Journal article
Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes
The Journal of arthroplasty, Vol.37(6), pp.S313-S320
06/2022
DOI: 10.1016/j.arth.2022.02.050
PMID: 35196567
Abstract
Coagulase-negative staphylococci (CoNS) are biofilm-producing pathogens whose role in periprosthetic joint infection (PJI) is increasing. There is little data on the prognosis and treatment considerations in the setting of PJI. We sought to evaluate the clinical characteristics, outcomes, and complications in these patients.
This is a retrospective cohort study of adult patients at a single tertiary medical center from 2009 to 2020 with culture-proven CoNS PJI after total knee arthroplasty, as diagnosed by Musculoskeletal Infection Society criteria. The primary outcome was treatment success, with failure defined as recurrent CoNS PJI, recurrent PJI with a new pathogen, and/or chronic oral antibiotic suppression at one year postoperatively.
We identified 55 patients with a CoNS total knee arthroplasty PJI with a mean follow-up of 29.8 months (SD: 16.3 months). The most commonly isolated organism was Staphylococcus epidermidis (n = 36, 65.5%). The overall prevalence of methicillin resistance was 63%. Surgical treatment included surgical debridement, antibiotics, and implant retention in 25 (45.5%) cases and two-stage revision (22 articulating and eight static antibiotic-impregnated spacers). At one-year follow-up, only 47% of patients had successful management of their infection. The surgical debridement, antibiotics, and implant retention cohort had the higher rate of treatment failure (60.0%) compared to two-stage revision (46.7%).
These results indicate a poor rate of success in treating CoNS PJI. This likely represents the interplay of inherent virulence through biofilm formation and decreased antibiotic efficacy.
Details
- Title: Subtitle
- Prosthetic Knee Infection With Coagulase-Negative Staphylococcus: A Harbinger of Poor Outcomes
- Creators
- Lefko T. Charalambous - Duke UniversityBilly I. Kim - Duke UniversityAndrew M. Schwartz - Duke UniversityAyden Case - Duke UniversityJessica L. Seidelman - Duke UniversityEdward F. Hendershot - Duke UniversityMichael P. Bolognesi - Duke UniversityThorsten M. Seyler - Duke UniversityWilliam A. Jiranek - Duke University
- Resource Type
- Journal article
- Publication Details
- The Journal of arthroplasty, Vol.37(6), pp.S313-S320
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.arth.2022.02.050
- PMID
- 35196567
- ISSN
- 0883-5403
- eISSN
- 1532-8406
- Language
- English
- Date published
- 06/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984303989802771
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