Microbiological Patterns in Periprosthetic Knee Infections over a Decade: Analysis of Resistance Patterns, Temporal Trends, and Patient Residence

Background: Infection following total knee arthroplasty (TKA) is a challenging complication. Optimal empirical antibiotic therapy and surgical management hinge on up-to-date knowledge of local pathogen distribution and resistance patterns. However, few studies have examined whether geographical factors, specifically rural versus urban residence, influence the microbiology or clinical outcomes of periprosthetic joint infection (PJI) within integrated healthcare systems. The goal of this study was to assess the temporal evolution of bacterial species and antimicrobial resistance in knee PJI over an 11-year period. As a secondary objective, we wanted to evaluate the potential impact of patient residence on microbiological trends and treatment success. Methods: We conducted a retrospective analysis of all patients diagnosed with knee PJI who underwent surgical treatment between 2013 and 2023 at our center. Infections were classified as acute postoperative, acute hematogenous, or chronic. Patient residence was categorized as rural ( 0.05). Furthermore, clinical treatment success rates were comparable (Rural 69.4% vs. Urban 63.0%, p = 0.500), despite a significantly higher prevalence of diabetes mellitus in rural patients (34.7% vs. 10.2%, p = 0.007). Conclusions: The microbiological landscape of knee PJI has remained stable, with no emergence of multidrug-resistant S. aureus. In our setting, standardized management protocols appeared to be equally effective regardless of patient residence. However, given the single-center nature and sample size of this study, broader multicenter validation is required before these findings can be generalized.