbiological profile of hip and knee PJI across international sites.
Methods:
A multicenter, international database that included all patients admitted to participating hospitals who had a confirmed diagnosis of PJI was utilized. In the present study, data from four institutions in the following cities were retrospectively reviewed: Melbourne (Australia, n = 167), Groningen (the Netherlands, n = 117), Weston (Florida, United States of America, n = 201), and Charlotte (North Carolina, United States of America, n = 180). The most common organisms identified in hip and knee PJI were compared between institutions. Rates of polymicrobial, fungal, and culture-negative PJI specifically were also evaluated. A total of 665 patients who had PJI were included (311 hip and 354 knee).
Results:
Coagulase-negative staphylococci were the most frequently isolated pathogens across all centers (26.5 to 38%), followed by Staphylococcus aureus (13 to 27%). Rates of polymicrobial PJI were high and varied widely between institutions (14 to 51%), whereas rates of fungal PJI were low and consistent between regions (1 to 3%). The prevalence of culture-negative PJI varied between 8% (Australia) and 22% (Florida).
Conclusions:
While subtle regional differences in the microbiology of PJI exist, Staphylococcus species remained the dominant pathogen, accounting for nearly half of the PJIs at each center. Differences in polymicrobial and culture-negative infections emphasize the impact of institutional and geographic factors, supporting the development of region-specific empiric and prophylactic antibiotic protocols.
Insights
Staphylococcus species are the leading cause of periprosthetic joint infection (PJI) worldwide. Regional differences in polymicrobial and culture-negative PJI highlight the need for location-specific antibiotic strategies.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) causes significant morbidity and economic burden globally.
- Understanding regional microbial patterns is crucial for effective empiric antibiotic therapy in PJI.
Purpose of the Study:
- To survey an international database and compare the microbiological profiles of hip and knee PJI across different global sites.
Main Methods:
- Retrospective review of a multi-center international database of 665 patients with confirmed PJI.
- Data analyzed from four institutions in Australia, the Netherlands, and the USA.
- Comparison of common organisms, polymicrobial, fungal, and culture-negative PJI rates between institutions.
Main Results:
- Coagulase-negative staphylococci (CoNS) and Staphylococcus aureus were the most common pathogens.
- Rates of polymicrobial PJI varied significantly (14-51%), while fungal PJI rates were consistently low (1-3%).
- Culture-negative PJI prevalence ranged from 8% in Australia to 22% in Florida, USA.
Conclusions:
- Staphylococcus species dominate PJI microbiology internationally, comprising nearly half of infections.
- Significant institutional and geographic variations in polymicrobial and culture-negative PJI exist.
- Development of region-specific empiric and prophylactic antibiotic protocols for PJI is supported.
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