Trends in Antibiotic-Resistant Bacteria in Surgically Treated Periprosthetic Joint Infection: A Decade of Experience at a Regional Referral Center.

Abstract

Periprosthetic joint infection (PJI) represents a devastating complication following total joint arthroplasty. Understanding trends in causative organisms and antibiotic resistance patterns is necessary for optimizing treatment strategies. We investigated (1) whether there has been a change in prevalence of drug-resistant organisms in surgically treated PJI over the past decade, and (2) if there are risk factors associated with drug-resistant PJI. A retrospective review of our institutional database was performed for surgically treated PJI between January 1, 2010, and December 31, 2021. A total of 915 patients met Musculoskeletal Infection Society (MSIS) criteria for PJI. The prevalence of patients who had drug-resistant organisms was recorded and compared over the study duration. Of 915 procedures, 25.1% (N = 230) were caused by resistant organisms. The most common resistant organisms were methicillin-resistant Staphylococcus aureus (MRSA) (63.0%), methicillin-resistant Staphylococcus epidermidis (MRSE) (24.3%), and resistant coagulase-negative Staphylococci (CoNS) (16.1%). Total PJI cases increased from 53 in 2010 to 109 in 2021, while resistant organism cases increased from 22 to 30. The percentage of resistant PJI decreased from 41.5% (22 of 53) in 2010 to 25.1% (30 of 109) in 2021, with no significant trend (P = 0.85). Patients who had higher co-morbidity burden had significantly higher rates of resistant infections (P = 0.04), as did patients who had local extremity compromise (P = 0.01). The MRSE and resistant CoNS were more common in knee infections. While PJI referrals to our center increased over time, the percentage of surgically treated PJIs caused by resistant organisms decreased, although not significantly. Patients who had a higher comorbidity burden and local extremity compromise were predictive of resistant infections. Understanding microbiological profiles remains critical for optimizing treatment strategies in referral centers.