Abblitt WP, et al. - The researchers performed this study to identify the risk of developing a second prosthetic joint infection (PJI) for their patients with multiple prosthetic joints. Furthermore, they investigated the effect of bacteremia on the development of a subsequent PJI. They identified the risk of developing a subsequent PJI to be one-half of previous studies. At the time of PJI, bacteremia was an important factor for developing subsequent PJI. For patients with PJI, multiple prosthetic joints could be less hazardous than previously thought implying that suppressive antibiotics could only be necessary in cases with bacteremia.

Methods

• All patients treated surgically for PJI by a single surgeon from 2003-2014 were retrospectively reviewed.
• The researchers identified time between initial and subsequent infection, bacteremia, and risk factors for PJI.

Results

• Multiple prosthetic joints were observed in 76 patients among 167 patients treated for PJI.
• Thirteen percent (10/76) developed a PJI in a second location.
• Despite having a 57% incidence of immunosuppression, diabetes, renal failure, smoking, or steroid use, the rate was 8.3% (6/72) excluding simultaneous infections.
• For patients with 1 PJI, average follow-up was 4.6 yrs (range: 0.03–13.6).
• At the time of initial infection, 70% (7/10) of patients with multiple infections were bacteremic compared to 18.1% (12/66) of patients with a single infection (p=.0004).
• The risk of developing an infection in a second joint was 20% if bacteremic and 5.2% if not bacteremic, excluding the 4 simultaneous infections (all bacteremic).