Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients
Abstract Introduction The management of periprosthetic joint infections (PJI) of the lower limb is challenging, and evidence-based recommendations are lacking. The present clinical investigation characterized the pathogens diagnosed in patients who underwent revision surgery for PJI of total hip ar...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-023-01138-y |
| _version_ | 1797822987547705344 |
|---|---|
| author | Filippo Migliorini Christian David Weber Andreas Bell Marcel Betsch Nicola Maffulli Vanessa Poth Ulf Krister Hofmann Frank Hildebrand Arne Driessen |
| author_facet | Filippo Migliorini Christian David Weber Andreas Bell Marcel Betsch Nicola Maffulli Vanessa Poth Ulf Krister Hofmann Frank Hildebrand Arne Driessen |
| author_sort | Filippo Migliorini |
| collection | DOAJ |
| description | Abstract Introduction The management of periprosthetic joint infections (PJI) of the lower limb is challenging, and evidence-based recommendations are lacking. The present clinical investigation characterized the pathogens diagnosed in patients who underwent revision surgery for PJI of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods The present study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The institutional databases of the RWTH University Medical Centre of Aachen, Germany, were accessed. The OPS (operation and procedure codes) 5–823 and 5–821 and the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8 were used. All patients with PJI of a previous THA and TKA who underwent revision surgery were retrieved and included for analysis. Results Data from 346 patients were collected (181 THAs and 165 TKAs). 44% (152 of 346 patients) were women. Overall, the mean age at operation was 67.8 years, and the mean BMI was 29.2 kg/m2. The mean hospitalization length was 23.5 days. 38% (132 of 346) of patients presented a recurrent infection. Conclusion PJI remain a frequent cause for revisions after total hip and knee arthroplasty. Preoperative synovial fluid aspiration was positive in 37%, intraoperative microbiology was positive in 85%, and bacteraemia was present in 17% of patients. Septic shock was the major cause of in-hospital mortality. The most common cultured pathogens were Staph. epidermidis, Staph. aureus, Enterococcus faecalis, and Methicillin-resistant Staph aureus (MRSA). An improved understanding of PJI pathogens is important to plan treatment strategies and guide the choice of empirical antibiotic regimens in patients presenting with septic THAs and TKAs. Level of Evidence: Level III, retrospective cohort study. |
| first_indexed | 2024-03-13T10:17:22Z |
| format | Article |
| id | doaj.art-fb1eeb6f74e64c9bb001e0839fde4f2a |
| institution | Directory Open Access Journal |
| issn | 2047-783X |
| language | English |
| last_indexed | 2024-03-13T10:17:22Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj.art-fb1eeb6f74e64c9bb001e0839fde4f2a2023-05-21T11:11:52ZengBMCEuropean Journal of Medical Research2047-783X2023-05-012811710.1186/s40001-023-01138-yBacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patientsFilippo Migliorini0Christian David Weber1Andreas Bell2Marcel Betsch3Nicola Maffulli4Vanessa Poth5Ulf Krister Hofmann6Frank Hildebrand7Arne Driessen8Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalDepartment of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalDepartment of Orthopaedic and Trauma SurgeryDepartment of Orthopaedic and Trauma Surgery, University Hospital of ErlangenDepartment of Medicine, Surgery and Dentistry, University of SalernoDepartment of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalDepartment of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalDepartment of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalDepartment of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University HospitalAbstract Introduction The management of periprosthetic joint infections (PJI) of the lower limb is challenging, and evidence-based recommendations are lacking. The present clinical investigation characterized the pathogens diagnosed in patients who underwent revision surgery for PJI of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods The present study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The institutional databases of the RWTH University Medical Centre of Aachen, Germany, were accessed. The OPS (operation and procedure codes) 5–823 and 5–821 and the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8 were used. All patients with PJI of a previous THA and TKA who underwent revision surgery were retrieved and included for analysis. Results Data from 346 patients were collected (181 THAs and 165 TKAs). 44% (152 of 346 patients) were women. Overall, the mean age at operation was 67.8 years, and the mean BMI was 29.2 kg/m2. The mean hospitalization length was 23.5 days. 38% (132 of 346) of patients presented a recurrent infection. Conclusion PJI remain a frequent cause for revisions after total hip and knee arthroplasty. Preoperative synovial fluid aspiration was positive in 37%, intraoperative microbiology was positive in 85%, and bacteraemia was present in 17% of patients. Septic shock was the major cause of in-hospital mortality. The most common cultured pathogens were Staph. epidermidis, Staph. aureus, Enterococcus faecalis, and Methicillin-resistant Staph aureus (MRSA). An improved understanding of PJI pathogens is important to plan treatment strategies and guide the choice of empirical antibiotic regimens in patients presenting with septic THAs and TKAs. Level of Evidence: Level III, retrospective cohort study.https://doi.org/10.1186/s40001-023-01138-yArthroplastyPathogensMortalityKneeHipInfection |
| spellingShingle | Filippo Migliorini Christian David Weber Andreas Bell Marcel Betsch Nicola Maffulli Vanessa Poth Ulf Krister Hofmann Frank Hildebrand Arne Driessen Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients European Journal of Medical Research Arthroplasty Pathogens Mortality Knee Hip Infection |
| title | Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients |
| title_full | Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients |
| title_fullStr | Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients |
| title_full_unstemmed | Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients |
| title_short | Bacterial pathogens and in-hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee: analysis of 346 patients |
| title_sort | bacterial pathogens and in hospital mortality in revision surgery for periprosthetic joint infection of the hip and knee analysis of 346 patients |
| topic | Arthroplasty Pathogens Mortality Knee Hip Infection |
| url | https://doi.org/10.1186/s40001-023-01138-y |
| work_keys_str_mv | AT filippomigliorini bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT christiandavidweber bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT andreasbell bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT marcelbetsch bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT nicolamaffulli bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT vanessapoth bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT ulfkristerhofmann bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT frankhildebrand bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients AT arnedriessen bacterialpathogensandinhospitalmortalityinrevisionsurgeryforperiprostheticjointinfectionofthehipandkneeanalysisof346patients |