Septic Failure After One-Stage Exchange for Prosthetic Joint Infection of the Hip: Microbiological Implications

Published:November 02, 2021DOI:https://doi.org/10.1016/j.arth.2021.10.020

      Abstract

      Background

      The microbiological implications of septic failure after 1-stage exchange for prosthetic joint infection (PJI) of the hip remain unclear.

      Methods

      Information was gathered on comorbidities, previous procedures, preoperative and postoperative microbiology results, methods of detection, and antibiotic resistance patterns, for all patients, who developed septic failure after 1-stage exchange for PJI of the hip performed at our institution during 2001-2017.

      Results

      Seventy-seven patients were identified. Septic failure was diagnosed a mean of 1.7 (standard deviation 2.3, range 0-11.8) years later. Although the spectrum of microorganisms was similar to preoperative, in the majority of patients (55%), the initial microorganism(s) was (were) replaced by (a) totally different microorganism(s). Overall, there was a decrease in the number of polymicrobial PJIs. The number of patients with high virulent microorganisms decreased significantly from 52 to 36 (P = .034). The number of PJIs due to gram-negative pathogens remained similar (11 vs 14, P = .491). The number of rifampicin-resistant staphylococci, fluoroquinolone-resistant streptococci, enterococci, and fungi changed from 8 to 15, 0 to 2, 7 to 3, and 1 to 2, respectively, but these changes did not reach statistical significance.

      Conclusion

      The majority of reinfections is caused by different infecting bacteria, hence it is essential to perform a new diagnostic workup and not base treatment decisions (solely) on historical cultures. We were furthermore unable to irrefutably prove that, from a microbiological point of view, septic failure after 1-stage exchange comes with increased challenges. Given the time interval to failure, we propose that a longer follow-up of these patients is needed, than previously suggested.

      Keywords

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      References

        • Kurtz S.M.
        • Lau E.
        • Watson H.
        • Schmier J.K.
        • Parvizi J.
        Economic burden of periprosthetic joint infection in the United States.
        J Arthroplasty. 2012; 27: 61-66
        • Parisi T.J.
        • Konopka J.F.
        • Bedair H.S.
        What is the long-term economic societal effect of periprosthetic infections after THA? A Markov analysis.
        Clin Orthop Relat Res. 2017; 475: 1891-1900
        • Bialecki J.
        • Bucsi L.
        • Fernando N.
        • Foguet P.
        • Guo S.
        • Haddad F.
        • et al.
        Hip and knee section, treatment, one stage exchange: proceedings of International Consensus on Orthopedic Infections.
        J Arthroplasty. 2019; 34: S421-S426
        • Choi H.R.
        • Kwon Y.M.
        • Freiberg A.A.
        • Malchau H.
        Comparison of one-stage revision with antibiotic cement versus two-stage revision results for infected total hip arthroplasty.
        J Arthroplasty. 2013; 28: 66-70
        • Leonard H.A.
        • Liddle A.D.
        • Burke O.
        • Murray D.W.
        • Pandit H.
        Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature.
        Clin Orthop Relat Res. 2014; 472: 1036-1042
        • Negus J.J.
        • Gifford P.B.
        • Haddad F.S.
        Single-stage revision arthroplasty for infection-an underutilized treatment strategy.
        J Arthroplasty. 2017; 32: 2051-2055
        • Sharqzad A.S.
        • Cavalheiro C.
        • Zahar A.
        • Lausmann C.
        • Gehrke T.
        • Kendoff D.
        • et al.
        Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty.
        Int Orthop. 2019; 43: 2025-2030
        • Thiesen D.M.
        • Sobhani H.
        • Gehrke T.
        • Suero E.M.
        • Klatte T.O.
        • Citak M.
        A comparison of short term complication rate between 44 two- and 385 one-stage septic exchange arthroplasties in chronic periprosthetic joint infections.
        Orthop Traumatol Surg Res. 2020; 107: 1-8
        • Callaghan J.J.
        • Katz R.P.
        • Johnston R.C.
        One-stage revision surgery of the infected hip. A minimum 10-year followup study.
        Clin Orthop Relat Res. 1999; 369: 139-143
        • George D.A.
        • Logoluso N.
        • Castellini G.
        • Gianola S.
        • Scarponi S.
        • Haddad F.S.
        • et al.
        Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review.
        BMC Infect Dis. 2016; 16: 553-565
        • Lange J.
        • Troelsen A.
        • Thomsen R.W.
        • Soballe K.
        Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis.
        Clin Epidemiol. 2012; 4: 57-73
        • Zahar A.
        • Klaber I.
        • Gerken A.M.
        • Gehrke T.
        • Gebauer M.
        • Lausmann C.
        • et al.
        Ten-year results following one-stage septic hip exchange in the management of periprosthetic joint infection.
        J Arthroplasty. 2019; 34: 1221-1226
        • Corona P.S.
        • Vicente M.
        • Carrera L.
        • Rodriguez-Pardo D.
        • Corro S.
        Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection.
        Bone Joint J. 2020; 102-B: 1682-1688
        • Gomez M.M.
        • Tan T.L.
        • Manrique J.
        • Deirmengian G.K.
        • Parvizi J.
        The fate of spacers in the treatment of periprosthetic joint infection.
        J Bone Joint Surg Am. 2015; 97: 1495-1502
        • Wang Q.
        • Goswami K.
        • Kuo F.C.
        • Xu C.
        • Tan T.L.
        • Parvizi J.
        Two-stage exchange arthroplasty for periprosthetic joint infection: the rate and reason for the attrition after the first stage.
        J Arthroplasty. 2019; 34: 2749-2756
        • Abdelaziz H.
        • Gruber H.
        • Gehrke T.
        • Salber J.
        • Citak M.
        What are the factors associated with re-revision after one-stage revision for periprosthetic joint infection of the hip? A case-control study.
        Clin Orthop Relat Res. 2019; 477: 2258-2263
        • Grau L.
        • Gunder M.A.
        • Schneiderbauer M.
        Difficult-to-detect low-grade infections responsible for poor outcomes in total knee arthroplasty.
        Am J Orthop (Belle Mead NJ). 2017; 46: E148-E153
        • Gehrke T.
        • Zahar A.
        • Kendoff D.
        One-stage exchange: it all began here.
        Bone Joint J. 2013; 95-B: 77-83
        • Zahar A.
        • Gehrke T.A.
        One-stage revision for infected total hip arthroplasty.
        Orthop Clin North Am. 2016; 47: 11-18
        • Shohat N.
        • Bauer T.
        • Buttaro M.
        • Budhiparama N.
        • Cashman J.
        • Della Valle C.J.
        • et al.
        Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints?: proceedings of International Consensus on Orthopedic infections.
        J Arthroplasty. 2019; 34: S325-S327
        • Morgenstern C.
        • Cabric S.
        • Perka C.
        • Trampuz A.
        • Renz N.
        Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection.
        Diagn Microbiol Infect Dis. 2018; 90: 115-119
        • Akgun D.
        • Perka C.
        • Trampuz A.
        • Renz N.
        Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study.
        Arch Orthop Trauma Surg. 2018; 138: 635-642
        • Faschingbauer M.
        • Bieger R.
        • Kappe T.
        • Weiner C.
        • Freitag T.
        • Reichel H.
        Difficult to treat: are there organism-dependent differences and overall risk factors in success rates for two-stage knee revision?.
        Arch Orthop Trauma Surg. 2020; 140: 1595-1602
        • Karlsen O.E.
        • Borgen P.
        • Bragnes B.
        • Figved W.
        • Grogaard B.
        • Rydinge J.
        • et al.
        Rifampin combination therapy in staphylococcal prosthetic joint infections: a randomized controlled trial.
        J Orthop Surg Res. 2020; 15: 365-383
        • Yang J.
        • Parvizi J.
        • Hansen E.N.
        • Culvern C.N.
        • Segreti J.C.
        • Tan T.
        • et al.
        2020 Mark Coventry Award: microorganism-directed oral antibiotics reduce the rate of failure due to further infection after two-stage revision hip or knee arthroplasty for chronic infection: a multicentre randomized controlled trial at a minimum of two years.
        Bone Joint J. 2020; 102-B: 3-9
        • Zmistowski B.
        • Tetreault M.W.
        • Alijanipour P.
        • Chen A.F.
        • Della Valle C.J.
        • Parvizi J.
        Recurrent periprosthetic joint infection: persistent or new infection?.
        J Arthroplasty. 2013; 28: 1486-1489
        • Cai Y.
        • Fang X.
        • Chen Y.
        • Huang Z.
        • Zhang C.
        • Li W.
        • et al.
        Metagenomic next generation sequencing improves diagnosis of prosthetic joint infection by detecting the presence of bacteria in periprosthetic tissues.
        Int J Infect Dis. 2020; 96: 573-578
        • Wang C.X.
        • Huang Z.
        • Fang X.
        • Li W.
        • Yang B.
        • Zhang W.
        Comparison of broad-range polymerase chain reaction and metagenomic next-generation sequencing for the diagnosis of prosthetic joint infection.
        Int J Infect Dis. 2020; 95: 8-12
        • Dudareva M.
        • Kumin M.
        • Vach W.
        • Kaier K.
        • Ferguson J.
        • McNally M.
        • et al.
        Short or Long Antibiotic Regimes in Orthopaedics (SOLARIO): a randomised controlled open-label non-inferiority trial of duration of systemic antibiotics in adults with orthopaedic infection treated operatively with local antibiotic therapy.
        Trials. 2019; 20: 693-701
        • Sandiford N.A.
        • McHale A.
        • Citak M.
        • Kendoff D.
        What is the optimal duration of intravenous antibiotics following single-stage revision total hip arthroplasty for prosthetic joint infection? A systematic review.
        Hip Int. 2021; 31: 286-294
        • Gristina A.G.
        Biomaterial-centered infection: microbial adhesion versus tissue integration.
        Science. 1987; 237: 1588-1595