Microbiology of hip and knee periprosthetic joint infections: a database study

Don Bambino Geno Tai, Robin Patel, Matthew P Abdel, Elie F Berbari, Aaron J Tande

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


OBJECTIVES: Knowledge of the microbiological aetiology of periprosthetic joint infection (PJI) is essential to its management. Contemporary literature from the United States on this topic is lacking. This study aimed to identify the most common microorganisms associated with types of arthroplasty, the timing of infection, and clues to polymicrobial infection.

METHODS: We performed an analytical cross-sectional study of patients 18 years of age or older with hip or knee PJI diagnosed at our institution between 2010 and 2019. PJI was defined using the criteria adapted from those of the Musculoskeletal Infection Society. Cases included PJI associated with primary or revision arthroplasty and arthroplasty performed at our institution or elsewhere.

RESULTS: A total of 2067 episodes of PJI in 1651 patients were included. Monomicrobial infections represented 70% of episodes (n = 1448), with 25% being polymicrobial (n = 508) and the rest (5%, n = 111) culture-negative. The most common group causing PJI was coagulase-negative Staphylococcus species (other than S. ludgunensis) (37%, n = 761). The distribution of most common organisms was similar regardless of arthroplasty type. The S. aureus complex, Gram-negative bacteria, and anaerobic bacteria (other than Cutibacterium species) were more likely to be isolated than other organisms in the first year following index arthroplasty (OR 1.7, 95%CI 1.4-2.2; OR 1.5, 95%CI 1.1-2.0; and OR 1.5, 95%CI 1.0-2.2, respectively). The proportion of culture-negative PJIs was higher in primary than revision arthroplasty (6.5% versus 3%, p 0.0005). The presence of a sinus tract increased the probability of the isolation of more than one microorganism by almost three-fold (OR 2.6, 95%CI 2.0-3.3).

CONCLUSIONS: Joint age, presence of a sinus tract, and revision arthroplasties influenced PJI microbiology.

Original languageEnglish (US)
Pages (from-to)255-259
Number of pages5
JournalClinical Microbiology and Infection
Issue number2
StatePublished - Feb 2022

Bibliographical note

Copyright © 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.


  • Adolescent
  • Adult
  • Arthroplasty, Replacement, Hip/adverse effects
  • Cross-Sectional Studies
  • Humans
  • Prosthesis-Related Infections/epidemiology
  • Retrospective Studies
  • Staphylococcus aureus

PubMed: MeSH publication types

  • Journal Article


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