Background. Infection is the most common complication of complications after jointarthroplasty. During the COVID-19 pandemic increased used antibacterial drugs by adults,this could change the spectrum of infectious agents and their antimicrobial resistance.The purpose of the study is to evaluate the microbial diversity of pathogens ofperiprosthetic infection in the pre- and post-Covid period, determining the sensitivityof the leading pathogens to antibiotics. Materials and methods. A comprehensivecomparative retrospective study was carried out on 342 cases of monomicrobial andpolymicrobial periprosthetic infection (PPI) of limb joints with microbiological growthof microorganisms in the pre-Covid (2018-2019) and post-Covid (2021-2022) periods.
A continuous comparative retrospective study of cases of PJI of the joints of the
extremities with positive microbiological growth of microorganisms in the pre-Covid
(2018-2019) and post-Covid (2021-2022) periods was carried out on the data basis from the
medical information system (MIS) of the Federal Center for Traumatology, Orthopedics and
Arthroplasty of Ministry of Health of Russia (Cheboksary, Russia), hereinafter referred
to as the Center.
Verification of the diagnosis of deep PJI was carried out according to the diagnostic
criteria of the Society for Musculoskeletal Infections.
The sample included cases of deep and superficial infection after arthroplasty of the
knee, hip, shoulder and wrist joints, regardless of the location of the primary
operation. Isolated microorganisms were identified based on growth in one or more
cultures obtained from punctate synovial fluid, intraoperative tissues, and from removed
implants (after their ultrasonic treatment).
The infection was classified as polymicrobial or monomicrobial. The role of the leading
pathogen was determined in the structure of monomicrobial infection. Polymicrobial
infection is represented by cases of simultaneous isolation of two or more pathogens in
one patient. The antibiotic resistance profile included all isolated pathogens of mono-
and polymicrobial PJI.
At least 4 samples of intraoperative material (tissue biopsies, joint aspirate, removed
endoprosthesis components) were taken from patients for examination.
The aspirate from the joint was placed into FA plus, FN plus bottles of the Bact/Alert 3D
analyzer (Bio Merieux, France). If the sample volume was insufficient (less than 1 ml),
it was inoculated into a vial with Schedler's broth and, when turbid, subcultured onto
solid media.
The endoprosthesis components removed during surgery were placed in a sterile plastic
container and delivered to the laboratory. In the laboratory, saline solution was added
to the container and processed in an ultrasonic machine according to the author's method.
After ultrasonication, 0.5 ml of the resulting liquid was applied to solid media.
Homogenized tissue samples were placed in broth with thioglycollate medium. The cultures
were incubated at 37°C for up to 14 days, subcultured on solid nutrient media: on the 1st
day - on Columbia, Chocolate and Schedler agars; on the 5th day - on Chocolate and
Schedler agar and on the 10th day - only on Schedler agar. For aerobic, anaerobic and
capnophilic microorganisms, incubation conditions were created using gas-generating
packages.
Identification of isolated microorganisms and sensitivity to antibiotics was carried out
using an automatic analyzer (Vitec2 compact; Bio Merieux, France) and a semi-automatic
analyzer (Multiscan FC; Thermo Fisher, USA) using kits (Erba Lachema, Czech Republic),
test systems ("Diagnostic systems", Russia).
Sensitivity to antibacterial drugs was tested using the disk diffusion method and
analyzer kits. Antibiotic sensitivity assessment was carried out in accordance with the
criteria of EUCAST 2018 (studies in 2018-2019), EUCAST 2021 (studies in 2021-2022).
Diagnostic Test: Microbiological examination of the patient's biological material and determination of antibiotic resistance
Isolated microorganisms were identified based on growth in one or more cultures obtained
from punctate synovial fluid, intraoperative tissues, and from removed implants (after
their ultrasonic treatment). At least 4 samples of intraoperative material (tissue
biopsies, joint aspirate, removed endoprosthesis components) were taken from patients for
examination. The endoprosthesis components removed during surgery were placed in a
sterile plastic container and delivered to the laboratory. In the laboratory, saline
solution was added to the container and processed in an ultrasonic machine according to
the author's method. Identification of isolated microorganisms and sensitivity to
antibiotics was carried out using an automatic analyzer and a semi-automatic analyzer
using kits, test systems. Sensitivity to antibacterial drugs was tested using the disk
diffusion method and analyzer kits. Antibiotic sensitivity assessment was carried out in
accordance with the criteria of EUCAST.
Other Name: Identification of the infectious agent and determination of antibiotic resistance
Inclusion Criteria:
- Clinically confirmed periprosthetic infection
Exclusion Criteria:
- No signs of periprosthetic infection
Federal Center for Traumatology, Orthopedics and Endoprosthetics
Cheboksary 569696, Chuvashskaya Respublika 567395, Russia
Not Provided