Abstract
Background
Periprosthetic joint infections (PJI), caused by pathogens, for which no biofilm-active antibiotics are available, are often referred to as difficult-to-treat (DTT). It is unclear whether DTT PJI has worse outcome due to unavailability of biofilm-active antibiotics. We evaluated the outcome of DTT and non-DTT PJI managed according to a standardized treatment regimen.
Methods
Patients with hip and knee PJI from 2013 to 2015 were prospectively included and followed-up for ≥2 years. DTT PJI was defined as growth of microorganism(s) resistant to biofilm-active antibiotics. The Kaplan-Meier survival analysis was used to compare the probability of infection-free survival between DTT and non-DTT PJI.
Results
Among 163 PJI, 30 (18.4%) were classified as DTT and 133 (81.6%) as non-DTT. At a mean follow-up of 33 months (range, 24–48 months), the overall treatment success was 82.8%. The infection-free-survival rate at 2 years was 80% (95% CI; 61%–90%) for DTT PJI and 84% (95% CI; 76%–89%) for non-DTT PJI (p=0.61). In DTT PJI, the following mean values were longer than in non-DTT PJI: prosthesis-free interval (89 vs. 58 days; p <0.001), duration of hospital stay (44.5 vs. 28.2 days; p <0.001) and the total duration of antimicrobial treatment (151 vs. 117 days; p=0.003).
Conclusions
The treatment outcome of DTT and non-DTT PJI was similar when a standardized treatment algorithm was used, however, a longer the prosthesis-free interval, hospital stay and antimicrobial treatment were needed.
