title: Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip.
abstract: BACKGROUND
  The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery.
  
  
  METHODS
  A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups-135 with monomicrobial and 54 with polymicrobial infection.
  
  
  RESULTS
  Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m2(p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0-10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0-27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18-16.37; p = 0.03).
  
  
  CONCLUSIONS
  Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation. clinpharm-rniito@yandex.ru.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Bozhkova
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.|Mechnikov North-Western State Medical University, St. Petersburg, Russian Federation.
authors.forename: Rashid
authors.initials: R
authors.lastname: Tikhilov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Labutin
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Alexey
authors.initials: A
authors.lastname: Denisov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Igor
authors.initials: I
authors.lastname: Shubnyakov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Vadim
authors.initials: V
authors.lastname: Razorenov
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Vasilii
authors.initials: V
authors.lastname: Artyukh
authors.affiliation: Vreden Russian Research Institute of Traumatology and Orthopaedics, Akademika Baikova Str., 8, 195427, St. Petersburg, Russian Federation.
authors.forename: Anna
authors.initials: A
authors.lastname: Rukina
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology* / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Polymicrobial PJI; Prosthetic joint infection; Two-stage revision