Corynebacterium Periprosthetic Joint Infections: A Single-Institution's Experience with a Virulent Organism.

Abstract

The outcome of periprosthetic joint infections (PJIs) is not only contingent on treatment strategy and host factors, but also on the infecting organism. Corynebacterium, a genus of gram-positive bacterium, is uncommonly implicated in PJIs, but represents a challenge when present, as it commonly demonstrates resistance to often-used antibiotics. Given the limited data available, we sought to report on our institution's historical experience with managing PJI of the hip or knee due to Corynebacterium. A retrospective review was conducted of all total hip and knee arthroplasties performed at our institution from 2016 to 2023 for PJI in which the Corynebacterium genus was identified. Demographic, surgical, and clinical outcomes data were collected. Overall, 18 patients were identified who had a mean age of 65 years, and there was a predominance of women (94.4%). Patients, on average, had 4.9 prior surgeries. Surgical treatment of the Corynebacterium PJI included single-stage revision (n = five), irrigation and debridement (n = two), resection arthroplasty (n = one), and two-stage revision (n = 10). Overall, five cases (27.8%) were polymicrobial infections. Most cases received multiagent treatment (61.1%) administered in a concurrent (90.9%) fashion. The average antibiotic duration was 6.5 weeks. The majority (57.9%) of patients had a prior PJI, and all but one, for which data were unavailable, were infected with a multidrug-resistant strain of Corynebacterium. In total, 13 patients had tetracycline-resistant strains of Corynebacterium, and no cases demonstrated vancomycin resistance. At final follow-up (mean = 2.9 years, standard deviation = 2.8), 16 patients had never undergone amputation, 15 had no reinfection, and 12 patients were alive. Corynebacterium-associated PJIs represent a unique subset of disease that can be challenging to manage, in part due to its antibiotic resistance profile. However, with close collaboration between surgical and infectious disease teams, reasonable outcomes can be expected.