26dkou256 10.3205/26dkou256 urn:nbn:de:0183-26dkou2561 Meeting Abstract Kühlwein Kühlwein Daniel D

Universitätsmedizin Mannheim, Mannheim, Deutschland

author Darwich Darwich Ali A

Universitätsmedizin Mannheim, Mannheim, Deutschland

author Al Fars Al Fars Faisal F

Universitätsmedizin Mannheim, Mannheim, Deutschland

author Bdeir Bdeir Mohammed M

Universitätsmedizin Mannheim, Mannheim, Deutschland

author Baumgärtner Baumgärtner Tobias T

Universitätsmedizin Mannheim, Mannheim, Deutschland

author Schilder Schilder Andreas A

Medizinische Fakultät Mannheim der Universität Heidelberg, Bibliothek, Mannheim, Deutschland

author Hetjens Hetjens Svetlana S

Medizinische Fakultät Mannheim der Universität Heidelberg, Bibliothek, Mannheim, Deutschland

author Gravius Gravius Sascha S

Universitätsmedizin Mannheim, Mannheim, Deutschland

author German Medical Science GMS Publishing House

Düsseldorf

610 20261020 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0659 256 Deutsche Gesellschaft für Orthopädie und Unfallchirurgie Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie Deutsche Gesellschaft für Unfallchirurgie Berufsverband für Orthopädie und Unfallchirurgie Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2026) Abstracts; AG EbM | Infektionen und perioperatives Management in der Hüftendoprothetik Berlin 20261020 20261023 DKOU26_Abs_2086 TextObjectives and questions: Periprosthetic joint infection remains one of the most severe complications following total joint arthroplasty. Infections caused by difficult-to-treat (DTT) pathogens represent a distinct clinical challenge due to limited biofilm-active and orally available antimicrobial options. While short-term outcomes of DTT-associated PJI have been described, data on long-term clinical and functional outcomes are scarce.Material and methods: This retrospective single-center observational study included patients treated for periprosthetic joint infection following primary total hip or knee arthroplasty between 2016 and 2020. Diagnosis was established according to the criteria of the Musculoskeletal Infection Society. Patients were categorized as having DTT or non-DTT infections based on antimicrobial susceptibility profiles. Clinical outcome was defined as infection free status or therapeutic failure and functional outcome was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The mean follow-up duration was 68.9 months. Outcomes were compared between groups using chi square tests for categorical variables and independent samples t tests for continuous variables.Results: A total of 105 patients were included, of whom 58 (55.2%) had infections caused by difficult-to-treat pathogens. DTT infections occurred significantly more frequently following hip arthroplasty than knee arthroplasty, accounting for 62.1% (36 of 58) of DTT infections compared with 37.9% (22 of 58) after knee arthroplasty (p = 0.0272). Infection eradication was achieved in 43.1% of patients in the DTT group compared with 78.7% in the non-DTT group (p = 0.0002). Therapeutic failure was significantly more common in patients with DTT infections (44.8% vs 10.6%, p = 0.0001). Infection-related mortality did not differ significantly between groups. Functional outcomes were significantly poorer in the DTT group, with higher mean WOMAC scores compared with non-DTT infections (49.61 ± 27.29 vs 38.74 ± 22.21, p = 0.0369). Patient-related risk factors including body mass index, ASA score, diabetes mellitus, and oral anticoagulation were not associated with DTT infection status.Discussion and conclusions: Over a long-term follow-up of nearly six years, periprosthetic joint infections caused by difficult-to-treat pathogens were associated with substantially lower infection eradication rates, higher therapeutic failure, and significantly worse functional outcomes compared with non-DTT infections. These findings indicate that the adverse impact of DTT pathogens extends beyond short-term treatment success and persists in long-term clinical and functional outcomes, underscoring the need for improved therapeutic strategies and long-term patient management. 0 0 0 0