Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip Reportar como inadecuado

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Journal of Orthopaedics and Traumatology

, Volume 17, Issue 4, pp 369–376

First Online: 07 July 2016Received: 13 November 2015Accepted: 26 June 2016


BackgroundThe unsuccessful treatment of prosthetic joint infection PJI with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery.

Materials and methodsA retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein CRP, white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups—135 with monomicrobial and 54 with polymicrobial infection.

ResultsOf all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg-m p = 0.05. The median CRP values were 5.7 mg-L IQR 4.0–10.0 mg-L in the monomicrobial compared to 8.8 mg-L IQR 5.0–27 mg-L in the polymicrobial group p = 0.01. The percentage of successful outcomes was 27.8 % in patients with microbial associations p < 0.0001. Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence OR 4.4; 95 % CI 1.18–16.37; p = 0.03.

ConclusionsOverweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful.

Level of evidenceLevel III, therapeutic study.

KeywordsProsthetic joint infection Two-stage revision Polymicrobial PJI  Download fulltext PDF

Autor: Svetlana Bozhkova - Rashid Tikhilov - Dmitry Labutin - Alexey Denisov - Igor Shubnyakov - Vadim Razorenov - Vasilii Artyukh


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