scholarly journals Late onset periprosthetic joint infection of the knee caused by Streptococcus anginosus. Case presentation and literature review

2021 ◽  
Vol 15 (03) ◽  
pp. 436-441
Author(s):  
Giuseppe Marongiu ◽  
Marco Conte ◽  
Vincenzo Verderosa ◽  
Stefano Congia ◽  
Giuseppe Dessì ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Late Onset ◽  
Joint Infection ◽  
Rare Event ◽  
Revision Arthroplasty ◽  
Orthopedic Implants ◽  
Streptococcus Anginosus ◽  
Joint Infections ◽  
Causative Agents ◽  
Periprosthetic Knee Infection

Periprosthetic joint infection (PJI) is one of the most dramatic complications of joint arthroplasty. Although streptococcal bone and joint infections are less common than staphylococcal cases, their role as causative agents of bone and joint remains significant accounting for at least 10% of PJIs. Streptococcus anginosus group (SAG) bacteria are usually found in the normal flora of the urogenital tract, intestinal tract and oropharynx and could cause pyogenic infections to affect brain, lungs and liver. SAG bacteria are uncommonly reported as a cause of osteomyelitis and the involvement of a joint represent a rare event. S. anginosus has been anecdotical related to implant devices infections such as vascular prosthesis or orthopedic implants, however, PJI of the knee has never been fully reported before. We describe the case of a late onset periprosthetic knee infection due to Streptococcus anginosus successfully treated by a two-stage revision arthroplasty and postoperative parenteral Vancomycin, (2 g per day) and Levofloxacin (750 mg per day) for 4 weeks and then oral Levofloxacin for a further 2 weeks.

scholarly journals Plasma fibrinogen in the diagnosis of periprosthetic joint infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fei Yang ◽  
Chenyu Zhao ◽  
Rong Huang ◽  
Hui Ma ◽  
Xiaohe Wang ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Plasma Fibrinogen ◽  
Evidence Based ◽  
Joint Infections ◽  
Auc Value

AbstractPeriprosthetic joint infections (PJIs) have become the most catastrophic complication for patients after arthroplasty. Although previous studies have found that many biomarkers have good performance for diagnosing PJI, early diagnosis remains challenging and a gold standard is lacking. This study aimed to investigate the diagnostic accuracy of plasma fibrinogen (FIB) in detecting PJI compared to other traditional biomarks (CRP, WBC and ESR). A total of 156 patients (including 57 PJI and 99 non-PJI patients) who underwent revision arthroplasty were retrospectively reviewed from 01/2014 to 01/2020. The diagnostic criteria of PJI were mainly based on the definition from the evidence-based definition for periprosthetic joint infection in 2018. The optimal plasma FIB predictive cutoff was 4.20 g/L, the sensitivity of the plasma fibrinogen was 0.860, the specificity was 0.900, the positive predictive value (PPV) was 0.831, and the negative predictive value (NPV) was 0.908. The area under the curve (AUC) value of plasma fibrinogen was 0.916 (95% CI 0.869–0.964), and the CRP, ESR and WBC levels had AUCs of 0.901, 0.822 and 0.647, respectively. Plasma FIB demonstrated better diagnostic strength compared with that of other serum biomarkers before revision arthroplasty. It represents a new horizon for the diagnosis of PJI due to the diagnosis values and cost-effective features.

scholarly journals Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

2019 ◽  
Vol 10 (10) ◽  
pp. 348-355 ◽  
Author(s):  
Ewout S Veltman ◽  
Dirk Jan F Moojen ◽  
Marc L van Ogtrop ◽  
Rudolf W Poolman
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Two Stage

Outcomes of revision arthroplasty for shoulder periprosthetic joint infection: a three-stage revision protocol

2019 ◽  
Vol 28 (2) ◽  
pp. 268-275 ◽  
Author(s):  
Wo-Jan Tseng ◽  
Drew A. Lansdown ◽  
Trevor Grace ◽  
Alan L. Zhang ◽  
Brian T. Feeley ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty

Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 171-176
Author(s):  
Antonio Klasan ◽  
Arne Schermuksnies ◽  
Florian Gerber ◽  
Matt Bowman ◽  
Susanne Fuchs-Winkelmann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Resistance ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bacterial Strains ◽  
Coagulase Negative Staphylococci ◽  
Primary Arthroplasty ◽  
Total Knee

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

scholarly journals On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results

2021 ◽  
Vol 11 (10) ◽  
pp. 1039
Author(s):  
Marco Balato ◽  
Carlo Petrarca ◽  
Vincenzo de Matteo ◽  
Marco Lenzi ◽  
Enrico Festa ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
High Morbidity ◽  
Virtual Planning ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Infection Treatment ◽  
Prosthetic Joint Infections ◽  
Surgical Complexity

Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).

scholarly journals Chronic prosthetic joint infections with a draining sinus. Who should receive suppressive antibiotic treatment?

2020 ◽  
Vol 6 (2) ◽  
pp. 43-45
Author(s):  
Karel-Jan Lensen ◽  
Rosa Escudero-Sanchez ◽  
Javier Cobo ◽  
Alex Soriano ◽  
Marjan Wouthuyzen-Bakker
Keyword(s):  
Antibiotic Treatment ◽  
Patient Group ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Sinus Tract ◽  
Advantages And Disadvantages ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Abstract. The benefit of suppressive antibiotic treatment in inoperable patients with a chronic periprosthetic joint infection and a sinus tract is unknown. Some physicians prefer to just let the sinus drain, while others prefer antibiotic treatment. In this viewpoint article we discuss the advantages and disadvantages of suppressive antibiotic treatment in this particular patient group.

scholarly journals Value of mNGS in sonication fluid for the diagnosis of periprosthetic joint infection

Arthroplasty ◽  
2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Chongjing Zhang ◽  
Xinyu Fang ◽  
Zida Huang ◽  
Wenbo Li ◽  
Chao-fan Zhang ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Pathogenic Microorganisms ◽  
Musculoskeletal Infection ◽  
Conventional Culture ◽  
Culture Positive ◽  
Positive Results ◽  
Aseptic Failure ◽  
Fluid Culture

Abstract Objective To evaluate the effectiveness of metagenomics next-generation sequencing (mNGS) for the detection of pathogenic microorganisms in periprosthetic joint infection (PJI) using the sonication fluid from removed prosthesis. Methods In this prospective diagnostic cohort study, 44 patients who underwent revision arthroplasty in our hospital from December 2016 to December 2018 were screened. Seven cases were excluded due to incomplete clinical data, insufficient synovial fluid or failure of sequencing. According to the PJI diagnostic criteria recommended by the Musculoskeletal Infection Society (MSIS), the patients were defined as PJI or aseptic failure (AF). Conventional culture, sonication fluid culture and mNGS were performed, in order to assess the value of mNGS using sonication fluid for the diagnosis of PJI, and the mNGS results were analyzed and compared with the conventional and sonication fluid culture. Results Among the 37 patients, 24 were diagnosed with PJI (64.86%), while 13 were diagnosed with aseptic failure. Among the 24 patients diagnosed with PJI, 15 cases (62.5%), 17 cases (70.8%) and 24 cases (100%) yielded positive results in conventional culture, sonication fluid culture and mNGS, respectively. In addition, mNGS detected the same pathogenic microorganisms in 16 out of the 17 (94.12%) culture-positive (conventional + sonication fluid) PJI cases. In the only one discrepancy case, Enterococcus faecalis was identified in the cultures, while Enterobacter cloacae was detected by mNGS. In the AF group, the results of the conventional culture were all negative. Nevertheless, Staphylococcus epidermidis was detected in the sonication fluid culture and mNGS in one case. The diagnostic sensitivity of mNGS for PJI was 100%, which was significantly higher than 70.83% (P = 0.039) of the sonication fluid culture and 62.5% (P = 0.021) of the conventional culture. The diagnostic specificity of mNGS for PJI was 92.31%, which was not significantly different (P > 0.05) from those of the conventional culture (100%) and sonication fluid culture (92.31%). Conclusion We demonstrated that mNGS using sonication fluid can improve the detection rate of pathogenic microorganisms and provide valuable information for the diagnosis of PJI. In addition, mNGS can effectively identify pathogenic microorganisms in culture-negative PJIs cases, especially for the cases who have been treated with antibiotics before sample acquisition or have fastidious microorganisms. Therefore, this method can potentially help to guide the clinical use of antibiotics.

The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty

2019 ◽  
Vol 140 (2) ◽  
pp. 255-262 ◽  
Author(s):  
Martin Thaler ◽  
Ricarda Lechner ◽  
Dietmar Dammerer ◽  
Hermann Leitner ◽  
Ismail Khosravi ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Anterior Approach ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Direct Anterior Approach ◽  
Two Stage

Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

2019 ◽  
Vol 10 (10) ◽  
pp. 340-347
Author(s):  
Ewout S Veltman ◽  
Dirk Jan F Moojen ◽  
Marc L van Ogtrop ◽  
Rudolf W Poolman
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Two Stage

scholarly journals Understanding Infection: A Primer on Animal Models of Periprosthetic Joint Infection

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Alexandra I. Stavrakis ◽  
Jared A. Niska ◽  
Amanda H. Loftin ◽  
Fabrizio Billi ◽  
Nicholas M. Bernthal
Keyword(s):  
Animal Models ◽  
Health System ◽  
Economic Impact ◽  
Periprosthetic Joint Infection ◽  
Periprosthetic Infection ◽  
Joint Infection ◽  
Joint Infections

Periprosthetic joint infections are devastating complications for patients and for our health system. With growing demand for arthroplasty, the incidence of these infections is projected to increase exponentially. This paper is a review of existing animal models to study periprosthetic infection aimed at providing scientists with a succinct presentation of strengths and weaknesses of available in vivo systems. These systems represent the tools available to investigate novel antimicrobial therapies and reduce the clinical and economic impact of implant infections.

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