scholarly journals Candida Prosthetic Joint Infection. A Review of Treatment Methods

2017 ◽  
Vol 2 (2) ◽  
pp. 114-121 ◽  
Author(s):  
Fernando Cobo ◽  
Javier Rodríguez-Granger ◽  
Antonio Sampedro ◽  
Luis Aliaga-Martínez ◽  
José María Navarro-Marí
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Favourable Outcome ◽  
Antifungal Drugs ◽  
Infection Site ◽  
Two Stage ◽  
Joint Infections ◽  
Candidal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Abstract. Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

Two-Stage Arthroplasty for Prosthetic Joint Infection

2013 ◽  
Vol 28 (9) ◽  
pp. 1490-1498.e1 ◽  
Author(s):  
Andrew Luu ◽  
Fahd Syed ◽  
Gowri Raman ◽  
Anshul Bhalla ◽  
Eavan Muldoon ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Prosthetic Joint

Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 110-115 ◽  
Author(s):  
N. Khan ◽  
D. Parmar ◽  
M. S. Ibrahim ◽  
B. Kayani ◽  
F. S. Haddad
Keyword(s):  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Successful Outcome ◽  
Two Stage ◽  
Persistent Symptoms ◽  
Prosthetic Joint ◽  
Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

scholarly journals Post-surgery and recovery experiences following one- and two-stage revision for prosthetic joint infection—A qualitative study of patients’ experiences

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237047 ◽  
Author(s):  
Cecily K. Palmer ◽  
Rachael Gooberman-Hill ◽  
Ashley W. Blom ◽  
Michael R. Whitehouse ◽  
Andrew J. Moore
Keyword(s):  
Qualitative Study ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Post Surgery ◽  
Prosthetic Joint ◽  
Recovery Experiences

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.

scholarly journals 257. Outcomes in Fungal Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Caitlyn M Hollingshead ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Jason Tank
Keyword(s):  
Prosthetic Joint Infection ◽  
Candida Species ◽  
Joint Infection ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint ◽  
Hip Replacements ◽  
Fungal Organisms ◽  
Poor Outcomes ◽  
Wbc Count

Abstract Background There is a paucity of data in the literature regarding the most effective treatment and related outcomes of fungal prosthetic joint infection. The majority of reported cases are treated using a two stage revision method in which the initial prosthesis is removed and the patient is treated with systemic antifungal medications and potentially irrigation of the joint cavity with antifungal and antibacterial agents. Alternately, others have suggested a one-stage revision in order to prevent a period of significant functional impairment and potentially improved functional outcomes and lower overall costs. Cases of radical removal of the prosthesis without replacement have been reported. To date, the largest studies of total hip arthroplasty and total knee arthroplasty have included 37 and 45 patients, respectively. Methods A retrospective record review of patients admitted within two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed. Results Eighteen patients fit criteria. Nine patients had knee replacements and nine patients had hip replacements. The average age at time of infection was 61. Ten patients were female. Average BMI was 32.1. Twelve presented with a painful joint, eight presented with drainage, and one with dehiscence. Average WBC count was 9.3, average ESR was 47, and average CRP was 11.8. All patients were noted with Candida species. Eight patients were treated with two stage revisions, three received one stage revisions as destination therapy. One required amputation. All but one patient was associated with concurrent bacterial infection. Of the twelve patients that had known outcomes, six were noted with cure and six were noted with relapse. All patients that were cured received two stage exchange or girdlestone procedure. Conclusion In our study, fungal prosthetic joint infection was associated with poor outcomes. All of the patients in our study were noted with Candida species, which is in concordance with the known literature. Two stage exchange was associated with better outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Microbiological Epidemiology Depending on Time to Occurrence of Prosthetic Joint Infection (PJI): Impact on the Empirical Antimicrobial Strategies

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S95-S96
Author(s):  
Tristan Ferry ◽  
Claire Triffault-Fillit ◽  
Frederic Laurent ◽  
Céline Dupieux ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Lactam Antibiotic ◽  
Revision Prosthesis ◽  
Current Guidelines ◽  
Microbiological Data

Abstract Background Empirical antimicrobial therapy of prosthetic-joint infection (PJI) is a major clinical challenge and current guidelines recommend the combination of vancomycin plus a broad-spectrum β-lactamin. As Gram-negative bacilli (GNB) are probably less represented in late infections, we evaluate the microbiological epidemiology in patients with PJI according to the chronology of infection. Methods All patients managed in a reference center for complex bone and joint infections in France (2011 and 2016) were included in a prospective cohort study. Microbiological data at the time of diagnosis were collected and analyzed according to the chronology of infection. Results We included 567 PJI (284 males, 50.1%; median age 70.3 years). The median occurrence time was 23.4 weeks after prosthesis implantation (285 hip and 255 knee PJI, which were revision prosthesis in 216 [40.3%] cases). Microbiological bone samples found 164 [28.9%] S. aureus (including 26 [16.3%] MRSA), 162 [28.6%] coagulase-negative Staphylococci (CoNS, including 80 [58.8%] methicillin-resistant CoNS), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) Streptococci, and 85 (15.0%) anaerobes (including 60 [10.6%] Propionibacterium). Infection was plurimicrobial in 10 [18.2%] cases. Among the 183 patients (32%) with late PJI (occurring >1 year), obtained after exclusion of the 59 patients (10.4%) with hematogenous origins, Enterobacteriacecae 
(n = 8; 4.4%; P < 10–3) were much less represented than in patients with early PJI occurring <1 year. No difference was observed regarding the the presence of non-fermenting GNB, with a prevalence of 4.6 and 2.7% in early and late PJI, respectively. Taken together, these data suggest that a broad-spectrum β-lactam antibiotic might be useful in only 12 (6.6%) patients with late PJI, compared with 66 (20.3%) patients with early PJI (P < 10–3). Of note, there were statistically more anaerobes (n = 40; 21.9%) in late PJI, including 32 Propionibacterium (17.5%; P < 10–3). Conclusion Considering the minority amount of GNB in late post-operative PJI and the overrepresentation of anaerobes including P. acnes, the empirical treatment should be reconsidered, especially when a two-stage exchange is planned. In those situations, another acceptable option could be the vancomycin+clindamycin combination. Disclosures T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee.

Specific microbiology issues relating to prosthetic joint infection

2018 ◽  
pp. 41-50
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antibiotic Use ◽  
Stopping Rules ◽  
Two Stage ◽  
Infected Case ◽  
Prosthetic Joint ◽  
Resistance Approach

This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.

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