Periprosthetic Joint Infections as a Consequence of Bacteremia

BACKGROUND: The risk for developing a periprosthetic joint infection (PJI) during bacteremia is unclear, except for Staphylococcus aureus bacteremia. The aim of this study was to examine the risk for developing a PJI during bacteremia and to identify possible risk factors leading to it. METHODS: Patients with a primary knee or hip joint replacement performed in a tertiary care hospital between September 2002 and December 2013 were identified (n = 14 378) and followed up until December 2014. Positive blood culture results during the study period and PJIs were recorded. PJIs associated with an episode of bacteremia were identified and confirmed from patient records. Potential risk factors for PJI among those with bacteremia were examined using univariate logistic regression. RESULTS: A total of 542 (3.8%) patients had at least 1 episode of bacteremia. Seven percent (47/643) of the bacteremias resulted in a PJI. Development of a PJI was most common for Staphylococcus aureus (21% of bacteremias led to a PJI) and beta-hemolytic streptococci (21%), whereas it was rare for gram-negative bacteria (1.3%). Having ≥2 bacteremias during the study period increased the risk for developing a PJI (odds ratio, 2.29; 95% confidence interval, 1.17–4.50). The risk for developing a PJI was highest for bacteremias occurring within a year of previous surgery. Chronic comorbidities did not affect the risk for PJI during bacteremia. CONCLUSIONS: The development of a PJI during bacteremia depends on the pathogen causing the bacteremia and the timing of bacteremia with respect to previous joint replacement surgery. However, significant patient-related risk factors for PJI during bacteremia could not be found.