4.5 Article

What is the rate of reinfection with different and difficult-to-treat bacteria after failed one-stage septic knee exchange?

Journal

INTERNATIONAL ORTHOPAEDICS
Volume 46, Issue 4, Pages 687-695

Publisher

SPRINGER
DOI: 10.1007/s00264-021-05291-z

Keywords

Prosthetic joint infection; Total knee arthroplasty; Revision; One-stage exchange; Microbiology

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This study provides novel insights into the microbiological changes following septic failure after a one-stage exchange for prosthetic joint infection of the knee. A higher prevalence of more difficult-to-treat bacteria might increase the complexity of subsequent procedures.
Purpose Re-operation after septic failure of a one-stage exchange for prosthetic joint infection (PJI) of the knee is a highly challenging procedure with concerns over residual bone stock, soft tissues, and stability. The associated changes in microbiology in cases of reinfection are still largely unknown. Methods A comprehensive analysis was performed of all patients treated at our tertiary institution between 2001 and 2017 who developed reinfection after a one-stage exchange for PJI of the knee. Prerequisites for inclusion were a certain diagnosis of PJI according to the ICM criteria and a minimum follow-up of three years. Data on comorbidities, previous surgical interventions, microbiological findings at the time of the initial one-stage exchange and at the time of reinfection, detection methods, and antibiotic resistance patterns were retrospectively studied. Results Sixty-six patients were identified that met the inclusion criteria. Reinfection occurred after a mean time interval of 27.7 months (SD +/- 33.9, range 1-165). Ten types of bacteria were found that were not present before the one-stage exchange. The causative pathogen remained identical in 22 patients (33%) and additional microorganisms were detected in ten patients (15%). Half of the reinfections were however due to (a) completely different microorganism(s). A significant increase in the number of PJIs on the basis of high-virulent (23 vs 30, p = 0.017) and difficult-to-treat bacteria (13 vs 24, p = 0.035) was found. Conclusion The present study provides a novel insight into the microbiological changes following septic failure after one-stage exchange for PJI of the knee. A higher prevalence of more difficult-to-treat bacteria might increase the complexity of subsequent procedures. Also, a longer follow-up of these patients than previously suggested seems in order.

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