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

Abstract

Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006. There were 58 men and 69 women, with an average age of 66 years. Patients were followed for a minimum of 2 years or until recurrence of infection. Débridement and retention of the prosthesis was performed in 35 patients and resection arthroplasty in 92.

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

“…We included patients with polymicrobial PJI, which may have confounded the outcome because some of these patients could have had sinus tract [6] and soft tissue defects, compromising outcome [21]. To minimize the effect of confounders, we excluded all patients in whom MRSA had been isolated at the same time because control of infection in patients with MRSA PJI is so challenging [9]. The other reason for higher failure is that fewer patients in our cohort underwent resection arthroplasty as the initial treatment.…”

Incidence and Reasons for Nonrevision Reoperation After Total Knee Arthroplasty

“…1). In the literature, the reported success of I&D in eradicating infections is 16% to 80% and is heavily dependent upon the timing of presentation [3,16,20,27]. Infection remains a difficult complication to treat and will provide a large treatment burden for the knee arthroplasty population both through NRR and revision TKA.…”

Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

“…The outcome following treatment for periprosthetic joint infection ranges from a return to full function to the possible need for amputation or arthrodesis 33,41,44,45 . Of rising concern throughout the joint replacement community is infection involving MRSA, as it is often resistant to aggressive treatment, resulting in suboptimal outcome [46][47][48][49] . Additionally, patient health status has been implicated in predicting the outcome of periprosthetic joint infection treatment 50 .…”