scholarly journals A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marta Bottagisio ◽  
Alessandro Bidossi ◽  
Nicola Logoluso ◽  
Antonio Pellegrini ◽  
Elena De Vecchi
Keyword(s):  
Candida Albicans ◽  
Synovial Fluid ◽  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Hip Prosthesis ◽  
Joint Infection ◽  
Microbiological Analysis ◽  
Two Stage ◽  
Staphylococcus Capitis ◽  
Prosthetic Joint

Abstract Background Prosthetic joint infection (PJI) is one of the most feared complications following total arthroplasty surgeries. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases. When dealing with PJIs, a two-stage revision arthroplasty is widely used. Briefly, a spacer is introduced until re-implantation of the definitive prosthesis to provide skeleton stabilization while delivering antibiotics in the site of the infection. Sometimes, antimicrobial therapy may fail, but the isolation of a second microorganism from the spacer is uncommon and even less frequent that of a yeast. Case presentation Here is described a case of a 75-year-old woman who underwent two-stage revision surgery of the left hip prosthesis secondary to a Staphylococcus capitis infection, whose spacer was found to be infected by Candida albicans at a later time. Briefly, the patient underwent revision surgery of the hip prosthesis for a suspected PJI. After the debridement of the infected tissue, an antibiotic-loaded spacer was implanted. The microbiological analysis of the periprosthetic tissues and the implant depicted a S. capitis infection that was treated according to the antimicrobial susceptibility profile of the clinical isolate. Three months later, the patient was admitted to the emergency room due to local inflammatory signs. Synovial fluid was sent to the laboratory for culture. No evidence of S. capitis was detected, however, a yeast was identified as Candida albicans. Fifteen days later, the patient was hospitalized for the removal of the infected spacer. Microbiological cultures confirmed the results of the synovial fluid analysis. According to the susceptibility profile, the patient was treated with fluconazole (400 mg/day) for 6 months. Seven months later, the patient underwent second-stage surgery. The microbiological tests on the spacer were all negative. After 12 months of follow-up, the patient has fully recovered and no radiological signs of infection have been detected. Conclusions Given the exceptionality of this complication, it is important to report these events to better understand the clinical outcomes after the selected therapeutic options to prevent and forestall the development of either bacterial or fungal spacer infections.

scholarly journals Prosthetic Joint Infection: Report on the One versus Two-stage Exchange EBJIS Survey

2016 ◽  
Vol 1 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Pedro Santos Leite ◽  
Sérgio Figueiredo ◽  
Ricardo Sousa
Keyword(s):  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Joint Infection ◽  
Clinical Aspects ◽  
Online Questionnaire ◽  
Two Stage ◽  
Significant Group ◽  
One Stage ◽  
Prosthetic Joint ◽  
Multicentre Research

Abstract. Background: Prosthetic Joint Infection (PJI) is one of the most challenging problems in orthopaedic surgery and musculoskeletal infections specifically. Some very important controversies remain and strong evidence-based recommendations are still lacking in many clinical aspects. Therefore, an undisputed methodology of treatment does not exist yet and there are many different valid approaches.Purposes: To draw a picture of the different practice patterns around Europe and understand the motivations of the European Bone & Joint Infection Society (EBJIS) members in choosing between one- or two-stage revision surgery in treating chronic PJI.Methods: The participants of the 34th EBJIS Annual Meeting were surveyed through an online questionnaire. The survey assessed the main philosophy in the treatment of chronic PJI, personal and institutional information as well as the importance of different factors in choosing two-stage or one-stage procedures.Results: One hundred and forty-three participants responded to the survey, including a significant group of skilful orthopaedic surgeons with large experience in treating musculoskeletal infections. Primarily two-stage was the most common philosophy regrading treatment of chronic PJI (60.1%), followed by two-stage or one-stage accordingly (34,8%) and primarily one-stage (5,1%). Significant soft tissue compromise, failure of previous revision surgery attempts, highly resistant or unclear infective microorganism(s) preoperatively and patient presenting with sepsis or immunosuppression, were considered the more relevant factors in choosing two-stage instead one-stage procedures.Interpretation: Treatment of chronic PJI is challenging and demanding. An open dialogue to share the different experiences and a collective effort to plan a major multicentre research in order to establish standardized protocols are essential.

scholarly journals Successful Two Stage Revision for Prosthetic Joint Infection Due to Candida albicans : Case Report

2015 ◽  
Vol 23 (1) ◽  
pp. 69-72
Author(s):  
Ş. Sarper GÜRSU ◽  
Timur YILDIRIM ◽  
M. Nursu ŞAHİN ◽  
Hakan SOFU ◽  
Vedat ŞAHİN
Keyword(s):  
Candida Albicans ◽  
Case Report ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Prosthetic Joint

Two-Stage Arthroplasty for Prosthetic Joint Infection

2013 ◽  
Vol 28 (9) ◽  
pp. 1490-1498.e1 ◽  
Author(s):  
Andrew Luu ◽  
Fahd Syed ◽  
Gowri Raman ◽  
Anshul Bhalla ◽  
Eavan Muldoon ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Prosthetic Joint

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.

Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 110-115 ◽  
Author(s):  
N. Khan ◽  
D. Parmar ◽  
M. S. Ibrahim ◽  
B. Kayani ◽  
F. S. Haddad
Keyword(s):  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Successful Outcome ◽  
Two Stage ◽  
Persistent Symptoms ◽  
Prosthetic Joint ◽  
Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

scholarly journals Post-surgery and recovery experiences following one- and two-stage revision for prosthetic joint infection—A qualitative study of patients’ experiences

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237047 ◽  
Author(s):  
Cecily K. Palmer ◽  
Rachael Gooberman-Hill ◽  
Ashley W. Blom ◽  
Michael R. Whitehouse ◽  
Andrew J. Moore
Keyword(s):  
Qualitative Study ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Post Surgery ◽  
Prosthetic Joint ◽  
Recovery Experiences

scholarly journals Evaluation of a rapid lateral flow calprotectin test for the diagnosis of prosthetic joint infection

2019 ◽  
Author(s):  
Alexander J. Trotter ◽  
Rachael Dean ◽  
Celia E. Whitehouse ◽  
Jarle Mikalsen ◽  
Claire Hill ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Sensitivity And Specificity ◽  
Prosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Lateral Flow ◽  
Lateral Flow Assay ◽  
Prosthetic Joint ◽  
Flow Test ◽  
Lateral Flow Test

AbstractBackgroundMicrobiological diagnosis of prosthetic joint infection (PJI) relies on culture techniques that are slow and insensitive. Rapid tests are urgently required to improve patient management. Calprotectin is a neutrophil biomarker of inflammation that has been demonstrated to be effective for the diagnosis of PJI. A calprotectin based lateral flow test has been developed for the rapid detection of PJI using synovial fluid samples.MethodsA convenience series of 69 synovial fluid samples from patients at the Norfolk and Norwich University Hospitals (NNUH) were collected intraoperatively from 52 hip and 17 knee revision operations. Calprotectin levels were measured using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone). For all samples, synovial fluid was pipetted onto the lateral flow device and the signal was read using a mobile phone app after 15 minutes incubation at room temperature.ResultsAccording to the Musculoskeletal Infection Society (MSIS) criteria, 24 patients were defined as PJI positive and the remaining 45 were negative. The overall accuracy of the lateral flow test against the MSIS criteria was 75%. The test had a sensitivity and specificity of 75% and 76% respectively with a positive predictive value (PPV) of 62% and a negative predictive value (NPV) of 85%. Discordant results were then reviewed by the clinical team using available patient data to develop an alternative gold standard for defining presence/absence of infection (MSIS+). Compared to MSIS+, the test showed an overall accuracy of 83%, sensitivity and specificity of 95% and 78% respectively, a PPV of 62% and an NPV of 98%. Test accuracy for hip revisions was 77% and for knee revisions was 100%.ConclusionsThis study demonstrates that the calprotectin lateral flow assay is an effective diagnostic test for PJI. Our data suggests that the test is likely to generate false positive results in patients with metallosis and gross osteolysis.

scholarly journals 257. Outcomes in Fungal Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Caitlyn M Hollingshead ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Jason Tank
Keyword(s):  
Prosthetic Joint Infection ◽  
Candida Species ◽  
Joint Infection ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint ◽  
Hip Replacements ◽  
Fungal Organisms ◽  
Poor Outcomes ◽  
Wbc Count

Abstract Background There is a paucity of data in the literature regarding the most effective treatment and related outcomes of fungal prosthetic joint infection. The majority of reported cases are treated using a two stage revision method in which the initial prosthesis is removed and the patient is treated with systemic antifungal medications and potentially irrigation of the joint cavity with antifungal and antibacterial agents. Alternately, others have suggested a one-stage revision in order to prevent a period of significant functional impairment and potentially improved functional outcomes and lower overall costs. Cases of radical removal of the prosthesis without replacement have been reported. To date, the largest studies of total hip arthroplasty and total knee arthroplasty have included 37 and 45 patients, respectively. Methods A retrospective record review of patients admitted within two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed. Results Eighteen patients fit criteria. Nine patients had knee replacements and nine patients had hip replacements. The average age at time of infection was 61. Ten patients were female. Average BMI was 32.1. Twelve presented with a painful joint, eight presented with drainage, and one with dehiscence. Average WBC count was 9.3, average ESR was 47, and average CRP was 11.8. All patients were noted with Candida species. Eight patients were treated with two stage revisions, three received one stage revisions as destination therapy. One required amputation. All but one patient was associated with concurrent bacterial infection. Of the twelve patients that had known outcomes, six were noted with cure and six were noted with relapse. All patients that were cured received two stage exchange or girdlestone procedure. Conclusion In our study, fungal prosthetic joint infection was associated with poor outcomes. All of the patients in our study were noted with Candida species, which is in concordance with the known literature. Two stage exchange was associated with better outcomes. Disclosures All Authors: No reported disclosures

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

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