Microbiologic Patterns Found in Periprosthetic Joint Infections Following Total Joint Arthroplasty Differ Across Race and Sex.

BACKGROUND: Despite extensive evidence demonstrating race- and sex-based disparities in periprosthetic joint infection (PJI) incidence following total joint arthroplasty, there is a lack of evidence on differences in the microbial profiles of pathogens identified. Our study evaluated the race- and sex-based differential microbial patterns of infecting organisms among patients with PJI. METHODS: The Premier Healthcare Database was queried from 2016 to 2023 for patients aged ≥18 years who underwent antibiotic spacer placement for a total joint arthroplasty PJI. Microbiology data were extracted from synovial and tissue cultures obtained during the hospital admission. Microbiological profiles were compared with respect to patient race via multivariable logistic regression. Race-sex subanalysis was then conducted via chi-squared testing. RESULTS: In total, 9014 patients were identified with 8189 (90.8%) White and 825 (9.2%) Black patients. Black patients had significantly higher adjusted odds of infection by methicillin-resistant Staphylococcus aureus (MRSA) (aOR: 1.45, [1.18-1.79], P < .001) and gram-negative enterics (aOR: 1.45, [1.15-1.85], P = .01). Furthermore, Black males had the highest rates of MRSA infection (15.1%), while Black females had the highest rates of polymicrobial infections (24.3%). CONCLUSIONS: Black patients had significantly greater risk of MRSA and gram-negative PJIs. Black males had the highest rates of MRSA and gram-negative enteric infection, while Black females exhibited the highest rates of polymicrobial infections. Further research into broader socioeconomic and health access disparities is warranted to explain the observed differences.