{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T18:09:10Z","timestamp":1791655750271,"version":"4.3.4"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005713","name":"Technische Universit\u00e4t M\u00fcnchen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005713","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Periprosthetic joint infections (PJI) represent a major complication of total joint arthroplasty. While most infections are caused by staphylococci species, a notable proportion involves gram-negative bacteria. Due to the smaller numbers, outcome reports in literature are scarce and heterogenous success rates have been reported. This study aimed to (1) evaluate the overall treatment success of gram-negative PJI and (2) identify the most suitable surgical treatment strategy in eradicating gram-negative PJI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Seventy-two cases of gram-negative PJI treated between 2010 and 2022 were analyzed in this retrospective cohort study. The median follow-up (IQR) was 18.0 (46.0) and at least 12 months. Outcomes were assessed based on the 2013 Delphi consensus on PJI outcome. PJI was defined according to the EBJIS-criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall infection-free and revision-free survival rate was 43.1% (31\/72) and 56.9% (41\/72). 32 out of 41 treatment failures (78.0%) appeared within the first 3 months. Among the causative pathogens, Pseudomonas aeruginosa-related PJI had the poorest outcome resulting in an infection-free survival of only 18.2% (2\/11), whereas infections caused by Enterobacter cloacae had the highest success rate of 58.3% (7\/12); (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.12). Success rates were 65.0% (13\/20) for two-stage revision, 38.1% (8\/21) for multi-stage revision, 36.0% (9\/25) for DAIR and 16.7% (1\/6) for single-stage revision. In total, 6 amputations, 2 knee arthrodesis, and 8 resection arthroplasties were required for definitive infection eradication.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Gram-negative PJI may follow a more aggressive course with earlier and higher failure rates than previously thought. DAIR may be an option in selected cases, while two-stage revision showed a trend towards a more favorable infection-free survival in comparison to single- and multi-stage revisions. The results suggest pathogen-specific differences may influence outcomes and support individualized treatment strategies, warranting confirmation in large, prospective, multicenter studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06188-5","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:26:20Z","timestamp":1770006380000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["High and strikingly early failure-rate following gram-negative periprosthetic joint infection \u2013 a retrospective cohort study on 72 cases"],"prefix":"10.1007","volume":"146","author":[{"given":"Benjamin","family":"Schlossmacher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibiana","family":"Mathes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Lallinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruediger","family":"von Eisenhart-Rothe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Lazic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"6188_CR1","doi-asserted-by":"crossref","unstructured":"Singh JA (2011) Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J, 5: p.80-85.","DOI":"10.2174\/1874325001105010080"},{"key":"6188_CR2","doi-asserted-by":"crossref","unstructured":"Kurtz SM et al (2012) Economic burden of periprosthetic joint infection in the united States. J Arthroplasty, 27(8 Suppl): p. 61\u2009\u2013\u200965.e1.","DOI":"10.1016\/j.arth.2012.02.022"},{"issue":"10","key":"6188_CR3","doi-asserted-by":"publisher","first-page":"e13520","DOI":"10.1371\/journal.pone.0013520","volume":"5","author":"KL Corbett","year":"2010","unstructured":"Corbett KL et al (2010) Population-based rates of revision of primary total hip arthroplasty: a systematic review. PLoS ONE 5(10):e13520","journal-title":"PLoS ONE"},{"issue":"2","key":"6188_CR4","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1128\/CMR.00111-13","volume":"27","author":"J Tande Aaron","year":"2014","unstructured":"Tande Aaron J, Patel R (2014) Prosthetic joint infection. Clin Microbiol Rev 27(2):302\u2013345","journal-title":"Clin Microbiol Rev"},{"issue":"7","key":"6188_CR5","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1086\/605593","volume":"49","author":"PH Hsieh","year":"2009","unstructured":"Hsieh PH et al (2009) Gram-negative prosthetic joint infections: risk factors and outcome of treatment. Clin Infect Dis 49(7):1036\u20131043","journal-title":"Clin Infect Dis"},{"issue":"6s","key":"6188_CR6","doi-asserted-by":"publisher","first-page":"S313","DOI":"10.1016\/j.arth.2022.02.050","volume":"37","author":"LT Charalambous","year":"2022","unstructured":"Charalambous LT et al (2022) Prosthetic knee infection with Coagulase-Negative staphylococcus: A harbinger of poor outcomes. J Arthroplasty 37(6s):S313\u2013s320","journal-title":"J Arthroplasty"},{"issue":"1","key":"6188_CR7","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.jos.2018.04.017","volume":"24","author":"Z Gao","year":"2019","unstructured":"Gao Z et al (2019) Comparison between the Staphylococci aureus and coagulase-negative Staphylococci infected total joint arthroplasty treated by two-stage revision: A retrospective study with two year minimum follow-up. J Orthop Sci 24(1):109\u2013115","journal-title":"J Orthop Sci"},{"issue":"10","key":"6188_CR8","doi-asserted-by":"publisher","first-page":"884","DOI":"10.5301\/ijao.5000148","volume":"35","author":"E Tornero","year":"2012","unstructured":"Tornero E et al (2012) Prosthetic joint infections due to Staphylococcus aureus and coagulase-negative Staphylococci. Int J Artif Organs 35(10):884\u2013892","journal-title":"Int J Artif Organs"},{"issue":"12","key":"6188_CR9","doi-asserted-by":"publisher","first-page":"5053","DOI":"10.1007\/s00402-023-05104-5","volume":"144","author":"D Karczewski","year":"2024","unstructured":"Karczewski D et al (2024) Gram negative periprosthetic hip infection: nearly 25% same pathogen infection persistence at a mean of 2 years. Arch Orthop Trauma Surg 144(12):5053\u20135059","journal-title":"Arch Orthop Trauma Surg"},{"issue":"11","key":"6188_CR10","doi-asserted-by":"publisher","first-page":"O911","DOI":"10.1111\/1469-0691.12649","volume":"20","author":"D Rodr\u00edguez-Pardo","year":"2014","unstructured":"Rodr\u00edguez-Pardo D et al (2014) Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect 20(11):O911\u2013O919","journal-title":"Clin Microbiol Infect"},{"issue":"3","key":"6188_CR11","doi-asserted-by":"publisher","first-page":"340","DOI":"10.3390\/antibiotics10030340","volume":"10","author":"RB da Silva","year":"2021","unstructured":"da Silva RB, Salles MJ (2021) Outcomes and risk factors in prosthetic joint infections by multidrug-resistant Gram-negative bacteria: A retrospective cohort study. Antibiotics 10(3):340","journal-title":"Antibiotics"},{"issue":"2","key":"6188_CR12","doi-asserted-by":"publisher","first-page":"101","DOI":"10.5194\/jbji-10-101-2025","volume":"10","author":"IK Sigmund","year":"2025","unstructured":"Sigmund IK et al (2025) Debridement, antimicrobial therapy, and implant retention (DAIR) as curative strategy for acute periprosthetic hip and knee infections: a position paper of the European bone & joint infection society (EBJIS). J Bone Joint Infect 10(2):101\u2013138","journal-title":"J Bone Joint Infect"},{"issue":"8","key":"6188_CR13","doi-asserted-by":"publisher","first-page":"786e9","DOI":"10.1016\/j.cmi.2015.04.012","volume":"21","author":"E Tornero","year":"2015","unstructured":"Tornero E et al (2015) KLIC-score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. Clin Microbiol Infect 21(8):786e9\u2013786e17","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"6188_CR14","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.jinf.2018.07.014","volume":"78","author":"M Wouthuyzen-Bakker","year":"2019","unstructured":"Wouthuyzen-Bakker M et al (2019) Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention. J Infect 78(1):40\u201347","journal-title":"J Infect"},{"key":"6188_CR15","doi-asserted-by":"crossref","unstructured":"McNally M et al (2021) The EBJIS definition of periprosthetic joint infection. Bone Joint J, 103\u2013b(1): p. 18\u201325","DOI":"10.1302\/0301-620X.103B1.BJJ-2020-1381.R1"},{"key":"6188_CR16","doi-asserted-by":"publisher","first-page":"101192","DOI":"10.1016\/j.eclinm.2021.101192","volume":"42","author":"AJ Hotchen","year":"2021","unstructured":"Hotchen AJ et al (2021) The Joint-Specific BACH classification: A predictor of outcome in prosthetic joint infection. EClinicalMedicine 42:101192","journal-title":"EClinicalMedicine"},{"issue":"4","key":"6188_CR17","doi-asserted-by":"publisher","first-page":"512","DOI":"10.2106\/00004623-199604000-00005","volume":"78","author":"DT Tsukayama","year":"1996","unstructured":"Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78(4):512\u2013523","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"6188_CR18","doi-asserted-by":"publisher","first-page":"2374","DOI":"10.1007\/s11999-013-2866-1","volume":"471","author":"C Diaz-Ledezma","year":"2013","unstructured":"Diaz-Ledezma C, Higuera CA, Parvizi J (2013) Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus. Clin Orthop Relat Res 471(7):2374\u20132382","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"6188_CR19","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1111\/j.1469-0691.2010.03361.x","volume":"17","author":"CA Aboltins","year":"2011","unstructured":"Aboltins CA et al (2011) Gram-negative prosthetic joint infection treated with debridement, prosthesis retention and antibiotic regimens including a fluoroquinolone. Clin Microbiol Infect 17(6):862\u2013867","journal-title":"Clin Microbiol Infect"},{"key":"6188_CR20","doi-asserted-by":"crossref","unstructured":"Gonzalez MR et al (2024) Microbiology, Treatment, and postoperative outcomes of Gram-Negative prosthetic joint Infections-A systematic review of the literature. J Am Acad Orthop Surg, 33(6): p. e327-e339.","DOI":"10.5435\/JAAOS-D-23-01203"},{"key":"6188_CR21","doi-asserted-by":"publisher","first-page":"25","DOI":"10.7150\/jbji.15722","volume":"1","author":"NB Shah","year":"2016","unstructured":"Shah NB et al (2016) Pseudomonas prosthetic joint infections: A review of 102 episodes. J Bone Jt Infect 1:25\u201330","journal-title":"J Bone Jt Infect"},{"issue":"9","key":"6188_CR22","doi-asserted-by":"publisher","first-page":"2593","DOI":"10.1093\/jac\/dkw202","volume":"71","author":"O Grossi","year":"2016","unstructured":"Grossi O et al (2016) Gram-negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones. J Antimicrob Chemother 71(9):2593\u20132597","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"6188_CR23","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/j.arth.2019.09.044","volume":"35","author":"IL Kalbian","year":"2020","unstructured":"Kalbian IL et al (2020) Treatment outcomes and attrition in Gram-Negative periprosthetic joint infection. J Arthroplasty 35(3):849\u2013854","journal-title":"J Arthroplasty"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06188-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06188-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06188-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:26:24Z","timestamp":1770006384000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-026-06188-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,2]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6188"],"URL":"https:\/\/doi.org\/10.1007\/s00402-026-06188-5","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,2]]},"assertion":[{"value":"16 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by the local institution\u2019s ethics under no. 714\/20 S. It was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written patients\u2019 consent on participation and anonymous publication was obtained prior to the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"37"}}