Microbiological Profi le of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries

Mozella, Alan de Paula; Assunção, Thales Nunes de; Cobra, Hugo Alexandre de Araújo Barros; Minamoto, Sandra Tie Nishibe; Salim, Rodrigo; Leal, Ana Carolina

doi:10.1055/s-0042-1758368

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Original Article • Rev Bras Ortop 58 (3) • May-Jun 2023 • https://doi.org/10.1055/s-0042-1758368 copy

Microbiological Profi le of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries^* * Study developed at Instituto Nacional de Traumatología e Ortopedia (INTO), Rio de Janeiro, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

We studied the microbiological profile of periprosthetic knee infections treated in a Brazilian tertiary hospital.

Methods

The study included all patients undergoing revision surgery for total knee arthroplasty (RTKA) between November 2019 and December 2021, with a diagnosis of periprosthetic infection confirmed per the 2018 International Consensus Meeting (ICM) criteria.

Results

Sixty-two patients had a periprosthetic joint infection (PJI) per the 2018 ICM criteria. Cultures were monomicrobial in 79% and polymicrobial in 21% of cases. The most frequent bacterium in microbiological tissue and synovial fluid cultures was Staphylococcus aureus, observed in 26% of PJI patients. Periprosthetic joint infection with negative cultures occurred in 23% of patients.

Conclusion

Our results show the following: i) a high prevalence of Staphylococcus as an etiological agent for knee PJI; ii) a high incidence of polymicrobial infections in early infections; iii) the occurrence of PJI with negative cultures in approximately one fourth of the subjects.

arthroplasty; replacement; knee; postoperative complications; intraarticular injections; prosthesis-related infections

Exclusion criteria
- Refusal to sign the informed consent form
- Revision of an unicompartmental arthroplasty
- Reimplants in patients with spacers (second time)
- Impossibility to sample synovial fluid
- Insufficient information to confirm or rule out an infectious diagnosis
- Use of antibiotic agents within 15 days before the surgery
- Patients with other active bacterial infectious diseases
- Patients with acquired immunodeficiency syndrome

Major criteria (at least one positive)				Decision
Two cultures positive for the same organism				Infected
Fistulae				Infected
Preoperative diagnosis	Minor criteria		Score	Decision
	Serum	Elevated CRP or D-dimer	2	> 6infected
	Serum	Elevated ESR	1	> 6infected
	Synovial fluid	Elevated leukocyte count or positive leukocyte esterase	3	2-5 Potentially infected*
		Positive alpha-defensin	3	0-1not infected
		Elevated neutrophil %	2
		Elevated CRP	1
Intraoperative diagnosis	Inconclusive preoperative criteria or lack of synovial fluid		Score	Decision
	Preoperative score		-	> 6infected
	Positive histopathological analysis		3	4-5 potentially infected
	Presence of pus		3	4-5 potentially infected
	One positive culture		2	< 3not infected

Variable	Infection
N	62
Gender, n(%)
Female	23 (37%)
Male	39 (63%)
Age (years), mean (±standard deviation)	68.9 (±8.7)
BMI (kg/m²), mean (±standard deviation)	27.4 (±9.9)
Diabetes, n(%)	12 (19%)
Inflammatory disease, n(%)	11 (18%)
Previous implant, n(%)
Primary prosthesis	38 (61%)
Revision	18 (29%)
Rate of events characterizing infection, n(%)
Fistulae	16 (25%)
> 2positivecultures	46 (74%)
Time between prosthesis implant and revision, n(%)
< 3months	23 (37%)
3-12 months	9 (15%)
> 12 months	30 (48%)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Alan de Paula Mozella, Instituto Nacional de Traumatologia e Ortopedia - INTO, Rio de Janeiro, RJ, Brasil (e-mail: apmozella@terra.com.br).

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Microbiological Profi le of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries* * Study developed at Instituto Nacional de Traumatología e Ortopedia (INTO), Rio de Janeiro, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Microbiological Profi le of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries^* * Study developed at Instituto Nacional de Traumatología e Ortopedia (INTO), Rio de Janeiro, Brazil.