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

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.

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

Antibiotics ◽

10.3390/antibiotics9120872 ◽

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.

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

Journal of Clinical Medicine ◽

10.3390/jcm8122113 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2113 ◽

Cited By ~ 2

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.

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Is Gram staining still useful in prosthetic joint infections?

Journal of Bone and Joint Infection ◽

10.7150/jbji.31312 ◽

2019 ◽

Vol 4 (2) ◽

pp. 56-59 ◽

Cited By ~ 1

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.

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Prosthetic joint infection by Bordetella holmesii: Case report and a review of the literature

The International Journal of Artificial Organs ◽

10.1177/0391398820912746 ◽

2020 ◽

Vol 43 (11) ◽

pp. 748-750

Author(s):

Mariana Fernandez-Pittol ◽

Jordi Bosch ◽

Laura Morata ◽

Luis Lozano ◽

Juan Carlos Martínez Pastor ◽

...

Keyword(s):

Case Report ◽

Synovial Fluid ◽

Antibiotic Treatment ◽

Knee Prosthesis ◽

Case Reports ◽

Joint Effusion ◽

Rrna Gene ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Introduction: Bordetella holmesii is a Gram-negative coccobacillus involved in different infections mostly described in case reports. Prosthetic joint infections in relation to this pathogen are rare. Here, we present the third case of B. holmesii in a patient without anatomical or functional spleen dysfunction. Case report: The patient was a 62-year-old female with a total knee prosthesis implanted in 1997 that required multiple replacements of the femoral component due to aseptic loosening in the past years. The patient was admitted to our hospital for an elective replacement surgery due to new radiological signs of loosening. B. holmesii was isolated from synovial fluid obtained during surgery. The identification was performed by matrix-assisted laser desorption ionization–time of flight mass spectrometry and confirmed by 16S rRNA gene amplification and sequencing. Antibiotic treatment was started but 14 days after surgery the patient presented pain and joint effusion. An arthrocentesis was performed and synovial fluid culture was positive again for B. holmesii. Surgical debridement including polyethylene replacement was performed and antibiotic treatment was continued for 3 months. After a 2-year follow-up period, the patient remained asymptomatic and physical examination showed normal function of the prosthesis. Conclusion: B. holmesii is an uncommon cause of bone and joint infections. This case indicates that this microorganism is a potential pathogen of prosthetic or native arthritis, and it should be considered when cultures are negative and in cases presenting torpid evolution.

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Prosthetic Joint Infections

10.1093/med/9780199976805.003.0048 ◽

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.

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

Journal of Clinical Medicine ◽

10.3390/jcm9124031 ◽

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.

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Role of Phenol-Soluble Modulins in Formation of Staphylococcus aureus Biofilms in Synovial Fluid

Infection and Immunity ◽

10.1128/iai.00394-15 ◽

2015 ◽

Vol 83 (7) ◽

pp. 2966-2975 ◽

Cited By ~ 42

Author(s):

Sana S. Dastgheyb ◽

Amer E. Villaruz ◽

Katherine Y. Le ◽

Vee Y. Tan ◽

Anthony C. Duong ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Synovial Fluid ◽

Antibiotic Treatment ◽

Joint Infection ◽

Regulatory System ◽

Surface Proteins ◽

Host Matrix ◽

Content Type ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Staphylococcus aureusis a leading cause of prosthetic joint infections, which, as we recently showed, proceed with the involvement of biofilm-like clusters that cause recalcitrance to antibiotic treatment. Here we analyzed why these clusters grow extraordinarily large, reaching macroscopically visible extensions (>1 mm). We found that while specificS. aureussurface proteins are a prerequisite for agglomeration in synovial fluid, low activity of the Agr regulatory system and subsequent low production of the phenol-soluble modulin (PSM) surfactant peptides cause agglomerates to grow to exceptional dimensions. Our results indicate that PSMs function by disrupting interactions of biofilm matrix molecules, such as the polysaccharide intercellular adhesin (PIA), with the bacterial cell surface. Together, our findings support a two-step model of staphylococcal prosthetic joint infection: As we previously reported, interaction ofS. aureussurface proteins with host matrix proteins such as fibrin initiates agglomeration; our present results show that, thereafter, the bacterial agglomerates grow to extremely large sizes owing to the lack of PSM expression under the specific conditions present in joints. Our findings provide a mechanistic explanation for the reported extreme resistance of joint infection to antibiotic treatment, lend support to the notions that Agr functionality and PSM production play a major role in defining different forms ofS. aureusinfection, and have important implications for antistaphylococcal therapeutic strategies.

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Periprosthetic Joint Infections: Clinical and Bench Research

The Scientific World JOURNAL ◽

10.1155/2013/549091 ◽

2013 ◽

Vol 2013 ◽

pp. 1-17 ◽

Cited By ~ 15

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.

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Prosthetic Joint Infection Due to Histoplasma capsulatum Complicating a Total Knee Arthroplasty

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx118 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 2

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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Micromonas micros Infection of a Prosthetic Hip Joint: A Case Report and Review of the Literature

Case Reports in Infectious Diseases ◽

10.1155/2021/9042790 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Abhimanyu Aggarwal ◽

Durane Walker

Keyword(s):

Antibiotic Prophylaxis ◽

Hip Joint ◽

Joint Infection ◽

Dental Procedure ◽

Joint Infections ◽

Prosthetic Joints ◽

Prosthetic Joint ◽

Dental Procedures ◽

Prosthetic Joint Infections ◽

Hematogenous Seeding

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.

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