Abstract

HIDDEMA, J S et al. Periprosthetic joint infection: A South African perspective. SAMJ, S. Afr. med. j. [online]. 2023, vol.113, n.6, pp.1213-1219. ISSN 2078-5135.  http://dx.doi.org/10.7196/SAMJ.2023.v113i6.16765.

BACKGROUND: South African (SA) data on the bacteriology and sensitivity profile of periprosthetic joint infection are lacking. Current regimens for systemic and local antibiotic therapy are based on international literature. These regimens are different for the USA and Europe, and therefore might not be relevant to SA OBJECTIVES: To determine the characteristics of periprosthetic joint infection in an SA clinical setting by identifying the most common organisms cultured, and establishing their antibiotic sensitivities in order to propose the most appropriate empiric antibiotic treatment regimen In the case of two-stage revision procedures, we aim to compare the organisms cultured during the first stage v. organisms cultured during the second stage in second-stage procedures that had positive cultures. Furthermore, in these culture-positive second-stage procedures we aim to correlate the bacterial culture with the erythrocyte sedimentation rate/C-reactive protein result. METHODS: We performed a retrospective cross-sectional study looking at all hip and knee periprosthetic joint infections in patients >18 years treated at a government institution and a private revision practice in Johannesburg, SA between January 2015 and March 2020. Data were collected from the Charlotte Maxeke Johannesburg Academic Hospital hip and knee and the Johannesburg Orthopaedic hip and knee databanks RESULTS: We included 69 patients who underwent 101 procedures relating to periprosthetic joint infection. Positive cultures were found in 63 samples, and 81 different organisms were identified. The most common organisms cultured were Staphylococcus aureus (n=16, 19.8%) and coagulase-negative Staphylococcus (n=16, 19.8%), followed by Streptococci species (n=l 1, 13.6%). The positive yield in our cohort was 62.4% (n=63). A polymicrobial growth was found in 19% (n=12) of the culture-positive specimens. Of all the micro-organisms cultured, 59.2% (n=48) were Gram-positive, v. 35.8% (n=29) Gram-negative. The remainder were fungal and anaerobic organisms, at 2.5% (n=2) each. Gram-positive cultures displayed 100% sensitivity to vancomycin and linezolid, whereas Gram-negative organisms displayed 82% sensitivity towards gentamicin and 89% sensitivity towards meropenem, respectively CONCLUSION: Our study identifies the bacteriology of periprosthetic joint infections and their sensitivities in a SA setting. We recommend that empiric antibiotic-loaded cement spacers and systemic antibiotic regimens should consist of meropenem or gentamicin, or vancomycin and rifampicin to achieve the broadest spectrum of coverage and most likely success in eradicating infection

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