{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T21:59:31Z","timestamp":1794261571062,"version":"4.9.0"},"reference-count":56,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Periprosthetic joint infection (PJI) is a severe complication following megaprosthetic reconstruction in musculoskeletal oncology. This study aimed to evaluate outcomes of different surgical strategies for PJI in lower-limb megaprostheses and identify factors associated with treatment failure. Methods: We performed a retrospective cohort study of 29 consecutive patients treated for PJI after oncologic megaprosthetic reconstruction. Reinfection was analyzed using cumulative incidence functions (CIFs) with death treated as a competing event. Overall survival was assessed using Kaplan\u2013Meier analysis. Univariable cause-specific Cox regression was performed for exploratory risk-factor analysis. Results: Among 29 patients, coagulase-negative staphylococci and Staphylococcus aureus were the most frequently isolated pathogens, and difficult-to-treat organisms were identified in a substantial proportion of cases. In patients managed with two-stage revision, the cumulative incidence of reinfection was 15% (95% CI: 0\u201330%) at 1 year and 30% (95% CI: 10\u201350%) at 2 and 5 years. In the DAIR cohort, the cumulative incidence of reinfection was 25% (95% CI: 0\u201362.5%) at 1 and 2 years and 37.5% (95% CI: 12.2\u201375%) at 3 years. Positive reimplantation cultures occurred in 38% of cases and were strongly associated with subsequent treatment failure. Polymicrobial infections were present in 27.5% of cases. Amputation was required in 17.2% of patients, often due to multidrug-resistant organisms or poor soft tissue. Conclusions: Two-stage revision remains the most effective strategy for PJI management in megaprostheses. DAIR may control acute infection but is suboptimal for definitive treatment. Individualized, multidisciplinary approaches are essential to improve outcomes in this high-risk population.<\/jats:p>","DOI":"10.3390\/pathogens15030306","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:00:37Z","timestamp":1773219637000},"page":"306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Microbiological Characteristics and Clinical Outcomes of Periprosthetic Infections Following Oncologic Megaprosthetic Reconstruction: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4082-1906","authenticated-orcid":false,"given":"Vasileios","family":"Karampikas","sequence":"first","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros","family":"Goumenos","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-0759","authenticated-orcid":false,"given":"Andreas G.","family":"Tsantes","sequence":"additional","affiliation":[{"name":"Laboratory of Haematology and Blood Bank Unit, University General Hospital \u201cAttiko\u201d, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"},{"name":"Microbiology Department, \u201cSaint Savvas\u201d Oncology Hospital, 115 22 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4759-4814","authenticated-orcid":false,"given":"Ioannis G.","family":"Trikoupis","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panayiotis","family":"Gavriil","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1685-5559","authenticated-orcid":false,"given":"Anastasios G.","family":"Roustemis","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Zikopoulos","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Petrakis","sequence":"additional","affiliation":[{"name":"2nd University Department of Internal Medicine, Department of Infectious Diseases, University General Hospital Alexandroupolis, Democritus University Thrace, 691 00 Komotini, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios V.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-5674","authenticated-orcid":false,"given":"Petros","family":"Ioannou","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Crete, 710 03 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0733-6565","authenticated-orcid":false,"given":"Olga","family":"Savvidou","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6356-4346","authenticated-orcid":false,"given":"Vasileios","family":"Kontogeorgakos","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panayiotis J.","family":"Papagelopoulos","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 106 79 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.2106\/JBJS.F.01324","article-title":"Endoprosthetic Reconstruction for the Treatment of Musculoskeletal Tumors of the Appendicular Skeleton and Pelvis","volume":"90","author":"Jeys","year":"2008","journal-title":"J. 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