Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

Abstract

BACKGROUND: evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention.METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrugsensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated. BackgroundPeriprosthetic joint infection (PJI) is one of the most demanding and challenging complications for orthopedic surgeons 1 . It has a low incidence in total hip (THA) and total knee (TKA) arthroplasty, ranging between 0.2 and 2% of primary procedures 2,3 . Despite its low incidence, PJI is the third leading cause of revision THA in the United States, representing 14.8% of all revision surgeries 4 . The ageing population has led to an increase number of arthroplasties performed worldwide, and the amount of cases of PJI is estimated to grow significantly in the coming decades 3 . Kurtz et al. 5