The Microbiology And Assoicated Risk Factor In Alloplastic Total Joint Infections: A Twenty-Year Retrospective Study

Publication date: Available online 8 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rhae Riegel, Kevin Sweeney, Gino Inverso, Peter Quinn, Eric J. Granquist
PurposeProsthetic joint infection (PJI) is a rare complication of temporomandibular joint replacement (TJR). This study aims to evaluate TJR PJI at our institution over a 20-year period including: microorganisms cultured, antibiotic resistances patterns, and intraoperative protocols of TJR.Patients and MethodsPatients were identified using CPT, ICD-9 codes, and surgical logs from January 1995-2015. Inclusion criteria: adults > 18 years with previous total alloplastic joint replacement, and the presence of infection of the prosthetic at explant. Exclusion criteria: patients < 18 years and who received hemiarthroplasty. Primary outcomes include culture data, and antibiotic selection for PJI. Secondary outcomes include intraoperative duration and in-vivo duration.ResultsEleven patients were identified and fifteen joints explanted. Average length in-vivo was 232 months (STD 478.9 months). Six percent (n=1) were identified as early PJI (0-3 months), 46% (n=7) intermediate PJI (3 months- 2 years), and 33% (n=5) late PJI (>2 years). One patient was not able to be classified as early, intermediate, or late. Staphylococcus aureus was present in 53% of subjects and was the predominant organism isolated. Propionibacterium acnes were isolated in 33% of subjects. Penicillin was the antibiotic with the most organism resistance (46%).ConclusionIn the current study, the most commonly cultured organisms were Staphylococcus aureus (53%) a finding consistent with current literature. The prevalence of Propionibacterium acnes colonization was noted in 33% of cases. Although the significance of P. acnes and its contribution to PJI still requires further investigation, it is known to be associated with PJI and biofilm formation. Consideration could be given, based on this study, for the use of vancomycin and first generation cephalosporins as perioperative antibiotic coverage.



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