scholarly journals Delayed Rifampin Administration in the Antibiotic Treatment of Periprosthetic Joint Infections Significantly Reduces the Emergence of Rifampin Resistance

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1139
Author(s):  
Ali Darwich ◽  
Franz-Joseph Dally ◽  
Mohamad Bdeir ◽  
Katharina Kehr ◽  
Thomas Miethke ◽  
...  
Keyword(s):  
Pathogen Detection ◽  
Joint Infection ◽  
Empiric Antibiotic Therapy ◽  
Resistant Organism ◽  
Joint Infections ◽  
Treatment Failure Rate ◽  
Empiric Antibiotic ◽  
Rifampin Resistance ◽  
Group 2 ◽  
Group 1

Rifampin is one of the most important biofilm-active antibiotics in the treatment of periprosthetic joint infection (PJI), and antibiotic regimens not involving rifampin were shown to have higher failure rates. Therefore, an emerging rifampin resistance can have a devastating effect on the outcome of PJI. The aim of this study was to compare the incidence of rifampin resistance between two groups of patients with a PJI treated with antibiotic regimens involving either immediate or delayed additional rifampin administration and to evaluate the effect of this resistance on the outcome. In this retrospective analysis of routinely collected data, all patients who presented with an acute/chronic PJI between 2018 and 2020 were recorded in the context of a single-center comparative cohort study. Two groups were formed: Group 1 included 25 patients with a PJI presenting in 2018–2019. These patients received additional rifampin only after pathogen detection in the intraoperative specimens. Group 2 included 37 patients presenting in 2019–2020. These patients were treated directly postoperatively with an empiric antibiotic therapy including rifampin. In all, 62 patients (32 females) with a mean age of 68 years and 322 operations were included. We found a rifampin-resistant organism in 16% of cases. Rifampin resistance increased significantly from 12% in Group 1 to 19% in Group 2 (p < 0.05). The treatment failure rate was 16% in Group 1 and 16.2% in Group 2 (p = 0.83). The most commonly isolated rifampin-resistant pathogen was Staphylococcus epidermidis (86%) (p < 0.05). The present study shows a significant association between the immediate start of rifampin after surgical revision in the treatment of PJI and the emergence of rifampin resistance, however with no significant effect on outcome.

scholarly journals Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1145
Author(s):  
Ali Darwich ◽  
Franz-Joseph Dally ◽  
Khaled Abu Olba ◽  
Elisabeth Mohs ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Joint Infection ◽  
Published Data ◽  
Joint Infections ◽  
Group 4 ◽  
Single Center Study ◽  
Group 3 ◽  
Group 2 ◽  
Related Mortality ◽  
Group 1

Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty. In the course of a PJI, superinfections with pathogens that do not match the primary infecting micro-organism may occur. To our knowledge, there are no published data on the outcome of such infections in the literature. The aim of this study was to assess the outcome of PJI with superinfections with a difficult-to-treat (DTT) pathogen. Data of 169 consecutive patients with PJI were retrospectively analyzed in this single-center study. Cases were categorized into: Group 1 including non-DTT-PJI without superinfection, Group 2 DTT-PJI without superinfection, Group 3 non-DTT-PJI with DTT superinfection, and Group 4 non-DTT-PJI with non-DTT superinfection. Group 3 comprised 24 patients and showed, after a mean follow-up of 13.5 ± 10.8 months, the worst outcome with infection resolution in 17.4% of cases (p = 0.0001), PJI-related mortality of 8.7% (p = 0.0001), mean revision rate of 6 ± 3.6 (p < 0.0001), and duration of antibiotic treatment of 71.2 ± 45.2 days (p = 0.0023). PJI caused initially by a non-DTT pathogen with a superinfection with a DTT pathogen is significantly associated with the worst outcome in comparison to non-DTT-PJI, PJI caused initially by a DTT pathogen, and to non-DTT-PJI with a non-DTT superinfection.

scholarly journals Is There a Difference in Microbiological Epidemiology and Effective Empiric Antimicrobial Therapy Comparing Fracture-Related Infection and Periprosthetic Joint Infection? A Retrospective Comparative Study

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 921
Author(s):  
Markus Rupp ◽  
Susanne Baertl ◽  
Nike Walter ◽  
Florian Hitzenbichler ◽  
Martin Ehrenschwender ◽  
...  
Keyword(s):  
Statistical Difference ◽  
Joint Infection ◽  
Empiric Therapy ◽  
Empiric Antibiotic Therapy ◽  
Joint Infections ◽  
Empiric Antibiotic ◽  
Retrospective Comparative Study ◽  
Resistance Rates ◽  
Susceptibility Profiles ◽  
Common Infection

This study aims to investigate (1) microbial patterns in fracture-related infections (FRIs) in comparison to microbiological patterns of periprosthetic joint infections (PJIs), (2) the identification of effective empiric antibiotic therapy for FRIs and PJIs and (3) analysis of difficult-to-treat (DTT) pathogens. Patients treated for FRIs or PJIs from 2017 to 2020 were evaluated for pathogens detected during treatment. Antibiotic susceptibility profiles were examined with respect to broadly used antibiotics and antibiotic combinations. Resistance rates to rifampicin or fluoroquinolone were determined. A total of 81 patients with PJI and 86 with FRI were included in the study. For FRIs Staphylococcus aureus was the most common infection-causing pathogen (37.4% vs. 27.9% for PJI). Overall, there was no statistical difference in pathogen distribution (p = 0.254). For FRIs, combinations of gentamicin + vancomycin (93.2%), co-amoxiclav + glycopeptide and meropenem + vancomycin (91.9% each) would have been effective for empiric therapy, similar to PJIs. Difficult to treat pathogens were more frequently detectable in PJIs (11.6% vs. 2.3%). Empiric therapy combinations such as gentamicin + vancomycin, co-amoxiclav + glycopeptide or meropenem + vancomycin, are effective antibiotic strategies for both FRI and PJI patients. More DTT pathogens were detectable in PJIs compared to FRIs.

Case of flexor tenosynovitis caused by Mycobacterium arupense

2021 ◽  
Vol 14 (10) ◽  
pp. e245130
Author(s):  
Kushali Patel ◽  
John Flaherty
Keyword(s):  
Drinking Water ◽  
Case Report ◽  
Water Systems ◽  
The Other ◽  
Empiric Antibiotic Therapy ◽  
Joint Infections ◽  
Empiric Antibiotic ◽  
Environmental Pathogens ◽  
Fish Tanks ◽  
Flexor Tenosynovitis

Mycobacterium arupense is a member of the Mycobacterium terrae complex (MTC) that is implicated in bone and joint infections, among others. This group of environmental pathogens can be found in soil, reclaimed and drinking water systems, rodents, fish tanks and bioaerosols in duck houses. Interestingly, while M. arupense is genotypically closely related to the other agents in the MTC, antibiotic susceptibility of these mycobacteria can vary widely and empiric antibiotic therapy is controversial. Our case report contributes to the very limited literature on M. arupense tenosynovitis—as only six cases have been reported since 2008—and sheds light on different courses of treatment. While previous cases have been successfully treated, a streamlined course of therapy for M. arupense tenosynovitis is still needed.

scholarly journals Possibilities of latent PJI detection in revision knee arthroplasty

2021 ◽  
Vol 27 (5) ◽  
pp. 562-569
Author(s):  
A.N. Panteleev ◽  
◽  
S.A. Bozhkova ◽  
P.M. Preobrazhensky ◽  
A.V. Kazemirsky ◽  
...  
Keyword(s):  
Aseptic Loosening ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Routine Screening ◽  
Screening Methods ◽  
Diagnostic Significance ◽  
Revision Knee Arthroplasty ◽  
Group 2 ◽  
Group 1

Abstract. Introduction The paper presents a comparative analysis of routine screening methods and the EBJIS 2021 algorithm in detection of latent periprosthetic joint infection in patients admitted for revision knee arthroplasty due to aseptic loosening and after spacer implantation. Materials and methods Group 1 included 49 patients who underwent revision knee arthroplasty due to aseptic loosening, group 2 were 47 patients with PJI after spacer implantation. Results and discussion There were no significant differences between patient groups in terms of age, gender, and preoperative ESR and CRP levels. In 62.2 % of all cases, the aspirate was inappropriate for cytological examination; this fact limited its diagnostic value. The most frequently intraoperatively isolated pathogen in both groups was coagulase-negative staphylococci. However, in 70 % of cases these results were not diagnostically significant, and infection was diagnosed only in 8.2 % of cases in group 1 and 12.8 % in group 2. Moreover, the chances of isolating the pathogen from tissue biopsies were 5.6 times higher than from intraoperative aspirate (OR = 5.6, 95 % CI = 1.2-26.4). In case of negative preoperative aspirate, in almost 25 % of cases, pathogens were isolated from intraoperative tissues, 40.9 % of them were diagnostically significant. The chances of its detection increased 4.7 times in combined increase in ESR and CRP blood level (OR = 4.686, 95 % CI = 0.765-28.700). Using EBJIS 2021 criteria, infection was confirmed in more than 10 % of cases in each group, and the diagnostic significance of the criteria exceeded the significance of using routine screening methods. At a follow-up period of more than 2 years, the effectiveness of treatment was 95.3 %, while signs of infection were detected in 4.7 % of cases, regardless of the group. Conclusion EBJIS 2021 criteria are characterized by high diagnostic sensitivity and specificity and enable to identify periprosthetic joint infection in knee revision cases even in its latent form and to correct treatment tactics in patients without a history of PJI.

scholarly journals Complications of Resection Arthroplasty in Two-Stage Revision for the Treatment of Periprosthetic Hip Joint Infection

2019 ◽  
Vol 8 (12) ◽  
pp. 2224 ◽  
Author(s):  
Irene K. Sigmund ◽  
Tobias Winkler ◽  
Nuri Önder ◽  
Carsten Perka ◽  
Nora Renz ◽  
...  
Keyword(s):  
Blood Loss ◽  
Bone Fractures ◽  
Joint Infection ◽  
Resection Arthroplasty ◽  
High Rate ◽  
Complication Rates ◽  
Two Stage ◽  
Free Survival ◽  
Group 2 ◽  
Group 1

Little data is available regarding complications associated with resection arthroplasty in the treatment of hip periprosthetic joint infection (PJI). We assessed complications during and after two-stage revision using resection arthroplasty. In this retrospective study, 93 patients undergoing resection arthroplasty for hip PJI were included. Patients were assigned to a prosthesis-free interval of ≤10 weeks (group 1; 49 patients) or >10 weeks (group 2; 44 patients). The complication rates between groups were compared using the chi-squared test. The revision-free and infection-free survival was estimated using a Kaplan–Meier survival analysis. Seventy-one patients (76%) experienced at least one local complication (overall 146 complications). Common complications were blood loss during reimplantation (n = 25) or during explantation (n = 23), persistent infection (n = 16), leg length discrepancy (n = 13) and reinfection (n = 9). Patients in group 1 experienced less complications after reimplantation (p = 0.012). With increasing severity of acetabular bone defects, higher incidence of complications (p = 0.008), periprosthetic bone fractures (p = 0.05) and blood loss (p = 0.039) was observed. The infection-free survival rate at 24 months was 93.9% in group 1 and 85.9% in group 2. The indication for resection arthroplasty needs to be evaluated carefully, considering the high rate of complications and reduced mobility, particularly if longer prosthesis-free intervals are used.

scholarly journals The results of screw augmentation of acetabular cement spacers for the treatment of periprosthetic hip joint infection

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jing-Yao Jin ◽  
Taek-Rim Yoon ◽  
Kyung-Soon Park ◽  
Sheng-Yu Jin ◽  
Dong-Min Jung ◽  
...  
Keyword(s):  
Joint Infection ◽  
Revision Arthroplasty ◽  
Harris Hip Score ◽  
Cement Spacer ◽  
Two Stage ◽  
Screw Augmentation ◽  
Medial Migration ◽  
Total Movement ◽  
Group 2 ◽  
Group 1

Abstract Introduction Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) is widely used in two-stage revision arthroplasty in periprosthetic joint infection (PJI) after total hip arthroplasty (THA). In our institution, we encountered several cases of acetabular cement spacer dislodgement. The aim of this study was to compare the results of two-stage revision arthroplasties with antibiotic-loaded cement spacers with or without screws on the acetabulum for PJI. Patients and methods This retrospective study included 44 patients who underwent a two-stage revision THA for PJI from June 2007 to May 2017. We divided the patients into two groups: group 1 consisted of 21 patients (21 hips) who underwent two-stage revision arthroplasty with screw augmentation, while group 2 consisted of 23 patients (23 hips) who underwent the same surgery without screw augmentation at the acetabular cement spacer. We compared the migration and dislodgement of the acetabular cement spacer between the two groups. Results Before the second-stage surgery, there was less vertical migration of the cement spacer in group 1 compared to group 2 (1.2 mm vs 3.1 mm, p < 0.001). There was also less medial migration of the cement spacer in group 1 (0.6 mm vs 1.6 mm, p = 0.001). After the first stage, the mean Harris Hip score was significantly higher in group 1 than in group 2 (75 vs 65, p = 0.033). Cement spacer rotation or total movement out of the acetabular area occurred in six patients, all in group 2. After first stage reinfection occurred in two patients, one in each group. Conclusions Screw augmentation to the acetabulum in the first-stage surgery provides better stability of acetabular antibiotic cement spacers without increasing reinfection rate.

The value of ring-fenced beds in elective lower limb arthroplasty

2019 ◽  
Vol 80 (7) ◽  
pp. 405-409
Author(s):  
Matthew Green ◽  
Eleanor Tung ◽  
Oday Al-Dadah
Keyword(s):  
Length Of Stay ◽  
Prosthetic Joint Infection ◽  
Lower Limb ◽  
Joint Infection ◽  
Admission Rates ◽  
Prosthetic Joint ◽  
Before And After ◽  
Group 2 ◽  
Inpatient Length Of Stay ◽  
Group 1

Background:Infection is a serious complication of prosthetic joint arthroplasty, associated with high rates of morbidity resulting in further surgical intervention and prolonged inpatient hospital admission. Rates of prosthetic joint infection have been reported as 1.5–2.5% following lower limb arthroplasty. This study compared infection rates in patients receiving primary hip and knee joint replacements before and after implementation of ring-fenced beds.Methods:Retrospective study of all patients undergoing primary total hip replacement and total knee replacement from April 2013 to February 2014. Group 1 included pre-ring-fencing patients, group 2 included post-ring-fencing patients.Results:The overall infection rate pre-ring-fencing was 6.3% (n=8). This reduced to 2.7% (n=3) post-ring-fencing. The mean inpatient length of stay for group 1 was 6 days vs 4 days for group 2.Conclusions:Ring-fencing beds for patients undergoing elective lower limb arthroplasty significantly reduced rates of prosthetic joint infection and inpatient length of stay.

scholarly journals Evaluation of serum procalcitonin as a significant marker in cases of septic arthritis and osteomyelitis: a two year study

2018 ◽  
Vol 4 (4) ◽  
pp. 601
Author(s):  
Harsha Kumar Koramutla ◽  
Balakondaiah Koyagura ◽  
Bijju Ravindran
Keyword(s):  
Septic Arthritis ◽  
Bacterial Infections ◽  
Specific Marker ◽  
Predictive Values ◽  
Joint Infections ◽  
Group 3 ◽  
Group 2 ◽  
Sensitivity Specificity ◽  
Group 1

<p class="abstract"><strong>Background:</strong> Acute bone infections like septic arthritis and osteomyelitis are a serious threat in management and diagnosis in the department of orthopaedics. Biochemical marker is needed with good sensitivity and specificity in diagnosing acute bone and joint infections. The aim of the present study was to study the role of PCT in conditions of septic arthritis and osteomyelitis.</p><p class="abstract"><strong>Methods:</strong> A two year prospective study was done and cases were grouped into three group and laboratory parameters TC, ESR, CRP and PCT were measured. The sensitivity, specificity and predictive values were compared using SPSS software version 20.<strong></strong></p><p class="abstract"><strong>Results:</strong> 238 patients, (males- 154 &amp; Females– 84) with mean age 34.1±8.20 years. Group-1 included 52 patients with raised PCT and MRSA and <em>Klebsiella</em> as the common isolates. Group-2 with 89 patients and mean PCT in the study group was 4.99 ng/ml. Ninety seven were included in Group-3. The mean PCT value was 2.6 ng/ml. In group-1, the specificity of PCT (comparing Group-1 &amp; 3) was 96.8 [95% CI, 94.2 -98.4], the sensitivity (26% [3.2-60.1], the PPV 16.1% [95% CI 2.3-48.3] and the NPV was 98% [95% CI, 95.5-99.8].</p><p class="abstract"><strong>Conclusions:</strong> To conclude our study, highlights the role of PCT as a sensitive and specific marker in diagnosing cases of septic arthritis and Osteomyelitis. This opens a gateway to further research in evaluating the PCT effectiveness as a response marker to treatment. PCT is more sensitive than CRP in acute bone and joint bacterial infections and raises early and faster.</p>

scholarly journals Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 486 ◽  
Author(s):  
Giovanni Autore ◽  
Luca Bernardi ◽  
Susanna Esposito
Keyword(s):  
Septic Arthritis ◽  
Laboratory Data ◽  
Underlying Disease ◽  
Narrative Review ◽  
Empiric Antibiotic Therapy ◽  
Evidence Based ◽  
First Line ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Empiric Antibiotic

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

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