The role of vancomycin in increasing antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

Objectives Management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a challenging task. Surgical management is guided by a consensus. Antibiotic managament remains elusive due to differences in epidemiology and resistances between countries and reports. Our aims were to investigate the main causative bacteria and evaluate the effectiveness of our antibiotic regime with vancomycin for PJI after TKA treated in our center. We also compared our antibiotic regime in PJI to other empirical regimes from the literature.

Methods A retrospective review of all revision TKAs between 2006 and 2018 in a tertiary referral center was performed. Included were cases meeting the consensus criteria for PJI. Excluded were cases without positive cultures. All patients were empirically treated with vancomycin and rifampicin, and a two-stage procedure with at least 6 weeks between procedures.

Results and Conclusion Out of 824 revision TKA procedures performed, there were 129 PJI with 161 culture identified bacteria. Coagulase-negative Staphylococci (CNS) were diagnosed in 46.6% cultures, followed by Staphylococcus aureus in 19.8% of cultures. Overall antibiotic resistance (p =0.454) and Staphylooccus aureus resistance (p =0.788) have not increased during the study period. CNS resistance to teicoplanin (4% to 44%; p < 0.001), fosfomycin (16% to 44%, p =0.016) and tetracycline (0% to 28%, p =0.014) has increased. Vancomycin had a 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent, also when compared to other combinations from the literature. In a high incidence of PJI with CNS after TKA, the only remaining treatment option is vancomycin. The increasing resistance to newer antibiotics is concerning. This study suggests that large centers should perform a detailed analysis of obtained cultures as this has significant implications for both prophylactic treatment in primary as well as empirical antibiotic treatment in PJI.

Stichwörter knee replacement, infection, revision, vancomycin

Publication History

Article published online:
15 October 2020