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Altogether 786 isolates from time interval 2008-2010 were grouped into 90 PCR ribotypes and eleven of them were shared among all host types and the environment. Ribotypes that were most common in humans were also present in water and different animals (014/020, 002, 029). Interestingly, non-toxigenic isolates were very common in the environment (30.8%) in comparison to humans (6.5%) and animals (7.7%). A high degree of similarity was observed for human and animal isolates with PFGE.
Etiology. The most commonly isolated microorganisms are Gram-positive cocci with coagulase-negative staphylococci, S. aureus and enterococci accounting for 65% of cases. Aerobic Gram-negative bacilli, including Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa, are far less frequent causes of infection (6%). Anaerobes, including Propionibacterium acnes, account for 4% of infections. Rare microbial causes of PJI have been reported (Figure 1 & Box 1, Box 2, Box 3). Approximately 7% of patients with PJI have aerobic and anaerobic cultures of periprosthetic tissue samples without any growth (i.e., culture-negative PJI).