title: Time trends in the aetiology of prosthetic joint infections: a multicentre cohort study.
abstract: It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements.
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: nbenito@santpau.cat.
authors.forename: N
authors.initials: N
authors.lastname: Benito
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Franco
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Soriano
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Rodriguez-Pardo
authors.affiliation: Department of Infectious Diseases, Hospital del Mar, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sorlí
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Fresco
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Valdecilla, Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Sampedro
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Dolores Del Toro
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Cruces, Bilbao, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Guío
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Sánchez-Rivas
authors.affiliation: Department of Internal Medicine-Infectious Diseases, Hospital el Bierzo, León, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Bahamonde
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Department of Infectious Diseases, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Riera
authors.affiliation: Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Esteban
authors.affiliation: Department of Infectious Diseases, Hospital de Basurto, Bilbao, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Baraia-Etxaburu
authors.affiliation: Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Alvarez
authors.affiliation: Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Jover-Sáenz
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Burgos, Burgos, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Dueñas
authors.affiliation: Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ramos
authors.affiliation: Department of Infectious Diseases, Hospital Regional Universitario Málaga, Málaga, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Sobrino
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Euba
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Clínic Universitari, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Morata
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Pigrau
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Coll
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Mur
authors.affiliation: Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ariza
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001170:Arthritis, Infectious / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D001178:Arthroplasty / Q000009:adverse effects; D001419:Bacteria / Q000187:drug effects; D015331:Cohort Studies; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005260:Female; D005658:Fungi / Q000187:drug effects; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology* / Q000266:history; D013030:Spain / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Microbial aetiology; Microbiology; Multidrug-resistant organisms; Prosthetic joint infection; Surgical site infection