TRENDS IN THE MICRO-ORGANISM PROFILES OF PERIPROSTHETIC JOINT INFECTION SINCE THE START OF THE 21ST CENTURY: A RETROSPECTIVE DATABASE STUDY

Periprosthetic joint infection (PJI) is a catastrophic complication following total joint arthroplasty (TJA), with an incidence ranging from 1% to 2% in primary procedures. Despite various prevention strategies, the management of PJI remains challenging, leading to significant revision surgeries. Identifying the causative microorganism is crucial for effective treatment, but limited research exists on the temporal changes in microbial profiles of PJIs. This retrospective cohort study analyzed septic exchange hip and knee arthroplasty cases at a high-volume tertiary infection referral center in Europe between 2001 and 2022. PJI cases were identified using the institution's electronic joint infection database. Patients’ demographics, culture results, CRP values, and antibiotic sensitivity were collected. Among 2,392 patients with infected hips (60.7%) and knees (39.3%), Staphylococcus was the most common causative organism (60.6%), followed by Streptococcus (10.9%) and Enterococcus (7.8%). Gram-negative organisms accounted for 4.7% of cases, with fluctuating rates over time. Culture-negative cases comprised 10.6% of all infections. Polymicrobial infections increased over the study period, reaching almost 40% in 2022. Rates of difficult-to-treat bacteria rose significantly from 22.8% in 2017 to 53.0% in 2022, with methicillin-resistant Staphylococcus aureus being the most common resistant organism. The rise in resistant organisms and polymicrobial infections poses challenges in managing PJI. Improved diagnostic techniques, such as next-generation sequencing, may aid in identifying culture-negative cases and refining PJI management strategies. Effective antimicrobial stewardship is essential to combat growing antibiotic resistance in PJI.