Implications of the Changing Pattern of Bacterial Infections following Total Joint Replacements

Abstract

demonstrated multiple-drug resistance. The incidence of positive culture in revision hip patients was 59%, 46% of which were MRSA. All 13 revision hips with positive cultures showed chronic sepsis: 4 occurred within one year and 10 occurred 2 or more years after the index arthroplasty. The incidence of positive culture in revision knee patients was 57%, 46% of which were MRSA. All 8 revision knees with positive cultures showed chronic sepsis: 3 occurred within one year, 5 occurred 2 or more years after the index arthroplasty. Only one patient, who was infected with gram-negative bacilli, required a second revision for residual sepsis. Harris hip scores for the revision hip patients improved from a mean of 65 (range, 55-75) to 85 (range, 75-90). Knee Society knee scores of the revision knee patients improved from a mean of 68 (range, 55-75) to 80 (range, 70-85). There were no radiological signs suggestive of loosening in the 2 groups at the latest follow-up. Conclusion. This study found a definite increase in multiple-drug-resistant bacteria isolated from periprosthetic infections around total hip and knee prostheses.

Periprosthetic Infection Due to Resistant Staphylococci: Serious Problems on the Horizon

“…The liberal use of antibiotics during the past decade has raised concern regarding the emergence of resistant organisms and their detrimental effect on joint arthroplasty [5,8]. According to the latest National Nosocomial Infection Surveillance System (NNIS) report [11], there has been a substantial rise in incidence of antibiotic resistance among organisms isolated from intensive care units compared to previous years.…”

Results after Late Polymicrobial, Gram-negative, and Methicillin-resistant Infections in Knee Arthroplasty

“…multiple-drug resistant bacteria until 1996, but from 1997 to 2003 they detected many isolates with multiple drug resistance [13]. Fulkerson et al have described in a recent report that, among organisms infecting joint arthroplasties, only 26% to 56% were susceptible to the usual prophylaxis [7].…”

<I>Staphylococcus epidermidis</I> device-related infections: pathogenesis and clinical management

“…Clinical presentation and infection syndrome are dependent upon the insertion site and type of medical device used . Examples of device-related infections associated with S. epidermidis include prosthetic valve endocarditis following prosthetic valve implantation (Verhoef & Fleer 1983), keratitis due to contact lens use (Elder et al 1995), delayed onset post-operative endophthalmitis associated with intraocular lens implantation (Jansen et al 1991), bacteriuria following the use of urinary catheters (Warren 2001), intravascular catheter-associated infection (Rupp & Archer 1994;Rupp & Hamer 1998;Rupp et al 1999) and prosthesis-related infection including the septic loosening of joint prostheses after total joint arthroplasty (Gallo et al 2003;Ip et al 2005). Such infections can have potentially devastating consequences.…”