Prosthetic Joint Infections

Paul G. Auwaerter, M.D., Sara Keller, M.D.

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

To view the entire topic, please log in or purchase a subscription.

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

COVID-19 Update with Dr. Paul Auwaerter of Johns Hopkins : Omicron Variant, Testing, and Treatment

Coronavirus COVID-19 (SARS-CoV-2)

Suicide Risk in the COVID-19 Pandemic

Moderna COVID-19 Vaccine

BNT162b2 COVID-19 Vaccine (BioNTech/Pfizer)

Managing Stress and Coping with COVID-19

Johnson & Johnson COVID-19 Vaccine

-- The first section of this topic is shown below --

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

-- To view the remaining sections of this topic, please log in or purchase a subscription --

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

There's more to see -- the rest of this entry is available only to subscribers.