Prosthetic Joint Infections

Prosthetic Joint Infections is a topic covered in the Johns Hopkins ABX Guide.

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PATHOGENS

  • Staphylococci account for >50% of total prosthetic joint infections (PJI). Gram negatives may account for 15%. Approximately 20% may be polymicrobial.
  • Culture-negative infections represent ~7-11% of infections; some may be due to prior abx therapy.
  • Bacterial:
    • Staphylococcus (coagulase-negative)
    • Staphylococcus aureus 
    • Viridans streptococci 
    • Cutibacterium acnes (especially shoulder implant infections, formerly Propionibacterium)
    • Enterococcal species
    • Gram-negative enteric bacteria
    • Pseudomonas aeruginosa
    • Anaerobes
    • Brucella spp (rare)
  • Mycobacterial:
    • Non-tubercular mycobacteria (rare)
    • M. tuberculosis (very rare)
  • Fungal:
    • Candida species
  • Typical pathogens by the time of onset following prosthesis placement:
    • Early infection (0-3 months post-op): predominantly S. aureus, β-hemolytic streptococci, Gram-negative bacilli, polymicrobial infection, anaerobic
    • Delayed (3 mos-2 yrs): usual pathogens include coagulase-negative Staphylococci,S. aureus,C. acnes, Enterococcus spp.
    • Late (>2 yrs): S. aureus, coagulase-negative Staphylococci, viridans Streptococci, Enterococci, C. acnes
      • Less common: Gram-negatives

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PATHOGENS

  • Staphylococci account for >50% of total prosthetic joint infections (PJI). Gram negatives may account for 15%. Approximately 20% may be polymicrobial.
  • Culture-negative infections represent ~7-11% of infections; some may be due to prior abx therapy.
  • Bacterial:
    • Staphylococcus (coagulase-negative)
    • Staphylococcus aureus 
    • Viridans streptococci 
    • Cutibacterium acnes (especially shoulder implant infections, formerly Propionibacterium)
    • Enterococcal species
    • Gram-negative enteric bacteria
    • Pseudomonas aeruginosa
    • Anaerobes
    • Brucella spp (rare)
  • Mycobacterial:
    • Non-tubercular mycobacteria (rare)
    • M. tuberculosis (very rare)
  • Fungal:
    • Candida species
  • Typical pathogens by the time of onset following prosthesis placement:
    • Early infection (0-3 months post-op): predominantly S. aureus, β-hemolytic streptococci, Gram-negative bacilli, polymicrobial infection, anaerobic
    • Delayed (3 mos-2 yrs): usual pathogens include coagulase-negative Staphylococci,S. aureus,C. acnes, Enterococcus spp.
    • Late (>2 yrs): S. aureus, coagulase-negative Staphylococci, viridans Streptococci, Enterococci, C. acnes
      • Less common: Gram-negatives

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