Microbiological Profiles of Patients with Acute Periprosthetic Joint Infection Undergoing Debridement, Antibiotics, Irrigation and Implant Retention (DAIR)

Abstract

<strong>Background:</strong> Periprosthetic joint infection (PJI) is one of the most serious complications following total joint arthroplasty. The debridement, antibiotics, irrigation, and implant retention (DAIR) procedure is commonly employed to treat acute, early-stage infections, but its success is highly variable, influenced by factors such as pathogen virulence and antibiotic susceptibility profiles. This study aimed to evaluate the impact of pathogens responsible for these infections on the outcome of DAIR. <strong>Methods:</strong> This retrospective, single-center study analyzed the microbiological profiles of 116 patients (66 hips and 50 knees) treated for acute periprosthetic joint infections (PJIs) with DAIR between 2018 and 2022. Acute PJI was defined as a duration of symptom less than three weeks, according to the criteria established by the Tsukayama and Izakovicova classification. Preoperative joint aspirations, intraoperatively collected tissue samples, and sonication of the exchanged mobile parts were analyzed for each case. We differentiated between monomicrobial PJI, polymicrobial PJI (defined as the identification of more than one microorganism from preoperative joint fluid aspiration or intraoperative samples), and difficult-to-treat (DTT) pathogens. <strong>Results:</strong> In this cohort, the following pathogen profiles were identified: culturenegative cases accounted for 11.1% of infections, while 64.2% were attributed to Grampositive bacteria, 19.8% to Gram-negative bacteria, and 4.9% to fungal pathogens. Among the identified microorganisms, coagulase-negative staphylococci (CNS) were the most frequently detected, exhibiting a notable oxacillin resistance rate of 52.9% and rifampicin resistance rate of 28.7%. Additionally, no significant difference in revision-free implant survival was found between patients with DTT pathogens and/or polymicrobial PJI and those without such infections. <strong>Conclusions:</strong> This study highlights that pathogens in prosthetic joint infections (PJIs) do not solely determine outcomes, as patient-specific factors (comorbidities, implant type) may also play a key role. Regional variations in pathogens and antibiotic resistance patterns should guide empirical therapy. For instance, this study found a high reliance on vancomycin due to high oxacillin resistance in CNS, the most frequent causative pathogen.