Research Summary

Prevalence and Impact of Bacteremia in Chronic Prosthetic Joint Infection

Miranda Manier, BA

Key Highlights

  • Preoperative bacteremia was identified in 15% of patients with chronic prosthetic joint infection (PJI).
  • Diabetes and ASA class III were independently associated with higher odds of positive blood cultures.
  • Infection-free implant survival at 30 months was similar between bacteremia-positive and bacteremia-negative groups.
  • Findings support selective use of preoperative blood cultures in higher-risk patients.

A prospective, observational study examining the prevalence and clinical significance of bacteremia in patients undergoing surgery for chronic prosthetic joint infection (PJI) found that 15% of patients had positive preoperative blood cultures, strongly associated with diabetes and higher baseline comorbidity burden. However, bacteremia was not associated with differences in infection-free implant survival at 30 months.

Chronic PJI is a serious complication of joint arthroplasty, often requiring revision surgery. While bacteremia has been reported in acute PJI and is linked to poorer outcomes, its prevalence and prognostic value in chronic cases remain unclear. Understanding these associations is important for perioperative management, particularly in patients with comorbidities or other prosthetic devices at risk of secondary infection.

Researchers enrolled 124 patients with chronic hip or knee PJI treated at a single academic center between June 2021 and August 2022, using modified Musculoskeletal Infection Society criteria for diagnosis. Patients undergoing revision surgery were eligible if they had two preoperative blood cultures drawn within 48 hours of admission and at least 1 hour apart from separate arms. After exclusions for delayed transfers, contamination, late hematogenous infection, or recent antibiotic exposure, 92 patients (74%) were included in the final analysis, with a minimum 2-year follow-up. Patients were divided into blood culture–positive and blood culture–negative groups. Demographic, clinical, and laboratory data were compared using chi-square and t-tests, while multivariable logistic regression controlled for potential confounders. Kaplan–Meier analysis assessed infection-free implant survival at 30 months.

Among the 92 patients analyzed, the mean age was 65 years, mean BMI was 28 kg/m², 40% were men, and most had knee PJIs (61%). Fourteen patients (15%) had positive preoperative blood cultures. After adjustment, patients with diabetes had markedly higher odds of bacteremia (OR 14; 95% CI 3–100; P < .001), as did those with ASA class III (OR 4; 95% CI 1–21; P = .04). No differences in infection-free implant survival at 30 months were observed between bacteremia-positive patients (86%) and bacteremia-negative patients (91%) (P = .51).

Ji and colleagues concluded, “In this prospective, observational study, we found that chronic PJI can potentially lead to hematogenous dissemination of pathogens, particularly in patients with poor overall health (such as those classified as ASA III and patients diagnosed with diabetes). Therefore, selective preoperative blood cultures may be crucial in helping clinicians implement early intervention measures to prevent the serious consequences of bacteremia in patients with poor baseline health and those with other implanted devices.”

Reference
Ji B, Perry KI, Li G, et al. How often does bacteremia occur in patients with chronic periprosthetic joint infection? A prospective, observational study. Clin Orthop Relat Res. 2025;483(7):1206-1214. doi:10.1097/CORR.0000000000003367