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27.08.2020 | Original Paper | Ausgabe 1/2021 Open Access

International Orthopaedics 1/2021

Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study

International Orthopaedics > Ausgabe 1/2021
Octavian Andronic, Yvonne Achermann, Thorsten Jentzsch, Flurin Bearth, Andreas Schweizer, Karl Wieser, Sandro F. Fucentese, Stefan Rahm, Annelies S. Zinkernagel, Patrick O. Zingg
Wichtige Hinweise
Octavian Andronic and Yvonne Achermann contributed equally to this work.
Level of Evidence: III (Retrospective Cohort Study)

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To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs).


A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution.


The most common isolated streptococcal species was Streptococcus dysgalactiae (9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05).


No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint.

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