Pathogens of periprosthetic infection in patients with hemophilia

Introduction. Endoprosthetics remains the only method of treating end-stage arthropathy in patients with hemophilia. Along with the increase in the number of endoprosthetics, the number of periprosthetic infections is also on the rise.

Objective. to determine the most common pathogens and their sensitivity to antimicrobial drugs, as well as risk factors for the development of periprosthetic infections in patients with hemophilia after endoprosthetics of large joints.

Materials and methods. A retrospective study analyzed cases of PJI of large joints in patients with hemophilia between 2015 and 2022, along with the causative agents of this complication.

Results. A total of 80 cases of PJI were identified. In patients with hemophilia A, PJI occurred in 76.0% of cases (61 patients), in patients with hemophilia B in 24.0% of cases (19 patients). Primary infection was detected in 47.5% of cases (38 PJI). Relapse of infection was detected in 42 episodes (52.5%). A washing system with dioxidine or polyhexadine was used in 9 cases (11.2%) of primary infection, in all other cases a two-stage revision tactic was used. 20 different pathogens were identified: 58 (65.0%) episodes of gram-positive flora, 13 (14.0%) cases of gram-negative flora, 3 (3.0%) episodes of fungal infection. It was not possible to identify the pathogen in 16 (18.0%) cases. The most common pathogens were S. aureus (21.1%) and S. epidermidis (21.1%), E. faecalis (7.3%). Among Staphylococcus aureus isolates, 18.8% were methicillin-resistant strains. Among gram-negative bacteria, P. aeruginosa was detected in 6 cases (7.3%), all of which exhibited multiple antibiotic resistance. The number of cases of PJI that arose in the first month or first year did not differ significantly from episodes when infectious complications arose in the period of a year or more. PJI after revision endoprosthetics most often debuted within 12 months after surgery.

Conclusion. The highest risk of PJI in patients with hemophilia occurs within the first year after revision endoprosthetics. PJI develops more frequently in patients with hemophilia than the general population, which is attributed to a greater number of risk factors in patients with hemophilia compared to the general patient population.

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