One of the most commonly used treatments for acute prosthetic joint infection (PJI) is DAIR (debridement, antibiotics and implant retention), which comprises the debridement and the retention of the implant, followed by antibiotic treatment. The efficacy of DAIR remains unclear, as the literature has demonstrated variable success rates, ranging from 26% to 92%. The Staphylococcus aureus is one of the most closely related causative microorganisms, especially with acute and late-acute PJI; it has been identified as one of the most significant predictors of DAIR failure. The current guidelines consider the use of vancomycin as the therapy of choice, but it requires the close control of possible side effects. The aim of this study is to determine if a new combination of antibiotics (a highly bactericidal initial combination followed by an antibiofilm scheme) decreases the failure of DAIR-treated acute prosthetic joint infection (PJI) caused by Staphylococcus aureus. A retrospective analysis of cases of orthopedic infections during a nine-year period (2011–2019) was performed. A total of 45 acute PJI cases caused by S. aureus were diagnosed. The results of two antibiotic schemes were compared: a novel scheme comprising 5 days of daptomycin (10 mg/kg/24 h) + cloxacillin (2 g/6 h) followed by levofloxacin (500 mg/24 h) + rifampicin (600 mg/24 h), versus a traditional, less bactericidal scheme of vancomycin (1000 mg/12 h) plus rifampicin (600 mg/24 h) or levofloxacin (500 mg/24 h) plus rifampicin (600 mg/24 h). Twenty-two out of the twenty-four patients treated with the new scheme (91.6%) were free of infection after 24.8 months of mean follow-up, whereas fourteen out of twenty-one patients (66.6%) were free of infection after 46.6 months of follow-up. This difference was statistically significant (p = 0.036). Demographic comparisons demonstrated homogeneous features, except the Charlson score, which was higher in the novel scheme group (p = 0.047). The combination of high-dose daptomycin and cloxacillin, followed by levofloxacin plus rifampicin, together with surgical treatment, shows better results when compared with other antibiotic schemes for treating acute PJI caused by S. aureus in which DAIR was performed.

Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty, with polymicrobial PJIs representing a distinct subset associated with worse outcomes. This study aims to characterize the risk factors, microbiological profiles, and clinical outcomes of polymicrobial PJIs in a single tertiary care center. A retrospective analysis was conducted on 499 patients diagnosed with PJI between 2010 and 2023. Polymicrobial infection was defined by isolation of ≥2 distinct pathogens from intraoperative samples. Demographic, microbiological, and clinical data were analyzed. Treatment success was defined as infection eradication without recurrence or chronic suppressive therapy. Polymicrobial PJIs accounted for 18.2% of cases. Patients with polymicrobial infections had higher rates of obesity, insulin-dependent diabetes, and higher Charlson comorbidity scores. Coagulase-negative staphylococci and gram-negative bacilli were more frequently isolated in polymicrobial infections, while S. aureus predominated in monomicrobial cases. Treatment success rates were significantly lower in polymicrobial infections, both in acute (61.5% vs. 94.5%, p = 0.003) and chronic settings (51.3% vs. 75.3%, p = 0.02). Polymicrobial PJIs are associated with distinct microbiological patterns, increased comorbidity burden, and significantly worse clinical outcomes. Recognition of specific risk factors and pathogen profiles is essential to optimize management strategies for this complex condition.

Despite the implications of trochanteric and subtrochanteric intramedullary (IM) nail infection for patients with hip fracture, little is known about risk factors for therapeutic failure and mortality in this population. We performed a retrospective observational analysis including patients diagnosed with trochanteric and subtrochanteric IM nail infection at a Spanish academic hospital during a 10-year period, with a minimum follow-up of 22 months. Of 4044 trochanteric and subtrochanteric IM nail implants, we identified 35 cases of infection during the study period (0.87%), 17 of which were chronic infections. Patients with therapeutic failure (n = 10) presented a higher average Charlson Comorbidity Index (CCI) (5.40 vs. 4.21, p 0.015, CI 0.26–2.13) and higher rates of polymicrobial (OR 5.70, p 0.033, CI 1.14–28.33) and multidrug-resistant (OR 7.00, p 0.027, CI 1.24–39.57) infections. Upon multivariate analysis, polymicrobial infection and the presence of multidrug-resistant pathogens were identified as independent risk factors for therapeutic failure. Implant retention was associated with an increased risk of failure in chronic infection and was found to be an independent risk factor for overall one-year mortality in the multivariate analysis. Our study highlights the importance of broad-spectrum empirical antibiotics as initial treatment of trochanteric and subtrochanteric IM nail-associated infection while awaiting microbiological results. It also provides initial evidence for the importance of implant removal in chronic IM-nail infection.

Infections following spinal surgery can result in potentially devastating complications. An accurate microbiological diagnosis is crucial for proper treatment. Sonication is a diagnostic method that can be beneficial in patients with acute or low-grade infections. This study aimed to assess the sensitivity and effectiveness of sonication as a method for diagnosing spinal implant infections in cases of both suspected and unsuspected infections during spinal surgical revision. We conducted a retrospective observational study that included all patients who underwent revision spinal surgery between March 2011 and October 2022. We collected the implants and surrounding tissues from these patients for microbiological analysis. The implant sonication was performed according to a previously published protocol. Patients were categorised into those undergoing surgical revision for suspected spinal implant infection (SSII) and those for non-suspected spinal implant infection (NSSII). We collected comprehensive patient data, including demographics, risk factors, Charlson Comorbidity Index (CCI), surgical details, microbiological findings, antibiotic regimens, and clinical outcomes. Sensitivity and specificity analyses were conducted on both sonicated and non-sonicated samples. A total of 158 patients met the inclusion criteria; 51 of them were diagnosed with infection during surgery revision. Patients with SSII had higher CCIs than those with NSSII. The sensitivity was significantly higher in sonicated samples (68.6%; 95% CI: 55.9–81.4%) than in non-sonicated samples (42%; 95% CI: 28.3–55.7%). The specificities were similar, with sonicated samples at 93.5% (95% CI: 88.8–98.1%) and non-sonicated samples at 99.05% (95% CI: 97.2–100.9%). Combining both methods resulted in sensitivity and specificity rates of 76% (95% CI: 64.2–87.8%) and 93.3% (95% CI: 88.2–98.1%), respectively. Methicillin-susceptible Staphylococcus aureus (MSSA) was common in SSII, whereas Cutibacterium acnes and coagulase-negative Staphylococcus (CNS) were predominant in NSSII. This study supports the routine use of implant sonication as a valuable supplementary method for peri-implant tissue cultures, especially for identifying low-grade spinal implant infections.