scholarly journals Microbiological Epidemiology Depending on Time to Occurrence of Prosthetic Joint Infection (PJI): Impact on the Empirical Antimicrobial Strategies

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S95-S96
Author(s):  
Tristan Ferry ◽  
Claire Triffault-Fillit ◽  
Frederic Laurent ◽  
Céline Dupieux ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Lactam Antibiotic ◽  
Revision Prosthesis ◽  
Current Guidelines ◽  
Microbiological Data

Abstract Background Empirical antimicrobial therapy of prosthetic-joint infection (PJI) is a major clinical challenge and current guidelines recommend the combination of vancomycin plus a broad-spectrum β-lactamin. As Gram-negative bacilli (GNB) are probably less represented in late infections, we evaluate the microbiological epidemiology in patients with PJI according to the chronology of infection. Methods All patients managed in a reference center for complex bone and joint infections in France (2011 and 2016) were included in a prospective cohort study. Microbiological data at the time of diagnosis were collected and analyzed according to the chronology of infection. Results We included 567 PJI (284 males, 50.1%; median age 70.3 years). The median occurrence time was 23.4 weeks after prosthesis implantation (285 hip and 255 knee PJI, which were revision prosthesis in 216 [40.3%] cases). Microbiological bone samples found 164 [28.9%] S. aureus (including 26 [16.3%] MRSA), 162 [28.6%] coagulase-negative Staphylococci (CoNS, including 80 [58.8%] methicillin-resistant CoNS), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) Streptococci, and 85 (15.0%) anaerobes (including 60 [10.6%] Propionibacterium). Infection was plurimicrobial in 10 [18.2%] cases. Among the 183 patients (32%) with late PJI (occurring >1 year), obtained after exclusion of the 59 patients (10.4%) with hematogenous origins, Enterobacteriacecae 
(n = 8; 4.4%; P < 10–3) were much less represented than in patients with early PJI occurring <1 year. No difference was observed regarding the the presence of non-fermenting GNB, with a prevalence of 4.6 and 2.7% in early and late PJI, respectively. Taken together, these data suggest that a broad-spectrum β-lactam antibiotic might be useful in only 12 (6.6%) patients with late PJI, compared with 66 (20.3%) patients with early PJI (P < 10–3). Of note, there were statistically more anaerobes (n = 40; 21.9%) in late PJI, including 32 Propionibacterium (17.5%; P < 10–3). Conclusion Considering the minority amount of GNB in late post-operative PJI and the overrepresentation of anaerobes including P. acnes, the empirical treatment should be reconsidered, especially when a two-stage exchange is planned. In those situations, another acceptable option could be the vancomycin+clindamycin combination. Disclosures T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee.

scholarly journals Microbiological Aetiology, Epidemiology, and Clinical Profile of Prosthetic Joint Infections: Are Current Antibiotic Prophylaxis Guidelines Effective?

2012 ◽  
Vol 56 (5) ◽  
pp. 2386-2391 ◽  
Author(s):  
Trisha N. Peel ◽  
Allen C. Cheng ◽  
Kirsty L. Buising ◽  
Peter F. M. Choong
Keyword(s):  
Antibiotic Prophylaxis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Content Type ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Surgical Antibiotic Prophylaxis

ABSTRACTProsthetic joint infections remain a major complication of arthroplasty. At present, local and international guidelines recommend cefazolin as a surgical antibiotic prophylaxis at the time of arthroplasty. This retrospective cohort study conducted across 10 hospitals over a 3-year period (January 2006 to December 2008) investigated the epidemiology and microbiological etiology of prosthetic joint infections. There were 163 cases of prosthetic joint infection identified. From a review of the microbiological culture results, methicillin-resistantStaphylococcus aureus(MRSA) and coagulase-negative staphylococci were isolated in 45% of infections. In addition, polymicrobial infections, particularly those involving Gram-negative bacilli and enterococcal species, were common (36%). The majority (88%) of patients received cefazolin as an antibiotic prophylaxis at the time of arthroplasty. In 63% of patients in this cohort, the microorganisms subsequently obtained were not susceptible to the antibiotic prophylaxis administered. The results of this study highlight the importance of ongoing reviews of the local ecology of prosthetic joint infection, demonstrating that the spectrum of pathogens involved is broad. The results should inform empirical antibiotic therapy. This report also provokes discussion about infection control strategies, including changing surgical antibiotic prophylaxis to a combination of glycopeptide and cefazolin, to reduce the incidence of infections due to methicillin-resistant staphylococci.

Diagnostic accuracy of alpha-defensin enzyme-linked immunosorbent assay in the clinical evaluation of painful hip and knee arthroplasty with possible prosthetic joint infection

2019 ◽  
Vol 101-B (8) ◽  
pp. 970-977 ◽  
Author(s):  
S. Kleiss ◽  
N. M. Jandl ◽  
A. Novo de Oliveira ◽  
W. Rüther ◽  
A. Niemeier
Keyword(s):  
Synovial Fluid ◽  
Diagnostic Accuracy ◽  
Immunosorbent Assay ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Coagulase Negative Staphylococci ◽  
Predictive Values ◽  
Prosthetic Joint

Aims The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA). Patients and Methods Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of 202 patients were analyzed and semiquantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery. Results Sensitivity and specificity of the alpha-defensin ELISA for PJI were 78.2% (95% confidence interval (CI) 66.7 to 88.5) and 96.6% (95% CI 93.0 to 99.3). Positive and negative predictive values were 89.6% (95% CI 80.6 to 97.8) and 92.2% (95% CI 87.5 to 96.1). The test remained false-negative in 22% of septic revisions, most of which were due to coagulase-negative staphylococci all occurring in either late-chronic or early-postoperative PJI. Conclusion The routine use of synovial fluid alpha-defensin laboratory ELISA in the preoperative evaluation of symptomatic THAs and TKAs is insufficient to accurately diagnose PJI. Particularly in cases involving low-virulence organisms, such as coagulase-negative staphylococci, there remains a need for tests with a higher sensitivity. Cite this article: Bone Joint J 2019;101-B:970–977.

scholarly journals Prosthetic Knee Septic Arthritis due toPseudomonas stutzeri

2000 ◽  
Vol 11 (6) ◽  
pp. 329-331 ◽  
Author(s):  
Jihad Bishara ◽  
Eyal Robenshtok ◽  
Zmira Samra ◽  
Silvio Pitlik
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Pseudomonas Stutzeri ◽  
Promyelocytic Leukemia ◽  
Artificial Joint ◽  
Coagulase Negative Staphylococci ◽  
Pertinent Literature ◽  
Prosthetic Knee ◽  
Prosthetic Joint ◽  
Artificial Joint Replacement

Prosthetic joint infection is usually caused byStaphylococcus aureus, coagulase-negative staphylococci and, less commonly, by Gram-negative bacilli and anaerobes. A case of prosthetic joint infection due toPseudomonas stutzeriin a 73-year-old female with acute promyelocytic leukemia is presented, and the pertinent literature is reviewed. Although the patient had prolonged neutropenia, the infection was successfully treated with antibiotics and without artificial joint replacement.

scholarly journals Periprosthetic Joint Infections: Clinical and Bench Research

2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Laurence Legout ◽  
Eric Senneville
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnostic Methods ◽  
High Morbidity ◽  
Substantial Cost ◽  
Prosthetic Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Definition Of

Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.

scholarly journals Prosthetic Joint Infection Due to Histoplasma capsulatum Complicating a Total Knee Arthroplasty

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Cima Nowbakht ◽  
Katherine Garrity ◽  
Nicholas Webber ◽  
Jairo Eraso ◽  
Luis Ostrosky-Zeichner
Keyword(s):  
Total Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Histoplasma Capsulatum ◽  
Joint Infection ◽  
Stage Management ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Oral Itraconazole ◽  
Total Knee

Abstract Histoplasmosis is a common pathogen but rarely reported in prosthetic joint infections. We present a case of Histoplasmosis capsulatum prosthetic joint infection along with a literature review revealing no guidelines or consensus on surgical and antifungal management. We chose the 2-stage management with an antifungal spacer and systemic oral itraconazole.

scholarly journals Same Organism, Different Phenotype - Are Phenotypic Criteria Adequate In Coagulase-Negative Staphylococcal Orthopaedic Implant-Associated Infections?

2019 ◽  
Vol 4 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Staffan Tevell ◽  
Sharmin Baig ◽  
Åsa Nilsdotter-Augustinsson ◽  
Marc Stegger ◽  
Bo Söderquist
Keyword(s):  
Genome Sequencing ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Orthopaedic Implant ◽  
Whole Genome ◽  
Joint Infections ◽  
Staphylococcus Capitis ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Microbiological Criteria

Abstract. In current diagnostic criteria for implant-associated bone- and joint infections, phenotypically identical low-virulence bacteria in two intraoperative cultures are usually required. Using whole-genome sequencing, we have further characterized three phenotypically different Staphylococcus capitis isolated from one prosthetic joint infection, highlighting the challenges in defining microbiological criteria for low-virulence prosthetic joint infections.

scholarly journals Candida Prosthetic Joint Infection. A Review of Treatment Methods

2017 ◽  
Vol 2 (2) ◽  
pp. 114-121 ◽  
Author(s):  
Fernando Cobo ◽  
Javier Rodríguez-Granger ◽  
Antonio Sampedro ◽  
Luis Aliaga-Martínez ◽  
José María Navarro-Marí
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Favourable Outcome ◽  
Antifungal Drugs ◽  
Infection Site ◽  
Two Stage ◽  
Joint Infections ◽  
Candidal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Abstract. Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

scholarly journals Treatment of <i>Neisseria meningitidis</i> prosthetic joint infections with short-course antibiotics: three cases and a literature review

2020 ◽  
Vol 6 (2) ◽  
pp. 33-37
Author(s):  
Sarah Browning ◽  
Harry N. Walker ◽  
Thomas Ryan ◽  
Robert Pickles ◽  
Michael Loftus ◽  
...  
Keyword(s):  
Literature Review ◽  
Neisseria Meningitidis ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Short Course ◽  
Prosthetic Joint Infections ◽  
Implant Retention

Abstract. Neisseria meningitidis is a rare cause of prosthetic joint infection (PJI), with only three cases previously reported. Here we report three further cases, all of which were successfully treated with implant retention and short-course antibiotics (<6 weeks).

scholarly journals Streptococcus salivarius Prosthetic Joint Infection following Dental Cleaning despite Antibiotic Prophylaxis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Lyra B. Olson ◽  
Daniel J. Turner ◽  
Gary M. Cox ◽  
Christopher J. Hostler
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Streptococcus Salivarius ◽  
Dental Procedure ◽  
Commensal Bacterium ◽  
Bacterial Peritonitis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Dental Procedures ◽  
Potential Pathogenicity

We present the case of a 92-year-old man with septic arthritis of a prosthetic hip joint due to Streptococcus salivarius one week following a high-risk dental procedure despite preprocedure amoxicillin. S. salivarius is a commensal bacterium of the human oral mucosa that is an uncommon cause of bacteremia. S. salivarius has previously been described as a causative agent of infective endocarditis and spontaneous bacterial peritonitis but was only recently recognized as a cause of prosthetic joint infection. This case highlights the potential pathogenicity of a common commensal bacteria and the questionable utility of prophylactic antibiotics before dental procedures to prevent periprosthetic joint infections.

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