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Authors: Duggal A, Avery RK, Schmitt SK, Cleveland Clinic, Cleveland Ohio

Title: Prosthetic Joint Infection in patients with Solid Organ Transplantation

Purpose: Due to increase in population of patients with solid organ transplantation (SOT) getting joint replacements, we evaluated the microbiology and timing of prosthetic joint infections (PJI) in such patients at our institution over the last 20 years.

Methods: We retrospectively reviewed electronic medical records of 13 patients, obtained by cross comparison of CPT coding lists for PJI after SOT from 1989 to 2008. Data collected included patient demographics, type and timing of SOT, type of immunosuppression, timing of arthroplasty, timing of PJI, pathogens involved, duration of follow-up and recurrence of PJI.

Results: The most common pathogens involved in PJI were Staphylococcus epidermidis (7 patients, 54%) and Staphylococcus aureus (3 patients, 23%). Eight patients (62%) had polymicrobial PJI. These included gram positive organisms (Enterococcus sp., Streptococcus sp., Stomatococcus sp., Staphylococcus epidermidis and Staphylococcus aureus); gram negative organisms (Klebsiella sp., Acinetobacter sp., Campylobacter sp); and fungi (Scedosporium sp). Seven patients (50%) had recurrence of PJI in the same joint; 4 of 7 had a different pathogen in the recurrence compared to the initial PJI.

Eight patients (62%) had PJI within 3 months of initial arthroplasty (early PJI), 2 (15%) had PJI between 3 to 24 months (late PJI), and 3 (23%) had PJI beyond 24 months (delayed PJI).

Discuassion and Conclusion: Microbiology of PJI in SOT patients at our institution is similar to that in the general population who get PJI as quoted in literature. Polymicrobial PJI were common, and included less common organisms in some cases. More than 50% of our study patients had early PJI.

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