title: Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes.
abstract: The definitive treatment and outcome of periprosthetic joint infection (PJI) caused by Enterococcus species is unknown. We performed a multi-institutional study to analyze the characteristics and treatment outcomes of patients with enterococcal PJI and to define an effective treatment protocol.
  
  
  
  We retrospectively reviewed all PJIs at 3 institutions between 1999 and 2014 using an electronic query followed by manual chart review. We included patients who met the Musculoskeletal Infection Society's criteria for PJI and had at least 1 positive intraoperative culture for any Enterococcus species. We identified 87 patients who had 12-month follow-up or treatment failure (mean, 4.03 years). Treatment failure was based on Delphi consensus criteria described previously. Kaplan-Meier survivorship analyses were performed. We assumed an alpha level of 0.05 for statistical significance.
  
  
  
  The overall incidence of enterococcal PJI was 4.2%. The overall treatment success rate was 51.7% (45 of 87 patients). Thirteen cases (14.9%) that failed treatment had adverse outcomes including salvage procedures and PJI-related mortality. Treatment success rates stratified by procedure were 62.8%, 39.4%, and 45.5% for 2-stage exchange arthroplasty, irrigation and debridement, and 1-stage exchange arthroplasty, respectively (P = .037). Antibiotic treatment was heterogeneous; although combination antibiotics demonstrated a trend toward higher treatment success, it was not statistically different from monotherapy regimens (P = .174).
  
  
  
  Enterococcal PJI has a high rate of treatment failure. Surgeons and patients should be aware of the difficulty in managing this condition and its dismal treatment outcomes. Although antibiotic treatment was heterogeneous, there was a trend toward higher success rates when combination antibiotic therapy was used.
authors: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Michael M
authors: MM
authors: Kheir
authors: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Timothy L
authors: TL
authors: Tan
authors: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Carlos
authors: C
authors: Higuera
authors: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio.
authors: Jaiben
authors: J
authors: George
authors: Midwest Orthopaedics at Rush University, Chicago, Illinois.
authors: Craig J
authors: CJ
authors: Della Valle
authors: Midwest Orthopaedics at Rush University, Chicago, Illinois.
authors: Mary
authors: M
authors: Shen
authors: The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors: Javad
authors: J
authors: Parvizi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D003646:Debridement / Q000379:methods; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology* / Q000628:therapy; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: enterococci; outcomes; periprosthetic joint infection; total hip arthroplasty; total knee arthroplasty