Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 27;13(7):1505.
doi: 10.3390/microorganisms13071505.

Comparison of Microbiological Profiles of Primary Hip and Knee Peri-Prosthetic Joint Infections Treated at Specialist Centers Around the World

Emin Suha Dedeogullari  1 , Pablo Slullitel  2 , Isabel Horton  3 , Bulent Atilla  1 , Saif Salih  4 , Paul Monk  5 , Ahmet Mazhar Tokgozoglu  1 , Michael Goplen  5 , Bonita Tsang  4 , Martin Buljubasich  2 , Hesham Abdelbary  3 , Simon Garceau  3 , George Grammatopoulos  3
Affiliations

Comparison of Microbiological Profiles of Primary Hip and Knee Peri-Prosthetic Joint Infections Treated at Specialist Centers Around the World

Emin Suha Dedeogullari et al. Microorganisms. .

Abstract

Periprosthetic joint infection (PJI) is a complex complication of total joint arthroplasty, with microbiological profiles varying across centers worldwide. However, most studies are limited to single-center or intra-country multicenter analyses, often including mixed cohorts of primary and revision PJI cases, with limited data regarding global antibiotic resistance patterns. This study compared the microbiological characteristics, polymicrobial culture rates, prevalence of culture-negative infections, and antibiotic resistance patterns in PJI cases across five referral centers from five continents. A total of 717 patients with primary hip and knee PJI were included from centers in Argentina, Canada, Turkey, England, and New Zealand. Staphylococcus aureus and Staphylococcus epidermidis were the most common pathogens (48.5%, p < 0.01). Culture-negative infection rates varied significantly, ranging from 4.2% (England) to 24.6% (Turkey) (p < 0.01). Polymicrobial infections were the most frequent in Canada (8.9%) and the least frequent in England (1.1%) (p < 0.01). Gram-negative bacteria comprised 13.1% of culture-positive cases, with no significant intercountry difference. Multidrug resistance was observed in all centers, ranging from 23.7% (Argentina) to 43.1% (Turkey), with no statistical significance. Vancomycin resistance was detected in England (2.3%) and Canada (1.2%) but absent in Turkey, New Zealand, and Argentina. These findings underscore significant intercontinental variability, emphasizing the need for regional considerations in regards to empiric antibiotic selection and PJI management.

Keywords: PJI; antibiotic resistance; culture; microbiological profile; microbiological trends; periprosthetic joint infection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence of culture results from PJI patients in each country. (single: culture results showed growth of one bacterium; polymicrobial: culture results showed growth of two or more bacteria).
Figure 2
Figure 2
Incidence of antibiotic resistance of the diverse offending organisms in each country. (None: no antibiotic resistance; single: resistance to only one antibiotic; multi: resistance to two or more antibiotics was reported).
See this image and copyright information in PMC

References

    1. Weinstein E.J., Stephens-Shields A.J., Newcomb C.W., Silibovsky R., Nelson C.L., O’Donnell J.A., Glaser L.J., Hsieh E., Hanberg J.S., Tate J.P., et al. Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty. JAMA Netw. Open. 2023;6:e2340457. doi: 10.1001/jamanetworkopen.2023.40457. - DOI - PMC - PubMed
    1. Kim H.S., Park J.W., Moon S.Y., Lee Y.K., Ha Y.C., Koo K.H. Current and Future Burden of Periprosthetic Joint Infection from National Claim Database. J. Korean Med. Sci. 2020;35:e410. doi: 10.3346/jkms.2020.35.e410. - DOI - PMC - PubMed
    1. Jin X., Gallego Luxan B., Hanly M., Pratt N.L., Harris I., de Steiger R., Graves S.E., Jorm L. Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data. Bone Joint J. 2022;104-B:1060–1066. doi: 10.1302/0301-620X.104B9.BJJ-2022-0116.R1. - DOI - PMC - PubMed
    1. Kurtz S.M., Lau E.C., Son M.S., Chang E.T., Zimmerli W., Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J. Arthroplast. 2018;33:3238. doi: 10.1016/j.arth.2018.05.042. - DOI - PubMed
    1. Gehrke T., Alijanipour P., Parvizi J. The management of an infected total knee arthroplasty. Bone Joint J. 2015;97-B((10 Suppl. A)):20. doi: 10.1302/0301-620X.97B10.36475. - DOI - PubMed

LinkOut - more resources