{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T11:07:18Z","timestamp":1779448038040,"version":"3.53.1"},"reference-count":17,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Periprosthetic joint infections (PJIs), a significant complication of total knee replacement surgery, are influenced by patient, surgeon, and healthcare system factors. Natural disasters can disrupt healthcare services and alter microbiological factors in the hospital environment. The impact of natural disasters on pathogen distribution in periprosthetic joint infection (PJI) is unclear. Therefore, this study investigated the association between the 2023 Kahramanmara\u015f-centered earthquakes in T\u00fcrkiye and changes in microbiological patterns of PJI after knee arthroplasty. Methods: This retrospective cohort study included patients who developed PJI following total knee arthroplasty at the study center. The patients were divided into two groups based on the timing of their PJI diagnosis: pre-earthquake and post-earthquake. The demographic characteristics, comorbid diseases, and perioperative characteristics of each patient were recorded, and their microbiological profiles were analyzed. Logistic regression analysis examined the relationships between patient-related factors and causative agents. Results: 56 patients were studied and divided into two groups: 26 patients in the pre-earthquake group and 30 in the post-earthquake group. Furthermore, 79 bacterial isolates were obtained from these patients. Demographic, metabolic, and preoperative characteristics were similar between the two groups. No significant difference was found in the overall distribution of bacterial isolates. However, Gram-negative organisms, primarily Acinetobacter baumannii and Pseudomonas aeruginosa, increased in the isolate distribution after the earthquake. Patient analysis revealed that polymicrobial PJIs were significantly more frequent after the earthquake (56.7% vs. 23.1%; p = 0.011). Diabetes mellitus (DM) and smoking were associated with an increased risk of polymicrobial infection; the association was not statistically significant. Conclusions: In the post-earthquake period, patients who had undergone total knee arthroplasty and developed PJI showed a higher proportion of polymicrobial infections and a numerical increase in Gram-negative pathogens, along with more complex infection patterns compared to the pre-earthquake period. Although both patient groups demonstrated similar characteristics regarding patient-related and surgical factors, the observed changes indicate that the pressure on the healthcare system after a natural disaster can affect a hospital\u2019s microbiological ecology. Identifying these indirect effects is crucial for guiding microbiological surveillance and infection control during post-disaster recovery periods, even for elective patients.<\/jats:p>","DOI":"10.3390\/jcm15114006","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:07:47Z","timestamp":1779444467000},"page":"4006","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between the 2023 Kahramanmara\u015f Double Earthquake and Pathogen Distribution in Periprosthetic Joint Infection After Knee Arthroplasty"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3660-3511","authenticated-orcid":false,"given":"Osman","family":"\u00c7ilo\u011flu","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Health Sciences Adana City Training and Research Hospital, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evren","family":"Karaali","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Health Sciences Adana City Training and Research Hospital, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1515-8388","authenticated-orcid":false,"given":"Hakan","family":"Uslu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Health Sciences Adana City Training and Research Hospital, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2268-4709","authenticated-orcid":false,"given":"O\u011fuzhan","family":"\u00c7i\u00e7ek","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Health Sciences Adana City Training and Research Hospital, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1243-2057","authenticated-orcid":false,"given":"Mehmet Yi\u011fit","family":"G\u00f6kmen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, \u00c7anakkale Onsekiz Mart University, 17020 Canakkale, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2345-0827","authenticated-orcid":false,"given":"\u00d6zhan","family":"Pazarc\u0131","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, University of Health Sciences Adana City Training and Research Hospital, 01250 Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3207-7101","authenticated-orcid":false,"given":"Mustafa","family":"\u00c7\u0131tak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Knappschaft Kliniken Dortmund, 44137 Dortmund, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101127","DOI":"10.1016\/j.nmni.2023.101127","article-title":"The earthquake in T\u00fcrkiye and infectious disease concerns","volume":"52","year":"2023","journal-title":"New Microbes New Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.3201\/eid2906.230316","article-title":"Antimicrobial-Resistant Infections after Turkey\/Syria Earthquakes, 2023","volume":"29","author":"Rizk","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","first-page":"549","article-title":"Earthquake in T\u00fcrkiye: Impact on Health Services and Infection Threats","volume":"45","author":"Orak","year":"2023","journal-title":"J. Clin. Pract. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4274\/jpr.galenos.2023.56767","article-title":"Infections after the earthquake disaster","volume":"10","author":"Avcu","year":"2023","journal-title":"J. Pediatr. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13049-024-01181-6","article-title":"Clinical features and outcomes of orthopaedic injuries after the Kahramanmara\u015f earthquake: A retrospective study from a hospital located in the affected region","volume":"32","author":"Melik","year":"2024","journal-title":"Scand. J. Trauma. Resusc. Emerg. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1017\/S1049023X24000062","article-title":"Kahramanmara\u015f-Pazarc\u0131k Earthquake 2023: Characteristics of patients presented to a tertiary hospital far from the region and infection characteristics in hospitalized patients","volume":"39","author":"Aktepe","year":"2024","journal-title":"Prehospital Disaster Med."},{"key":"ref_7","first-page":"579","article-title":"Data analysis of patients admitted to the emergency medicine clinic after the Kahramanmara\u015f earthquake","volume":"30","author":"Beydilli","year":"2024","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"684","DOI":"10.52312\/jdrs.2024.1517","article-title":"Infections after musculoskeletal injuries in earthquake survivors","volume":"35","author":"Hasanoglu","year":"2024","journal-title":"Jt. Dis. Relat. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.ajic.2023.12.005","article-title":"An outbreak analysis of wound infection due to Acinetobacter baumannii in earthquake-trauma patients","volume":"52","author":"Yalcin","year":"2024","journal-title":"Am. J. Infect. Control"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1007\/s00383-024-05755-4","article-title":"Analysis of wound infections among pediatric patients following the 2023 T\u00fcrkiye\u2013Syria earthquakes","volume":"40","author":"Tezol","year":"2024","journal-title":"Pediatr. Surg. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e15827","DOI":"10.1111\/ped.15827","article-title":"Infections and treatment modalities in pediatric victims of the 2023 Kahramanmara\u015f\/T\u00fcrkiye earthquakes","volume":"66","author":"Kaya","year":"2024","journal-title":"Pediatr. Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"112338","DOI":"10.1016\/j.injury.2025.112338","article-title":"Lessons learned from the 2023 Turkey\u2013Syria earthquake: Outcomes of fasciotomy including infection and complications in crush injuries","volume":"56","author":"Yilmaz","year":"2025","journal-title":"Injury"},{"key":"ref_13","first-page":"565","article-title":"Evaluation of healthcare-associated skin and soft tissue infections developed after the February 6, 2023 Kahramanmara\u015f\u2013T\u00fcrkiye earthquakes","volume":"54","year":"2025","journal-title":"Am. J. Infect. Control"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kaya, E.K., Halacli, B., Guven, G., Yildirim, M., Seven, A.E., Gemcioglu, E., Simsek, M., Sullu, B.E., Yuksel, R.C., and Kaynar, A.S. (2025). Infections among adults hospitalized in intensive care after the 2023 earthquake in the southeastern part of T\u00fcrkiye: A multi-center observational study. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-024-10416-x"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Mei, J., Hu, H., Zhu, S., Ding, H., Huang, Z., Li, W., Yang, B., Zhang, W., and Fang, X. (2023). Diagnostic Role of mNGS in Polymicrobial Periprosthetic Joint Infection. J. Clin. Med., 12.","DOI":"10.3390\/jcm12051838"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1186\/s13018-025-06231-y","article-title":"Multi-limb amputations after the 2023 T\u00fcrkiye earthquake: Early mortality, complications, and two-year outcomes","volume":"20","author":"Yavuz","year":"2025","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"995","DOI":"10.14744\/tjtes.2025.54617","article-title":"Open fractures associated with earthquakes and high-energy trauma: Infection-related outcomes in a tertiary center cohort","volume":"31","author":"Ulusoy","year":"2025","journal-title":"Ulus. Travma Acil Cerrahi Derg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4006\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T10:36:26Z","timestamp":1779446186000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/11\/4006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":17,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15114006"],"URL":"https:\/\/doi.org\/10.3390\/jcm15114006","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]}}}