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Ilker Uækay, Louis Bernard, Gram-Negative versus Gram-Positive Prosthetic Joint Infections, Clinical Infectious Diseases, Volume 50, Issue 5, 1 March 2010, Page 795, https://doi.org/10.1086/650540
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To the Editor—We read with great interest the report by Hsieh et al [1] in the 1 October 2009 issue of the journal on gram-negative prosthetic joint infections (GN PJIs). We congratulate the authors for their substantial contribution.
The authors revealed that treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success than treating gram-positive (GP) PJI with debridement (27% vs 47% of episodes were successfully treated) [1]. This difference vanishes when 2-stage exchange is performed and stands in contrast to higher success rates of 40% [2] or 80% [2–4], even if the literature usually mixes up GP and GN organisms or concentrates only on GP organisms [4]. Hsieh et al [1] could not identify a statistically significant risk factor, probably because their study was underpowered. We think that the attribution of the 6 GN PJI cases with sinus tracts to the debridement-and-retention arm may have decreased the success rate. As shown in the authors' Table5, no episode with a sinus tract has been cured with retention alone. This strong risk for treatment failure is congruent with expert opinion [5, 6].
