Significant Difference in Antimicrobial Resistance of Bacteria in Septic Revision between Total Knee Arthroplasty and Total Hip Arthroplasty

Stevoska, Stella; Himmelbauer, Felix; Stiftinger, Julian; Stadler, Christian; Pisecky, Lorenz; Gotterbarm, Tobias; Klasan, Antonio

doi:10.3390/antibiotics11020249

Cited by 9 publications

(9 citation statements)

References 33 publications

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“…Our study showed a significant diversity of practice and in many cases a lack of guidance regarding prophylactic antibiotics. The difficulty in establishing such guidelines lies in differences in antibiotic strains over time [ 22 ], between geographic regions and centres [ 23 ] and even hip and knee arthroplasty [ 24 ]. Contribution to guidelines was also heterogenous with only six (35%) explicitly stating multidisciplinary involvement.…”

Section: Discussionmentioning

confidence: 99%

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

et al. 2022

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(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.

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Section: Discussionmentioning

confidence: 99%

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

et al. 2022

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“…Although previous studies have shown that Gram-positive cocci are the most frequently detected pathogens in patients with PJI, the literature is not consistent regarding the role of S. aureus and coagulase-negative staphylococci [ 3 , 12 ]. While Tsai et al identified S. aureus as the most common pathogen with a detection rate of 26%, more recent studies by Hu et al and Stevoska et al identified coagulase-negative staphylococci with detection rates of 38.1 to 56.6% as more common [ 12 , 15 , 17 ]. In accordance with the more recent studies, our most frequently detected pathogens are coagulase-negative staphylococci (44.9%), followed by S. aureus (14.1%), Gram-negative bacteria (13.1%) and Enterococcus species (9.3%).…”

Section: Discussionmentioning

confidence: 99%

“…An additional frequently discussed aspect of PJI is a possible difference of the causative pathogens in patients with PJI of the hip and the knee. While Bjerke-Kroll et al could not detect a difference in the identified species in patients with PJI of the hip or knee, Stevoska et al described a significantly higher rate of Gram-negative bacteria in patients with PJI of the hip [ 14 , 17 ]. As our previous studies did not detect an overall difference in causative pathogens between patients with PJI of the hip and the knee, we did not evaluate this topic [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Microbiological Trends and Antibiotic Susceptibility Patterns in Patients with Periprosthetic Joint Infection of the Hip or Knee over 6 Years

et al. 2022

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We sought to analyze trends of the causative pathogens and their antibiotic susceptibility patterns in patients with periprosthetic joint infections (PJI) of the hip and knee to get better insights and improve treatment. Retrospective evaluation of all consecutive patients with microbiological detection of a causative pathogen at a tertiary endoprothetic referral center between January 2016 and December 2021 in Germany was performed. Overall, 612 different microorganisms could be detected in 493 patients (hip: n = 293; knee: n = 200). Evaluation did not show a change in the relative abundance of pathogens detected, with coagulase-negative staphylococci (n = 275; 44.9%) found frequently, followed by S. aureus (n = 86; 14.1%), Enterococcus species (n = 57; 9.3%), Streptococcus species (n = 48; 7.8%), and Gram-negative bacteria (n = 80; 13.1%). Evaluation of the antibiotic susceptibilities showed increasing rates of oxacillin-resistant coagulase-negative staphylococci (60.4%; 46.8–76.7%) and piperacillin-tazobactam-resistant Gram-negative bacteria (26.5%; 0–57.1%), although statistically not significant. Resistance of Gram-positive bacteria to vancomycin (<1%) and Gram-negative microorganisms to meropenem (1.25%) remained an exception. In summary, coagulase-negative staphylococci, as the most frequent pathogen, displayed a continuously high rate of oxacillin resistance. For the highest antimicrobial coverage in the case of an empiric therapy/unknown pathogen, vancomycin might be chosen. Level of evidence: IV.

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“…Patients meeting other criteria established by the Musculoskeletal Infections Society (MSIS) [ 32 ] were excluded. Due to different rates of PJI depending on the joint to be replaced [ 33 ], a stratification into two groups, THA and UKA/TKA, and an independent analysis was performed.…”

Section: Methodsmentioning

confidence: 99%

The Impact of Patient-Reported Penicillin or Cephalosporin Allergy on the Occurrence of the Periprosthetic Joint Infection in Primary Knee and Hip Arthroplasty

et al. 2022

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Reducing the risk of periprosthetic joint infections (PJI) requires a multi-pronged strategy including usage of a prophylactic antibiotic. A history of penicillin or cephalosporin allergy often leads to a change in prophylactic antibiotic regimen to avoid serious side effects. The purpose of the present retrospective study was to determine incidence of PJI based on perioperative antibiotic regimen in total hip arthroplasty (THA), total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). A review of all primary THAs, primary TKAs and primary UKAs, undertaken between 2011 and 2020 in a tertiary referral hospital, was performed. The standard perioperative antibiotic for joint arthroplasty (JA) in the analyzed tertiary hospital is cefuroxime. There were no differences in prophylactic antibiotic regimen over time. In 7.9% (211 of 2666) of knee arthroplasties and in 6.0% (206 of 3419) of total hip arthroplasties, a second-line prophylactic antibiotic was used. There was no statistically significant higher occurrence of PJI between the first-line and second-line prophylactic antibiotic in knee arthroplasties (p = 0.403) as well as in total hip arthroplasties (p = 0.309). No relevant differences in age, American Society of Anesthesiologists (ASA) score and body mass index (BMI) between the groups were observed.

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Significant Difference in Antimicrobial Resistance of Bacteria in Septic Revision between Total Knee Arthroplasty and Total Hip Arthroplasty

Cited by 9 publications

References 33 publications

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty

Microbiological Trends and Antibiotic Susceptibility Patterns in Patients with Periprosthetic Joint Infection of the Hip or Knee over 6 Years

The Impact of Patient-Reported Penicillin or Cephalosporin Allergy on the Occurrence of the Periprosthetic Joint Infection in Primary Knee and Hip Arthroplasty

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