Clinical comparison between exogenous and haematogenous periprosthetic joint infections caused by Staphylococcus aureus

Abstract

Patient-related risk factors for invasive Staphylococcus aureus infection overlap with those for periprosthetic joint infections (PJIs). We compared these factors and clinical characteristics between 17 exogenous and 40 haematogenous PJIs caused by S. aureus. Exogenous cases presented significantly more often with damaged periprosthetic soft tissue, whereas haematogenous cases more often had systemic signs of infection, such as fever, chills, and sepsis syndrome. However, comorbid conditions associated with S. aureus infection and/or PJIs did not differ between the two groups. These findings imply that patient-related risk factors for S. aureus infection do not help to predict the mode of infection acquisition in prosthetic joints.

Prosthetic Joint Infection

“…This likely reflects the fact that 90% of the patients in this study were within 3 months of implantation, suggesting that the mechanism of infection initiation dictates some of the clinical presentation. This is corroborated by several studies that found that the presence of soft tissue damage, such as an open wound, sinus tract, or abscess, was more common in patients with contiguous or perioperatively acquired Staphylococcus aureus PJI than in those with hematogenously acquired S. aureus infection (59,63). In contrast, systemic signs or symptoms such as fever or chills were significantly more common in patients with hematogenous PJI.…”

“…Commonly reported signs or symptoms of PJI include pain, joint swelling or effusion, erythema or warmth around the joint, fever, drainage, or the presence of a sinus tract communicating with the arthroplasty (7,(57)(58)(59). The presence of a sinus tract is considered by most investigators to be definitive evidence of PJI, leading to its inclusion as definitive evidence of PJI in several consensus documents (60)(61)(62), as discussed in Diagnosis, below.…”

“…Concomitant bacteremia occurs in 10 to 60% of cases of PJI (59,63,(125)(126)(127)(128), with higher rates in patients treated with debridement with prosthesis retention (127) than in patients with resection arthroplasty (128). Infection occurs at all time periods after implantation, but delayed-onset infection appears to occur less often than infection in early or late time periods (125).…”

Prevention of Periprosthetic Joint Infection

“…Nevertheless, some studies reported seeding from the respiratory, urinary, and gastrointestinal tracts, and dental infections (16). Sendi et al reported that in 57.5% of hematogenous PJI, there was no sign of primary bacteremia or infection during the clinical manifestation; therefore, it is usually difficult to identify the source of infection (17).…”

Prevention of periprosthetic joint infection: Pre-, intra-, and post-operative strategies

“…Nevertheless, some studies reported seeding from the respiratory, urinary and gastrointestinal tracts, and dental infections. 16 Sendi et al 17 reported that in 57.5% of haematogenous PJI, there was no sign of primary bacteraemia or infection during the clinical manifestation; therefore, it is usually difficult to identify the source of infection.…”