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976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year

BACKGROUND: Escherichia Coli (E coli) is a gram-negative rod that can cause devastating periprosthetic joint infections (PJIs) in patients with total hip and knee replacements (THA/TKA). Minimal literature exists on outcomes of E coli PJIs. METHODS: Retrospective review of our institution’s electron...

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Autores principales: Polascik, Breanna A, Bethell, Mikhail A, Briggs, Damon V, Adu-Kwarteng, Kwabena, Kim, Billy I, Case, Ayden, Prado, Isabel P, Wixted, Colleen M, Hendershot, Edward F, Jiranek, William A, Seidelman, Jessica, Seyler, Thorsten M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752165/
http://dx.doi.org/10.1093/ofid/ofac492.818
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author Polascik, Breanna A
Bethell, Mikhail A
Briggs, Damon V
Adu-Kwarteng, Kwabena
Kim, Billy I
Case, Ayden
Prado, Isabel P
Wixted, Colleen M
Hendershot, Edward F
Jiranek, William A
Seidelman, Jessica
Seyler, Thorsten M
author_facet Polascik, Breanna A
Bethell, Mikhail A
Briggs, Damon V
Adu-Kwarteng, Kwabena
Kim, Billy I
Case, Ayden
Prado, Isabel P
Wixted, Colleen M
Hendershot, Edward F
Jiranek, William A
Seidelman, Jessica
Seyler, Thorsten M
author_sort Polascik, Breanna A
collection PubMed
description BACKGROUND: Escherichia Coli (E coli) is a gram-negative rod that can cause devastating periprosthetic joint infections (PJIs) in patients with total hip and knee replacements (THA/TKA). Minimal literature exists on outcomes of E coli PJIs. METHODS: Retrospective review of our institution’s electronic medical record from 2009-2020 identified 21 patients that met MusculoSkeletal Infection Society criteria for E coli hip or knee PJI. Primary outcome was 1-year infection clearance - eradication of infection off antibiotics with no further surgeries for 1 year after completion of standard postoperative antibiotics. Minimum followup was 1 year. RESULTS: We analyzed 21 patients (mean age 66.6 yrs, 47.6% male, 23.8% nonWhite, 38.1% knee PJIs). There were 11 acute, 8 acute hematogenous (AH), and 2 chronic PJIs. Several patients had recent gastrointestinal/urinary tract surgery (14.3%), recurrent urinary tract infections (9.5%), or >1 E coli urine culture <1 mo pre-PJI (14.3%). Surgical treatments included DAIR (66.7%), 2-stage revision (14.3%), Girdlestone/Resection Arthroplasty (G/RA; 14.3%), and fusion (4.8%), with 7.1%, 100%, 66.7%, and 100% 1-year infection clearance, respectively, and 33.3% 1-year infection clearance overall (p=.001). Common reasons for treatment failure were reinfection requiring surgery (57.1%) and chronic antibiotics (38.1%). Patients clear at 1 year had a longer mean time from most recent surgery to index PJI surgery (48.7 vs 7mo;p=.043) and more AH than acute or chronic infections (54.6% vs 27.3% vs 18.2%;p=.0412). Patients who were not clear at 1 year had more acute infections (80% vs 20% AH;p=.0412). The E coli PJI persisted in 23.8% of patients. Outcomes at final followup included G/RA (28.6%), original prosthetic (28.6%), new prosthetic (19%), above knee amputation (9.5%), destination spacer (9.5%), and arthrodesis (4.8%). CONCLUSION: E coli PJI 1-year infection clearance is poor, with DAIR being the most common yet least effective surgical treatment. Most E coli PJIs occurred postoperatively as opposed to hematogenously, as is sometimes assumed. This serves as a foundation for future studies evaluating E coli treatment outcomes. DISCLOSURES: William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson & Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith & Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research.
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spelling pubmed-97521652022-12-16 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year Polascik, Breanna A Bethell, Mikhail A Briggs, Damon V Adu-Kwarteng, Kwabena Kim, Billy I Case, Ayden Prado, Isabel P Wixted, Colleen M Hendershot, Edward F Jiranek, William A Seidelman, Jessica Seyler, Thorsten M Open Forum Infect Dis Abstracts BACKGROUND: Escherichia Coli (E coli) is a gram-negative rod that can cause devastating periprosthetic joint infections (PJIs) in patients with total hip and knee replacements (THA/TKA). Minimal literature exists on outcomes of E coli PJIs. METHODS: Retrospective review of our institution’s electronic medical record from 2009-2020 identified 21 patients that met MusculoSkeletal Infection Society criteria for E coli hip or knee PJI. Primary outcome was 1-year infection clearance - eradication of infection off antibiotics with no further surgeries for 1 year after completion of standard postoperative antibiotics. Minimum followup was 1 year. RESULTS: We analyzed 21 patients (mean age 66.6 yrs, 47.6% male, 23.8% nonWhite, 38.1% knee PJIs). There were 11 acute, 8 acute hematogenous (AH), and 2 chronic PJIs. Several patients had recent gastrointestinal/urinary tract surgery (14.3%), recurrent urinary tract infections (9.5%), or >1 E coli urine culture <1 mo pre-PJI (14.3%). Surgical treatments included DAIR (66.7%), 2-stage revision (14.3%), Girdlestone/Resection Arthroplasty (G/RA; 14.3%), and fusion (4.8%), with 7.1%, 100%, 66.7%, and 100% 1-year infection clearance, respectively, and 33.3% 1-year infection clearance overall (p=.001). Common reasons for treatment failure were reinfection requiring surgery (57.1%) and chronic antibiotics (38.1%). Patients clear at 1 year had a longer mean time from most recent surgery to index PJI surgery (48.7 vs 7mo;p=.043) and more AH than acute or chronic infections (54.6% vs 27.3% vs 18.2%;p=.0412). Patients who were not clear at 1 year had more acute infections (80% vs 20% AH;p=.0412). The E coli PJI persisted in 23.8% of patients. Outcomes at final followup included G/RA (28.6%), original prosthetic (28.6%), new prosthetic (19%), above knee amputation (9.5%), destination spacer (9.5%), and arthrodesis (4.8%). CONCLUSION: E coli PJI 1-year infection clearance is poor, with DAIR being the most common yet least effective surgical treatment. Most E coli PJIs occurred postoperatively as opposed to hematogenously, as is sometimes assumed. This serves as a foundation for future studies evaluating E coli treatment outcomes. DISCLOSURES: William A. Jiranek, MD, Biomech Holdings LLC: Stocks/Bonds|DePuy, A Johnson & Johnson Company: IP royalties Thorsten M. Seyler, MD, PhD, Heraeus: Paid consultant|Pattern Health: IP royalties|Restor3d: IP royalties|Smith & Nephew: Paid consultant|Total Joint Orthopedics: Paid consultant|Zimmer: research. Oxford University Press 2022-12-15 /pmc/articles/PMC9752165/ http://dx.doi.org/10.1093/ofid/ofac492.818 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Polascik, Breanna A
Bethell, Mikhail A
Briggs, Damon V
Adu-Kwarteng, Kwabena
Kim, Billy I
Case, Ayden
Prado, Isabel P
Wixted, Colleen M
Hendershot, Edward F
Jiranek, William A
Seidelman, Jessica
Seyler, Thorsten M
976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title_full 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title_fullStr 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title_full_unstemmed 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title_short 976. E coli Periprosthetic Joint Infections: Poor Infection Clearance at One Year
title_sort 976. e coli periprosthetic joint infections: poor infection clearance at one year
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752165/
http://dx.doi.org/10.1093/ofid/ofac492.818
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