2025 Southeastern Residency Conference

Title: Analysis of Prosthetic Joint Infections in a Community Hospital  
Authors: Sydney Hege, Heather Gibson, Allison Cid, Gretchen Arnoczy 


Background: Joint replacement surgery has become a common surgical procedure for patients and improves independence, mobility, and quality of life. Prosthetic joint infections (PJIs) are a serious complication of prosthetic joint implantation and must be managed appropriately. Management of infections vary from practice to practice and current guidelines offer a range of recommendations. This study aims to compare the treatment of PJIs at FirstHealth of the Carolinas to current guideline recommendations. 

Methods: Eligible participants were identified via retrospective chart review using electronic medical records from March 1st, 2022, through September 30th, 2023. This 18 months of data was censored at 12 months post-infection and included data from all FirstHealth of the Carolinas facilities. Patients were included if they were ≥ 18 years old, diagnosed with a PJI at FirstHealth, treated by an Infectious Disease (ID) physician, and discharged on outpatient parenteral antibiotic therapy (OPAT). Only pregnant patients were excluded. The primary objective was to analyze initial antimicrobial treatment duration of PJIs, utilization of rifampin in staphylococcal infections, and use and duration of suppressive antimicrobials compared to Infectious Diseases Society of America (IDSA) guideline recommendations. Secondary objectives include evaluating Clostridioides difficile infection (CDI) rates, antimicrobial complications, and prolonged or recurrent infection within 12 months of surgery for confirmed PJI. All data collected was de-identified and only the primary investigators have access to the data via a password encrypted file.


Results: A total of 95 patients were identified. 10 patients were duplicates, leaving 85 patients included in this IRB-exempt study. Patient characteristics evaluated included age, gender, body mass index (BMI), type of prosthetic joint, diabetes diagnosis, time since initial surgery to diagnosis of PJI, and tobacco use.  The majority of PJIs were categorized as late infections (47%), followed by delayed (27%), and early infections (22%). The main prosthetic joints infected were knee (64%) followed by hip (27%), while causative organisms included staphylococcus aureus (37%), followed by non-aureus staphylococcus (22%) and streptococcus species (14%). PJI procedures included debridement, antibiotics, and implant retention (DAIR) (31%), 1 stage (41%), 2 stage (2%), and our modified 2 stage procedure (22%). During this time frame, 2200 hip and knee surgeries were performed at FirstHealth. Out of 85 PJIs, 45 patients had their initial surgery at FirstHealth, estimating an annual rate of PJIs at FirstHealth of 0.83% compared to 1-2% in the U.S. The initial intravenous (IV) antimicrobial treatment duration of 4-6 weeks per IDSA guidelines was achieved in 82 of 85 patients (96%), while the use of adjunctive rifampin for staphylococcal PJIs was utilized in 15 of 39 eligible patients (38%). The use of suppressive oral antimicrobials after IV therapy is recommended in DAIR or 1 stage procedures and 54 of 61 eligible patients (89%) received suppression. The secondary objectives included a CDI rate of 1 in 85 patients (1.2%), 16 reported IV antimicrobial complications, and 9 of 85 patients (10.6%) experienced a prolonged or recurrent infection. 


Conclusion: In this study, results show that FirstHealth’s current standard of practice for managing PJIs mostly aligns with IDSA guideline recommendations. Of note, there is room for improvement in our duration of oral suppression and rifampin utilization in managing these infections. However, there were low rates of complications, including CDI, as well as a low rate of prolonged or recurrent infection in this population. Further steps should be taken to assess the need for a standardized protocol for the treatment of PJIs at FirstHealth of the Carolinas.