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. 2023 Jul;143(7):3871-3878.
doi: 10.1007/s00402-022-04635-7. Epub 2022 Sep 29.

Changes in microbiological spectrum and antibiotic susceptibility in two-stage exchange for periprosthetic shoulder infections

Paul Siegert  1   2 , Bernhard J H Frank  3 , Sebastian Simon  3 , Dominik Meraner  4 , Alexandra Pokorny-Olsen  4 , Julian Diepold  5 , Christian Wurnig  4 , Jochen G Hofstaetter  3   6
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Changes in microbiological spectrum and antibiotic susceptibility in two-stage exchange for periprosthetic shoulder infections

Paul Siegert et al. Arch Orthop Trauma Surg. 2023 Jul.

Abstract

Background: Periprosthetic joint infections (PJI) are a major concern in shoulder arthroplasty, which in some cases require two-stage exchange. While it was shown that low-virulence bacteria are the most isolated pathogens in shoulder PJI, little is known about changes in microbiological spectrum and resistance patterns during two-stage revision.

Methods: This retrospective study included all patients (n = 25) who received a two-stage revision from January 2011 to December 2020 for shoulder PJI in one institution. Microbiological spectrum, antimicrobial resistance patterns, and re-revision rates of culture positive first- and second-stage procedures were analyzed. The mean follow-up time was 29.7 months (range 8; 115 months). At final follow-up, subjective shoulder value (SSV) and visual analog scale (VAS) score for pain and satisfaction with the surgery were assessed.

Results: In 25 patients, a total of 54 2-stage exchange procedures were performed and positive cultures were obtained in 36 of these surgeries (66.7%). A total of 7 out of 25 patients (28.0%) showed a positive microbiological culture at first and second stages. In those patients, the mean time between first and second stages was 30.9 weeks (range 6; 70). Three out of those seven patients (42.9%) had a polymicrobial spectrum with one microorganism persistent at stage two, including Cutibacterium acnes (n = 1) and Staphylococcus epidermidis (MRSE) (n = 2). In all these cases, antimicrobial resistance patterns changed. All cultures with monomicrobial spectrum (n = 4) at first stage showed a changed spectrum. Patients with positive first- and second-stage revisions showed a mean SSV of 49.3% ± 23.5 versus 52.9% ± 29.5 in single positive patients (p = 0.76). Re-revision was performed in five cases, two of those in patients with positive first- and second-stage cultures.

Conclusion: There is a high rate of changes in microbiological spectrum and resistance patterns between culture positive first- and second-stage procedures as well as subsequent re-revisions. Intraoperative samples during reimplantation should be taken and resistance reconsidered in case of re-revision.

Keywords: Microbiological spectrum; Resistance pattern; Shoulder periprosthetic joint infection.

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References

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