Analysis of Prosthetic Joint Infections, Risk Factors for Treatment Failure and Effect of Teicoplanin in Treatment: A Single-Center, Retrospective, Observational Study

Abstract

Objective: This study aimed to identify the risk factors for treatment failure in prosthetic joint infections (PJIs) and the most appropriate approach to these infections, especially the effect of teicoplanin on treatment response. Materials and Methods: The data of patients who were followed up with a diagnosis of Gram-positive or culture-negative PJI for seven years in a tertiary-care referral hospital were included in the study retrospectively. Results: One hundred sixty-nine PJI attacks were included in the study. The overall infection eradication rate was 82.7%. Preoperative hemoglobin (Hb) and hematocrit (Hct) levels were higher, and C-reactive protein (CRP) levels were lower in treatment responders (p=0.006, p=0.003, and p=0.021, respectively). The relationship between CRP and treatment response emerged in the second week, while a significant decline in the erythrocyte sedimentation rate (ESR) levels was seen at the end of treatment. Treatment was successful in 91.7% of cases that underwent two-stage revision surgery and 89.4% in those who used teicoplanin for more than two weeks. In multivariate analysis, two-stage revision surgery and the use of teicoplanin for more than two weeks increased treatment success. Conclusion: Hb, Hct, and CRP levels could help to predict the treatment response in the preoperative period, and in the postoperative follow-up, CRP could predict the treatment response earlier. Although one-stage surgeries seem practical, the patient's best interests are paramount, and two-stage revisions should be selected whenever needed. Finally, teicoplanin, a practical once-daily, well-tolerated antibiotic, was associated with high treatment success rates in Gram-positive and culture-negative PJIs.