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. 2025 Apr 14;13(4):904.
doi: 10.3390/microorganisms13040904.

Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli

Wai-Yan Liu  1   2 , Johannes G E Hendriks  2 , Robin W T M van Kempen  1 , Walter van der Weegen  3 , Wim H C Rijnen  4 , Jon H M Goosen  5 , Babette C van der Zwaard  6 , Yvette Pronk  7 , Wierd P Zijlstra  8 , Bas L E F Ten Have  9 , Joris J W Ploegmakers  10 , Marjan Wouthuyzen-Bakker  11
Affiliations

Clinical Outcome of Patients with Acute Periprosthetic Joint Infections Caused by Pseudomonas aeruginosa Compared to Other Gram-Negative Bacilli

Wai-Yan Liu et al. Microorganisms. .

Abstract

Pseudomonas aeruginosa is considered as more difficult to treat than other Gram-negatives in patients with acute periprosthetic joint infections (PJIs). However, clinical data to support this hypothesis are lacking. This retrospective multicenter cohort study included 39 patients with acute PJIs caused by P. aeruginosa and 84 control patients with another Gram-negative bacillus (i.e., Enterobacterales). Both groups were managed by surgical debridement, antibiotics, and implant retention (DAIR). Treatment failure within one-year follow-up was defined as prosthesis extraction, a clinical need for suppressive antibiotic treatment and/or PJI-related death. Distribution of affected joints, and revision versus primary arthroplasties, did not differ between groups. Most PJIs were polymicrobial (87% in cases, 81% in control patients, p = 0.451). Surgical and antibiotic management was similar between groups. Treatment failure did not differ between groups: 5/39 cases (12.8%) and 14/84 control patients (16.7%, p = 0.610). An acceptable success rate of acute PJI caused by P. aeruginosa when treated with DAIR was observed. This success rate did not differ compared to PJIs caused by Enterobacterales. Therefore, P. aeruginosa should not be considered a more difficult to treat microorganism compared to other Gram-negatives. No additional surgical or antimicrobial interventions are needed when patients can be treated with a fluoroquinolone.

Keywords: antibiotics; debridement; outcome; treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Kunutsor S.K., Whitehouse M.R., Blom A.W., Beswick A.D., INFORM Team Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS ONE. 2016;11:e0150866. doi: 10.1371/journal.pone.0150866. - DOI - PMC - PubMed
    1. Karachalios T., Komnos G.A. Management strategies for prosthetic joint infection: Long-term infection control rates, overall survival rates, functional and quality of life outcomes. EFORT Open. Rev. 2021;6:727–734. doi: 10.1302/2058-5241.6.210008. - DOI - PMC - PubMed
    1. Longo U.G., Salvatore S.D., Bandini B., Lalli A., Barillà B., Budhiparama N.C., Lustig S. Debridement, antibiotics, and implant retention (DAIR) for the early prosthetic joint infection of total knee and hip arthroplasties: A systematic review. J. ISAKOS. 2024;9:62–70. doi: 10.1016/j.jisako.2023.09.003. - DOI - PubMed
    1. Löwik C.A.M., Parvizi J., Jutte P.C., Zijlstra W.P., Knobben B.A.S., Xu C., Goswami K., Belden K.A., Sousa R., Carvalho A., et al. Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty. Clin. Infect. Dis. 2020;71:630–636. doi: 10.1093/cid/ciz867. - DOI - PubMed
    1. Vilchez F., Martínez-Pastor J.C., García-Ramiro S., Bori G., Tornero E., García E., Mensa J., Soriano A. Efficacy of debridement in hematogenous and early post-surgical prosthetic joint infections. Int. J. Artif. Organs. 2011;34:863–869. doi: 10.5301/ijao.5000029. - DOI - PubMed