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A comparison of the clinical characteristics and outcomes of aerobic and anaerobic prosthetic joint infections (PJIs): a single-center retrospective review
Journal article   Open access   Peer reviewed

A comparison of the clinical characteristics and outcomes of aerobic and anaerobic prosthetic joint infections (PJIs): a single-center retrospective review

Lemuel R. Non and Poorani Sekar
Journal of bone and joint infection, Vol.10(6), pp.471-477
11/18/2025
DOI: 10.5194/jbji-10-471-2025
PMCID: PMC12645905
PMID: 41306295
url
https://doi.org/10.5194/jbji-10-471-2025View
Published (Version of record) Open Access

Abstract

Background: Prosthetic joint infection (PJI) is an uncommon but serious complication of joint arthroplasty, associated with significant morbidity and healthcare costs. Anaerobic organisms are an under-recognized cause of PJI, either as sole pathogens or within polymicrobial infections, and data on their clinical impact are limited. This study compared clinical presentation and outcomes of anaerobic vs. aerobic PJIs. Methods: This is a retrospective review of 284 patients who met Musculoskeletal Infection Society (MSIS) criteria for PJI from 2014 to 2020 at the University of Iowa Hospitals and Clinics (UIHC). A total of 38 had anaerobic PJI; 268 had aerobic PJI. Statistical analyses were performed using Pearson's χ2, a Fisher exact test, and a t test. Results: Anaerobic PJIs represented 13.4 % of PJIs in our institution. Compared to aerobic cases, anaerobic PJIs had longer symptom duration (19.4 vs. 10.9 weeks, p=0.005), more sinus tracts (23.7 % vs. 6.1 %, p<0.001), fewer fevers (13.2 % vs. 31.3 %, p=0.022), more radiographic abnormalities (44.7 % vs. 29.3 %, p=0.024), and lower ESR and CRP (ESR: 49.0 vs. 67.4 mm h−1; CRP: 6.6 vs. 12.3 mg dL−1; both p=0.003). Shoulder PJIs were more often anaerobic (39.5 % vs. 4.9 %, p<0.001). Anaerobic PJIs were more likely to be treated with two-stage exchange (65.8 %), while aerobic cases more often underwent debridement and implant retention (44.7 %). Recurrence rates were similar. Conclusion: Anaerobic PJIs tend to present with features such as shoulder involvement, prolonged or chronic symptoms, sinus tract formation, and radiographic signs of infection, whereas aerobic PJIs are more commonly linked to acute presentations. For this reason, both aerobic and anaerobic cultures should be performed routinely to optimize diagnostic yield.

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