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Changes in microbiological spectrum and antibiotic susceptibility in two-stage exchange for periprosthetic shoulder infections

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Periprosthetic joint infections (PJI) are a major concern in shoulder arthroplasty, which in some cases require two-stage exchange. While it was shown that low-virulence bacteria are the most isolated pathogens in shoulder PJI, little is known about changes in microbiological spectrum and resistance patterns during two-stage revision.

Methods

This retrospective study included all patients (n = 25) who received a two-stage revision from January 2011 to December 2020 for shoulder PJI in one institution. Microbiological spectrum, antimicrobial resistance patterns, and re-revision rates of culture positive first- and second-stage procedures were analyzed. The mean follow-up time was 29.7 months (range 8; 115 months). At final follow-up, subjective shoulder value (SSV) and visual analog scale (VAS) score for pain and satisfaction with the surgery were assessed.

Results

In 25 patients, a total of 54 2-stage exchange procedures were performed and positive cultures were obtained in 36 of these surgeries (66.7%). A total of 7 out of 25 patients (28.0%) showed a positive microbiological culture at first and second stages. In those patients, the mean time between first and second stages was 30.9 weeks (range 6; 70). Three out of those seven patients (42.9%) had a polymicrobial spectrum with one microorganism persistent at stage two, including Cutibacterium acnes (n = 1) and Staphylococcus epidermidis (MRSE) (n = 2). In all these cases, antimicrobial resistance patterns changed. All cultures with monomicrobial spectrum (n = 4) at first stage showed a changed spectrum. Patients with positive first- and second-stage revisions showed a mean SSV of 49.3% ± 23.5 versus 52.9% ± 29.5 in single positive patients (p = 0.76). Re-revision was performed in five cases, two of those in patients with positive first- and second-stage cultures.

Conclusion

There is a high rate of changes in microbiological spectrum and resistance patterns between culture positive first- and second-stage procedures as well as subsequent re-revisions. Intraoperative samples during reimplantation should be taken and resistance reconsidered in case of re-revision.

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Acknowledgements

We thank Sophie Bischofter for her involvement in the primary data collection.

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Authors and Affiliations

  1. 1st Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria

    Paul Siegert, Dominik Meraner, Alexandra Pokorny-Olsen & Christian Wurnig

  2. Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria

    Paul Siegert, Bernhard J. H. Frank, Sebastian Simon & Jochen G. Hofstaetter

  3. Department of Orthopedics and Traumatology, Salzburg University Hospital, Paracelsus Medical University, 5020, Salzburg, Austria

    Julian Diepold

  4. 2nd Orthopaedic Department, Orthopaedic Hospital Speising, Vienna, Austria

    Jochen G. Hofstaetter

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Contributions

All the listed authors have contributed substantially to this work: PS, JGH and BJHF for the study conception and design; PS, BJHF and SS for the data collection, PS, DM and AP-O for the data analysis; PS, DM and CW for the data interpretation; PS, JGH, BJHF and JD for the first drafting of the manuscript, the figures, and the literature research. All the authors contributed to the writing and critical reading of the final manuscript and approved it for submission.

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Correspondence to Paul Siegert.

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Siegert, P., Frank, B.J.H., Simon, S. et al. Changes in microbiological spectrum and antibiotic susceptibility in two-stage exchange for periprosthetic shoulder infections. Arch Orthop Trauma Surg 143, 3871–3878 (2023). https://doi.org/10.1007/s00402-022-04635-7

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