Periprosthetic joint infections treated with two-stage revision over 14 years: an evolving microbiology profile

Abstract

Late periprosthetic joint infection (PJI) occurs in 0.3%-1.7% of total hip arthroplasties (THAs) and 0.8%-1.9% of total knee arthroplasties (TKAs). Surgical debridement, explant, and appropriate antibiotics are imperative for successful treatment. We analyzed organisms from PJIs at one institution for temporal trends over 14 years. Poisson regression model demonstrated a linear increase in infection rate for the following bacteria as the primary organism: MRSA (incidence rate ratio [IRR] = 1.11, P = 0.019), Streptococcus viridans (IRR = 1.18, P = 0.002), and Propionibacterium acnes (IRR = 1.21, P = 0.024). The increase in proportion of these organisms may warrant further discussion on pre-surgical MRSA screening and empiric therapy to include MRSA coverage, increased incubation time to detect P. acnes, and dental prophylaxis against S. viridans.

Keywords: complications; infected total hip arthroplasty; infectious; revision total hip arthroplasty; revision total knee arthroplasty; total hip arthroplasty infection; total knee arthroplasty infection.