title: Prosthetic joint infection caused by gram-negative organisms.
abstract: Traditionally, periprosthetic joint infections (PJIs) due to gram-negative organisms are considered more difficult to manage; however, little literature exists with regard to outcome of PJI caused by gram-negative organisms. We identified 277 patients with 282 culture-positive PJI receiving surgical treatment. Thirty-one joints were treated for gram-negative PJI. The gram-negative group was then compared with the gram-positive and polymicrobial PJI. A single debridement and retention of prosthesis were successful in 70% (7/10) of isolated gram negative compared with 33.3% (13/39) of methicillin-sensitive gram positive, 48.9% (23/47) of methicillin-resistant gram positive, and 57.1% (4/7) of polymicrobial. Of those patients undergoing a planned 2-stage exchange, a successful reimplantation was performed in 52% (12/23) of gram-negative, 51% (52/103) of methicillin-resistant gram-positive, 69% (65/94) of methicillin-sensitive gram-positive, and 0% (0/8) of polymicrobial PJI cases. These results indicate that PJI due to gram-negative pathogens, although less common, is difficult to treat and is associated with limited success.
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zmistowski
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Fedorka
authors.forename: Eoin
authors.initials: E
authors.lastname: Sheehan
authors.forename: Gregory
authors.initials: G
authors.lastname: Deirmengian
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Austin
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000302:isolation & purification; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000150:complications* / Q000628:therapy; D006622:Hip Prosthesis / Q000382:microbiology*; D006801:Humans; D007720:Knee Prosthesis / Q000382:microbiology*; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents