Description of reinfection of joint prosthesis after 2-stage replacement (infection of the 2nd stage prosthesis): A multicenter study

Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery. Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018. We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases). The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate. El recambio en 2 tiempos es un procedimiento habitual en el tratamiento de las infecciones de prótesis articular (IPA). Sin embargo, la prótesis que se coloca en el segundo tiempo (2T) puede reinfectarse de nuevo (ReIPA). Además, existe escasa evidencia sobre qué profilaxis antibiótica debe utilizarse en el 2T. Nuestro objetivo es describir las características de las ReIPA, su pronóstico y las profilaxis antibióticas que se emplean habitualmente en la cirugía del 2T. Estudio observacional retrospectivo descriptivo multicéntrico en hospitales españoles de pacientes con ReIPA en el periodo 2009–2018. Se registraron 92 casos de 12 hospitales. El microorganismo más frecuentemente implicado fue Staphylococcus epidermidis con 35 casos (38,5%). El 61,1% de Staphylococcus spp. eran meticilin-resistentes. En 12 casos (13%), la ReIPA fue provocada por el mismo microrganismo re