Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania

Serban Dragosloveanu; Rares-Mircea Birlutiu; Bogdan Neamtu; Victoria Birlutiu

doi:10.3390/microorganisms13051168

journal article Open Access May 21, 2025

Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania

Serban Dragosloveanu

Rares-Mircea Birlutiu

Bogdan Neamtu

Victoria Birlutiu

Microorganisms Vol. 13 No. 5 pp. 1168 · MDPI AG

View at Publisher Save 10.3390/microorganisms13051168

Abstract

This study examines temporal patterns in pathogens isolated from prosthetic joint infection (PJI) cases and antimicrobial resistance patterns at a Romanian orthopedic center. We have conducted a retrospective cohort study that included 674 patients undergoing hip or knee replacement revision surgery between January 2016 and December 2023. From these, 102 confirmed PJI cases requiring surgical intervention were selected for analysis. We isolated 27 microorganisms from acute PJI cultures and 82 from chronic PJIs. Staphylococcus epidermidis (33 cases, 30.3%; 95% CI 22.0–40.3) was the predominant pathogen, with coagulase-negative Staphylococci (22 cases, 20.18%; 95% CI 0.9–41.3) and Enterobacteriaceae (13 cases, 11.9%; 95% CI 6.4–18.3) also prevalent. Methicillin resistance was identified in 43.6% of coagulase-negative staphylococci and 45.5% of Staphylococcus aureus isolates. All Gram-positive isolates remained susceptible to vancomycin, linezolid, and tigecycline. Among Gram-negative bacilli, Klebsiella oxytoca and Proteus mirabilis showed resistance to third-generation cephalosporins, with phenotypic profiles suggestive of extended-spectrum β-lactamase (ESBL) production. All Escherichia coli, Enterobacter spp., and Citrobacter freundii strains were fully susceptible to tested agents, while Pseudomonas aeruginosa exhibited reduced susceptibility to ciprofloxacin, aztreonam, and imipenem. Among the isolated strains, 47 were multidrug-resistant (MDR), with Staphylococcus aureus accounting for the highest MDR count, including methicillin resistance. The distribution of microorganism types and MDR strains remained consistent throughout the study period, with no significant association between infection type and MDR strain presence or between infection site and microorganism presence except for a strong association between MDR strains and the type of microorganism (p < 0.05). The microbial profile and resistance patterns in PJIs have remained stable over eight years. Our observations do not suggest that MDR PJIs are more commonly acute cases, contrary to what has been highlighted in previous reports. The ongoing prevalence of MDR strains underscores the importance of targeted antimicrobial treatments based on local susceptibility profiles.

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Details

Published: May 21, 2025
Vol/Issue: 13(5)
Pages: 1168
License: View

Authors

S

Serban Dragosloveanu

Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 021382 Bucharest, Romania

R

Rares-Mircea Birlutiu

Department 14-Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; Foisor Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 021382 Bucharest, Romania

B

Bogdan Neamtu

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; Pediatric Research Department, Pediatric Clinical Hospital Sibiu, 550166 Sibiu, Romania; Bioinformatics and Biostatistics Department, University of Louisville, Louisville, KY 40202, USA

V

Victoria Birlutiu

Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; County Clinical Emergency Hospital, 550245 Sibiu, Romania

Funding

University of Medicine and Pharmacy Carol Davila

Cite This Article

Serban Dragosloveanu, Rares-Mircea Birlutiu, Bogdan Neamtu, et al. (2025). Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania. Microorganisms, 13(5), 1168. https://doi.org/10.3390/microorganisms13051168

Microbiological Profiles, Antibiotic Susceptibility Patterns and the Role of Multidrug-Resistant Organisms in Patients Diagnosed with Periprosthetic Joint Infection over 8 Years: Results from a Single-Center Observational Cohort Study from Romania

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