Microbiological profiles and antibiotic resistance of periprosthetic joint infection after hip replacement in patients with fracture or non-fracture: A comparative study

Abstract

BACKGROUND: Periprosthetic joint infection (PJI) is one of the worst complications following total joint arthroplasty (TJA). Unfortunately, effective prevention strategies to reduce the burden of PJI have not been fully determined in hip replacement patients with fracture and non-fracture. OBJECTIVE: This study aimed to analyze and compare the demographic characteristics, microbiological profiles and antibiotic resistance of PJI after hip replacement between patients with fracture and non-fracture. METHODS: We retrospectively analyzed the data of 132 patients who treated PJI. There were divided into two groups: non-fracture group (64 patients infected after hip replacement for fracture) and non-fracture group (68 patients infected after hip replacement for non-fracture). Microorganisms were obtained from the synovial fluid and infected necrotic tissue in the joint capsule, medullary cavity, or acetabulum in all patients, and microbiological profiles and antibiotic resistance were evaluated. RESULTS: Coagulase-negative staphylococci (CoNS) were the most common pathogenic microorganisms in all patients. Methicillin-resistant Staphylococcus (MRS) accounted for 25% in all pathogenic microbes. Staphylococci showed high drug resistance rates to clindamycin, levofloxacin, and all of the first- and second-generation cephalosporins. MRS isolates in non-fracture group had higher drug resistance rates to clindamycin and levofloxacin than than those in fracture group. Gram-negative bacilli (GNB) showed high drug resistance rates to Aztreonam, gentamicin and all of the third- and fourth-generation cephalosporins. Furthermore, GNB isolates in the non-fracture group showed higher resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins. CONCLUSIONS: MRS isolates in the non-fracture group showed higher drug resistance rates to clindamycin and levofloxacin, and GNB isolates in non-fracture group showed higher drug resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins.