Journal Article

Gram-negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment

Pang-Hsin Hsieh, Mel S. Lee, Kuo-Yao Hsu, Yu-Han Chang, Hsin-Nung Shih and Steve W. Ueng

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 7, pages 1036-1043
Published in print October 2009 | ISSN: 1058-4838
Published online October 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/605593
Gram-negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment

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Background. Little information is available regarding the demographic characteristics and outcomes of prosthetic joint infection (PJI) resulting from Gram-negative (GN) organisms when compared to those resulting from Gram-positive (GP) organisms.

Methods. We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution between 2000 and 2006.

Results: GN microorganisms were involved in 53 (15.3%) of 346 first-time episodes of PJI, and Pseudomonas aeruginosa was the most commonly isolated pathogen (21 episodes; 40%). Patients with GN PJI were older (median age, 68 vs. 59 years, p< 0.001) and developed infection earlier (median joint age, 74 vs. 109 days, p< 0.001) than those with GP PJI. Fifty-one percent, 30%, and 19% of GN PJIs were treated with debridement, two-stage exchange, and resection arthroplasty, respectively. When compared to GP PJI, treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success (27% vs. 47%, p= 0.0016); no difference was found when it was treated with two-stage exchange or resection arthroplasty. A longer duration of symptoms before debridement was associated with treatment failure for GN PJI (median, 11 vs. 5 days, p= 0.02).

Conclusions: GN PJI represents a substantial proportion of all PJI occurrences. 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 for GN PJI is associated with a favorable outcome rate that is comparable to that associated with PJI due to GP pathogens.

Journal Article.  3586 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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