title: Characteristics of prosthetic joint infections leading to bacteremia: a case-control study.
abstract: The possible systemic infectious consequences of prosthetic joint infections (PJI) are poorly documented in the literature. We assessed the frequency of postoperative prosthetic hip and knee infections leading to bacteremia and investigated their associated factors among patients treated between 2005 and 2009. Among 633 patients with PJI, 62 (9.8%) also had positive blood cultures (95% confidence interval (CI) 7.5-12.1). After complete investigations, the prosthesis was considered as the direct cause of bacteremia in 14 cases (2.2%; 95% CI 1.1-3.4). In the conditional logistic regression analysis, PJI leading to bacteremia was more frequently observed in cases of relapses of a prior PJI (adjusted odds ratio (aOR) 7.3, p = 0.07) and in patients with a C-reactive protein value upon admission ≥ 180 mg/l (aOR 4.5, p = 0.04). None of the 8 bacteremic patients treated with surgical debridement and prosthetic retention were cured from joint infection. These preliminary results raise concerns about the fact that debridement with prosthetic retention may not be an appropriate option in the context of PJI leading to bacteremia, contrary to PJI resulting from hematogenous seeding.
authors.affiliation: From the 1 Department of Infectious and Tropical Diseases, University Hospital Pellegrin.
authors.forename: Frédéric-Antoine
authors.initials: FA
authors.lastname: Dauchy
authors.forename: Hervé
authors.initials: H
authors.lastname: Dutronc
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lawson-Ayayi
authors.forename: Gaëtane
authors.initials: G
authors.lastname: Wirth
authors.forename: Pauline
authors.initials: P
authors.lastname: Hofmann
authors.forename: Bertille
authors.initials: B
authors.lastname: de Barbeyrac
authors.forename: Thierry
authors.initials: T
authors.lastname: Fabre
authors.forename: Michel
authors.initials: M
authors.lastname: Dupon
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000209:etiology* / Q000473:pathology*; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D003646:Debridement; D005260:Female; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein