High Rate of Reinfection With New Bacteria Following One-Stage Exchange for Enterococcal Periprosthetic Infection of the Knee: A Single-Center Study
| Autor: | Thorsten Gehrke, Nemandra A Sandiford, Mustafa Citak, Markus Rossmann, Till Orla Klatte, Hussein Abdelaziz, Thore Minde |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Reoperation High rate medicine.medical_specialty Prosthesis-Related Infections Knee Joint business.industry Risk of infection Aseptic loosening Periprosthetic One stage Single Center Treatment Outcome Older patients Reinfection Internal medicine Humans Medicine Orthopedics and Sports Medicine Aseptic processing Arthroplasty Replacement Knee business Retrospective Studies |
| Zdroj: | The Journal of Arthroplasty. 36:711-716 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2020.08.015 |
| Popis: | Background A wide range of success rates following the surgical management of enterococcal periprosthetic joint infection (PJI) with a tendency toward worse outcomes have been reported. However, the role of 1-stage exchange remains under-investigated. Therefore, we aimed to evaluate our results after the 1-stage knee exchange for enterococcal PJI. Methods Forty patients were retrospectively included between 2002 and 2017 with a mean follow-up of survivors of 80 months (range 22-172; standard deviation [SD] = 5). Polymicrobial infections occurred in 45% (18/40) of patients. Patients’ characteristics, joint-related data, and antibiotic therapy were recorded. Rates of enterococcal infection relapse, reinfection with new microorganisms, and re-revision for any reason were determined. Bivariate analysis was conducted to identify risk factors of infection recurrence. Results Revision surgery was required in 22 cases (55%) with a mean time to revision surgery of 27 months (range 1-78; SD = 25). Indications for aseptic revisions (18%) included aseptic loosening (10%), periprosthetic fracture (5%), and patellar instability (3%). The most common cause of re-revision was a subsequent PJI (15/22; 68%) after a mean time of 22 months (range 1-77; SD = 24). Overall infection recurrence rate was 37.5% (15/40), substantially due to entirely non-enterococcal infections (9/15; 60%). Infection relapse with Enterococci occurred in 4 cases (10%) within 16 months postoperatively. Older patients (P = .05) and male gender (P = .05) were associated with a higher risk of infection recurrence. Conclusion Overcoming the Enterococci using the 1-stage exchange for knee PJI is achievable but the rate of reinfection due to new microorganisms is high . However, the overall infection recurrence rate is comparable to other treatment approaches. |
| Databáze: | OpenAIRE |
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