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Gram-negative prosthetic joint infections: risk factors and outcome of treatment.
Clin Infect Dis 2009; 49(7):1036-43CI

Abstract

BACKGROUND

Little information is available regarding the demographic characteristics and outcomes of patients with prosthetic joint infection (PJI) resulting from gram-negative (GN) organisms, compared with patients with PJI resulting from gram-positive (GP) organisms.

METHODS

We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution during the period from 2000 through 2006.

RESULTS

GN microorganisms were involved in 53 (15%) of 346 first-time episodes of PJI, and Pseudomonas aeruginosa was the most commonly isolated pathogen (21 [40%] of the 53 episodes). Patients with GN PJI were older (median age, 68 vs. 59 years; P<.001) and developed infection earlier (median joint age, 74 vs. 109 days; P<.001) than those with GP PJI. Of the 53 episodes of GN PJI, 27 (51%) were treated with debridement, 16 (30%) with 2-stage exchange arthroplasty, and 10 (19%) with resection arthroplasty. Treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success than treating GP PJI with debridement (27% vs. 47% of episodes were successfully treated; P=.002); no difference was found when a PJI was treated with 2-stage exchange or resection arthroplasty. A longer duration of symptoms before treatment with debridement was associated with treatment failure for GN PJI, compared with for GP PJI (median duration of symptoms, 11 vs. 5 days; P=.02).

CONCLUSIONS

GN PJI represents a substantial proportion of all occurrences of PJI. Debridement alone has a high failure rate and should not be attempted when the duration of symptoms is long. Resection of the prosthesis, with or without subsequent reimplantation, as a result of GN PJI is associated with a favorable outcome rate that is comparable to that associated with PJI due to GP pathogens.

Authors+Show Affiliations

Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St., 333 Kweishian, Taoyuan, Taiwan. hsiehph@adm.cgmh.org.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19691430

Citation

Hsieh, Pang-Hsin, et al. "Gram-negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 49, no. 7, 2009, pp. 1036-43.
Hsieh PH, Lee MS, Hsu KY, et al. Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis. 2009;49(7):1036-43.
Hsieh, P. H., Lee, M. S., Hsu, K. Y., Chang, Y. H., Shih, H. N., & Ueng, S. W. (2009). Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 49(7), pp. 1036-43. doi:10.1086/605593.
Hsieh PH, et al. Gram-negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment. Clin Infect Dis. 2009 Oct 1;49(7):1036-43. PubMed PMID: 19691430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gram-negative prosthetic joint infections: risk factors and outcome of treatment. AU - Hsieh,Pang-Hsin, AU - Lee,Mel S, AU - Hsu,Kuo-Yao, AU - Chang,Yu-Han, AU - Shih,Hsin-Nung, AU - Ueng,Steve W, PY - 2009/8/21/entrez PY - 2009/8/21/pubmed PY - 2009/11/3/medline SP - 1036 EP - 43 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 49 IS - 7 N2 - BACKGROUND: Little information is available regarding the demographic characteristics and outcomes of patients with prosthetic joint infection (PJI) resulting from gram-negative (GN) organisms, compared with patients with PJI resulting from gram-positive (GP) organisms. METHODS: We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution during the period from 2000 through 2006. RESULTS: GN microorganisms were involved in 53 (15%) of 346 first-time episodes of PJI, and Pseudomonas aeruginosa was the most commonly isolated pathogen (21 [40%] of the 53 episodes). Patients with GN PJI were older (median age, 68 vs. 59 years; P<.001) and developed infection earlier (median joint age, 74 vs. 109 days; P<.001) than those with GP PJI. Of the 53 episodes of GN PJI, 27 (51%) were treated with debridement, 16 (30%) with 2-stage exchange arthroplasty, and 10 (19%) with resection arthroplasty. Treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success than treating GP PJI with debridement (27% vs. 47% of episodes were successfully treated; P=.002); no difference was found when a PJI was treated with 2-stage exchange or resection arthroplasty. A longer duration of symptoms before treatment with debridement was associated with treatment failure for GN PJI, compared with for GP PJI (median duration of symptoms, 11 vs. 5 days; P=.02). CONCLUSIONS: GN PJI represents a substantial proportion of all occurrences of PJI. Debridement alone has a high failure rate and should not be attempted when the duration of symptoms is long. Resection of the prosthesis, with or without subsequent reimplantation, as a result of GN PJI is associated with a favorable outcome rate that is comparable to that associated with PJI due to GP pathogens. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/19691430/Gram_negative_prosthetic_joint_infections:_risk_factors_and_outcome_of_treatment_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/605593 DB - PRIME DP - Unbound Medicine ER -