Differences in microorganism profile in periprosthetic joint infections of the knee in patients affected by chronic kidney disease

Abstract

Background: Periprosthetic joint infections (PJIs) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients? Methods: Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups as follows: patients those who had and those who did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson Comorbidity Index scores (P < 0.001). Results: Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were as follows: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), methicillin-resistant Staphylococcus aureus (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06). Conclusion: Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and methicillin-resistant Staphylococcus aureus. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.