scholarly journals Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections

2020 ◽  
Vol 9 (12) ◽  
pp. 4031
Author(s):  
Chiara Lauri ◽  
Giancarlo Lauretti ◽  
Filippo Galli ◽  
Giuseppe Campagna ◽  
Simone Tetti ◽  
...  
Keyword(s):  
Visual Analysis ◽  
Joint Infection ◽  
White Blood Cells ◽  
Final Diagnosis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Significant Difference ◽  
Sensitivity Specificity

Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases. We retrospectively evaluated all [99mTc]HMPAO-WBC scintigraphies performed, in the last 7 years, for a suspected monolateral prosthetic joint infection (PJI). In doubtful cases, we used five different thresholds of increase of target-to-background (T/B) ratio, between delayed and late images, as criteria of positivity (5%, 10%, 15%, 20% and 30%). BMS were also analysed and sensitivity, specificity and accuracy of different methods were calculated according to final diagnosis. The sensitivity, specificity and accuracy were, respectively, 77.8%, 43.8% and 53.0% for the cut-off at 5%; 72.2%, 66.7% and 68.2% for the cut-off at 10%; 66.7%, 75.0% and 72.7% for the cut-off at 15%; 66.7%, 85.4% and 80.3% for the cut-off at 20%; 33.3%, 93.8% and 77.3% for the cut-off at 30%. BMS provided a significantly higher diagnostic performance than 5%, 10% and 15% thresholds. Conversely, we did not observe any statistically significant difference between BMS and the cut-off of more than 20%. Therefore, doubtful cases should be analysed semi-quantitatively. An increase in T/B ratio of more than 20% between delayed and late images, should be considered as a criterion of positivity, thus avoiding BMS.

scholarly journals Outcome of debridement, antibiotics and implant retention for staphylococcal hip and knee prosthetic joint infections, focused on rifampicin use: a systematic review and meta-analysis

2021 ◽  
Author(s):  
H Scheper ◽  
L M Gerritsen ◽  
B G Pijls ◽  
S A Van Asten ◽  
L G Visser ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Joint Infection ◽  
Success Rates ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
Important Evidence

Abstract The treatment of staphylococcal prosthetic joint infection (PJI) with debridement, antibiotics and retention of the implant (DAIR) often results in failure. An important evidence gap concerns the treatment with rifampicin for PJI. A systematic review and meta-analysis were conducted to assess the outcome of staphylococcal hip and/or knee PJI after DAIR, focused on the role of rifampicin. Studies published until September 2nd, 2020 were included. Success rates were stratified for type of joint and type of micro-organism. Sixty-four studies were included. The pooled risk ratio for rifampicin effectiveness was 1.10 (95% CI 1.00-1.22). Pooled success rate was 69% for S. aureus hip PJI, 54% for S. aureus knee PJI, 83% for CNS hip PJI and 73% for CNS knee PJI. Success rates for MRSA PJI (58%) were similar to MSSA PJI (60%). The meta-analysis indicates that rifampicin may only prevent a small fraction of all treatment failures.

scholarly journals Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 872
Author(s):  
Isabel Mur ◽  
Marcos Jordán ◽  
Alba Rivera ◽  
Virginia Pomar ◽  
José Carlos González ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Infection ◽  
Assistive Device ◽  
Matched Cohort ◽  
Knee Prostheses ◽  
Matched Cohort Study ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

scholarly journals The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

2019 ◽  
Vol 8 (12) ◽  
pp. 2113 ◽  
Author(s):  
Deroche ◽  
Bémer ◽  
Valentin ◽  
Jolivet-Gougeon ◽  
Tandé ◽  
...  
Keyword(s):  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Microbiological Diagnosis ◽  
Joint Infections ◽  
Time To Positivity ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Two Samples ◽  
The Right ◽  
Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

scholarly journals Is Gram staining still useful in prosthetic joint infections?

2019 ◽  
Vol 4 (2) ◽  
pp. 56-59 ◽  
Author(s):  
Marjan Wouthuyzen-Bakker ◽  
Noam Shohat ◽  
Marine Sebillotte ◽  
Cédric Arvieux ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Joint Infection ◽  
Individual Case ◽  
Gram Stain ◽  
Reactive Protein ◽  
Joint Infections ◽  
Gram Staining ◽  
Causative Microorganism ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

Prosthetic Joint Infections

2016 ◽  
Author(s):  
David Mabey ◽  
Hasan E. Baydoun ◽  
Jamil D. Bayram
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Joint Infection ◽  
Treatment Options ◽  
Joint Fluid ◽  
Care Providers ◽  
Joint Replacement Surgery ◽  
Fluid Analysis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Prosthetic joint infection (PJI), a complication of joint replacement surgery, presents with fever, joint pain, erythema, effusion, and joint loosening. Many advances have decreased the risk of infection, such as the use of perioperative antimicrobial prophylaxis and intraoperative laminar airflow. Joint fluid analysis should be pursued by the orthopedic surgeons; primary and acute care providers should consult the definitive care team and refer these patients for admission. Organisms causing prosthetic joint infections often grow in biofilms, which make them difficult to treat. Surgical treatment options include one or two-stage prosthesis exchange, debridement with retention of the prosthesis, resection arthroplasty, arthrodesis, or amputation. Antibiotic therapy should be guided by intraoperative cultures and selected in consultation with the infectious disease service.

scholarly journals 402. Clinical Characteristics and Outcome of Staphylococcus lugdunensis Prosthetic Joint Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S205-S205
Author(s):  
Komal Masood ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Geehan Suleyman
Keyword(s):  
Clinical Characteristics ◽  
Surgical Intervention ◽  
Treatment Modalities ◽  
Coagulase Negative Staphylococcus ◽  
Two Stage ◽  
Staphylococcus Lugdunensis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Significant Difference

Abstract Background Although Staphylococcus lugdunensis is a coagulase-negative staphylococcus, it shares similar characteristics with S. aureus and is increasingly recognized as the cause of serious infections, including prosthetic joint infections (PJIs). The aim of this study was to determine the clinical characteristics and outcome of S. lugdunensis PJIs. Methods This was a retrospective multicenter study conducted from January 2007 through December 2017 involving consecutive adult patients with S. lugdunensis PJIs in northwest Ohio. Clinical and microbiologic characteristics, treatment modalities and outcome were evaluated. Results A total of 695 patients were evaluated and 29 (4%) patients met inclusion criteria (Table 1). All patients were Caucasian and 52% were female with a median age 68.8. Comorbidities included Diabetes Mellitus (34%), CAD (41%), CHF (20%), COPD (20%) and cancer (14%). The most common clinical presentations were pain (28/29, 97%), decreased range of motion (27/29, 93%) and joint swelling (21/29, 72%). Two patients had concomitant bacteremia. Knee was the most commonly affected joint (69%), followed by hip (24%). All isolates, except one, were susceptible to oxacillin. Thirteen (45%) patients had a two-stage revision, nine (31%) debridement with/without revision, six (21%) no surgical intervention and one (3%) a 1-stage revision. The majority of patients (71%) received ≥4 weeks of antibiotics (abx). Two patients with no surgical intervention and one with debridement received no abx. Another was discharged to hospice without intervention. Relapse was observed in two (15%) patients who had a 2-stage revision, four (44%) who had debridement, 6 (100%) who had no surgical intervention or 1-stage revision. Overall, there was a statistically significant difference in cure rates in patients who underwent 2-stage revision compared with other treatment modalities (P = 0.003) regardless of abx treatment regimen, including prolonged IV abx therapy. However, IV abx were superior to oral (P = 0.009). Conclusion Appropriate management of S. lugdunensis PJIs includes both aggressive surgical management with a prolonged course of abx with excellent clinical responses. Relapse is high in patients treated without two-stage revision irrespective of route or duration of abx therapy. Disclosures All authors: No reported disclosures.

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.

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