Clinical features and outcome of Streptococcus agalactiae bone and joint infections over a 6-year period in a French university hospital

Background Bone and joint infections (BJIs) due to Streptococcus agalactiae are rare but has been described to increase in the past few years. The objective of this study was to describe clinical features and outcomes of cases of S. BJIs. Methods We conducted a retrospective analysis of adult cases of S. agalactiae BJIs that occurred between January 2009 and June 2015 in a French university hospital. The treatment success was assessed until 24 months after the end of antibiotic treatment. Results Among the 26 patients included, 20 (77%) were male, mean age was 62 years ± 13 and mean Charlson comorbidity index score was 4.9 ± 3.2. Diabetes mellitus was the most common comorbidity (n = 14, 54%). Six had PJI (Prosthetic Joint Infections), five osteosynthesis-associated infections, 11 osteomyelitis and four native septic arthritis. Eleven patients had a delayed or late infection: six with a prosthetic joint infection and five with an internal fixation device infection. Sixteen patients (62%) had a polymicrobial BJI, most commonly with Gram-positive cocci (75%) notably Staphylococcus aureus (44%). Polymicrobial infections were more frequently found in foot infections (90% vs 44%, p = 0.0184). During the two-year follow-up, three patients died (3/25, 12%) and seven (7/25, 28%) had treatment failure. Conclusion Diabetes mellitus was the most common comorbidity. We observed an heterogenous management and a high rate of relapse.

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Antimicrobial Activity of Dalbavancin and Comparator Agents Tested against Gram-Positive Clinical Isolates Causing Bone and Joint Infections in United States (US) Medical Centers (2011–2016)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.917 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S373-S373

Author(s):

Helio S Sader ◽

Rodrigo E Mendes ◽

Robert K Flamm ◽

Michael A Pfaller

Keyword(s):

Active Agent ◽

Coagulase Negative Staphylococci ◽

Gram Positive ◽

Joint Infections ◽

Bone And Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Viridans Group Streptococci ◽

Research Grant

Abstract Background Bone and joint infections (BJI) comprise a series of disorders, including septic arthritis, osteomyelitis, and prosthetic joint infections. We evaluated the activity of dalbavancin (DALBA) against pathogens isolated from BJI in US hospitals. Methods A total of 744 organisms collected from 55 hospitals in 2011–2016 were evaluated, including 463 S. aureus, 88 coagulase-negative staphylococci (CoNS), 104 β-haemolytic streptococci (BHS), 60 E. faecalis, and 29 viridans group streptococci (VGS). Bacteria were identified by standard algorithms and MALDI-TOF-MS. Susceptibility testing was performed by CLSI methods (M07-A10); interpretation of MIC results used CLSI (2017) and EUCAST (2017) criteria. Results S. aureus (62.2%) was the most common pathogen associated with BJI, followed by BHS (14.0%) and CoNS (11.8%). All S. aureus (41.5% methicillin-resistant [MRSA]) isolates were susceptible (S) to DALBA, linezolid (LNZ), teicoplanin (TEI) and vancomycin (VAN), while daptomycin (DAPTO) and clindamycin (CLI) showed susceptibility rates of 99.8% and 87.7% (CLSI), respectively. DALBA MIC results (MIC50/90, ≤0.03/0.06 μg/mL) were ≥8-fold lower compared with DAPTO (MIC50/90, 0.25/0.5 μg/mL) against all S. aureus. Among CoNS, (61.4% MRSA), DALBA (MIC50/90, ≤0.03/0.06 μg/mL) was the most potent agent, followed by DAPTO (MIC50/90, 0.25/0.5 μg/mL), LNZ (MIC50/90, 0.5/1 μg/mL), and VAN (MIC50/90, 1/2 μg/mL). DALBA inhibited all E. faecalis isolates at ≤0.25 μg/mL (FDA S breakpoint), except for 3 VAN-resistant (VanA) isolates. High susceptibility rates for ampicillin (98.3%; CLSI), DAPTO (100.0%), LNZ (100.0%), TEI (93.3%) and VAN (93.3%) were obtained against E. faecalis. DALBA, DAPTO, LNZ, ceftriaxone, penicillin, and VAN were active against all BHS (100.0%S), while DALBA (MIC50/90, ≤0.03/0.06 μg/mL; 100.0%S) was the most active agent against VGS, inhibiting all isolates at ≤0.06 μg/mL. Ceftriaxone, LNZ, DAPTO, and VAN were also active against VGS (93.1 – 100.0%S; CLSI), whereas CLI (82.8%S) had marginal activity. Conclusion DALBA demonstrated potent in vitro activity against common gram-positive isolates causing BJI (2011–2016) and appears to be a viable candidate for treating BJI/osteomyelitis caused by gram-positive cocci. Disclosures H. S. Sader, Allergan: Research Contractor, Research grant; R. E. Mendes, Allergan: Research Contractor, Research grant; R. K. Flamm, Allergan: Research Contractor, Research grant; M. A. Pfaller, Allergan: Research Contractor, Research grant

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Molecular characteristics of Staphylococcus aureus associated prosthetic joint infections after hip fractures treated with hemiarthroplasty: a retrospective genome-wide association study

Scientific Reports ◽

10.1038/s41598-020-73736-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

J. Christopher Noone ◽

Marc Stegger ◽

Berit Lilje ◽

Knut Stavem ◽

Karin Helmersen ◽

...

Keyword(s):

Staphylococcus Aureus ◽

University Hospital ◽

Genome Wide Association ◽

Molecular Characteristics ◽

Joint Infections ◽

Orthopaedic Patients ◽

Prosthetic Joint ◽

Genome Wide ◽

A Genome ◽

Prosthetic Joint Infections

Abstract A retrospective study of Staphylococcus aureus isolates from orthopaedic patients treated between 2000 and 2017 at Akershus University Hospital, Norway was performed using a genome-wide association approach. The aim was to characterize and investigate molecular characteristics unique to S. aureus isolates from HHA associated prosthetic joint infections and potentially explain the HHA patients’ elevated 1-year mortality compared to a non-HHA group. The comparison group consisted of patients with non-HHA lower-extremity implant-related S. aureus infections. S. aureus isolates from diagnostic patient samples were whole-genome sequenced. Univariate and multivariate analyses were performed to detect group-associated genetic signatures. A total of 62 HHA patients and 73 non-HHA patients were included. Median age (81 years vs. 74 years; p < 0.001) and 1-year mortality (44% vs. 15%, p < 0.001) were higher in the HHA group. A total of 20 clonal clusters (CCs) were identified; 75% of the isolates consisted of CC45, CC30, CC5, CC15, and CC1. Analyses of core and accessory genome content, including virulence, resistance genes, and k-mer analysis revealed few group-associated variants, none of which could explain the elevated 1-year mortality in HHA patients. Our findings support the premise that all S. aureus can cause invasive infections given the opportunity.

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403. Clinical Features and Treatment Outcome of Enterobacter Prostethic Joint Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.476 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S205-S205

Author(s):

Dima Youssef ◽

Babak Hooshmand ◽

Ashish Bhargava

Keyword(s):

Clinical Features ◽

Connective Tissue Diseases ◽

Surgical Site Infections ◽

Implant Removal ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Implant Retention ◽

Surgical History

Abstract Background Enterobacter prosthetic joint infections (PJIs) are rare, occurring mainly in elderly people usually with complex medical and surgical history, and their treatment is usually challenging. Aim of this study is to assess the characteristics and outcomes of Enterobacter PJIs. Methods A retrospective multi-centric cohort was studied at three hospitals from January 2012 to December 2018. Patients with PJIs were identified using ICD codes. Enterobacter PJIs were then identified through reviewing patients’ electronic medical records. Results 13 enterobacter PJIs were identified. 9 (69%) were polymicrobial. Mean age of the patients was 61.7 years, and mean BMI was 34.6 kg/m2. 8 patients (62%) were females, and 8 patients (62%) were Caucasians. Infected sites were: Hip in 5 patients (38%%), knee in 5 patients (38%) and ankle in 3 patients (23%) patients. 9 patients (69%) had osteoarthritis, 3 patients (23%) had diabetes mellitus, and 1 patient (8%) had connective tissue diseases requiring steroids. Most patients (11 out of 13) (85%) presented within 1 week of symptoms onset. Presenting clinical features were pain in 9 patients (69%), drainage in 10 patients (77%), purulence in 7 patients (54%), and fever in 5 patients (38%). 11 patients (85%) were managed with debridement, antibiotics and implant retention (DAIR), and 2 patients (15%) with antibiotics alone. Antibiotics used while managing were as follows: Cefepime n = 6, quinolones n = 2, carbapenems n = 4 and aminoglycosides n = 1. Outcome: 4 patients (31%) developed deep surgical site infections (and two of them required implant removal), 5 patients had no events in 12 months of follow-up, 3 patients (23%) had less than 6 months of follow-up, and one patient died in the hospital due to cardiac failure. Conclusion In our study, most cases of Enterobacter PJIs were polymicrobial. The success rate in monomicrobial infections was 75% while overall it was noted to be 38%. DAIR was associated with high readmission rates and deep surgical site infections (36%). 18% cases managed with DAIR required implant removal. Disclosures All authors: No reported disclosures.

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Prosthetic-joint Infections: Mortality Over The Last 10 Years

Journal of Bone and Joint Infection ◽

10.7150/jbji.35428 ◽

2019 ◽

Vol 4 (4) ◽

pp. 198-202 ◽

Cited By ~ 3

Author(s):

Arnaud Fischbacher ◽

Olivier Borens

Keyword(s):

Surgical Treatment ◽

University Hospital ◽

Cumulative Mortality ◽

Risk Of Death ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Significant Difference ◽

One Year ◽

The One

Abstract. Background: There is a constant increase of joint arthroplasties to improve the quality of life of an ever-aging population. Although prosthetic-joint infections are rare, with an incidence of 1-2%, they represent a serious complication in terms of morbidity and mortality. Infection related mortality is known to be approaching 8% at one year. The aim of this retrospective study is to reassess the one and two-year mortality over the last ten years.Methods: Patients treated for prosthetic joint infection at the University Hospital of Lausanne (Switzerland) between 2006 and 2016 were included. The one and two-year cumulative mortality depending on sex, age, type of prosthesis, infecting organism and type of surgical treatment were computed.Results: 363 patients (60% hips, 40% knees) were identified with a median age of 70 years. The one-year cumulative mortality was 5.5% and it was 7.3% after two years. No difference was seen between hip and knee prostheses, but the mortality was higher in men than in women and increased with age. Furthermore, there was a significant difference depending of the germ with enterococci infections associated with a higher risk of death. Finally, patients treated with a one-stage or two-stage exchange had a lower mortality than those treated with debridement and retention.Conclusion: The mortality is still high and differs according to sex, age, infecting organism and type of surgical treatment. There is a need of studies to improve the management of patients at risk of increased mortality.

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Clinical Features of Group B Streptococcus Prosthetic Joint Infections and Molecular Characterization of Isolates

Journal of Clinical Microbiology ◽

10.1128/jcm.00581-10 ◽

2010 ◽

Vol 49 (1) ◽

pp. 380-382 ◽

Cited By ~ 18

Author(s):

S. Corvec ◽

M. Illiaquer ◽

S. Touchais ◽

D. Boutoille ◽

N. van der Mee-Marquet ◽

...

Keyword(s):

Molecular Characterization ◽

Clinical Features ◽

Group B Streptococcus ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Group B

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Fungal prosthetic joint infection in total hip or knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1227.r2 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 589-595 ◽

Cited By ~ 10

Author(s):

C. Theil ◽

T. Schmidt-Braekling ◽

G. Gosheger ◽

E. A. Idelevich ◽

B. Moellenbeck ◽

...

Keyword(s):

Knee Arthroplasty ◽

Fungal Infections ◽

Joint Infection ◽

Treatment Success ◽

Two Stage ◽

Musculoskeletal Infection ◽

Total Hip ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.

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Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Scientific Reports ◽

10.1038/s41598-020-62751-z ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 6

Author(s):

Peter Wildeman ◽

Staffan Tevell ◽

Carl Eriksson ◽

Amaya Campillay Lagos ◽

Bo Söderquist ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Treatment Success ◽

Antimicrobial Treatment ◽

Related Factors ◽

Genetic Traits ◽

Joint Infections ◽

Prosthetic Joint ◽

Related Risk ◽

Prosthetic Joint Infections ◽

And Control

AbstractStaphylococcus aureus is a commensal colonizing the skin and mucous membranes. It can also act as a pathogen, and is the most common microorganism isolated from prosthetic joint infections (PJIs). The aim of this study was to explore the genomic relatedness between commensal and PJI S. aureus strains as well as microbial traits and host-related risk factors for treatment failure. Whole-genome sequencing (WGS) was performed on S. aureus isolates obtained from PJIs (n = 100) and control isolates from nares (n = 101). Corresponding clinical data for the PJI patients were extracted from medical records. No PJI-specific clusters were found in the WGS phylogeny, and the distribution of the various clonal complexes and prevalence of virulence genes among isolates from PJIs and nares was almost equal. Isolates from patients with treatment success and failure were genetically very similar, while the presence of an antibiotic-resistant phenotype and the use of non-biofilm-active antimicrobial treatment were both associated with failure.In conclusion, commensal and PJI isolates of S. aureus in arthroplasty patients were genetically indistinguishable, suggesting that commensal S. aureus clones are capable of causing PJIs. Furthermore, no association between genetic traits and outcome could be demonstrated, stressing the importance of patient-related factors in the treatment of S. aureus PJIs.

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Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital

Advances in Orthopedics ◽

10.1155/2019/4629503 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Robert P. Runner ◽

Amanda Mener ◽

James R. Roberson ◽

Thomas L. Bradbury ◽

George N. Guild ◽

...

Keyword(s):

Incidence Rate ◽

Joint Infection ◽

Hospital Setting ◽

University Hospital ◽

Gram Negative ◽

Joint Infections ◽

Orthopaedic Hospital ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Specialty Hospital

Introduction. Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods. A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results. The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.

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Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series

Journal of Bone and Joint Infection ◽

10.7150/jbji.25887 ◽

2018 ◽

Vol 3 (5) ◽

pp. 241-244

Author(s):

Fernanda Medina ◽

Vanina Meyssonnier ◽

Valérie Zeller ◽

Beate Heym ◽

Jean-Marc Ziza ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Case Series ◽

Venous Access ◽

Access Device ◽

Joint Infections ◽

Staphylococcus Capitis ◽

Prosthetic Joint ◽

Device Infection ◽

Prosthetic Joint Infections ◽

Venous Access Device

Abstract. Introduction: Prosthetic joint infections (PJIs) can be acquired hematogenously from a distant site or device. Notably, 30%-40% of patients with PJIs have Staphylococcus aureus bacteremia. No case reports or series of PJIs acquired from totally implantable venous-access device (TIVAD) infection or colonization have been published. This study was undertaken to describe epidemiological, clinical, microbiological and radiological characteristics of such PJIs, their treatments and outcomes.Methods: This retrospective study included all patients, identified in a prospective French Bone-and-Joint Infections Referral Center cohort treated between 2004 and 2017, with PJI secondary to TIVAD infection, with the same microbiologically documented microorganism isolated from both.Results: We describe six consecutive hematogenous PJIs (4 women, 2 men; median age: 66.5 years) acquired from TIVAD primary infections. The main infection risk factors were malignancy (n=5) and prior septic arthritis (n=2). Four participants' TIVADs were implanted for chemotherapy, preceding the prosthesis for one patient. The median TIVAD-implantation-to-symptom-onset interval was 12 months. Microorganisms were Staphylococcus epidermidis (n=4), Staphylococcus capitis (n=1) and Staphylococcus aureus (n=1). All TIVADs were removed. Five participants received curative treatment, with a median of 12 weeks of antibiotics. After median follow-up of 42 months, none have relapsed.Conclusions: When PJI occurs in a patient with a TIVAD, the latter must be tested as a potential source of the prosthesis infection. Conversely, PJIs must sought in all patients with bacteremia.

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Clinical Experience with Tigecycline in the Treatment of Prosthetic Joint Infections

Journal of Bone and Joint Infection ◽

10.7150/jbji.34866 ◽

2019 ◽

Vol 4 (3) ◽

pp. 126-132

Author(s):

Allison Lastinger ◽

Nathanael McLeod ◽

Matthew J Dietz ◽

John Guilfoose ◽

Arif R Sarwari

Keyword(s):

Joint Infection ◽

Treatment Success ◽

Soft Tissue Infections ◽

Inclusion Criteria ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

The Mean ◽

Medical Referral ◽

Culture Negative

Abstract. Purpose: The purpose of this study was to examine the use of tigecycline in the treatment of prosthetic joint infection (PJI).Methods: This is a retrospective review performed from 2008 to 2017, examining adult patients with PJI at a tertiary medical referral center who received tigecycline for 75% or greater of the treatment course. Failure was defined as need to return to the operating room for an infectious complication or persistent drainage from the joint.Results: A total of 37 patients met inclusion criteria. The median age was 65 years, and 65% of patients were female. The most common reasons for tigecycline use were culture negative infection, polymicrobial infection, and renal failure, but other reasons included antimicrobial allergies and resistant organisms. The mean duration of tigecycline therapy was 40 days (range 28-52 days). Treatment success was documented in 16 cases (43%).Conclusions: Tigecycline is a glycylcycline approved for treatment of a variety of infections including skin and soft tissue infections, but little is known about its use in the treatment of PJI. We found that tigecycline is well-tolerated for prolonged durations. Our success rate was 43%, but the majority of patients in this study had complicated infectious surgical histories and had received prior prolonged courses of antimicrobial therapy which likely affected treatment outcome. We concluded that tigecycline should be reserved as an alternative when other antimicrobials for PJI have been exhausted. More studies are needed to assess tigecycline's use in the treatment of PJI.

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