Arthroplasty · Published 2025-11-24 · DOI 10.1186/s42836-025-00341-y
Abstract Background There is no consensus on the antibiotic course or type of surgical treatment in streptococcal periprosthetic-joint infections (PJIs). We aimed to compare the treatment failure rate at 2 years of PJIs caused by streptococci to PJIs caused by other pathogens and identify factors associated with failure. Methods It was a single-center retrospective cohort study conducted between 2009 and 2019. We included all patients aged ≥ 18 years undergoing treatment for hip or knee PJI with a 2-year follow-up. We analyzed the treatment failure rate at 2 years of streptococcal PJIs versus PJIs caused by other pathogens with failure defined as a non-successful treatment using the Delphi-based international multidisciplinary consensus of success. We also analyzed factors associated with failure including streptococcal etiology and type of treatment. Results We included 404 patients; 62 (15%) had a streptococcal PJI, of which 14 (23%) exhibited treatment failure at 2 years. The treatment failure rate was similar to that for PJIs caused by other pathogens (21%, 71/342) (P = 0.78). Streptococci were not associated with failure (OR = 1.55, 95% CI 0.62–3.89, P = 0.35). However, Streptococcus dysgalactiae (OR = 9.45, 95% CI 1.37–65.46, P = 0.02) and debridement, antibiotics and implant retention (DAIR) (OR = 9.31, 95% CI 1.80–48.20, P = 0.008) were associated with failure among patients with a streptococcal PJI. Conclusions The treatment failure rate of streptococcal PJIs was similar to that for PJIs caused by other pathogens. However, Streptococcus dysgalactiae and DAIR were factors associated with failure among patients with a streptococcal PJI. Our results suggest that streptococcal PJIs, especially Streptococcus dysgalactiae PJIs, should be surgically treated more aggressively with an implant exchange.
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