scholarly journals Diagnostic accuracy of neutrophil counts in histopathological tissue analysis in periprosthetic joint infection using the ICM, IDSA, and EBJIS criteria

2021 ◽  
Vol 10 (8) ◽  
pp. 536-547
Author(s):  
Irene K. Sigmund ◽  
Martin A. McNally ◽  
Markus Luger ◽  
Christoph Böhler ◽  
Reinhard Windhager ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Joint Infection ◽  
Test Methods ◽  
Polymorphonuclear Neutrophils ◽  
Histopathological Analysis ◽  
Roc Curve Analysis ◽  
International Consensus ◽  
Joint Infections ◽  
Test Thresholds ◽  
The Mean

Aims Histology is an established tool in diagnosing periprosthetic joint infections (PJIs). Different thresholds, using various infection definitions and histopathological criteria, have been described. This study determined the performance of different thresholds of polymorphonuclear neutrophils (≥ 5 PMN/HPF, ≥ 10 PMN/HPF, ≥ 23 PMN/10 HPF) , when using the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and the International Consensus Meeting (ICM) 2018 criteria for PJI. Methods A total of 119 patients undergoing revision total hip (rTHA) or knee arthroplasty (rTKA) were included. Permanent histology sections of periprosthetic tissue were evaluated under high power (400× magnification) and neutrophils were counted per HPF. The mean neutrophil count in ten HPFs was calculated (PMN/HPF). Based on receiver operating characteristic (ROC) curve analysis and the z-test, thresholds were compared. Results Using the EBJIS criteria, a cut-off of ≥ five PMN/HPF showed a sensitivity of 93% (95% confidence interval (CI) 81 to 98) and specificity of 84% (95% CI 74 to 91). The optimal threshold when applying the IDSA and ICM criteria was ≥ ten PMN/HPF with sensitivities of 94% (95% CI 79 to 99) and 90% (95% CI 76 to 97), and specificities of 86% (95% CI 77 to 92) and 92% (95% CI 84 to 97), respectively. In rTKA, a better performance of histopathological analysis was observed in comparison with rTHA when using the IDSA criteria (p < 0.001). Conclusion With high accuracy, histopathological analysis can be supported as a confirmatory criterion in diagnosing periprosthetic joint infections. A threshold of ≥ five PMN/HPF can be recommended to distinguish between septic and aseptic loosening, with an increased possibility of detecting more infections caused by low-virulence organisms. However, neutrophil counts between one and five should be considered suggestive of infection and interpreted carefully in conjunction with other diagnostic test methods. Cite this article: Bone Joint Res 2021;10(8):536–547.

scholarly journals Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections

2021 ◽  
Vol 6 (6) ◽  
pp. 229-234
Author(s):  
Zachary K. Christopher ◽  
Kade S. McQuivey ◽  
David G. Deckey ◽  
Jack Haglin ◽  
Mark J. Spangehl ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Operating Characteristic ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Chronic Patients ◽  
Joint Infections ◽  
The Mean ◽  
Acute Patients ◽  
The Ideal

Abstract. Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients >18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients (p<0.001). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for ESR / CRP to predict a chronic (>0.96) vs. acute (<0.96) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and the specificity was 0.90 (95 % CI 0.81–0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?

2022 ◽  
Vol 104-B (1) ◽  
pp. 183-188
Author(s):  
Maxime van Sloten ◽  
Joan Gómez-Junyent ◽  
Tristan Ferry ◽  
Nicolò Rossi ◽  
Sabine Petersdorf ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Molecular Techniques ◽  
Secondary Outcome ◽  
International Consensus ◽  
Joint Infections ◽  
Causative Microorganism ◽  
Culture Negative

Aims The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. Results None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). Conclusion When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183–188.

scholarly journals Poor outcome of octogenarians admitted to ICU due to periprosthetic joint infections: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Alexandra Poell ◽  
Hinnerk Baecker ◽  
Sven Frieler ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Joint Infection ◽  
Invasive Ventilation ◽  
Very Elderly ◽  
Saps Ii ◽  
Poor Outcome ◽  
Joint Infections ◽  
Saps Ii Score ◽  
The Mean

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69–140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28–71.9; p = 0.028) and CCI (OR 1.5, CI 1.004–2.12; p = 0.048) were independent risk factors for mortality. Conclusion Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.

scholarly journals Doppler ultrasound for diagnosis of soft tissue sarcoma: efficacy of ultrasound-based screening score

2015 ◽  
Vol 49 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Satoshi Nagano ◽  
Yuhei Yahiro ◽  
Masahiro Yokouchi ◽  
Takao Setoguchi ◽  
Yasuhiro Ishidou ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Ultrasound Imaging ◽  
Operating Characteristic ◽  
Soft Part ◽  
Imaging Modality ◽  
Screening Method ◽  
Area Under The Curve ◽  
Roc Curve Analysis ◽  
Diagnostic Efficacy ◽  
The Mean

Abstract Background. The utility of ultrasound imaging in the screening of soft-part tumours (SPTs) has been reported. We classified SPTs according to their blood flow pattern on Doppler ultrasound and re-evaluated the efficacy of this imaging modality as a screening method. Additionally, we combined Doppler ultrasound with several values to improve the diagnostic efficacy and to establish a new diagnostic tool. Patients and methods. This study included 189 cases of pathologically confirmed SPTs (122 cases of benign disease including SPTs and tumour-like lesions and 67 cases of malignant SPTs). Ultrasound imaging included evaluation of vascularity by colour Doppler. We established a scoring system to more effectively differentiate malignant from benign SPTs (ultrasound-based sarcoma screening [USS] score). Results. The mean scores in the benign and malignant groups were 1.47 ± 0.93 and 3.42 ± 1.30, respectively. Patients with malignant masses showed significantly higher USS scores than did those with benign masses (p < 1 × 10-10). The area under the curve was 0.88 by receiver operating characteristic (ROC) analysis. Based on the cut-off value (3 points) calculated by ROC curve analysis, the sensitivity and specificity for a diagnosis of malignant SPT was 85.1% and 86.9%, respectively. Conclusions. Assessment of vascularity by Doppler ultrasound alone is insufficient for differentiation between benign and malignant SPTs. Preoperative diagnosis of most SPTs is possible by combining our USS score with characteristic clinical and magnetic resonance imaging findings.

scholarly journals The Role of Serum Fibrinogen in Predicting Reinfection after DAIR (debridement, antibiotics, and implant retention) Treatment of Periprosthetic Joint Infections

2021 ◽  
Author(s):  
Dacheng Zhao ◽  
He Jinwen ◽  
Wang Xingwen ◽  
Zhao Xiaobing ◽  
Bin Geng ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Joint Infection ◽  
Diagnostic Value ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Joint Infections ◽  
Implant Retention

Abstract Background Fibrinogen (FIB) has been used to differentiate periprosthetic joint infection (PJI) from aseptic loosening. The purpose of this study was to evaluate the diagnostic value of FIB in predicting postoperative reinfection in patients with debridement, antibiotics and implant retention (DAIR). Methods We retrospectively analyzed the patients who were admitted to DAIR from January 2013 to August 2019 for consideration of PJI readmission. Subgroups were divided into subgroups based on whether there was reinfection after DAIR treatment, and the diagnostic value of serum fibrinogen, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before DAIR treatment was analyzed by receiver operating Characteristic curve (ROC). To evaluate the diagnostic value of FIB in predicting postoperative reinfection in DAIR patients. Results FIB expression was different in acute PJI patients and chronic PJI patients treated with DAIR (4.03 VS 3.08; P < .05, 4.28 VS 3.68; P < .05). In patients with acute PJI treated with DAIR, the sensitivity and specificity of FIB were 81.82% and 83.33%, respectively, significantly higher than CRP (sensitivity, 72.73%; Specificity, 50%; P < .05), while the specificity was higher than ESR (specificity,41.67%; P < .05). In patients with chronic PJI treated with DAIR, the sensitivity and specificity of FIB were 80.00% and 66.66%, respectively, significantly higher than CRP (sensitivity, 53.33%; Specificity, 66.66%; P < .05), ESR (sensitivity was 66.00%; Specificity, 16.66 %; P < .05). Conclusion FIB can predict reinfection after DAIR treatment for acute or chronic PJI. Considering the low success rate of DAIR treatment for chronic PJI, it should be chosen carefully.

scholarly journals Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection

2020 ◽  
Vol 69 (8) ◽  
pp. 1100-1104
Author(s):  
Malte Ohlmeier ◽  
Sergei Filitarin ◽  
Giorgio Delgado ◽  
Jannik Frings ◽  
Hussein Abdelaziz ◽  
...  
Keyword(s):  
Revision Rate ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Content Type ◽  
One Stage ◽  
Joint Infections ◽  
The Mean ◽  
The One ◽  
Final Cohort

Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange. Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs. Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1–9 years). Reinfection and complications rates after the one-stage exchange were analysed. Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis. Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.

scholarly journals The Globulin, A/G and NLR do not Perform better than CRP and ESR in PJI Diagnosis

2021 ◽  
Author(s):  
JingBo Jiao ◽  
Jin-cheng Huang ◽  
Xiao Chen ◽  
Yi Jin
Keyword(s):  
Aseptic Loosening ◽  
Roc Curve ◽  
Roc Analysis ◽  
Operating Characteristic ◽  
Demographic Data ◽  
Joint Infection ◽  
Expression Level ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Better Than

Abstract Objective: To test the significance of serum C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), globulin(GLN) , albumin to globulin ratio (A/G), and neutrophil to lymphocyterate (NLR) in periprosthetic joint infection (PJI) diagnosis. Methods: We retrospectively analyzed the clinical data of 115 patients diagnosed from January 2017 to December 2020 with PJI (PJI group, median age 71.00 years [range, 41-94 years], 24 males, 29 females), and aseptic loosening (aseptic group, median age 68.50 years [range, 34–85 years], 32 male, 30 female) in our department. Demographic data and thesensitivity and specificity of preoperative CRP, ESR, GLB,A/G, and NLR in PJI diagnosis were compared. Results: There were no significant differences when the demographic data of the two groups were compared. The expression level of CRP (24.89 mg/L([IQR], 0.1 to 200)), ESR (3 mm/h([IQR], 6 to 120)), GLB (31.70 g/L ( [IQR], 18.50 to 60.60)), and NLR (2.51([IQR], 0.93 to 12.23)) in the PJI group were higher than in the aseptic loosening group (CRP: 2.245 mg/L([IQR], 0.2 to 111.94);ESR: 16 mm/h ([IQR], 2 to 76); GLB: 26.60 g/L([IQR], 17.90 to 68.20); NLR: 1.85([IQR], 0.63 to 9.09)). The expression level of A/G (1.15([IQR], 0.55 to 2.16)) in the PJI group was lower than in the aseptic loosening group (1.51([IQR], 0.71 to 2.40)). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, GLB,A/G, and NLR were 0.841 (95% confidence interval, 0.761-0.903), 0.850 (0.771-0.910),0.747(0.658-0.824),0.779(0.692–0.851), and 0.708 (0.616–0.789), respectively. When GLB > 26.6g/L, A/G ＜1.32, and NLR >2.1 were set as the threshold values for the diagnosis of PJI, The sensitivity of GLB and A/G (90.57%, 81.13%) is higher than CRP (71.70%) and ESR (79.25%), but the specificity (GLB: 51.61%, A/G: 72.58%) was significantly lower than of CRP (87.10%) and ESR (75.81%). The ROC analysis of NLR showed that its sensitivity (73.58%) and specificity (70.97) had no significant advantages over CRP and ESR. Conclusion: globulin, A/G and NLR do not perform better than CRP and ESR in PJI diagnos is.

scholarly journals Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
G. Bori ◽  
M. A. McNally ◽  
N. Athanasou
Keyword(s):  
High Power ◽  
Periprosthetic Joint Infection ◽  
Histological Study ◽  
Joint Infection ◽  
Polymorphonuclear Neutrophils ◽  
Polymorphonuclear Neutrophil ◽  
High Power Field ◽  
Histological Techniques ◽  
Musculoskeletal Infection ◽  
Joint Infections

The presence of a polymorphonuclear neutrophil infiltrate in periprosthetic tissues has been shown to correlate closely with the diagnosis of septic implant failure. The histological criterion considered by the Musculoskeletal Infection Society to be diagnostic of periprosthetic joint infection is “greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at ×400 magnification.” Surgeons and pathologists should be aware of the qualifications introduced by different authors during the last years in the histological techniques, samples for histological study, cutoffs used for the diagnosis of infection, and types of patients studied. Recently, immunohistochemistry and histochemistry studies have appeared which suggest that the cutoff point of five polymorphonuclear neutrophils in five high-power fields is too high for the diagnosis of many periprosthetic joint infections. Therefore, morphomolecular techniques could help in the future to achieve a more reliable histological diagnosis of periprosthetic joint infection.

scholarly journals The Globulin, Albumin To Globulin Ratio(A/G) and Neutrophil To Lymphocyterate (NLR) Do Not Perform Better Than CRP and ESR in PJI Diagnosis

2021 ◽  
Author(s):  
Jing-bo Jiao ◽  
Jin-Cheng Huang ◽  
Xiao Chen ◽  
Yi Jin
Keyword(s):  
Aseptic Loosening ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Demographic Data ◽  
Joint Infection ◽  
Expression Level ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Albumin To Globulin Ratio ◽  
Better Than

Abstract Objective: To test the significance of serum C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), globulin(GLN) ,albumin to globulin ratio(A/G), and neutrophil to lymphocyterate(NLR) in periprosthetic joint infection (PJI) diagnosis. Methods: We retrospectively analyzed the clinical data of 115 patients diagnosed from January 2017 to December 2020 with PJI (PJI group, median age 71.00 years [range, 41-94 years], 24 males, 29 females), and aseptic loosening (aseptic group, median age 68.50 years [range, 34–85 years], 32 male, 30 female) in our department. Demographic data and thesensitivity and specificity of preoperative CRP, ESR, GLB,A/G, and NLR in PJI diagnosis were compared. Results: There were no significant differences when the demographic data of the two groups were compared. The expression level of CRP (24.89 mg/L([IQR], 0.1 to 200)), ESR (3 mm/h([IQR], 6 to 120)), GLB (31.70 g/L ( [IQR], 18.50 to 60.60)), and NLR (2.51([IQR], 0.93 to 12.23)) in the PJI group were higher than in the aseptic loosening group (CRP: 2.245 mg/L([IQR], 0.2 to 111.94);ESR: 16 mm/h ([IQR], 2 to 76); GLB: 26.60 g/L([IQR], 17.90 to 68.20); NLR: 1.85([IQR], 0.63 to 9.09)). The expression level of A/G (1.15([IQR], 0.55 to 2.16)) in the PJI group was lower than in the aseptic loosening group (1.51([IQR], 0.71 to 2.40)). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, GLB,A/G, and NLR were 0.841 (95% confidence interval, 0.761-0.903), 0.850 (0.771-0.910),0.747(0.658-0.824),0.779(0.692–0.851), and 0.708 (0.616–0.789), respectively. When GLB > 26.6g/L, A/G ＜1.32, and NLR >2.1 were set as the threshold values for the diagnosis of PJI, The sensitivity of GLB and A/G (90.57%, 81.13%) is higher than CRP (71.70%) and ESR (79.25%), but the specificity (GLB: 51.61%, A/G: 72.58%) was significantly lower than of CRP (87.10%) and ESR (75.81%). The ROC analysis of NLR showed that its sensitivity (73.58%) and specificity (70.97) had no significant advantages over CRP and ESR. Conclusion: globulin, A/G and NLR do not perform better than CRP and ESR in PJI diagnosis.

scholarly journals Linezolid plus Rifampin as a Salvage Therapy in Prosthetic Joint Infections Treated without Removing the Implant

2011 ◽  
Vol 55 (9) ◽  
pp. 4308-4310 ◽  
Author(s):  
J. Gómez ◽  
E. Canovas ◽  
V. Baños ◽  
L. Martínez ◽  
E. García ◽  
...  
Keyword(s):  
Salvage Therapy ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Duration Of Treatment ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Mean

ABSTRACTThe aim of this study is to describe our experience with linezolid plus rifampin as a salvage therapy in prosthetic joint infections (PJIs) when other antibiotic regimens failed or were not tolerated. A total of 161 patients with a documented prosthetic joint infection were diagnosed with a PJI and prospectively followed up from January 2000 to April 2007. Clinical characteristics, inflammatory markers, microbiological and radiological data, and antibiotic treatment were recorded. After a 2-year follow-up, patients were classified as cured when the prosthesis was not removed, symptoms of infection disappeared, and inflammatory parameters were within the normal range. Any other outcome was considered a failure. The mean age of the entire cohort (n= 161) was 67 years. Ninety-five episodes were on a knee prosthesis (59%), and 66 were on a hip prosthesis (41%). A total of 49 patients received linezolid plus rifampin: 45 due to failure of the previous antibiotic regimen and 4 due to an adverse event associated with the prior antibiotics. In no case was the implant removed. The mean (standard deviation) duration of treatment was 80.2 (29.7) days. The success rate after 24 months of follow-up was 69.4% (34/49 patients). Three patients developed thrombocytopenia and 3 developed anemia; however, it was not necessary to stop linezolid. Linezolid plus rifampin is an alternative salvage therapy when the implant is not removed.

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