Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy

Front Cell Infect Microbiol. 2024 May 21:14:1388385. doi: 10.3389/fcimb.2024.1388385. eCollection 2024.

Abstract

Objectives: This study aimed to determine whether combined of pathogen detection strategies, including specimen acquisition, culture conditions, and molecular diagnostics, can improve treatment outcomes in patients with periprosthetic joint infections (PJI).

Methods: This retrospective study included suspected PJI cases from three sequential stages at our institution: Stage A (July 2012 to June 2015), Stage B (July 2015 to June 2018), and Stage C (July 2018 to June 2021). Cases were categorized into PJI and aseptic failure (AF) groups based on European Bone and Joint Infection Society (EBJIS) criteria. Utilization of pathogen diagnostic strategies, pathogen detection rates, targeted antibiotic prescription rates, and treatment outcomes were analyzed and compared across the three stages.

Results: A total of 165 PJI cases and 38 AF cases were included in this study. With the progressive implementation of the three optimization approaches across stages A, B and C, pathogen detection rates exhibited a gradual increase (χ2 = 8.282, P=0.016). Similarly, utilization of targeted antibiotic therapy increased stepwise from 57.1% in Stage A, to 82.3% in Stage B, and to 84% in Stage C (χ2 = 9.515, P=0.009). The 2-year infection control rate exceeded 90% in both stages B and C, surpassing stage A (71.4%) (χ2 = 8.317, P=0.011). Combined application of all three optimized protocols yielded the highest sensitivity of 91.21% for pathogen detection, while retaining higher specificity of 92.11%.

Conclusion: The utilization of combined pathogen diagnostic strategies in PJI can increase pathogen detection rates, improve targeted antibiotic prescription, reduce the occurrence of antibiotic complications, and achieve better treatment outcomes.

Keywords: antibiotic; bacteria; diagnosis; periprosthetic joint infection; total joint arthroplasty.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents* / therapeutic use
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prosthesis-Related Infections* / diagnosis
  • Prosthesis-Related Infections* / drug therapy
  • Prosthesis-Related Infections* / microbiology
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Natural Science Foundation of China (grant number 82272510), the Joint Funds for the Innovation of Science and Technology, Fujian Province, China (grant number 2022Y4003), the Fujian Medical Innovation Grant, China (grant number 2023CXA020), and the Fujian Provincial Health Commission's Program for Cultivating Middle-aged and Young Leading Talents (grant number 2023ZQNRCYX-FXY).