Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection

J Med Microbiol. 2020 Aug;69(8):1100-1104. doi: 10.1099/jmm.0.001229. Epub 2020 Jul 8.

Abstract

Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange.Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs.Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1-9 years). Reinfection and complications rates after the one-stage exchange were analysed.Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis.Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.

Keywords: MRSA; Methicillin-resistant Staphylococcus aureus; One-stage exchange; Periprosthetic Joint Infection; Total hip arthroplasty; Total knee arthroplasty.

MeSH terms

  • Adult
  • Aftercare
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Arthritis, Infectious / surgery
  • Arthritis, Infectious / therapy*
  • Cohort Studies
  • Debridement
  • Female
  • Hip Prosthesis / adverse effects*
  • Humans
  • Knee Prosthesis / adverse effects*
  • Male
  • Methicillin-Resistant Staphylococcus aureus*
  • Middle Aged
  • Prosthesis-Related Infections / surgery
  • Prosthesis-Related Infections / therapy*
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Staphylococcal Infections / surgery
  • Staphylococcal Infections / therapy*
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents