Microbiological Spectrum, Antibiotic Resistance and Clinical Outcomes of Prosthetic Joint Infections

Abstract

Objectives: To determine the incidence of prosthetic joint infections (PJIs), causative organisms, their antimicrobial susceptibility profile, and clinical outcomes in patients who underwent joint replacement.

Methodology: This descriptive cross-sectional study was done at Sharif Medical City Hospital and Alrazi Healthcare Hospital, Lahore after ethical approval from September 2025 to February 2026. After obtaining written consent, 843 patients with severe joint disease who fulfilled the criteria for joint replacement were included using convenience sampling. Patients received a single preoperative dose of second-generation cephalosporin and a post-operative broad-spectrum oral antibiotic for 1 week. Follow-up of the patients was done at 2 weeks, 6 weeks, and 3 months. For patients with PJIs, the causative organisms were isolated on culture, and their antimicrobial susceptibility testing was performed. Patients were treated either by using DAIR or two-staged revision. The Statistical Package for the Social Sciences version 27 was used for statistical analysis.

Results: Fifteen (1.8%) patients developed PJIs. Out of 15 infected cases, 7(46.7%) were Staphylococcus aureus, 4(26.6%) were Coagulase-negative Staphylococci, 2(13.3%) were Streptococcus species, 1(6.7%) was Pseudomonas aeruginosa, and 1(6.7%) was E. coli. Three (42.9%) isolates of Staphylococcus aureus were methicillin-resistant (MRSA), and 4(57.1%) were methicillin-sensitive. E. coli and Pseudomonas showed no resistance to imipenem, meropenem, and tazocin. Sixty and forty percent of the patients underwent DAIR and two-staged revision, respectively, and recovered completely. The incidence of PJIs was associated with advanced age and diabetes mellitus (p-value = 0.01).

Conclusion: Our study showed 1.8% incidence of prosthetic joint infections after joint replacement. Gram-positive cocci, including Staphylococcus aureus and Coagulase-negative Staphylococcus species, account for the majority of the cases of PJIs followed by gram-negative rods. The antimicrobials of choice for gram-positive cocci are vancomycin, linezolid, and tigecycline. For gram-negative rods, carbapenems and tazocin showed no resistance. Both the procedures: DAIR and two-staged revision are associated with patient recovery. Advanced age and diabetes mellitus are linked to a higher incidence of PJIs.