title: Eight years experience in treatment of prosthetic joint infections at a teaching hospital in Central Taiwan.
abstract: OBJECTIVE
  Prosthetic joint infection (PJI) has become an important issue in the management of patients who receive prostheses. We compared the clinical outcomes of PJIs caused by Gram-negative bacteria (GN PJIs) and Gram-positive bacteria (GP PJIs).
  
  
  METHODS
  Patients with culture-proven PJIs admitted to China Medical University Hospital between March 2001 and March 2009 were included in this retrospective study.
  
  
  RESULTS
  Fifty-nine patients were diagnosed with PJI during the study period. Nineteen patients had GN PJIs (mean age: 68 years) and 40 had GP PJIs (mean age: 61 years). The most common comorbid condition was diabetes mellitus (23.7%) and the most common presentation was joint pain (79.7%). Staphylococcus aureus was the most common pathogen, whereas Klebsiella pneumoniae was the most common Gram-negative pathogen. The GN PJI group included more cases of hematogenous infection (36.8% vs. 20%; p < 0.001), showed a shorter interval between onset of infection symptoms and surgical intervention (median: 8 days vs. 21 days; p = 0.04), and required longer medical treatment (median: 259 days vs. 161 days; p = 0.04). In comparison with patients whose prostheses were eventually removed, patients whose prostheses were not removed had a shorter interval between onset of infection symptoms and surgical intervention (median: 6 days vs. 90 days; p = 0.004 and median: 6 days vs. 44 days; p = 0.04) in the GP PJI and GN PJI groups, respectively.
  
  
  CONCLUSIONS
  GN PJI was less common than GP PJI, but GN PJI was more complicated and required longer treatment. Prospective randomized clinical studies are needed to investigate whether prosthesis implantation should be reserved if the patient undergoes early surgical intervention for PJI.
authors.affiliation: Section of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung City, Taiwan.
authors.forename: Shu-Wen
authors.initials: SW
authors.lastname: Tseng
authors.forename: Chih-Yu
authors.initials: CY
authors.lastname: Chi
authors.forename: Chia-Huei
authors.initials: CH
authors.lastname: Chou
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Wang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Liao
authors.forename: Cheng-Mao
authors.initials: CM
authors.lastname: Ho
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lin
authors.forename: Mao-Wang
authors.initials: MW
authors.lastname: Ho
authors.forename: Jen-Hsian
authors.initials: JH
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome