{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:44:08Z","timestamp":1784259848202,"version":"3.55.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020273","name":"PRO-IMPLANT Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100020273","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["393148499"],"award-info":[{"award-number":["393148499"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Open Access Publication Fund of the University of Greifswald"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The outcomes of hematogenous periprosthetic joint infection (PJI) and reasons for failure are largely unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The outcomes of consecutive patients with hematogenous PJI treated at our institution between 2010 and 2019 were evaluated. Failure was classified as persistence or relapse of infection or new infection. Failure-free survival was assessed using Kaplan-Meier analysis. Proportions between groups were compared with the Fisher exact test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One hundred thirty-two hematogenous PJI episodes involving knee (n\u2005=\u200576), hip (n\u2005=\u200554), shoulder (n\u2005=\u20051), or elbow (n\u2005=\u20051) prostheses experienced by 110 patients were included. The median follow-up (range) was 20.7 (0.2\u201389.9) months. Hematogenous PJIs were caused by Staphylococcus aureus (n\u2005=\u200549), Streptococcus spp. (n\u2005=\u200536), Enterococcus faecalis (n\u2005=\u200517), Enterobacterales (n\u2005=\u200516), coagulase-negative staphylococci (n\u2005=\u20059), and other (n\u2005=\u20056). Debridement and implant retention were performed in 50 (38%), prosthesis exchange or removal in 79 (60%), and no surgery in 3 episodes (2%). Treatment failed in 42 episodes (32%), including 6 infection-related deaths. Among 36 nonfatal failures, 21 were caused by a new pathogen and 8 by the same pathogen, in 7 episodes no pathogen was isolated. Of all nonfatal failures, 19 (53%) PJIs were of hematogenous origin. Identification of the primary focus, causative pathogen, and CRIME80 Score did not influence treatment outcome, but the failure rate was higher following prosthesis retention compared with multistage exchange.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Persistence-\/relapse-free survival after treatment of hematogenous PJI was high (84%). New hematogenous PJI due to the same or a new pathogen occurred frequently, reducing treatment success to 62% after 4 years of follow-up, suggesting an individual predisposition to hematogenous PJI. The outcome was similar for different pathogens but worse in episodes treated with prosthesis retention compared with multistage exchange.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofac094","type":"journal-article","created":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T11:45:24Z","timestamp":1646912724000},"source":"Crossref","is-referenced-by-count":25,"title":["Outcome and Failure Analysis of 132 Episodes of Hematogenous Periprosthetic Joint Infections\u2014A Cohort Study"],"prefix":"10.1093","volume":"9","author":[{"given":"Nora","family":"Renz","sequence":"first","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt Universit\u00e4t zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany"},{"name":"Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5219-2521","authenticated-orcid":false,"given":"Andrej","family":"Trampuz","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt Universit\u00e4t zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten","family":"Perka","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt Universit\u00e4t zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6171-8292","authenticated-orcid":false,"given":"Anastasia","family":"Rakow","sequence":"additional","affiliation":[{"name":"Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt Universit\u00e4t zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Berlin, Germany"},{"name":"Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,3,10]]},"reference":[{"key":"2022032913370651900_CIT0001","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/cis803","article-title":"Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.","volume":"56","author":"Osmon","year":"2013","journal-title":"Clin Infect Dis"},{"key":"2022032913370651900_CIT0002","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1302\/2058-5241.4.180092","article-title":"Periprosthetic joint infection: current concepts and outlook.","volume":"4","author":"Izakovicova","year":"2019","journal-title":"EFORT Open Rev"},{"key":"2022032913370651900_CIT0003","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.cmi.2018.10.010","article-title":"Origin and characteristics of haematogenous periprosthetic joint infection.","volume":"25","author":"Rakow","year":"2019","journal-title":"Clin Microbiol Infect"},{"key":"2022032913370651900_CIT0004","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jinf.2018.07.014","article-title":"Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention.","volume":"78","author":"Wouthuyzen-Bakker","year":"2019","journal-title":"J Infect"},{"key":"2022032913370651900_CIT0005","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1111\/j.1469-0691.2010.03157.x","article-title":"Acute haematogenous prosthetic joint infection: prospective evaluation of medical and surgical management.","volume":"16","author":"Rodriguez","year":"2010","journal-title":"Clin Microbiol Infect"},{"key":"2022032913370651900_CIT0006","article-title":"Outcomes and risk factors associated with failures of debridement, antibiotics, and implant retention in patients with acute hematogenous periprosthetic joint infection.","author":"Chen","year":"2021","journal-title":"J Am Acad Orthop Surg"},{"key":"2022032913370651900_CIT0007","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.jinf.2017.12.016","article-title":"Analysis of postoperative and hematogenous prosthetic joint-infection microbiological patterns in a large cohort.","volume":"76","author":"Zeller","year":"2018","journal-title":"J Infect"},{"key":"2022032913370651900_CIT0008","doi-asserted-by":"crossref","first-page":"XXX\u2013XX","DOI":"10.1093\/ofid\/ofz218","article-title":"Periprosthetic joint infections as a consequence of bacteremia.","volume":"6","author":"Honkanen","year":"2019","journal-title":"Open Forum Infect Dis"},{"key":"2022032913370651900_CIT0009","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1097\/CORR.0000000000001171","article-title":"Lower success rate of debridement and implant retention in late acute versus early acute periprosthetic joint infection caused by Staphylococcus spp. results from a matched cohort study.","volume":"478","author":"Wouthuyzen-Bakker","year":"2020","journal-title":"Clin Orthop Relat Res"},{"key":"2022032913370651900_CIT0010","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/os.12641","article-title":"Debridement, antibiotics, and implant retention for acute periprosthetic joint infection.","volume":"12","author":"Zhang","year":"2020","journal-title":"Orthop Surg"},{"key":"2022032913370651900_CIT0011","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.arth.2018.09.088","article-title":"Acceptable success rate in patients with periprosthetic knee joint infection treated with debridement, antibiotics, and implant retention.","volume":"34","author":"Ottesen","year":"2019","journal-title":"J Arthroplasty"},{"key":"2022032913370651900_CIT0012","doi-asserted-by":"crossref","first-page":"102774","DOI":"10.1016\/j.otsr.2020.102774","article-title":"Methods and probability of success after early revision of prosthetic joint infections with debridement, antibiotics and implant retention.","volume":"107","author":"Boyer","year":"2021","journal-title":"Orthop Traumatol Surg Res"},{"key":"2022032913370651900_CIT0013","first-page":"330","article-title":"Debridement and implant retention in the management of hip periprosthetic joint infection: outcomes following guided and rapid treatment at a single centre.","volume":"99-b","author":"Sendi","year":"2017","journal-title":"Bone Joint\u00a0J"},{"key":"2022032913370651900_CIT0014","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.arth.2013.07.021","article-title":"Acute hematogenous infection following total hip and knee arthroplasty.","volume":"29","author":"Konigsberg","year":"2014","journal-title":"J Arthroplasty"},{"key":"2022032913370651900_CIT0015","doi-asserted-by":"crossref","first-page":"863","DOI":"10.5301\/ijao.5000029","article-title":"Efficacy of debridement in hematogenous and early post-surgical prosthetic joint infections.","volume":"34","author":"Vilchez","year":"2011","journal-title":"Int J Artif Organs"},{"key":"2022032913370651900_CIT0016","doi-asserted-by":"crossref","first-page":"696","DOI":"10.2106\/JBJS.18.00381","article-title":"Increased failure after irrigation and debridement for acute hematogenous periprosthetic joint infection.","volume":"101","author":"Shohat","year":"2019","journal-title":"J\u00a0Bone Joint\u00a0Surg Am"},{"key":"2022032913370651900_CIT0017","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.medmal.2019.11.005","article-title":"Implant retention and high rate of treatment failure in hematogenous acute knee and hip prosthetic joint infections.","volume":"50","author":"Pansu","year":"2020","journal-title":"Med Mal Infect"},{"key":"2022032913370651900_CIT0018","doi-asserted-by":"crossref","first-page":"742","DOI":"10.2106\/JBJS.17.01005","article-title":"Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection: not a screening but a confirmatory test.","volume":"100","author":"Renz","year":"2018","journal-title":"J\u00a0Bone Joint\u00a0Surg Am"},{"key":"2022032913370651900_CIT0019","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.prp.2014.09.017","article-title":"Revised histopathological consensus classification of joint implant related pathology.","volume":"210","author":"Krenn","year":"2014","journal-title":"Pathol Res Pract"},{"key":"2022032913370651900_CIT0020","article-title":"Biofilm-active antibiotic treatment improved the outcome of knee periprosthetic joint infection: results from a 6-year prospective cohort.","volume":"105904","author":"Gellert","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"2022032913370651900_CIT0021","doi-asserted-by":"crossref","first-page":"138","DOI":"10.5371\/hp.2018.30.3.138","article-title":"Management of periprosthetic joint infection.","volume":"30","author":"Li","year":"2018","journal-title":"Hip Pelvis"},{"key":"2022032913370651900_CIT0022","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00402-015-2237-3","article-title":"Open debridement and prosthesis retention is a viable treatment option for acute periprosthetic joint infection after total knee arthroplasty.","volume":"135","author":"Koh","year":"2015","journal-title":"Arch Orthop Trauma Surg"},{"key":"2022032913370651900_CIT0023","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jinf.2019.07.003","article-title":"Timing of implant-removal in late acute periprosthetic joint infection: a multicenter observational study.","volume":"79","author":"Wouthuyzen-Bakker","year":"2019","journal-title":"J Infect"},{"key":"2022032913370651900_CIT0024","doi-asserted-by":"crossref","first-page":"221.e11","DOI":"10.1016\/j.amjmed.2015.09.006","article-title":"Clinical presentation, risk factors, and outcomes of hematogenous prosthetic joint infection in patients with Staphylococcus aureus bacteremia.","volume":"129","author":"Tande","year":"2016","journal-title":"Am J Med"},{"key":"2022032913370651900_CIT0025","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1093\/cid\/ciw383","article-title":"Risk factors of endocarditis in patients with Enterococcus faecalis bacteremia: external validation of the NOVA Score.","volume":"63","author":"Dahl","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2022032913370651900_CIT0026","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.3855\/jidc.6587","article-title":"Clinical and microbiological features of bacteremia caused by Enterococcus faecalis.","volume":"9","author":"Ceci","year":"2015","journal-title":"J Infect Dev Ctries"},{"key":"2022032913370651900_CIT0027","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jinf.2013.10.015","article-title":"Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies.","volume":"68","author":"Kaasch","year":"2014","journal-title":"J Infect"},{"key":"2022032913370651900_CIT0028","doi-asserted-by":"crossref","first-page":"XXX\u2013XX","DOI":"10.1093\/ofid\/ofab387","article-title":"Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections caused by ampc \u03b2-lactamase-producing Enterobacter spp, Citrobacter freundii, Morganella morganii, Providencia spp, or Serratia marcescens: a pilot multicenter randomized controlled trial (MERINO-2) .","volume":"8","author":"Stewart","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2022032913370651900_CIT0029","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1016\/j.arth.2019.01.066","article-title":"Failed debridement and implant retention does not compromise the success of subsequent staged revision in infected total knee arthroplasty.","volume":"34","author":"Kim","year":"2019","journal-title":"J Arthroplasty"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofac094\/42802866\/ofac094.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/4\/ofac094\/43058300\/ofac094.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/9\/4\/ofac094\/43058300\/ofac094.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T13:50:37Z","timestamp":1648561837000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofac094\/6546277"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,10]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofac094","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,4,1]]},"published":{"date-parts":[[2022,3,10]]},"article-number":"ofac094"}}