Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip
Open Access
- 7 July 2016
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of Orthopaedics and Traumatology
- Vol. 17 (4), 369-376
- https://doi.org/10.1007/s10195-016-0417-8
Abstract
Background The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery. Materials and methods A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups—135 with monomicrobial and 54 with polymicrobial infection. Results Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m2 (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0–10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0–27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18–16.37; p = 0.03). Conclusions Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful. Level of evidence Level III, therapeutic study.Keywords
Funding Information
- Ministry of Health of the Russian Federation (115030510010)
This publication has 27 references indexed in Scilit:
- Comparison of One-Stage Revision With Antibiotic Cement Versus Two-Stage Revision Results for Infected Total Hip ArthroplastyThe Journal of Arthroplasty, 2013
- The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form BiofilmsJournal of Clinical and Diagnostic Research, 2013
- Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?Antimicrobial Agents and Chemotherapy, 2012
- Gram‐Negative Prosthetic Joint Infections: Risk Factors and Outcome of TreatmentClinical Infectious Diseases, 2009
- Polymicrobial Prosthetic Joint Infections: Risk Factors and OutcomeClinical Orthopaedics and Related Research, 2008
- Obesity is a Major Risk Factor for Prosthetic Infection after Primary Hip ArthroplastyClinical Orthopaedics and Related Research, 2008
- Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retentionJournal of Infection, 2007
- Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030The Journal of Bone & Joint Surgery, 2007
- Value of Preoperative Investigations in Diagnosing Prosthetic Joint Infection: Retrospective Cohort Study and Literature ReviewScandinavian Journal of Infectious Diseases, 2004
- Risk Factors for Prosthetic Joint Infection: Case‐Control StudyClinical Infectious Diseases, 1998