Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty — Implications for Empiric Antibiotic Treatment
Prosthetic joint infection (PJI) is the leading cause of revision following total knee arthroplasty (TKA). Prior to microorganism identification, the choice of the correct empiric antibiotics is critical to treatment success. This study aims to 1) compare the microorganism and resistance profile in...
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| Veröffentlicht in: | The Journal of arthroplasty 2022-09, Vol.37 (9), p.1858-1864.e1 |
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| container_title | The Journal of arthroplasty |
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| creator | Kim, Katy Zhu, Mark Coleman, Brendan Munro, Jacob Terrill Young, Simon W. |
| description | Prosthetic joint infection (PJI) is the leading cause of revision following total knee arthroplasty (TKA). Prior to microorganism identification, the choice of the correct empiric antibiotics is critical to treatment success. This study aims to 1) compare the microorganism and resistance profile in early and late PJIs; 2) recommend appropriate empiric antibiotics.
A multicentre retrospective review was performed over a 15-year period. First episode PJIs were classified by both the Tsukayama Classification and Auckland Classification. For each PJI case, the causative organism and antibiotic sensitivity were recorded.
Of eligible patients, 232 culture-positive PJI cases were included. Using either classification system, early PJIs ( |
| doi_str_mv | 10.1016/j.arth.2022.04.014 |
| format | Article |
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A multicentre retrospective review was performed over a 15-year period. First episode PJIs were classified by both the Tsukayama Classification and Auckland Classification. For each PJI case, the causative organism and antibiotic sensitivity were recorded.
Of eligible patients, 232 culture-positive PJI cases were included. Using either classification system, early PJIs (<4 weeks or <1 year since primary) were significantly more likely to be resistant and polymicrobial. The predominant organisms were coagulase-negative Staphylococci in early PJIs while Staphylococcus aureus was the most common in late PJIs. The distribution of gram-negative cases was higher in early Class-A than late Class-C PJIs (25% versus 6%, P = .004). Vancomycin provided significantly superior coverage when compared to Flucloxacillin for early infections, and addition of a gram-negative agent achieved coverage over 90% using both classification systems.
Based on the microbiological pattern in Tsukayama criteria, Vancomycin with the consideration of Gram-negative agent should be considered for Class-A infections given the high proportion of resistant and polymicrobial cases. For Class-C infections, Cephazolin or Flucloxacillin is likely sufficient. We recommend antibiotics to be withheld in Class-B infections until cultures and sensitivities are known.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2022.04.014</identifier><identifier>PMID: 35460813</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>antibiotic stewardship ; empirical antibiotic treatment ; microorganism profile ; prosthetic joint infection ; total knee joint arthroplasty</subject><ispartof>The Journal of arthroplasty, 2022-09, Vol.37 (9), p.1858-1864.e1</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-f7286cea08a2a10915bb8421ecbef81d10a3e39c525752d75cd0468564cde4f43</citedby><cites>FETCH-LOGICAL-c356t-f7286cea08a2a10915bb8421ecbef81d10a3e39c525752d75cd0468564cde4f43</cites><orcidid>0000-0001-5465-7217</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arth.2022.04.014$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35460813$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Katy</creatorcontrib><creatorcontrib>Zhu, Mark</creatorcontrib><creatorcontrib>Coleman, Brendan</creatorcontrib><creatorcontrib>Munro, Jacob Terrill</creatorcontrib><creatorcontrib>Young, Simon W.</creatorcontrib><title>Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty — Implications for Empiric Antibiotic Treatment</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Prosthetic joint infection (PJI) is the leading cause of revision following total knee arthroplasty (TKA). Prior to microorganism identification, the choice of the correct empiric antibiotics is critical to treatment success. This study aims to 1) compare the microorganism and resistance profile in early and late PJIs; 2) recommend appropriate empiric antibiotics.
A multicentre retrospective review was performed over a 15-year period. First episode PJIs were classified by both the Tsukayama Classification and Auckland Classification. For each PJI case, the causative organism and antibiotic sensitivity were recorded.
Of eligible patients, 232 culture-positive PJI cases were included. Using either classification system, early PJIs (<4 weeks or <1 year since primary) were significantly more likely to be resistant and polymicrobial. The predominant organisms were coagulase-negative Staphylococci in early PJIs while Staphylococcus aureus was the most common in late PJIs. The distribution of gram-negative cases was higher in early Class-A than late Class-C PJIs (25% versus 6%, P = .004). Vancomycin provided significantly superior coverage when compared to Flucloxacillin for early infections, and addition of a gram-negative agent achieved coverage over 90% using both classification systems.
Based on the microbiological pattern in Tsukayama criteria, Vancomycin with the consideration of Gram-negative agent should be considered for Class-A infections given the high proportion of resistant and polymicrobial cases. For Class-C infections, Cephazolin or Flucloxacillin is likely sufficient. We recommend antibiotics to be withheld in Class-B infections until cultures and sensitivities are known.</description><subject>antibiotic stewardship</subject><subject>empirical antibiotic treatment</subject><subject>microorganism profile</subject><subject>prosthetic joint infection</subject><subject>total knee joint arthroplasty</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp9kUGOFCEUhonROO3oBVwYlm6qBAqq6cRNZ6ZHW9s4i3ZNKOoxQ4eCFmhN7zyEl_BansSq1OjSFQv-_4P3PoReUlJTQts3h1qncl8zwlhNeE0of4QWVDSskpy0j9GCSNlUgpPmAj3L-UAIpULwp-iiEbwlkjYL9OvaWQvJhTv8yZkUY7rTweUB36ZonQfsAt7o5M9Yhx7vdIHpJpd7KM7gD9GFgrfBgikuhoxvovfx-0S7TW7Q6Yz3sWiPPwYAvB5_m-LR61zO-PePn3g7HL0zeq7amPBmOLo0ctehuM7F6Yl9Al0GCOU5emK1z_Di4bxEX242-6v31e7zu-3VeleZRrSlsksmWwOaSM00JSsquk5yRsF0YCXtKdENNCsjmFgK1i-F6QlvpWi56YFb3lyi1zP3mOLXE-SiBpcNeK8DxFNWrBWcLVeSsjHK5ui4uJwTWHWcp1aUqEmROqhJkZoUKcLVqGgsvXrgn7oB-n-Vv07GwNs5AOOU3xwklY2DYKB3adyz6qP7H_8PlsWm0w</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Kim, Katy</creator><creator>Zhu, Mark</creator><creator>Coleman, Brendan</creator><creator>Munro, Jacob Terrill</creator><creator>Young, Simon W.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5465-7217</orcidid></search><sort><creationdate>20220901</creationdate><title>Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty — Implications for Empiric Antibiotic Treatment</title><author>Kim, Katy ; Zhu, Mark ; Coleman, Brendan ; Munro, Jacob Terrill ; Young, Simon W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-f7286cea08a2a10915bb8421ecbef81d10a3e39c525752d75cd0468564cde4f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>antibiotic stewardship</topic><topic>empirical antibiotic treatment</topic><topic>microorganism profile</topic><topic>prosthetic joint infection</topic><topic>total knee joint arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Katy</creatorcontrib><creatorcontrib>Zhu, Mark</creatorcontrib><creatorcontrib>Coleman, Brendan</creatorcontrib><creatorcontrib>Munro, Jacob Terrill</creatorcontrib><creatorcontrib>Young, Simon W.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Katy</au><au>Zhu, Mark</au><au>Coleman, Brendan</au><au>Munro, Jacob Terrill</au><au>Young, Simon W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty — Implications for Empiric Antibiotic Treatment</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2022-09-01</date><risdate>2022</risdate><volume>37</volume><issue>9</issue><spage>1858</spage><epage>1864.e1</epage><pages>1858-1864.e1</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Prosthetic joint infection (PJI) is the leading cause of revision following total knee arthroplasty (TKA). Prior to microorganism identification, the choice of the correct empiric antibiotics is critical to treatment success. This study aims to 1) compare the microorganism and resistance profile in early and late PJIs; 2) recommend appropriate empiric antibiotics.
A multicentre retrospective review was performed over a 15-year period. First episode PJIs were classified by both the Tsukayama Classification and Auckland Classification. For each PJI case, the causative organism and antibiotic sensitivity were recorded.
Of eligible patients, 232 culture-positive PJI cases were included. Using either classification system, early PJIs (<4 weeks or <1 year since primary) were significantly more likely to be resistant and polymicrobial. The predominant organisms were coagulase-negative Staphylococci in early PJIs while Staphylococcus aureus was the most common in late PJIs. The distribution of gram-negative cases was higher in early Class-A than late Class-C PJIs (25% versus 6%, P = .004). Vancomycin provided significantly superior coverage when compared to Flucloxacillin for early infections, and addition of a gram-negative agent achieved coverage over 90% using both classification systems.
Based on the microbiological pattern in Tsukayama criteria, Vancomycin with the consideration of Gram-negative agent should be considered for Class-A infections given the high proportion of resistant and polymicrobial cases. For Class-C infections, Cephazolin or Flucloxacillin is likely sufficient. We recommend antibiotics to be withheld in Class-B infections until cultures and sensitivities are known.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35460813</pmid><doi>10.1016/j.arth.2022.04.014</doi><orcidid>https://orcid.org/0000-0001-5465-7217</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | antibiotic stewardship empirical antibiotic treatment microorganism profile prosthetic joint infection total knee joint arthroplasty |
| title | Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty — Implications for Empiric Antibiotic Treatment |
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