Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Population
2.3. Data Collection
2.4. Surgical and Antimicrobial Treatment
2.5. Outcomes
2.6. Statistical Analysis
3. Results
3.1. Characteristics Cases and Control Patients
3.2. Clinical Outcome
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
PJI | Periprosthetic Joint Infection |
DAIR | Debridement, Antibiotics, and Implant Retention |
RIC | Regional Infection Cohort |
NINJA | Northern Infection Network Joint Arthroplasty |
Appendix A
Pathogens | Cases | Control Patients |
---|---|---|
Pseudomonas + Proteus hauseri + Other | 1 | |
Pseudomonas + Klebsiella pneumoniae + Other | 1 | |
Pseudomonas + Other | 15 | |
Pseudomonas + Escherichia coli | 5 | |
Pseudomonas + Proteus mirabilis | 3 | |
Pseudomonas + Klebsiella pneumoniae + Proteus mirabilis | 1 | |
Pseudomonas + Staphylococcus aureus | 2 | |
Pseudomonas + Klebsiella oxytoca + Proteus mirabilis | 1 | |
Pseudomonas + Staphylococcus aureus + Other | 2 | |
Pseudomonas + Proteus vulgaris + Other | 1 | |
Pseudomonas + Enterobacter cloacae | 1 | |
Pseudomonas + Escherichia coli + Other | 1 | |
Enterobacter cloacae + Klebsiella pneumoniae + Staphylococcus aureus | 1 | |
Enterobacter cloacae + Proteus mirabilis + Staphylococcus aureus | 1 | |
Escherichia coli + Other | 14 | |
Escherichia coli + Proteus mirabilis + Other | 3 | |
Escherichia coli + Proteus mirabilis + Staphylococcus aureus + Other | 1 | |
Escherichia coli + Staphylococcus aureus | 6 | |
Escherichia coli + Staphylococcus aureus + Other | 7 | |
Escherichia vulneris + Staphylococcus aureus + Other | 1 | |
Klebsiella oxytoca + Other | 3 | |
Klebsiella oxytoca + Proteus mirabilis + Other | 1 | |
Klebsiella oxytoca + Proteus mirabilis + Staphylococcus aureus + Other | 1 | |
Klebsiella oxytoca + Staphylococcus aureus + Other | 2 | |
Klebsiella pneumoniae + Other | 3 | |
Klebsiella pneumoniae + Proteus mirabilis+ Other | 1 | |
Proteus mirabilis + Other | 12 | |
Proteus mirabilis + Staphylococcus aureus | 5 | |
Proteus mirabilis + Staphylococcus aureus + Other | 4 |
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Characteristic | Cases | Control Patients | p-Value |
---|---|---|---|
Median age (IQR), years | 75 (64–82) | 74 (65–83) | 0.598 |
Median BMI (IQR), kg/m2 | 29 (25–35) # | 29 (26–36) ^ | 0.920 |
Male sex, n (%) | 18 (46) | 37 (44) | 0.848 |
ASA classification | |||
ASA I, n (%) | 2 (5.1) | 8 (9.5) | 0.665 |
ASA II, n (%) | 21 (53.8) | 47 (56.0) | |
ASA III–IV, n (%) | 16 (41.1) | 29 (34.5) | |
Involved joint | |||
Knee arthroplasty, n (%) | 13 (33.3) | 24 (28.6) | 0.674 |
Hip arthroplasty, n (%) | 26 (66.7) | 60 (71.4) | |
Type of arthroplasty | |||
Primary arthroplasty, n (%) | 26 (66.7) | 68 (81.0) | 0.110 |
Revision arthroplasty, n (%) | 13 (33.3) | 15 (17.9) | |
Comorbidities | |||
Diabetes mellitus, n (%) | 4 (10.3) | 14 (16.7) ‡ | 0.420 |
Ischemic heart disease, n (%) | 2 (5.1) | 14 (16.7) † | 0.089 |
Immunosuppressant, n (%) | 5 (12.8) | 1 (1.2) $ | 0.013 |
Hypertension, n (%) | 18 (46.2) | 40 (47.6) ¶ | 0.849 |
Rheumatoid arthritis, n (%) | 3 (7.7) | 8 (9.5) ¥ | 1 |
Heart failure, n (%) | 5 (12.8) | 13 (15.5) § | 0.789 |
Use of acenocoumarol, n (%) | 11 (28.2) | 18 (21.4) ¥ | 0.496 |
Chronic obstructive pulmonary disease, n (%) | 5 (12.8) | 15 (17.9) † | 0.603 |
Malignancy, n (%) | 7 (17.9) | 14 (16.7) £ | 1 |
Smoking, n (%) | 7 (17.9) | 9 (10.7) ∨ | 0.388 |
Alcohol use, n (%) | 13 (33.3) | 26 (31.0) ∨ | 0.838 |
Characteristic | Cases | Control Patients | p-Value |
---|---|---|---|
Clinical Presentation | |||
Purulence, n (%) | 5 (12.8) | 13 (15.5) | 0.790 |
Persistent wound leakage, n (%) | 33 (84.6) | 69 (82.1) | 0.803 |
Redness, n (%) | 19 (48.7) | 40 (47.6) | 1 |
Fever (temperature > 38 degrees Celsius), n (%) | 3 (7.7) | 19 (22.6) | 0.074 |
Wound dehiscence, n (%) | 3 (7.7) | 6 (7.1) | 1 |
Hematoma, n (%) | 2 (5.1) | 7 (8.3) | 0.718 |
Septic shock, n (%) | 1 (2.6) | 7 (8.3) | 0.279 |
Necrosis, n (%) | 3 (7.7) | 2 (2.4) | 0.325 |
CRP before first DAIR, mg/L median (IQR) | 48 (8–97) | 75 (27–172) $ | 0.014 |
Leucocytes before first DAIR × 109/L median (IQR). | 8.5 (8–11) † | 10 (9–14) ‡ | 0.046 |
Days between index surgery and first DAIR, n (IQR) | 16 (13–22) | 17 (14–22) | 0.465 |
Polymicrobial, n (%) | 34 (87.2) | 68 (81) | 0.451 |
Surgical and antibiotic treatment | |||
Second DAIR n (%) | 12 (30.8) | 39 (46.4) | 0.118 |
Local gentamicin usage during first DAIR, n (%) | 15 (38.5) | 37 (44.0) $ | 0.561 |
Modular component exchange during first DAIR, n (%) | 16 (41) | 30 (35.7) † | 0.693 |
Intravenous antibiotic treatment <2 weeks, n (%) | 21 (54) | 39 (46) | 0.561 |
Administration of ciprofloxacin, n (%) | 35 (89.7) | 51 (60.7) # | 0.019 |
Use of combination therapy longer than 3 days, n (%) | 5 (12.8) | 26 (31) ^ | 0.014 |
Days of antimicrobial therapy, median (IQR) | 91 (18.3–95.5) † | 92 (20–124.5) ^ | 0.221 |
Pathogens | Cases | Control Patients |
---|---|---|
Pseudomonas, n (%) | 39 (100) | 0 (0) |
Enterobacter cloacae, n (%) | 1 (2.6) | 2 (2.4) |
Escherichia coli, n (%) | 6 (15.4) | 37 (44.6) |
Escherichia vulneris, n (%) | 0 (0) | 1 (1.2) |
Klebsiella oxytoca, n (%) | 1 (2.6) | 9 (10.8) |
Klebsiella pneumoniae, n (%) | 2 (5.1) | 7 (8.4) |
Proteus mirabilis, n (%) | 5 (12.8) | 36 (43.4) |
Proteus hauseri, n (%) | 1 (2.6) | 0 (0) |
Proteus vulgaris, n (%) | 1 (2.6) | 0 (0) |
Staphylococcus aureus, n (%) | 4 (10.6) | 29 (34.9) |
Other, n (%) | 22 (56.4) | 50 (60.2) |
Type | Cases | Control Patients |
---|---|---|
Fluoroquinolones, n (%) | 39 (100) | 84 (100) |
Rifampicin, n (%) | 9 (23.1) | 26 (31.0) |
Amoxicillin, n (%) | 6 (15.4) | 7 (8.3) |
Clindamycin, n (%) | 5 (12.8) | 4 (4.8) |
Amoxicillin/clavulanic acid, n (%) | 2 (5.1) | 5 (6.0) |
Linezolid, n (%) | 2 (5.1) | 3 (3.6) |
Cotrimoxazol, n (%) | 1 (2.6) | 3 (3.6) |
Other, n (%) | 3 (7.7) | 13 (16.2) |
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Liu, W.-Y.; Hendriks, J.G.E.; van Kempen, R.W.T.M.; van der Weegen, W.; Rijnen, W.H.C.; Goosen, J.H.M.; van der Zwaard, B.C.; Pronk, Y.; Zijlstra, W.P.; ten Have, B.L.E.F.; et al. Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli. Microorganisms 2025, 13, 904. https://doi.org/10.3390/microorganisms13040904
Liu W-Y, Hendriks JGE, van Kempen RWTM, van der Weegen W, Rijnen WHC, Goosen JHM, van der Zwaard BC, Pronk Y, Zijlstra WP, ten Have BLEF, et al. Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli. Microorganisms. 2025; 13(4):904. https://doi.org/10.3390/microorganisms13040904
Chicago/Turabian StyleLiu, Wai-Yan, Johannes G. E. Hendriks, Robin W. T. M. van Kempen, Walter van der Weegen, Wim H. C. Rijnen, Jon H. M. Goosen, Babette C. van der Zwaard, Yvette Pronk, Wierd P. Zijlstra, Bas L. E. F. ten Have, and et al. 2025. "Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli" Microorganisms 13, no. 4: 904. https://doi.org/10.3390/microorganisms13040904
APA StyleLiu, W.-Y., Hendriks, J. G. E., van Kempen, R. W. T. M., van der Weegen, W., Rijnen, W. H. C., Goosen, J. H. M., van der Zwaard, B. C., Pronk, Y., Zijlstra, W. P., ten Have, B. L. E. F., Ploegmakers, J. J. W., & Wouthuyzen-Bakker, M. (2025). Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli. Microorganisms, 13(4), 904. https://doi.org/10.3390/microorganisms13040904