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. 2016 Dec;17(4):369-376.
doi: 10.1007/s10195-016-0417-8. Epub 2016 Jul 7.

Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip

Svetlana Bozhkova  1 , Rashid Tikhilov  2   3 , Dmitry Labutin  2 , Alexey Denisov  2 , Igor Shubnyakov  2 , Vadim Razorenov  2 , Vasilii Artyukh  2 , Anna Rukina  2
Affiliations

Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip

Svetlana Bozhkova et al. J Orthop Traumatol. 2016 Dec.

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: Polymicrobial PJI; Prosthetic joint infection; Two-stage revision.

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Conflict of interest statement

The authors declare that they have no conflict of interest. Ethical standards The study was approved by the Institutional Review Board. Obtaining the informed consent from involved patients was waived by the Institutional Review Board. All procedures involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments.

Figures

Fig. 1
Fig. 1
Percentage of cases with successful and unsuccessful outcomes in monomicrobial and polymicrobial PJI
Fig. 2
Fig. 2
Percentage of cases with successful and unsuccessful outcomes in polymicrobial PJI depending on the presence of Gram-negative pathogens in microbial associations
See this image and copyright information in PMC

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References

    1. Berend KR, Lombardi AV, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Rel Res. 2012;471:510. doi: 10.1007/s11999-012-2595-x. - DOI - PMC - PubMed
    1. Kurtz S. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780. doi: 10.2106/JBJS.F.00222. - DOI - PubMed
    1. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2012;56:e1–e25. doi: 10.1093/cid/cis803. - DOI - PubMed
    1. Choi H-R, Kwon Y-M, Freiberg AA, Malchau H. Comparison of one-stage revision with antibiotic cement versus two-stage revision results for infected total hip arthroplasty. J Arthroplasty. 2013;28:66–70. doi: 10.1016/j.arth.2013.02.037. - DOI - PubMed
    1. ECDC (2012) European Centre for Disease Prevention and Control. Title. Surveillance of surgical site infections in Europe, 2008–2009. Stockholm. doi: 10.2900/21096