Article
Differences in the bacterial spectrum and the pathogens resistance pattern of infected knee and hip arthroplasty and infected anterior cruciate ligament reconstruction
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Authors
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Max Paul Lechmann
- Institut für Hygiene , Krankenhaus Merheim, Kliniken Köln, Köln, Germany
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Frauke Mattner
- Institut für Hygiene , Krankenhaus Merheim, Kliniken Köln, Köln, Germany
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Holger Bäthis
- Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Köln , Germany
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Sven Shafizadeh
- Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Köln , Germany
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Bertil Bouillon
- Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Köln , Germany
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Robin Otchwemah
- Institut für Hygiene , Krankenhaus Merheim, Kliniken Köln, Köln, Germany
| Published: | November 6, 2018 |
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Outline
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Objectives: Although the infection rate after arthroplasty or arthroscopy is low, these severe complications may cause major damage. Immediate empiric antibiotic therapy aims at limiting the degree of joint destruction. The increase of antimicrobial resistance to conventional agents among clinical isolates is a significant factor.
Surveillance and antibiotic stewardship approach the rising problems of accurate medical treatment.
The aim of this study was to characterize the bacterial spectrum and resistance patterns of the pathogens isolated from patients treated for joint infection on the same ward and to consider any implications for calculated antibiotic therapy.
Methods: In this retrospective study patients with joint infection following elective knee or hip arthroplasty due to arthrosis (IDSA criteria) and ACL reconstruction (CDC criteria) between 01.01.2009 and 31.12.2015 with positive microbiological cultures were included. The bacterial species and antibiograms of the patients of both groups were compared.
For statistical analysis, 2x2 contingency table was performed (odds ratio (OR), 95%-confidence interval (CI))
Results and conclusion: Fifty-seven patients were included in the arthroplasty group, their mean age was 70 years (45 to 83 years range), 67 % were male and 33 % female. Eighty-seven antibiograms were available.
In the ACL group 67 were included, 79 % were male and 11 % female. The mean age was 31 years (16 to 60 years range). Ninety-one antibiograms were available.
The most common organisms identified in both groups were coagulase-negative Staphylococcus (CNS) (76 % ACL-group, 44 % arthroplasty-group) and Staphylococcus aureus (SA) (11 % ACL-group, 18 % arthroplasty-group). Gram-negative bacteria were isolated with a frequency of 9 % in the ACL-group and 13 % in the arthroplasty-group. Streptococcus species were identified only in the arthroplasty cohort (12 %) (OR 24.7935, CI 1.4296-429.9895).
The proportion of oxacillin-resistant Staphylococcus species varied between the groups. In the arthroplasty-group 33% (21 % of all pathogens) were resistant and in the ACL-group 57 % (48% of all pathogens) (OR 2.5143, CI 1.2249-5.1611).
The bacterial spectrum and the pathogens resistance pattern of infected knee and hip arthroplasty and infected anterior cruciate ligament reconstruction differs although being treated on the same ward.
In our study, the amount of resistant Staphylococcal pattern was significantly higher in the ACL group compared to the arthroplasty group. Furthermore, the bacterial spectrum alternated, as there were significantly more Streptococcus species in the arthroplasty group.
In the maximum-care hospital the study took place, the calculated therapy for infected joints after arthroplasty is beta-lactamase-inhibitor in combination with penicillin. For infected knees after ACL reconstruction it is vancomycin plus ceftriaxone.
Our results suggest that even on the same ward the specific surveillance of treated entities is needed to improve calculated therapy.
