Related Experiment Video
Updated: Aug 24, 2026
A Periprosthetic Joint Candida albicans Infection Model in Mouse
Published on: February 2, 2024
Microbiologic Patterns Found in Periprosthetic Joint Infections Following Total Joint Arthroplasty Differ Across Race
Pranit Kumaran1, Julian Wier1, Sahil S Telang1
1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Background:
Despite extensive evidence demonstrating race- and sex-based disparities in periprosthetic joint infection (PJI) incidence following total joint arthroplasty, there is a lack of evidence on differences in the microbial profiles of pathogens identified. Our study evaluated the race- and sex-based differential microbial patterns of infecting organisms among patients with PJI.
Methods:
The Premier Healthcare Database was queried from 2016 to 2023 for patients aged ≥18 years who underwent antibiotic spacer placement for a total joint arthroplasty PJI. Microbiology data were extracted from synovial and tissue cultures obtained during the hospital admission. Microbiological profiles were compared with respect to patient race via multivariable logistic regression. Race-sex subanalysis was then conducted via chi-squared testing.
Results:
In total, 9014 patients were identified with 8189 (90.8%) White and 825 (9.2%) Black patients. Black patients had significantly higher adjusted odds of infection by methicillin-resistant Staphylococcus aureus (MRSA) (aOR: 1.45, [1.18-1.79], P < .001) and gram-negative enterics (aOR: 1.45, [1.15-1.85], P = .01). Furthermore, Black males had the highest rates of MRSA infection (15.1%), while Black females had the highest rates of polymicrobial infections (24.3%).
Conclusions:
Black patients had significantly greater risk of MRSA and gram-negative PJIs. Black males had the highest rates of MRSA and gram-negative enteric infection, while Black females exhibited the highest rates of polymicrobial infections. Further research into broader socioeconomic and health access disparities is warranted to explain the observed differences.
Insights
Black patients have a higher risk of periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria. Black males showed the highest MRSA rates, while Black females had the most polymicrobial infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Health Disparities
Background:
- Race and sex disparities in periprosthetic joint infection (PJI) incidence are documented.
- Limited evidence exists on racial and sex differences in PJI microbial profiles.
Purpose of the Study:
- To evaluate race- and sex-based differential microbial patterns of infecting organisms in patients with PJI.
- To identify specific pathogens associated with PJI in different racial and sex groups.
Main Methods:
- Utilized the Premier Healthcare Database (2016-2023) for patients aged ≥18 with PJI requiring antibiotic spacer placement.
- Extracted microbiology data from synovial and tissue cultures during hospital admission.
- Compared microbiological profiles by race using multivariable logistic regression and race-sex subanalysis via chi-squared testing.
Main Results:
- Identified 9014 patients: 90.8% White, 9.2% Black.
- Black patients had higher odds of infection by methicillin-resistant Staphylococcus aureus (MRSA) (aOR: 1.45) and gram-negative enterics (aOR: 1.45).
- Black males had the highest MRSA rates (15.1%); Black females had the highest polymicrobial infection rates (24.3%).
Conclusions:
- Black patients face a significantly greater risk of MRSA and gram-negative PJI.
- Distinct microbial patterns observed: Black males highest for MRSA/gram-negative, Black females for polymicrobial infections.
- Further research into socioeconomic and health access disparities is recommended to explain these findings.
