Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections

Abstract

Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty. In the course of a PJI, superinfections with pathogens that do not match the primary infecting micro-organism may occur. To our knowledge, there are no published data on the outcome of such infections in the literature. The aim of this study was to assess the outcome of PJI with superinfections with a difficult-to-treat (DTT) pathogen. Data of 169 consecutive patients with PJI were retrospectively analyzed in this single-center study. Cases were categorized into: Group 1 including non-DTT-PJI without superinfection, Group 2 DTT-PJI without superinfection, Group 3 non-DTT-PJI with DTT superinfection, and Group 4 non-DTT-PJI with non-DTT superinfection. Group 3 comprised 24 patients and showed, after a mean follow-up of 13.5 ± 10.8 months, the worst outcome with infection resolution in 17.4% of cases (p = 0.0001), PJI-related mortality of 8.7% (p = 0.0001), mean revision rate of 6 ± 3.6 (p < 0.0001), and duration of antibiotic treatment of 71.2 ± 45.2 days (p = 0.0023). PJI caused initially by a non-DTT pathogen with a superinfection with a DTT pathogen is significantly associated with the worst outcome in comparison to non-DTT-PJI, PJI caused initially by a DTT pathogen, and to non-DTT-PJI with a non-DTT superinfection.

Superinfections of the Spine: A Single-Institution Experience

“…In the context of arthroplasty, Darwich et al found that 23.7% of 169 periprosthetic joint infections (PJIs) eventually evolved into superinfections with a new organism. The authors then showed that patients with superinfections had worse outcomes in terms of infection eradication, therapy failure, number of revisions, and mortality [19]. While our series showed a lower rate of superinfection than Darwich et al's, we deemed nine cases as indeterminable.…”

The Impact of a Dedicated Multidisciplinary Team Approach for Prosthetic Joint Infections of the Lower Limb

“…Differentiating aspects of treatment included utilisation of intravenous anti-fungal agents, topical anti-fungal use in cement spacer, and extended duration of antibiotics post second stage revision arthroplasty. One case in the post-MDT group involved a patient with a chronic PJI involving polymicrobial growth which included Candida albicans , MRSA and Aspergillus niger — all of which are known difficult-to-treat organisms [ 33 ]. This patient over a 2.5-year period underwent 8 operations given the number of recurrent episodes of PJI.…”

“…This patient over a 2.5-year period underwent 8 operations given the number of recurrent episodes of PJI. Given PJI broad presentation, including whether they involve difficult-to-treat organisms, comparison does become difficult as outcome from set management may be confounded by a multitude of factors [ 33 – 35 ].…”

Effect of Multiantibiotic-Loaded Bone Cement on the Treatment of Periprosthetic Joint Infections of Hip and Knee Arthroplasties—A Single-Center Retrospective Study

“…Multidrug-resistant bacteria complicate adequate antibiotic therapy. In particular, the antibiotic treatment of PJIs caused by biofilm-forming pathogens that are resistant to biofilm-active antibiotics is a particular challenge: because fluoroquinolones target biofilm-forming Gram-negative bacteria and rifampicin targets biofilm-forming Gram-positive bacteria, rifampicin-resistant pathogens and fluoroquinolone-resistant Gram-negative bacteria are considered difficult-to-treat bacteria [ 16 , 17 ].…”