Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections
Abstract
:1. Introduction
2. Results
3. Discussion
- PJI caused initially by a non-DTT micro-organism where no pathogen switch is detected in the entire course of the infection (Group 1);
- PJI caused initially by a DTT micro-organism from the start, detected in the first surgical revision where no pathogen switch is detected in the entire course of the infection (Group 2);
- PJI caused initially by a non-DTT micro-organism with a superinfection or pathogen switch to another non-DTT pathogen in the course of the infection (Group 4);
- PJI caused initially by a non-DTT micro-organism with a superinfection or pathogen switch to a DTT pathogen in the course of the infection (Group 3).
4. Materials and Methods
4.1. Study Population
4.2. Periprosthetic Joint Infection and DTT Pathogens
- Group 1: PJI with an initial detection of a non-DTT pathogen and no superinfection;
- Group 2: PJI with an initial detection of a DTT pathogen and no superinfection;
- Group 3: PJI with an initial detection of a non-DTT pathogen and a DTT superinfection item;
- Group 4: PJI with an initial detection of a non-DTT pathogen and a non-DTT superinfection.
4.3. Recorded Parameters
4.4. Surgical Treatment
4.5. Antimicrobial Treatment Regime
4.6. Outcome
- Free of infection:
- ○
- Definitely free of infection: CRP < 10 mg/L, no clinical signs of infection, follow-up more than 2 years;
- ○
- Probably free of infection: CRP < 10 mg/L, no clinical signs of infection, follow-up less than 2 years;
- Therapy failure:
- ○
- Recurrence: Recurrence of the infection caused by the same pathogen or without evidence of pathogens;
- ○
- New infection: Recurrence of the infection caused by a new pathogen;
- ○
- Change of the surgical treatment regimen to resection arthroplasty, amputation, or chronic antibiotic suppression;
- Death due to sepsis;
- Death due to a non-PJI-related cause.
4.7. Statistical Analysis
4.8. Ethics Approval
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patient Characteristics | Total (n = 169) | Group 1 (n = 91) | Group 2 (n = 54) | Group 3 (n = 24) | Group 4 (n = 16) | p-Value * | ||
---|---|---|---|---|---|---|---|---|
Age | Mean ± SD (range) | 71.1 ± 13.1 (20–97) | 70.6 ± 13.9 (20–93) | 71.75 ± 10.9 (48–89) | 71.1 ± 14.6 (35–97) | 65.9 ± 10.9 (50–86) | 0.6809 | |
Sex | Female | n (%) | 84 (49.7%) | 47 (51.7%) | 28 (51.9%) | 9 (37.5%) | 6 (37.5%) | 0.5898 |
Male | 85 (50.3%) | 44 (48.3%) | 26 (48.1%) | 15 (62.5%) | 10 (62.5%) | |||
Side | Right | n (%) | 81 (47.9%) | 38 (41.8%) | 26 (48.1%) | 15 (62.5%) | 5 (31.3%) | 0.2663 |
Left | 88 (52.1%) | 53 (58.2%) | 28 (51.9%) | 9 (37.5%) | 11 (68.7%) | |||
Affected joint | Hip | n (%) | 89 (52.5%) | 39 (43.4%) | 34 (63%) | 15 (61.9%) | 5 (30.8%) | 0.8602 |
Knee | 80 (47.5%) | 52 (56.6%) | 20 (37%) | 9 (38.1%) | 11 (69.2%) | |||
BMI (Kg/m2) | Mean ± SD (range) | 29.5 ± 6.5 (16.4–46.8) | 28.8 ± 6.5 (17.6–46.8) | 30.7 ± 6.3 (16.4–45.1) | 29.5 ± 6.7 (18.5–42.3) | 31.7 ± 7 (20–44.1) | 0.3324 | |
ASA Score | Median ± SD | 3 ± 0.6 | 3 ± 0.6 | 3 ± 0.6 | 3 ± 0.8 | 2.5 ± 0.5 | 0.7147 | |
Anti- coagulation | Yes | n (%) | 67 (39.5%) | 31 (34.1%) | 24 (44.4%) | 13 (54.2%) | 2 (12.5%) | 0.0743 |
No | 102 (60.5%) | 60 (65.9%) | 30 (55.6%) | 11 (45.8%) | 14 (87.5%) |
Parameters | Total (n = 169) | Group 1 (n = 91) | Group 2 (n = 54) | Group 3 (n = 24) | Group 4 (n = 16) | p-Value * | ||
---|---|---|---|---|---|---|---|---|
Treatment before admission | Antibiotic | n (%) | 24 (14.2%) | 13 (14.3%) | 6 (11.1%) | 5 (20.8%) | 2 (12.5%) | 0.8534 |
Surgical | 25 (14.8%) | 11 (12.1%) | 6 (11.1%) | 5 (20.8%) | 2 (12.5%) | |||
Antibiotic treatment | Total duration in days | Mean ± SD (range) | 54.8 ± 36.7 (4–228) | 46.3 ± 29.5 (4–217) | 61.1 ± 39.7 (4–181) | 71.2 ± 45.2 (14–228) | 64.3 ± 47.3 (22–217) | 0.0023 |
Surgical treatment |
| n (%) | 66 (40.7%) | 44 (52.4%) | 15 (28.8%) | 7 (30.2%) | 4 (25%) | 0.0080 |
| 75 (46.3%) | 33 (39.3%) | 31 (57.4%) | 11 (45.8%) | 12 (75%) | |||
| 21 (13%) | 7 (8.3%) | 8 (14.8%) | 6 (24%) | 0 | |||
Replantation after prosthesis removal | n (%) | 65/96 (67.7%) | 29/40 (72.5%) | 27/39 (69.2%) | 9/17 (52.9%) | 9/12 (75%) | 0.6221 | |
Number of revisions | Mean ± SD (range) | 3.3 ± 3 (1–20) | 2.3 ± 1.9 (1–14) | 3.7 ± 3.3 (1–20) | 6 ± 3.6 (2–14) | 4.4 ± 2.9 (2–14) | <0.0001 |
Pathogen | Total (n = 78) | Group 2 (n = 54) | Group 3 (n = 24) |
---|---|---|---|
Coagulase-negative staphylococci n (%) | 47 (60.3%) | 35 (64.8%) | 12 (50%) |
Enterococci n (%) | 25 (32.1%) | 15 (27.8%) | 10 (41.7%) |
Pseudomonas aeruginosa n (%) | 5 (6.4%) | 3 (5.6%) | 2 (8.3%) |
Candida albicans n (%) | 4 (5.1%) | 3 (5.6%) | 1 (4.2%) |
Polymicrobial * n (%) | 3 (3.9%) | 2 (3.8%) | 1 (4.2%) |
Outcome | Total (n = 169) | Group 1 (n = 91) | Group 2 (n = 54) | Group 3 (n = 24) | Group 4 (n = 16) | |
---|---|---|---|---|---|---|
Free of infection | 84 (52.2%) | 57 (67.9%) | 23 (42.6%) | 4 (17.4%) | 7 (43.8%) | |
| 9 (5.6%) | 7 (8.3%) | 2 (3.7%) | 0 (%) | 2 (12.5%) | |
| 75 (46.6%) | 50 (59.5%) | 21 (38.9%) | 4 (17.4%) | 5 (31.3%) | |
Therapy failure | 59 (36.6%) | 21 (25%) | 22 (40.7%) | 16 (69.6%) | 9 (56.2%) | |
| 20 (12.4%) | 9 (10.7%) | 8 (14.8%) | 3 (13.1%) | 4 (25%) | |
| 19 (11.8%) | 7 (8.3%) | 8 (14.8%) | 4 (17.4%) | 3 (18.7%) | |
Change of the surgical treatment regimen | 20 (12.4%) | 5 (6%) | 6 (11.1%) | 9 (39.1%) | 2 (12.5%) | |
Death | 18 (11.2%) | 6 (7.1%) | 9 (16.7%) | 3 (13%) | 0 | |
| 6 (3.7%) | 3 (3.55%) | 1 (1.9%) | 2 (8.7%) | - | |
| 12 (7.5%) | 3 (3.55%) | 8 (14.8%) | 1 (4.3%) | - |
Pathogen | Resistance |
---|---|
Staphylococcus spp. | Rifampin Fluoroquinolones Oxacillin Trimethoprim/sulfamethoxazole Linezolid Doxycyclin |
Enterococcus spp. | Aminopenicillin |
Pseudomonas spp. | Fluoroquinolones |
Yeast | Oral available azoles |
Small colony variants (SCV) |
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Darwich, A.; Dally, F.-J.; Abu Olba, K.; Mohs, E.; Gravius, S.; Hetjens, S.; Assaf, E.; Bdeir, M. Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections. Antibiotics 2021, 10, 1145. https://doi.org/10.3390/antibiotics10101145
Darwich A, Dally F-J, Abu Olba K, Mohs E, Gravius S, Hetjens S, Assaf E, Bdeir M. Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections. Antibiotics. 2021; 10(10):1145. https://doi.org/10.3390/antibiotics10101145
Chicago/Turabian StyleDarwich, Ali, Franz-Joseph Dally, Khaled Abu Olba, Elisabeth Mohs, Sascha Gravius, Svetlana Hetjens, Elio Assaf, and Mohamad Bdeir. 2021. "Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections" Antibiotics 10, no. 10: 1145. https://doi.org/10.3390/antibiotics10101145