Archive for April 7, 2017

Gram-negative prosthetic joint infections: risk factors and outcome of treatment.

Clin Infect Dis. 2009 Oct 1;49(7):1036-43

Hsieh PH, Lee MS, Hsu KY, Chang YH, Shih HN, Ueng SW.

Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St., 333 Kweishian, Taoyuan, Taiwan. hsiehph@adm.cgmh.org.tw

BACKGROUND:

Little information is available regarding the demographic characteristics and outcomes of patients with prosthetic joint infection (PJI) resulting from gram-negative (GN) organisms, compared with patients with PJI resulting from gram-positive (GP) organisms.

METHODS:

We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution during the period from 2000 through 2006.

RESULTS:

GN microorganisms were involved in 53 (15%) of 346 first-time episodes of PJI, and Pseudomonas aeruginosa was the most commonly isolated pathogen (21 [40%] of the 53 episodes). Patients with GN PJI were older (median age, 68 vs. 59 years; P<.001) and developed infection earlier (median joint age, 74 vs. 109 days; P<.001) than those with GP PJI. Of the 53 episodes of GN PJI, 27 (51%) were treated with debridement, 16 (30%) with 2-stage exchange arthroplasty, and 10 (19%) with resection arthroplasty. Treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success than treating GP PJI with debridement (27% vs. 47% of episodes were successfully treated; P=.002); no difference was found when a PJI was treated with 2-stage exchange or resection arthroplasty. A longer duration of symptoms before treatment with debridement was associated with treatment failure for GN PJI, compared with for GP PJI (median duration of symptoms, 11 vs. 5 days; P=.02).

CONCLUSIONS:

GN PJI represents a substantial proportion of all occurrences of PJI. Debridement alone has a high failure rate and should not be attempted when the duration of symptoms is long. Resection of the prosthesis, with or without subsequent reimplantation, as a result of GN PJI is associated with a favorable outcome rate that is comparable to that associated with PJI due to GP pathogens.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/49/7/10.1086/605593/2/49-7-1036.pdf?Expires=1491958662&Signature=IxAKWF6-WgKZaPGD72JDtgQ9EfZuwpmNFPVdR-BdK33eRJu1GUZJXyCJ7ri9ZaJ-a4T2iy6Mj1nesDu5OTWvIfp2j5XaVprK679YVFFTXrSfwHRKFO8JDumpQWlBnByaEbCEsj~ky9lFBC~~2xrpArBj31INcTvo1vLo5sICnAjdiELud-7DVPsbupIMI7ZE3HJiWJFNiP8FGIgyiCEeD2EhGUieinh7IbChHW6tjzh5v-AIB1LCiQzHPaVo8QPMbu9HH7ggA0JlS7YXjwhwJJfdjYU4pgWxeBL9p464aVUmZWotZzoN-lNM46Wyryl4U1xrPETeCZOVC1u8fGMdNQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

Advertisements

April 7, 2017 at 10:07 pm


Calendar

April 2017
M T W T F S S
« Mar   May »
 12
3456789
10111213141516
17181920212223
24252627282930

Posts by Month

Posts by Category