Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centr
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ORIGINAL PAPER
Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study Octavian Andronic 1 & Yvonne Achermann 2 & Thorsten Jentzsch 1 & Flurin Bearth 3 & Andreas Schweizer 1 & Karl Wieser 1 & Sandro F. Fucentese 1 & Stefan Rahm 1 & Annelies S. Zinkernagel 2 & Patrick O. Zingg 1 Received: 19 May 2020 / Accepted: 7 July 2020 # The Author(s) 2020
Abstract Purpose To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs). Methods A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution. Results The most common isolated streptococcal species was Streptococcus dysgalactiae (9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05). Conclusion No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint. Keywords Periprosthetic joint infection . PJI . Streptococcus infection . Biofilm . Rifampin
Introduction
Octavian Andronic and Yvonne Achermann contributed equally to this work. Level of Evidence: III (Retrospective Cohort Study) * Octavian Andronic [email protected] 1
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
2
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
3
University of Zurich, Rämistrasse 71, 8006 Zürich, Switzerland
Periprosthetic joint infections (PJIs) pose a significant problem in orthopaedics due to increased morbidity and mortality [1–3]. Streptococci are the second leading cause of infections and account for about 10% of PJIs [4] (incidence varies between 4 and 16% among report
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