Increased Incidence of Methicillin-Resistant Staphylococcus aureus in Knee and Hip Prosthetic Joint Infection

• Published in: The Journal of arthroplasty Vol. 38; no. 6; pp. S326 - S330
• Main Authors: Hays, Matthew R., Kildow, Beau J., Hartman, Curtis W., Lyden, Elizabeth R., Springer, Bryan D., Fehring, Thomas K., Garvin, Kevin L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2023
• Subjects: Anti-Bacterial Agents - therapeutic use; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Coagulase - therapeutic use; complications; Humans; Incidence; Methicillin-Resistant Staphylococcus aureus; MRSA; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - etiology; prosthetic joint infection; Retrospective Studies; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology; total hip arthroplasty; total knee arthroplasty; total knee arthroplasty; total hip arthroplasty; complications; MRSA; prosthetic joint infection
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2023.02.025

Periprosthetic joint infection (PJI) is a devastating complication of knee and hip arthroplasty. Past literature has shown that gram-positive bacteria are commonly responsible for these infections, although limited research exists studying the changes in the microbial profile of PJIs over time. This study sought to analyze the incidence and trends of pathogens responsible for PJI over three decades. This is a multi-institutional retrospective review of patients who had a knee or hip PJI from 1990 to 2020. Patients with a known causative organism were included and those with insufficient culture sensitivity data were excluded. There were 731 eligible joint infections from 715 patients identified. Organisms were divided into multiple categories based on genus/species and 5-year increments were used to analyze the study period. The Cochran-Armitage trend tests were used to evaluate linear trends in microbial profile over time and a P-value <.05 was considered statistically significant. There was a statistically significant positive linear trend in the incidence of methicillin-resistant Staphylococcus aureus over time (P = .0088) as well as a statistically significant negative linear trend in the incidence of coagulase-negative staphylococci over time (P = .0018). There was no statistical significance between organism and affected joint (knee/hip). The incidence of methicillin-resistant Staphylococcus aureus PJI is increasing over time, whereas, coagulase-negative staphylococci PJI is decreasing, paralleling the global trend of antibiotic resistance. Identifying these trends may help with the prevention and treatment of PJI through methods such as remodeling perioperative protocols, modifying prophylactic/empiric antimicrobial approaches, or transitioning to alternative therapeutic strategies.