Are There Any Changes in the Causative Microorganisms Isolated in the Last Years from Hip and Knee Periprosthetic Joint Infections? Antimicrobial Susceptibility Test Results Analysis

Abstract

Background: PJIs following total hip and knee arthroplasty represent severe complications with broad implications, and with significant disability, morbidity, and mortality. To be able to provide correct and effective management of these cases, an accurate diagnosis is needed. Classically, acute PJIs are characterized by a preponderance of virulent microorganisms, and chronic PJIs are characterized by a preponderance of less-virulent pathogens like coagulase-negative staphylococci or Cutibacterium species. This paper aims to analyze if there are any changes in the causative microorganisms isolated in the last years, as well as to provide a subanalysis of the types of PJIs. Methods: In this single-center study, we prospectively included all retrospectively consecutive collected data from patients aged over 18 years that were hospitalized from 2016 through 2022, and patients that underwent a joint arthroplasty revision surgery. A standardized diagnostic protocol was used in all cases, and the 2021 EBJIS definition criteria for PJIs was used. Results: 114 patients were included in our analysis; of them, 67 were diagnosed with PJIs, 12 were acute/acute hematogenous, and 55 were chronic PJIs. 49 strains of gram-positive aerobic or microaerophilic cocci and 35 gram-negative aerobic bacilli were isolated. Overall, Staphylococcus aureus was the most common isolated pathogen, followed by coagulase-negative staphylococci (CoNS). All cases of acute/acute hematogenous PJIs were caused by gram-positive aerobic or microaerophilic cocci pathogens. Both Staphylococcus epidermidis and methicillin-resistant S. aureus were involved in 91.66% of the acute/acute hematogenous PJIs cases. 21.8% of the chronic PJIs cases were caused by pathogens belonging to the Enterobacterales group of bacteria, followed by the gram-negative nonfermenting bacilli group of bacteria, which were involved in 18.4% of the cases. 12 chronic cases were polymicrobial. Conclusion: Based on our findings, empiric broad-spectrum antibiotic therapy in acute PJIs could be focused on the bacteria belonging to the gram-positive aerobic or microaerophilic cocci, but the results should be analyzed carefully, and the local resistance of the pathogens should be taken into consideration.

A Study on the Contributions of Sonication to the Identification of Bacteria Associated with Intubation Cannula Biofilm and the Risk of Ventilator-Associated Pneumonia

“…Because the traditional methods could not isolate any microorganism, the biofilm was dislodged with the help of the ultrasounds, and a rare bacteria were isolated: Ralstonia pickettii. The patient with a hip infection with R. picketii could be treated with targeted antibiotics after the bacteria responsible for the infection was finally isolated [ 30 ].…”

Antibiotic Prophylaxis in One-Stage Revision of Septic Total Knee Arthroplasty: A Scoping Review

“…Both Staphylococcus epidermidis and methicillin-resistant S. Aureus were found in 91.66% of haematogenic PJI cases. In this context, empirical antimicrobial therapy for acute PJI should focus on aerobic or microaerophilic Gram-positive cocci [ 46 ].…”

Lelliottia amnigena and Pseudomonas putida Coinfection Associated with a Critical SARS-CoV-2 Infection: A Case Report

“…Biofilm-related infections (BRI) can take on many forms, ranging from catheter-associated urinary tract infections (which are still the most common type of BRI) to central line-associated bloodstream infections, cystic fibrosis, fracture-related infections, BRI associated with the use of fixed braces, and periprosthetic joint infections [ 14 ]. Although there is still no universally agreed upon definition of a biofilm, biofilms are defined as “a coherent cluster of bacterial cells imbedded in a biopolymer matrix, which, compared with planktonic cells, shows increased tolerance to antimicrobials and resists the antimicrobial properties of the host defence” [ 15 ].…”