Clinical characteristics, microbiology, and outcomes of prosthetic joint infection in Taiwan.
BACKGROUND
Prosthetic joint infection (PJI) after total knee or hip replacement is a devastating complication associated with substantial morbidity and economic cost. The incidence of prosthetic joint infection is increasing as the use of mechanical joint replacement increases. The treatment approach to prosthetic joint infection is based on different clinical situations such as a patient's comorbidities, epidemic microbiology data, and surgical procedures. The aim of our study was to understand clinical characteristics of prosthetic joint infection, the microbiology of the prosthetic joint infection, and the outcomes of different treatment strategies during 2006-2011.


METHODS
We retrospectively collected cases of prosthetic joint infection in the National Taiwan University Hospital between January 1, 2006 and December 31, 2011. The patients' characteristics, microbiology, outcomes, and factors associated with treatment success were recorded.


RESULTS
One hundred and forty-four patients were identified as having PJI. Of these, 92 patients were entered into per-protocol analysis. Staphylococcus aureus was the most common causative organism (29.9%), followed by coagulase-negative Staphylococci (16.7%), and Enterococci (9.7%). The overall treatment success rate was 50%. Patients who received a two-stage revision had a better outcome, compared to patients who underwent other types of surgeries (70% vs. 32.7%, respectively; p < 0.001). In multivariate analysis, the two-stage revision was significantly associated with treatment success (odds ratio = 3.923, 95% confidence interval = 1.53-10.04).


CONCLUSIONS
Our study demonstrates that Staphylococcus aureus was the most common causative organisms in PJI. Performing two-stage revisions was significantly associated with a better outcome.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan; Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Jen-Chih
JC
Tsai
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan. Electronic address: whsheng@ntu.edu.tw.
Wang-Huei
WH
Sheng
Department of Orthopedic Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
Wan-Yu
WY
Lo
Department of Orthopedic Surgery, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
Ching-Chuan
CC
Jiang
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan.
Shan-Chwen
SC
Chang
D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology* / Q000628:therapy; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
Prosthetic joint infection; Two-stage revision