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Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment...
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Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 28934

Special Issue Editors

Dr. Natividad Benito

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Guest Editor
1. Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau—Institut d\'Investigació Biomèdica Sant Pau, Barcelona, Spain
2. Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
Interests: prevention; diagnosis and treatment of complex infections (bone and joint, endovascular, and central nervous system infections; health care-associated and multidrug-resistant infections; infections in immunocompromised patients)
Special Issues, Collections and Topics in MDPI journals
Dr. Jaime Esteban

E-Mail Website
Guest Editor
Departamento de Microbiología Clínica, Hospital, Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
Interests: biofilms; mycobacterium; non-tuberculous mycobacteria; prosthetic joint infections; implant-related infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Joint replacements are common and increasingly performed surgical procedures. The main indications for arthroplasties are to relieve pain and improve joint function in patients with advanced joint disease (mainly osteoarthritis), and to restore function in patients with fractures (typically femoral fractures in elderly patients). The most common joint replacements are hip and knee, although virtually all extra-axial joints can be replaced. Prosthetic joint infections (PJIs) are devastating complications with significant patient morbimortality and substantial healthcare and societal costs. While the percentage of PJIs in patients with arthroplasties could be considered low (1–3%), the increasing frequency of such procedures converts an apparently low risk into a substantial and increasing burden of infection. In most developed countries, PJI is considered a public health issue of major importance.

PJIs are a paradigm of extravascular biofilm-associated infection. The presence of biofilm influences and hinders all aspects of the prevention, diagnosis, and management of PJI. Infection eradication always requires surgery and antimicrobial therapy. Unlike other infections, however, the goal of PJI treatment is not only to eradicate infection, but also to relieve pain and maintain joint function, and not all of these outcomes are always possible in every patient. Strong collaboration between all medical and surgical specialists involved is a critical component of the care of patients with PJIs.

In this complex scenario, and despite the considerable amount of research performed in this field in recent decades, many unresolved questions remain about the prevention, diagnosis, treatment, and outcome of PJIs; indeed, most recommendations in these areas are based on expert opinion due to the limitations of the available information. Nevertheless, these limitations also bring opportunities, and the weaknesses of many of the available studies on PJI constitute a call to join forces in order to conduct well-designed international multidisciplinary studies.

This Special Issue aims to advance knowledge and expand our perspectives on the prevention, diagnosis, management, and outcome of PJIs. After the successful first volume on prosthetic joint infections, and considering the great challenges that these infections entail, we are delighted to launch a second volume, in which we hope to bring together the new advances in this exciting topic.

Dr. Natividad Benito
Dr. Jaime Esteban
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Prosthetic joint infection
  • Arthroplasty infection
  • Definition of prosthetic joint infection
  • Prosthetic joint infection prevention
  • Diagnosis of prosthetic joint infection
  • Prosthetic joint infection management
  • Antimicrobial therapy of prosthetic joint infection

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Published Papers (11 papers)

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8 pages, 435 KiB  
Article
The Clinical Outcome of Early Periprosthetic Joint Infections Caused by Staphylococcus epidermidis and Managed by Surgical Debridement in an Era of Increasing Resistance
by Nada S. Shabana, Gesine Seeber, Alex Soriano, Paul C. Jutte, Silvia Westermann, Glenn Mithoe, Loredana Pirii, Théke Siebers, Bas ten Have, Wierd Zijlstra, Djordje Lazovic and Marjan Wouthuyzen-Bakker
Antibiotics 2023, 12(1), 40; https://doi.org/10.3390/antibiotics12010040 - 27 Dec 2022
Cited by 6 | Viewed by 1936
Abstract
Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We [...] Read more.
Introduction: A risk factor for the failure of surgical debridement in patients with early periprosthetic joint infections (PJI) is the presence of multidrug-resistant microorganisms. Staphylococcus epidermidis is one of the most isolated microorganisms in PJI and is associated with emerging resistance patterns. We aimed to assess the antibiotic resistance patterns of S. epidermidis in early PJIs treated with surgical debridement and correlate them to clinical outcomes. Material and Methods: A retrospective multicentre observational study was conducted to evaluate patients with an early PJI (within 3 months after the index arthroplasty) by S. epidermidis with at least two positive intraoperative cultures. Clinical failure was defined as the need for additional surgical intervention or antibiotic suppressive therapy to control the infection. Results: A total of 157 patients were included. The highest rate of resistance was observed for methicillin in 82% and ciprofloxacin in 65% of the cases. Both were associated with a higher rate of clinical failure (41.2% vs. 12.5% (p 0.048) and 47.3% vs. 14.3% (p 0.015)), respectively. Furthermore, 70% of the cases had reduced susceptibility to vancomycin (MIC ≥ 2), which showed a trend towards a higher failure rate (39.6% vs. 19.0%, NS). Only 7% of the cases were rifampin-resistant. Only the resistance to fluoroquinolones was an independent risk factor for clinical failure in the multivariate analysis (OR 5.45, 95% CI 1.67–17.83). Conclusion: S. epidermidis PJIs show a high rate of resistance. Resistance to fluoroquinolones is associated with clinical failure. Alternative prophylactic antibiotic regimens and optimising treatment strategies are needed to improve clinical outcomes. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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11 pages, 477 KiB  
Article
Redo DAIR: The Game Is Seldom Worth the Candle
by Ignacio Sancho, Iñaki Otermin-Maya, Jorge Gutiérrez-Dubois, Ignacio Aláez, Julián Librero, Maria Eugenia Portillo and Ángel Hidalgo-Ovejero
Antibiotics 2023, 12(1), 18; https://doi.org/10.3390/antibiotics12010018 - 22 Dec 2022
Cited by 1 | Viewed by 1426
Abstract
Debridement, antibiotics and implant retention (DAIR) remains a commonly utilized technique in the treatment of acute prosthetic joint infections despite its inconsistent outcomes. The performance of a second DAIR after a failed first debridement is controversial as outcomes are uncertain and the final [...] Read more.
Debridement, antibiotics and implant retention (DAIR) remains a commonly utilized technique in the treatment of acute prosthetic joint infections despite its inconsistent outcomes. The performance of a second DAIR after a failed first debridement is controversial as outcomes are uncertain and the final prognosis in the event of failure may be unfavorable. This study analyzes 84 cases of acute prosthetic (hip & knee) joint infection treated with DAIR between 2011 and 2020 at the same institution. In 12 failed cases, a second DAIR was performed, whose success rate was significantly lower than that of the first procedure (8% [95% CI, 0–38] vs. 57% [46–68]). Moreover, the ultimate outcome of the second failed DAIRs was unfavorable with eradication of the infection being achieved in none of the patients. Due to the high likelihood of failure and the potentially grim final prognosis following a second debridement, removal of the components should be considered. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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16 pages, 904 KiB  
Article
Cutibacterium acnes Prosthetic Joint Infections: Is Rifampicin-Combination Therapy Beneficial?
by Grégoire Saltiel, Vanina Meyssonnier, Younes Kerroumi, Beate Heym, Olivier Lidove, Simon Marmor and Valérie Zeller
Antibiotics 2022, 11(12), 1801; https://doi.org/10.3390/antibiotics11121801 - 11 Dec 2022
Cited by 2 | Viewed by 4287
Abstract
No consensus has been reached on the optimal antibiotic regimen to treat Cutibacterium acnes PJIs (Ca-PJIs). In vitro studies showed excellent rifampicin efficacy against biofilm-associated C. acnes infections, but clinical studies did not confirm the superiority of rifampicin-combined therapy over monotherapy. This prospective [...] Read more.
No consensus has been reached on the optimal antibiotic regimen to treat Cutibacterium acnes PJIs (Ca-PJIs). In vitro studies showed excellent rifampicin efficacy against biofilm-associated C. acnes infections, but clinical studies did not confirm the superiority of rifampicin-combined therapy over monotherapy. This prospective cohort study was undertaken to analyze the outcomes of 70 patients who underwent exchange arthroplasty for chronic monomicrobial Ca-PJI and were treated with rifampicin or without between 2004 and 2019. The 37 patients treated from January 2004 to August 2014 were prescribed rifampicin-combination therapy and the 33 treated from September 2014 to December 2019 received monotherapy without rifampicin. The primary endpoint was the 2-year Kaplan–Meier-estimated reinfection-free probability, including relapses and new-pathogen PJIs. The 2-year reinfection-free rate was high and not different for patients who had received rifampicin or not (89.2% vs. 93.8%, respectively; p = 0.524). None of the patients relapsed and six developed new-pathogen PJIs. Our results do not support a benefit of rifampicin-combination therapy for patients who underwent exchange arthroplasty for chronic Ca-PJIs. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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8 pages, 265 KiB  
Article
Microbiological Characterization of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections
by Llanos Salar-Vidal, John Jairo Aguilera-Correa, Holger Brüggemann, Yvonne Achermann and Jaime Esteban
Antibiotics 2022, 11(9), 1260; https://doi.org/10.3390/antibiotics11091260 - 16 Sep 2022
Cited by 6 | Viewed by 2711
Abstract
Aims: This study aimed to characterize 79 Cutibacterium acnes strains isolated from prosthetic joint infections (PJIs) originated from eight European hospitals. Methods: Isolates were phylotyped according to the single-locus sequence typing (SLST) scheme. We evaluated the ability of the biofilm formation of C. [...] Read more.
Aims: This study aimed to characterize 79 Cutibacterium acnes strains isolated from prosthetic joint infections (PJIs) originated from eight European hospitals. Methods: Isolates were phylotyped according to the single-locus sequence typing (SLST) scheme. We evaluated the ability of the biofilm formation of C. acnes strains isolated from PJIs and 84 isolates recovered from healthy skin. Antibiotic susceptibility testing of planktonic and biofilm cells of PJI isolates and skin isolates was performed. Results: Most of the isolates from PJIs belonged to the SLST class H/phylotype IB (34.2%), followed by class D/phylotype IA1 (21.5%), class A/phylotype IA1 (18.9%), and class K/phylotype II (13.9%). All tested isolates were biofilm producers; no difference in biofilm formation was observed between the healthy skin group and the PJI group of strains. Planktonic and sessile cells of C. acnes remained highly susceptible to a broad spectrum of antibiotics, including beta-lactams, clindamycin, fluoroquinolones, linezolid, rifampin, and vancomycin. The minimal inhibitory concentrations (MICs) for planktonic and biofilm states coincided in most cases. However, the minimal biofilm eradication concentration (MBEC) was high for all antimicrobial drugs tested (>32 mg/L), except for rifampin (2 mg/L). Conclusions: C. acnes strains isolated from healthy skin were able to produce biofilm to the same extent as isolates recovered from PJIs. All C. acnes strains in planktonic and sessile states were susceptible to most antibiotics commonly used for PJI treatment, although rifampin was the only antimicrobial agent able to eradicate C. acnes embedded in biofilm. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
15 pages, 1342 KiB  
Article
Microbiological and Molecular Features Associated with Persistent and Relapsing Staphylococcus aureus Prosthetic Joint Infection
by Irene Muñoz-Gallego, María Ángeles Meléndez-Carmona, Jaime Lora-Tamayo, Carlos Garrido-Allepuz, Fernando Chaves, Virginia Sebastián and Esther Viedma
Antibiotics 2022, 11(8), 1119; https://doi.org/10.3390/antibiotics11081119 - 18 Aug 2022
Cited by 6 | Viewed by 1907
Abstract
Background: Persistent and relapsing prosthetic joint infection (PJI) due to Staphylococcus aureus presents a clinical challenge. This study aimed to provide an extensive description of phenotypic and genomic changes that could be related to persistence or relapse. Methods: Initial and second S. aureus [...] Read more.
Background: Persistent and relapsing prosthetic joint infection (PJI) due to Staphylococcus aureus presents a clinical challenge. This study aimed to provide an extensive description of phenotypic and genomic changes that could be related to persistence or relapse. Methods: Initial and second S. aureus isolates from 6 cases of persistent and relapsing PJI, along with clinical isolates from 8 cases, with favorable outcome were included. All isolates were studied by phenotypic and genotypic approaches. Results: Recurrent S. aureus isolates exhibited a significant increase in adhesive capacity, invasion and persistence compared to resolved isolates. No association was found for the presence or absence of certain genes with the persistence or relapse of PJI. All sequential isolates showed identical sequence type (ST). Resistance gene loss during the infection and a great diversity of variants in different virulence genes between the pair of strains, mainly in genes encoding adhesins such as fnbA, were observed. Conclusions: S. aureus-caused relapse and persistence PJI is associated with bacterial phenotypical and genotypical adaptation. The main paths of adaptation were persistence in the intracellular compartment, and the loss of antibiotic resistance genes and variant acquisition, especially in genes encoding adhesins. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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9 pages, 1640 KiB  
Article
Does a New Antibiotic Scheme Improve the Outcome of Staphylococcus aureus-Caused Acute Prosthetic Joint Infections (PJI) Treated with Debridement, Antibiotics and Implant Retention (DAIR)?
by Álvaro Auñón, Miguel Tovar-Bazaga, Antonio Blanco-García, Joaquín García-Cañete, Raúl Parrón and Jaime Esteban
Antibiotics 2022, 11(7), 922; https://doi.org/10.3390/antibiotics11070922 - 8 Jul 2022
Cited by 5 | Viewed by 1934
Abstract
One of the most commonly used treatments for acute prosthetic joint infection (PJI) is DAIR (debridement, antibiotics and implant retention), which comprises the debridement and the retention of the implant, followed by antibiotic treatment. The efficacy of DAIR remains unclear, as the literature [...] Read more.
One of the most commonly used treatments for acute prosthetic joint infection (PJI) is DAIR (debridement, antibiotics and implant retention), which comprises the debridement and the retention of the implant, followed by antibiotic treatment. The efficacy of DAIR remains unclear, as the literature has demonstrated variable success rates, ranging from 26% to 92%. The Staphylococcus aureus is one of the most closely related causative microorganisms, especially with acute and late-acute PJI; it has been identified as one of the most significant predictors of DAIR failure. The current guidelines consider the use of vancomycin as the therapy of choice, but it requires the close control of possible side effects. The aim of this study is to determine if a new combination of antibiotics (a highly bactericidal initial combination followed by an antibiofilm scheme) decreases the failure of DAIR-treated acute prosthetic joint infection (PJI) caused by Staphylococcus aureus. A retrospective analysis of cases of orthopedic infections during a nine-year period (2011–2019) was performed. A total of 45 acute PJI cases caused by S. aureus were diagnosed. The results of two antibiotic schemes were compared: a novel scheme comprising 5 days of daptomycin (10 mg/kg/24 h) + cloxacillin (2 g/6 h) followed by levofloxacin (500 mg/24 h) + rifampicin (600 mg/24 h), versus a traditional, less bactericidal scheme of vancomycin (1000 mg/12 h) plus rifampicin (600 mg/24 h) or levofloxacin (500 mg/24 h) plus rifampicin (600 mg/24 h). Twenty-two out of the twenty-four patients treated with the new scheme (91.6%) were free of infection after 24.8 months of mean follow-up, whereas fourteen out of twenty-one patients (66.6%) were free of infection after 46.6 months of follow-up. This difference was statistically significant (p = 0.036). Demographic comparisons demonstrated homogeneous features, except the Charlson score, which was higher in the novel scheme group (p = 0.047). The combination of high-dose daptomycin and cloxacillin, followed by levofloxacin plus rifampicin, together with surgical treatment, shows better results when compared with other antibiotic schemes for treating acute PJI caused by S. aureus in which DAIR was performed. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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10 pages, 602 KiB  
Article
Clindamycin Efficacy for Cutibacterium acnes Shoulder Device-Related Infections
by Audrey Courdurié, Romain Lotte, Raymond Ruimy, Vincent Cauhape, Michel Carles, Marc-Olivier Gauci, Pascal Boileau and Johan Courjon
Antibiotics 2022, 11(5), 608; https://doi.org/10.3390/antibiotics11050608 - 30 Apr 2022
Cited by 3 | Viewed by 3358
Abstract
Clindamycin is an antibiotic with high bioavailability and appropriate bone diffusion, often proposed as an alternative in guidelines for C. acnes prosthetic joint infections. We aimed to evaluate the efficacy of clindamycin in the treatment of C. acnes shoulder implant joint infections (SIJI). [...] Read more.
Clindamycin is an antibiotic with high bioavailability and appropriate bone diffusion, often proposed as an alternative in guidelines for C. acnes prosthetic joint infections. We aimed to evaluate the efficacy of clindamycin in the treatment of C. acnes shoulder implant joint infections (SIJI). Methods: A retrospective analysis was conducted at the University Hospital of Nice (France) between 2010 and 2019. We included patients with one shoulder implant surgical procedure and at least one C. acnes positive sample. We selected the C. acnes SIJI according to French and international recommendations. The primary endpoint was favorable outcome of C. acnes SIJI treatment after at least 1-year follow-up in the clindamycin group compared to another therapeutic group. Results: Forty-eight SIJI were identified and 33 were treated with clindamycin, among which 25 were treated with monotherapy. The median duration of clindamycin antibiotherapy was 6 weeks. The average follow-up was 45 months; one patient was lost to follow-up. Twenty-seven patients out of 33 (82%) were cured with clindamycin, compared to 9/12 (75%) with other antibiotics. The rate of favorable outcomes increased to 27/31 (87%) with clindamycin and to 9/10 (90%) for other antibiotics when no septic revision strategies were excluded (P = 1.00). Conclusions: The therapeutic strategy based on one- or two-stage revision associated with 6 weeks of clindamycin seems to be effective. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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Review

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16 pages, 1940 KiB  
Review
Diagnosis of Periprosthetic Joint Infection: The Utility of Biomarkers in 2023
by Mehmet Kursat Yilmaz, Ahmad Abbaszadeh, Saad Tarabichi, Ibrahim Azboy and Javad Parvizi
Antibiotics 2023, 12(6), 1054; https://doi.org/10.3390/antibiotics12061054 - 15 Jun 2023
Cited by 7 | Viewed by 3558
Abstract
Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test [...] Read more.
Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities for the identification of infections in this setting. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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26 pages, 2719 KiB  
Review
Profiling the Immune Response to Periprosthetic Joint Infection and Non-Infectious Arthroplasty Failure
by Cody R. Fisher and Robin Patel
Antibiotics 2023, 12(2), 296; https://doi.org/10.3390/antibiotics12020296 - 1 Feb 2023
Cited by 11 | Viewed by 3641
Abstract
Arthroplasty failure is a major complication of joint replacement surgery. It can be caused by periprosthetic joint infection (PJI) or non-infectious etiologies, and often requires surgical intervention and (in select scenarios) resection and reimplantation of implanted devices. Fast and accurate diagnosis of PJI [...] Read more.
Arthroplasty failure is a major complication of joint replacement surgery. It can be caused by periprosthetic joint infection (PJI) or non-infectious etiologies, and often requires surgical intervention and (in select scenarios) resection and reimplantation of implanted devices. Fast and accurate diagnosis of PJI and non-infectious arthroplasty failure (NIAF) is critical to direct medical and surgical treatment; differentiation of PJI from NIAF may, however, be unclear in some cases. Traditional culture, nucleic acid amplification tests, metagenomic, and metatranscriptomic techniques for microbial detection have had success in differentiating the two entities, although microbiologically negative apparent PJI remains a challenge. Single host biomarkers or, alternatively, more advanced immune response profiling-based approaches may be applied to differentiate PJI from NIAF, overcoming limitations of microbial-based detection methods and possibly, especially with newer approaches, augmenting them. In this review, current approaches to arthroplasty failure diagnosis are briefly overviewed, followed by a review of host-based approaches for differentiation of PJI from NIAF, including exciting futuristic combinational multi-omics methodologies that may both detect pathogens and assess biological responses, illuminating causes of arthroplasty failure. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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Other

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11 pages, 1356 KiB  
Systematic Review
Design Characteristics and Recruitment Rates for Randomized Trials of Peri-Prosthetic Joint Infection Management: A Systematic Review
by Laurens Manning, Bethwyn Allen and Joshua S. Davis
Antibiotics 2023, 12(10), 1486; https://doi.org/10.3390/antibiotics12101486 - 27 Sep 2023
Cited by 1 | Viewed by 1212
Abstract
Prosthetic joint infections (PJI) present a major management challenge for practicing orthopedic surgeons and infectious disease physicians. There are few high-quality data to inform treatment guidelines. The aim of this systematic review was to report the design characteristics and recruitment rates for randomized [...] Read more.
Prosthetic joint infections (PJI) present a major management challenge for practicing orthopedic surgeons and infectious disease physicians. There are few high-quality data to inform treatment guidelines. The aim of this systematic review was to report the design characteristics and recruitment rates for randomized controlled trials (RCTs) of PJI management. Trials were considered eligible for inclusion if human participants were randomized to any management intervention for PJI. We searched Medline, PubMed, Embase, Web of Science, Cochrane Database, ANZ Clinical Trials Registry, ClinicalTrials.gov, and the EU Clinical Trials Register until the end of May 2023. The systematic review was registered with PROSPERO (CRD42018112646). We identified 15 published RCTs with a total of 1743 participants with PJI. The median (interquartile range [IQR]) number of successfully recruited participants was 63 (38–140), with 0.28 (0.13–0.96) enrolments per site per month. Only four trials (36.4%) achieved the target recruitment. All RCTs applied different primary endpoints and varying definitions of a ‘good’ outcome. Despite recent improvements, PJI RCTs are characterized by slow recruitment and heterogeneous endpoint assessments, which preclude synthesis in a standard meta-analytic framework. To inform international guidelines, future PJI trials should be run as multi-country trials at high-recruiting sites. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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7 pages, 241 KiB  
Brief Report
Prevalence and Factors Associated with Prosthetic Joint Infections in Patients with Staphylococcus aureus Bacteraemia: A 7-Year Retrospective Study
by Matthaios Papadimitriou-Olivgeris, Laurence Senn, Claire Bertelli, Bruno Grandbastien, Sylvain Steinmetz and Noémie Boillat-Blanco
Antibiotics 2022, 11(10), 1323; https://doi.org/10.3390/antibiotics11101323 - 28 Sep 2022
Cited by 9 | Viewed by 1572
Abstract
Background: Staphylococcus aureus is the main cause of haematogenous prosthetic joint infections (PJI). We aimed to describe the prevalence and factors associated with PJI in patients with documented S. aureus bacteraemia. Methods: Adult patients with S. aureus bacteraemia and presence of prosthetic joint [...] Read more.
Background: Staphylococcus aureus is the main cause of haematogenous prosthetic joint infections (PJI). We aimed to describe the prevalence and factors associated with PJI in patients with documented S. aureus bacteraemia. Methods: Adult patients with S. aureus bacteraemia and presence of prosthetic joint hospitalized in Lausanne University Hospital during a seven-year period (2015–2021) were included. Results: Among 135 patients with S. aureus bacteraemia and prosthetic joints, 38 (28%) had PJI. Multivariate analysis revealed that the presence of PJI was associated with knee arthroplasty (P 0.029; aOR 3.00, 95% CI 1.12–8.05), prior arthroplasty revision (P 0.034; aOR 3.59, 95% CI 1.10–11.74), community-acquired bacteraemia (P 0.005; aOR 4.74, 95% CI 1.61–14.01) and age < 70 years (P 0.007; aOR 9.39, 95% CI 1.84–47.85). Conclusions: PJI was common among patients with documented S. aureus bacteraemia. PJI was associated with characteristics of the prosthesis, such as prior arthroplasty revisions and knee prosthesis. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research - 2nd Volume)
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