Effective treatment of single-stage revision using intraarticular antibiotic infusion for polymicrobial prosthetic joint infection.

Abstract Background The treatment of polymicrobial periprosthetic joint infection (PJI) confronted distinct challenges. No reports have assessed the efficacy of local antibiotic delivery combined with one-stage exchange in polymicrobial PJI. Methods Between January 2013 and December 2018, we retrospectively analysed the data of 126 patients, including 19 polymicrobial PJI and 107 monomicrobial PJI, who underwent single-stage revision using intraarticular antibiotic infusion. The risk factors, microbiology, infection control rate, and clinical outcomes were compared between the two groups. Results Higher body mass index, presence of a sinus tract, and prior revisions were the risk factors for polymicrobial PJI. Isolation of S. epidermidis, streptococcus, enterococcus, and gram-negative pathogens were highly associated with polymicrobial PJI. Of the 19 polymicrobial PJI, only 2 patients occurred infection recurrence, which is similar with the result of 6 of 107 patients in the monomicrobial PJI (p = 0.225). The Harris Hip Score (HHS) of the polymicrobial group showed no difference from that of the monomicrobial group (78 vs. 80; p = 0.181). Nevertheless, the polymicrobial group exhibited inferior Hospital for Special Surgery (HHS) knee score relative to the monomicrobial group (77 vs. 79; p = 0.017). Conclusion With rational and targeted use of antibiotics, single-stage revision can effectively control polymicrobial infections, and achieve favourable outcomes similar to that in monomicrobial patients. However, this regimen is still needed to be further confirmed, especially in the infections with different microbial species simultaneously. Additionally, obese patients with a sinus tract and those who had prior revisions had a greater risk of polymicrobial PJI.