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ORIGINAL RESEARCH article

Front. Cell. Infect. Microbiol.
Sec. Clinical Microbiology
Volume 14 - 2024 | doi: 10.3389/fcimb.2024.1388385

Improved Cure Rate of Periprosthetic Joint Infection through Targeted Antibiotic Therapy based on Integrated Pathogen Diagnosis Strategy Provisionally Accepted

Qijin Wang1 Yongfa Chen1 Yang Chen1 Jianhua Lv1 Haiqi Ding1 Qijin Wang1 Jiexin Huang1 Zida Huang1 Bin Yang2 Wenming Zhang1 Xinyu Fang2*
  • 1Department of Orthopedics, First Affiliated Hospital of Fujian Medical University, China
  • 2First Affiliated Hospital of Fujian Medical University, China

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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%.

Conclusions: 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: periprosthetic joint infection, diagnosis, antibiotic, Bacteria, total joint arthroplasty

Received: 19 Feb 2024; Accepted: 18 Apr 2024.

Copyright: © 2024 Wang, Chen, Chen, Lv, Ding, Wang, Huang, Huang, Yang, Zhang and Fang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Xinyu Fang, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China