Authors: Parvizi J, Aazzam K, Ghanem E., Austin M, Rothman R
Title: Periprosthetic Infection: Serious Problems on the Horizon?
Institution: Rothman Institute, Philadelphia, PA
Purpose: In this study we have evaluated the economic impact of antibiotic resistance and the outcome of treatment of PJI caused by resistant versus sensitive organisms.
Methods: All 300 patients presenting with PJI (hip and knee) to our institution were included in this study. The medical records of these patients were evaluated in detail. Detailed cost breakdown for the in hospital care of these patients were also extracted from the billing database at our institution.
Results: The study confirmed that the incidence of PJI caused by antibiotic resistant organisms (MRSA,MRSE, and VRE) is on the rise with a near two fold increase in the incidence over the past five years.Currently over 40% of PJIs being treated at out institution are caused by resistant organisms. The outcome of surgery for patients with resistant pathogens is significantly inferior compared to PJIs caused by sensitive organisms. The attempt to retain prosthesis and perform I&D failed in over 2/3 of patients with PJI caused by resistant organisms. Patients with resistant organism infection had a more protracted and complicated postoperative course leading to a much higher cost of care.
Discussion and Conclusion: The orthopedic community needs to brace itself for the worrisome trend in the rise of PJIs caused by resistant organisms. It appears that an immense economic and social burden will need to be tolerated by the healthcare over the coming years as more infections with resistant organisms will be seen. More effective strategies for prevention of spread of these organisms need to be implemented. Further efforts to examine the role of preoperative decolonization and change in antibiotic prophylaxis need to be invested.