Microbiology, Treatment, and Postoperative Outcomes of Gram-Negative Prosthetic Joint Infections—A Systematic Review of the Literature

Abstract

Introduction: Gram-negative prosthetic joint infections (PJIs) represent 10% to 25% of all PJIs and are associated with worse outcomes than gram-positive infections. We sought to assess the microbiology, surgical treatment, and outcomes of patients with gram-negative PJIs. Methods: A systematic review using the PubMed and Embase databases was conducted. Our study was conducted following the PRISMA guidelines. Included studies were assessed for quality using the STROBE checklist. The primary outcome of analysis was treatment failure. Results: A total of 593 patients with gram-negative PJIs were included. Two-year survival free of treatment failure for hip and knee PJIs was 66% and 68% for acute infections, 39% and 78% for acute hematogenous infections, and 75% and 63% for chronic infections, respectively. Two-year survival free of treatment failure for acute infections treated with débridement, antibiotics, and implant retention was 65% and 67% for hip and knee PJIs, respectively. Exchange of the polyethylene during débridement, antibiotics, and implant retention was associated with higher treatment success (P = 0.045). Chronic PJIs treated with two-stage revision had a two-year treatment success rate of 87% and 65% for the hip and knee, respectively. Risk factors of treatment failure were chronic obstructive pulmonary disease and C-reactive protein ≥30 mg/L in acute PJIs and female sex, knee infection, and previously revised implant in chronic PJIs. Acute PJIs caused by Pseudomonas spp. were associated with lower treatment failure rates. Conclusion: Gram-negative PJIs are associated with a high treatment failure rate. Patient comorbidities, preoperative biochemical tests, microorganism etiology, and PJI characteristics affected the treatment success rate.