Increased Polymicrobial Infection Rates and Associated Mortality in Patients With Chronic Gastrointestinal Disease...

Emerging evidence has identified gut dysbiosis, as a contributor to periprosthetic joint infection (PJI) risk. Chronic gastrointestinal (CGI) disease may result in unique causative organisms in PJI. As such, the present study sought to compare the infective organisms of PJI patients presenting with or without CGI disease.

The Premier Healthcare Database was retrospectively queried to identify patients (≥18 years) who underwent spacer placement for PJI following total hip or knee arthroplasty between January 2016 and December 2023. Multivariable logistic regression models accounting for joint (hip or knee), sex, and Charlson Comorbidity Index were used to calculate the odds of isolating a particular bacterial species in CGI disease. A subanalysis of patients with polymicrobial infections was conducted to determine rates and adjusted odds of inpatient 90-day mortality.

A total of 9756 patients undergoing antibiotic spacer placement for PJI were identified. Of which, 339 (3.5%) had a history of CGI disease and 9417 (96.5%) had no history of CGI disease. When compared to patients without CGI disease, patients with CGI disease were at a 1.6 (95% confidence interval (CI) = 1.1-2.3) and 4.7 (95% CI = 1.3-16.6) times higher adjusted odds of polymicrobial and Clostridial infection. In the cohort of patients with polymicrobial infections, 7.5-times (95% CI = 3.7-15.3) greater adjusted odds of death was observed when compared to patients without CGI disease (14 patients [13.2%] vs 31 patients [1.4%]).

CGI disease was associated with significantly higher odds of polymicrobial infections and Clostridial species.

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