title: Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia.
abstract: BACKGROUND
  Staphylococcus aureus bacteremia is a life-threatening condition that may lead to metastatic infection, including prosthetic joint infection.
  
  
  METHODS
  To assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a 5-year period at our institution. Patients with postsurgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded.
  
  
  RESULTS
  There were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (odds ratio [OR] 18.07; 95% confidence interval [CI] 2.64-infinity; P = .001), as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of ≥3 joint arthroplasties in place was associated with a nearly ninefold increased odds of hematogenous prosthetic joint infection as compared with those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; P = .012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infections diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia.
  
  
  CONCLUSIONS
  Prosthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia is rare.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn. Electronic address: tande.aaron@mayo.edu.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Tande
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Bharath Raj
authors.initials: BR
authors.lastname: Palraj
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Osmon
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Elie F
authors.initials: EF
authors.lastname: Berbari
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.affiliation: Department of Biostatistics and Informatics, Mayo Clinic, Rochester, Minn.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: James M
authors.initials: JM
authors.lastname: Steckelberg
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minn.
authors.forename: M Rizwan
authors.initials: MR
authors.lastname: Sohail
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001178:Arthroplasty / Q000009:adverse effects*; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy; D017714:Community-Acquired Infections / Q000150:complications; D003428:Cross Infection / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000150:complications* / Q000175:diagnosis; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Arthroplasty; Bacteremia; Osteomyelitis; Prosthetic joint infection; Staphylococcus aureus