Publication:
Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort

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Date

2021-09-09

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Mancheño-Losa, Mikel
Lora-Tamayo, Jaime
Fernandez-Sampedro, Marta
Rodriguez-Pardo, Dolors
Muñoz-Mahamud, Ernesto
Soldevila, Laura
Palou, Mariona
Barbero, Jose Maria
Del-Toro, Maria Dolores
Iribarren, Jose Antonio

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Elsevier
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Abstract

Background: The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. Methods: A retrospective, observational, multicenter study was performed during 2007-2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. Results: 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3-13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03-12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91-7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90-6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. Conclusion: Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.

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MeSH Terms

Bacteria
Arthroplasty
Prostheses and Implants
Biofilms
Fluoroquinolones
Anti-Bacterial Agents

DeCS Terms

Infecciones
Prótesis e Implantes
Biopelículas
Artroplastia
Articulaciones
Antibacterianos

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Keywords

Prosthetic joint infection, Infected arthroplasty, Biofilm, Foreign-boy infection, Arthritis

Citation

Mancheño-Losa M, Lora-Tamayo J, Fernández-Sampedro M, Rodríguez-Pardo D, Muñoz-Mahamud E, Soldevila L, et al. Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort. J Infect. 2021 Nov;83(5):542-549