Assessment of antimicrobial mismatches in empirical treatment in early PJI after aseptic revision arthroplasty

C M Veerman; J H M Goosen; D S C Telgt; W H M Rijnen; M H Nabuurs; H F L Wertheim

doi:10.1093/jacamr/dlac124

Assessment of antimicrobial mismatches in empirical treatment in early PJI after aseptic revision arthroplasty

JAC Antimicrob Resist. 2022 Dec 7;4(6):dlac124. doi: 10.1093/jacamr/dlac124. eCollection 2022 Dec.

Authors

C M Veerman^{1

2}, J H M Goosen¹, D S C Telgt^{1

2}, W H M Rijnen³, M H Nabuurs⁴, H F L Wertheim⁵

Affiliations

¹ Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands.
² Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
³ Department of Orthopedics Nijmegen, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁴ Department of Medical Microbiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
⁵ Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

Background: In early periprosthetic joint infection (PJI), 'debridement, antibiotics and implant retention' (DAIR) is a widely accepted form of treatment. Empirical antimicrobial treatment is started while culture results of tissue samples taken during debridement are pending.

Objectives: In this retrospective study we assessed the antimicrobial mismatch rate between empirical treatment and the susceptibility of the causative microorganisms of PJI after aseptic revision arthroplasty. We analysed risk factors for antimicrobial mismatches and the impact of mismatches on the outcome of PJI treatment.

Results: A total of 119 patients were included in the analysis. In 72% (86/119) of the cases there was an antimicrobial mismatch in empirical treatment. Most of the antimicrobial mismatches were caused by multidrug-resistant (MDR) Staphylococcus spp. (77%, 66/86). In multivariable analysis, polymicrobial PJI was significantly associated with antimicrobial mismatch (OR: 6.89; 95% CI: 2.38-19.53; P < 0.001), and antimicrobial mismatch was significantly associated with reduced success rate of PJI treatment (OR: 0.20; 95% CI: 0.05 ± 0.82; P = 0.026). There was no difference in successful outcome between PJI caused by Gram-negative bacilli (61%) and Gram-positive bacteria (69%, P = 0.516).

Conclusions: Mismatching empirical antimicrobial treatment after DAIR following aseptic revision arthroplasty was significantly associated with failure of PJI treatment. Polymicrobial PJI is a risk factor for antimicrobial mismatch of the empirical treatment of PJI. Antimicrobial mismatch and delay in targeted treatment should be integrated in the approach to optimize antibiotic treatment to improve clinical outcomes, while minimizing unintended side effects of antimicrobial use (antimicrobial stewardship).