Common infecting organisms after major joint replacement

• coagulase-negative staphylococci (Staphylococcus epidermidis): 25-45%
• Staphylococcal aureus (note 1): 19-25%
• polymicrobial: 3-16%
• aerobic Gram-negative bacilli: 7-13%
• Streptococci: 2-11%
• anaerobes: 6-9%
• Enterococci: 3-5%
• Diptheroids: 2-5%

Note 1: the proportion of MRSA varies between hospitals and over time.

In the period 1997-1999 over 50% of all superficial and deep wound infections detected during the hospital admission, following hip prosthesis, were due to S. aureus and about 28% of infections were due to MRSA. Following total knee replacement, 8-10% of infections were due to MRSA.

A more recent study revealed that coagulase-negative staphylococci and Staphylococcus aureus were the most common organisms causing joint related infections (5).

Reference:

• 1) NINSS partnership. Surveillance of surgical site infection in English hospitals 1997-99. London: Public Health Laboratory Service, 2000.
• (2) Antibiotic prophylaxis in surgery. SIGN Publication number 45 (2000). Scottish Intercollegiate Guidelines Network. Available: http://www.sign.ac.uk [July 2000]
• (3) Ahnfelt L et al. Prognosis of total hip replacement. A Swedish multicentre study of 4664 revisions. Acta Orthop Scand 1990; 61 (suppl 238): 1-269.
• (4) Berbari EF et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998; 27: 1247-54.
• (5)Jonsson EO et al.Bacterial contamination of the wound during primary total hip and knee replacement. Median 13 years of follow-up of 90 replacements.Acta Orthop. 2014 Apr;85(2):159-64.