Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Different microbial and resistance patterns in primary total knee arthroplasty infections – a report on 283 patients from Lithuania and Sweden

Sebastian, Sujeesh LU orcid ; Sezgin, Erdem Aras LU ; Stučinskas, Justinas ; Tarasevičius, Šarūnas LU ; Liu, Yang LU ; Raina, Deepak Bhushan LU ; Tägil, Magnus LU ; Lidgren, Lars LU and W-Dahl, Annette LU (2021) In BMC Musculoskeletal Disorders 22(1).
Abstract

Background: The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. Methods: Primary TKAs revised for the first time due to verified or suspected infection were... (More)

Background: The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. Methods: Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision. Results: The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41). Conclusions: The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Drug resistance, Knee arthroplasty register, Microbial profile, Polymicrobial infections, Prosthetic joint infection
in
BMC Musculoskeletal Disorders
volume
22
issue
1
article number
800
publisher
BioMed Central (BMC)
external identifiers
  • scopus:85115181807
  • pmid:34535109
ISSN
1471-2474
DOI
10.1186/s12891-021-04689-5
language
English
LU publication?
yes
id
ba4e1330-8bca-45fe-8820-efe514b287e7
date added to LUP
2021-10-01 12:08:08
date last changed
2024-04-20 12:14:36
@article{ba4e1330-8bca-45fe-8820-efe514b287e7,
  abstract     = {{<p>Background: The microbiology and the susceptibility patterns of infected total knee arthroplasties (TKAs) vary depending on demographic, local antimicrobial stewardship, and surgical factors. We wanted to compare the recent microbial profile and antimicrobial resistance pattern in revisions due to infections after primary TKAs in Sweden and Lithuania. Our hypothesis was that there is a difference in bacteriology and resistance pattern based on patient related, societal and local hospital factors as almost similar praxis have been applied for TKA surgery, short term systemic prophylaxis and routine use of local gentamicin containing bone cement. Methods: Primary TKAs revised for the first time due to verified or suspected infection were collected nationwide in Sweden during 2018, and in Lithuania between 2011 and 2020 from a single major TKA revision centre in Kaunas. We identified 202 TKAs in Sweden from the Swedish Knee Arthroplasty Register and 84 from Kaunas revised due to infection. We collected available culture reports and evaluated the type of microorganisms with antimicrobial resistance pattern at revision. Results: The majority of the infected cases in Sweden were early-type prosthetic joint infection (PJI) (44%), whereas late-type PJI (52%) were more common in the Kaunas cases. Gram-positive bacteria prevailed in both Sweden (55%) and Lithuania (80%). Staphylococcus aureus was the most frequent organism identified in both countries (33% in Sweden and 34% in Lithuania). More polymicrobial infections were observed in Sweden than in Lithuania (16 and 6% respectively). Methicillin resistance in Staphylococcus aureus and coagulase-negative staphylococci were higher in Lithuania (4/28 and 19/29) than in Sweden (1/42 and 9/41). Conclusions: The type of infections, microbial profile, and drug resistance pattern differed between Sweden and Lithuania. Societal and local hospitals factors with emerging resistance in Lithuania are the most plausible explanation for the difference. Lack of complete data on a national level in Lithuania underlines the importance of adding microbiology of PJIs in implant registers for national aggregation and allow cross country comparisons.</p>}},
  author       = {{Sebastian, Sujeesh and Sezgin, Erdem Aras and Stučinskas, Justinas and Tarasevičius, Šarūnas and Liu, Yang and Raina, Deepak Bhushan and Tägil, Magnus and Lidgren, Lars and W-Dahl, Annette}},
  issn         = {{1471-2474}},
  keywords     = {{Drug resistance; Knee arthroplasty register; Microbial profile; Polymicrobial infections; Prosthetic joint infection}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Musculoskeletal Disorders}},
  title        = {{Different microbial and resistance patterns in primary total knee arthroplasty infections – a report on 283 patients from Lithuania and Sweden}},
  url          = {{http://dx.doi.org/10.1186/s12891-021-04689-5}},
  doi          = {{10.1186/s12891-021-04689-5}},
  volume       = {{22}},
  year         = {{2021}},
}