Darwich Ali, Baumgärtner Tobias, Hetjens Svetlana, Gravius Sascha, Bdeir Mohamad
Department of Orthopedic and Trauma Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Institute of Medical Statistics and Biomathematics, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Antibiotics (Basel). 2025 Jul 25;14(8):752. doi: 10.3390/antibiotics14080752.
Periprosthetic joint infections (PJIs) are considered as one of the most serious complications after total joint arthroplasty. Aim of this study was to evaluate the prevalence of PJI caused by difficult-to-treat (DTT) pathogens as well as PJIs with a superinfection with a DTT pathogen in the course of the infection and assess the risk factors leading to this emergence. Data of 169 consecutive patients with a PJI was analyzed in this retrospective observational single-center study, and cases were categorized into PJIs with initial DTT pathogens, PJIs with DTT pathogen superinfection, non-DTT PJIs, and PJIs with superinfection. Recorded parameters comprised age, gender, side, body mass index (BMI), preoperative anticoagulation, and serum level of C-reactive protein (CRP) at admission, as well as preoperative patient status using the ASA (American Society of Anesthesiologists) score and the age-adjusted form of the Charlson comorbidity index (CCI). Furthermore, the infecting microorganism and the type of infection as well as the chosen operative treatment regime, duration of the antibiotics interval, and the outcome were recorded. In total, 46.2% of cases were DTT PJIs, and 30.8% of them were superinfections. Elevated serum CRP levels at admission (≥92.1 mg/L) were linked to a nearly 7-fold increased likelihood of a DTT PJI (OR 6.981, CI [1.367-35.63], = 0.001), compared to patients with a non-DTT PJI. Hip joint involvement was also associated with a 3.5-fold higher risk compared to knee joints (OR 3.478, CI [0.361-33.538], = 0.0225). Furthermore, patients undergoing ≥3 revision surgeries demonstrated a significantly 1.3-fold increased risk of developing a DTT superinfection (OR 1.288, CI [1.100-1.508], < 0.0001). Chronic PJIs were similarly associated with a markedly 3.5-fold higher likelihood of superinfection by DTT pathogens (OR 3.449, CI [1.159-10.262], = 0.0387). Remaining parameters did not significantly affect the rate of a DTT PJI or a PJI with DTT superinfection. These findings underscore the importance of early identification of high-risk patients and highlight the need for tailored preventive and therapeutic strategies in managing DTT PJIs.
人工关节周围感染（PJI）被认为是全关节置换术后最严重的并发症之一。本研究的目的是评估由难治性（DTT）病原体引起的PJI的患病率，以及在感染过程中合并DTT病原体重叠感染的PJI，并评估导致这种情况出现的危险因素。在这项回顾性观察性单中心研究中，分析了169例连续的PJI患者的数据，并将病例分为初始感染DTT病原体的PJI、合并DTT病原体重叠感染的PJI、非DTT PJI和合并重叠感染的PJI。记录的参数包括年龄、性别、患侧、体重指数（BMI）、术前抗凝情况、入院时血清C反应蛋白（CRP）水平，以及使用美国麻醉医师协会（ASA）评分和Charlson合并症指数（CCI）的年龄校正形式评估的术前患者状况。此外，还记录了感染微生物、感染类型以及所选择的手术治疗方案、抗生素间隔时间和结果。总体而言，46.2%的病例为DTT PJI，其中30.8%为重叠感染。与非DTT PJI患者相比，入院时血清CRP水平升高（≥92.1 mg/L）与DTT PJI的发生可能性增加近7倍相关（OR 6.981，CI [1.367 - 35.63]，P = 0.001）。与膝关节相比，髋关节受累的风险也高出3.5倍（OR 3.478，CI [0.361 - 33.538]，P = 0.0225）。此外，接受≥3次翻修手术的患者发生DTT重叠感染的风险显著增加1.3倍（OR 1.288，CI [1.100 - 1.508]，P < 0.0001）。慢性PJI同样与DTT病原体重叠感染的可能性显著高出3.5倍相关（OR 3.449，CI [1.159 - 10.262]，P = 0.0387）。其余参数对DTT PJI或合并DTT重叠感染的PJI发生率没有显著影响。这些发现强调了早期识别高危患者的重要性，并突出了在管理DTT PJI时制定针对性预防和治疗策略的必要性。
