Prosthetic-joint Infections: Mortality Over The Last 10 Years

Abstract. Background: There is a constant increase of joint arthroplasties to improve the quality of life of an ever-aging population. Although prosthetic-joint infections are rare, with an incidence of 1-2%, they represent a serious complication in terms of morbidity and mortality. Infection related mortality is known to be approaching 8% at one year. The aim of this retrospective study is to reassess the one and two-year mortality over the last ten years.Methods: Patients treated for prosthetic joint infection at the University Hospital of Lausanne (Switzerland) between 2006 and 2016 were included. The one and two-year cumulative mortality depending on sex, age, type of prosthesis, infecting organism and type of surgical treatment were computed.Results: 363 patients (60% hips, 40% knees) were identified with a median age of 70 years. The one-year cumulative mortality was 5.5% and it was 7.3% after two years. No difference was seen between hip and knee prostheses, but the mortality was higher in men than in women and increased with age. Furthermore, there was a significant difference depending of the germ with enterococci infections associated with a higher risk of death. Finally, patients treated with a one-stage or two-stage exchange had a lower mortality than those treated with debridement and retention.Conclusion: The mortality is still high and differs according to sex, age, infecting organism and type of surgical treatment. There is a need of studies to improve the management of patients at risk of increased mortality.

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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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Molecular characteristics of Staphylococcus aureus associated prosthetic joint infections after hip fractures treated with hemiarthroplasty: a retrospective genome-wide association study

Scientific Reports ◽

10.1038/s41598-020-73736-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

J. Christopher Noone ◽

Marc Stegger ◽

Berit Lilje ◽

Knut Stavem ◽

Karin Helmersen ◽

...

Keyword(s):

Staphylococcus Aureus ◽

University Hospital ◽

Genome Wide Association ◽

Molecular Characteristics ◽

Joint Infections ◽

Orthopaedic Patients ◽

Prosthetic Joint ◽

Genome Wide ◽

A Genome ◽

Prosthetic Joint Infections

Abstract A retrospective study of Staphylococcus aureus isolates from orthopaedic patients treated between 2000 and 2017 at Akershus University Hospital, Norway was performed using a genome-wide association approach. The aim was to characterize and investigate molecular characteristics unique to S. aureus isolates from HHA associated prosthetic joint infections and potentially explain the HHA patients’ elevated 1-year mortality compared to a non-HHA group. The comparison group consisted of patients with non-HHA lower-extremity implant-related S. aureus infections. S. aureus isolates from diagnostic patient samples were whole-genome sequenced. Univariate and multivariate analyses were performed to detect group-associated genetic signatures. A total of 62 HHA patients and 73 non-HHA patients were included. Median age (81 years vs. 74 years; p < 0.001) and 1-year mortality (44% vs. 15%, p < 0.001) were higher in the HHA group. A total of 20 clonal clusters (CCs) were identified; 75% of the isolates consisted of CC45, CC30, CC5, CC15, and CC1. Analyses of core and accessory genome content, including virulence, resistance genes, and k-mer analysis revealed few group-associated variants, none of which could explain the elevated 1-year mortality in HHA patients. Our findings support the premise that all S. aureus can cause invasive infections given the opportunity.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.475 ◽

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.

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P2754Streptococcal infective endocarditis: distribution of species and their prognosis

European Heart Journal ◽

10.1093/eurheartj/ehz748.1071 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Chamat ◽

A Dahl ◽

C Hassager ◽

M Arpi ◽

L Oestergaard ◽

...

Keyword(s):

Infective Endocarditis ◽

Electronic Device ◽

Species Level ◽

University Hospital ◽

Heart Valve Disease ◽

Significant Difference ◽

Streptococcal Species ◽

Species Groups ◽

One Year ◽

The One

Abstract Background Infective endocarditis (IE) is frequently caused by streptococcal species. However, there is limited knowledge about the relationship between different streptococcal species and IE, and their associated outcomes. Purpose To examine the prevalence of streptococci at species level in IE, and to relate these different species to outcomes. Methods From 2002–2012 we prospectively collected consecutive patients with IE admitted to two tertiary heart centres covering a catchment area of 2.4 million people. The registry comprises 915 IE patients, 366 (40%) with streptococcal IE. Based on phylogenetic relationship, streptococcal species were classified into seven main groups: Mitis, Bovis, Mutans, Anginosus, Salivarius, Pyogenic and Nutritionally Variant Streptococcus (NVS). Classification at species level was not possible in 51 patients, who were excluded. Complications and prognosis of streptococcal IE were compared between the subgroups, and at species level. Results We included 315 patients with streptococcal IE. Mean age was 63 (IQR 52–76) years, and most were men (67%). A total of 115 patients (37%) had a previous heart valve disease, 58 (18%) had a prosthetic valve, 22 (7%) had previously had IE and 29 (9%) had a cardiac electronic device. With 148 episodes (47%) the Mitis group was the most common cause of IE. Other frequent groups were the Pyogenic group and the Bovis group, accounting for 66 (21%) and 51 (16%) of the cases, respectively. Surgery was carried out in 55% (n=173) of all cases. Patients infected with S. pneumoniae or S. agalactiae had a significantly higher rate of surgery, 72.2% (n=13) and 71.9% (n=23) respectively, whereas the Bovis group had a significantly lower rate, 35.5% (n=18) (p=0.048). The aortic valve was infected in 137 patients (43.5%), mitral valve in 105 patients (33.3%) and both valves were infected in 53 patients (16.8%). Twenty patients (6.3%) had right-sided IE, including pacemaker lead IE. There was no significant difference between the species subgroups regarding type of infected valve. Embolization and osteitis were observed in 76 (24.1%) and 30 (9.5%) patients, respectively. There was no significant difference between the species groups, as was the case with mortality: 23 patients (7.3%) died in-hospital and the one-year mortality was 16% (n=50). Distribution of streptococcal IE Conclusion Species of the Mitis group were the most frequent Streptococci causing IE. Patients infected with S. pneumonia or S. agalactiae had significantly higher rate of surgery, and patients infected with S. bovis group had lower rate of surgery. There was no significant difference in rate of complications such as abscesses, embolization, osteitis or mortality between the streptococcal species. Acknowledgement/Funding Supported by grants from Herlev-Gentofte University Hospital Research Foundation

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Clinical features and outcome of Streptococcus agalactiae bone and joint infections over a 6-year period in a French university hospital

PLoS ONE ◽

10.1371/journal.pone.0248231 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248231

Author(s):

Paul Loubet ◽

Yatrika Koumar ◽

Catherine Lechiche ◽

Nicolas Cellier ◽

Sophie Schuldiner ◽

...

Keyword(s):

Diabetes Mellitus ◽

Clinical Features ◽

Streptococcus Agalactiae ◽

Treatment Success ◽

University Hospital ◽

Joint Infections ◽

Bone And Joint Infections ◽

Prosthetic Joint ◽

Device Infection ◽

Prosthetic Joint Infections

Background Bone and joint infections (BJIs) due to Streptococcus agalactiae are rare but has been described to increase in the past few years. The objective of this study was to describe clinical features and outcomes of cases of S. BJIs. Methods We conducted a retrospective analysis of adult cases of S. agalactiae BJIs that occurred between January 2009 and June 2015 in a French university hospital. The treatment success was assessed until 24 months after the end of antibiotic treatment. Results Among the 26 patients included, 20 (77%) were male, mean age was 62 years ± 13 and mean Charlson comorbidity index score was 4.9 ± 3.2. Diabetes mellitus was the most common comorbidity (n = 14, 54%). Six had PJI (Prosthetic Joint Infections), five osteosynthesis-associated infections, 11 osteomyelitis and four native septic arthritis. Eleven patients had a delayed or late infection: six with a prosthetic joint infection and five with an internal fixation device infection. Sixteen patients (62%) had a polymicrobial BJI, most commonly with Gram-positive cocci (75%) notably Staphylococcus aureus (44%). Polymicrobial infections were more frequently found in foot infections (90% vs 44%, p = 0.0184). During the two-year follow-up, three patients died (3/25, 12%) and seven (7/25, 28%) had treatment failure. Conclusion Diabetes mellitus was the most common comorbidity. We observed an heterogenous management and a high rate of relapse.

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Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital

Advances in Orthopedics ◽

10.1155/2019/4629503 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Robert P. Runner ◽

Amanda Mener ◽

James R. Roberson ◽

Thomas L. Bradbury ◽

George N. Guild ◽

...

Keyword(s):

Incidence Rate ◽

Joint Infection ◽

Hospital Setting ◽

University Hospital ◽

Gram Negative ◽

Joint Infections ◽

Orthopaedic Hospital ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Specialty Hospital

Introduction. Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods. A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results. The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.

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Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.03.014 ◽

2015 ◽

Vol 30 (6) ◽

pp. 912-918 ◽

Cited By ~ 44

Author(s):

William A. Jiranek ◽

Andrew C. Waligora ◽

Shane R. Hess ◽

Gregory L. Golladay

Keyword(s):

Surgical Treatment ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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Economic Analysis in a Diagnosis Related Groups System for Two-stage Exchange of Prosthetic-joint Infections

Journal of Bone and Joint Infection ◽

10.7150/jbji.26146 ◽

2018 ◽

Vol 3 (5) ◽

pp. 249-254 ◽

Cited By ~ 1

Author(s):

Arnaud Fischbacher ◽

Karine Peltier ◽

Olivier Borens

Keyword(s):

Hospital Stay ◽

Diagnosis Related Groups ◽

Joint Infection ◽

Short Interval ◽

University Hospital ◽

Two Stage ◽

Optimal Interval ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract. Background: There is a constant increase of joint arthroplasties performed, with an infectious risk of 1-2%. Different therapeutic options for prosthetic-joint infections exist, but surgery remains essential. With a two-stage exchange procedure, a success rate above 90% can be expected. Currently, there is no consensus regarding the optimal interval duration between explantation and reimplantation. This retrospective study aimed to assess the economic impact of a two-stage exchange from a single-hospital perspective.Methods: 21 patients who have undergone a two-stage exchange of a hip or knee prosthetic-joint infection at the University Hospital of Lausanne (Switzerland) from 2012 to 2013 were included. The revenues earned according to the Swiss Diagnosis Related Groups (SwissDRG) system introduced in 2012 and the costs were compared for each hospital stay.Results: The remuneration ranged from 26'806 to 42'978 Swiss francs (CHF) (~ 22'905-36'723 EUR, median 36'338 CHF, ~ 31'049 EUR). The median total cost per patient was 76'000 CHF (~ 65'000 EUR) (51'151 to 118'263; hip median 79'744, knee median 66'708). The main determinant of the costs was the length of the hospital stay. Revenues never covered all the costs, even with a short-interval procedure. The hospital lost a median of 35'000 CHF per patient (~ 30'000 EUR) (22'280 to 64'666).Conclusion: The current DRG system may not be specific enough for rewarding prosthetic-joint infections. Several options could be considered to act on the length of the hospital stay. In order to cover costs in complicated cases, such as prosthetic-joint infections, more specific DRGs are needed.

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Rifampin Combination Therapy in Staphylococcal Prosthetic Joint Infections: A Randomized Controlled Trial

10.21203/rs.2.23809/v1 ◽

2020 ◽

Author(s):

Øystein Karlsen ◽

Pål Borgen ◽

Bjørn Bragnes ◽

Wender Figved ◽

Bjarne Grøgaard ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Combination Therapy ◽

Methicillin Resistance ◽

Controlled Trial ◽

Combination Group ◽

Randomized Controlled ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Significant Difference

Abstract Background The evidence supporting rifampin combination therapy in prosthetic joint infections (PJI) is limited due to the lack of controlled studies. The aim of this study is to evaluate the effect of adding rifampin to conventional antimicrobial therapy in early staphylococcal PJIs treated with debridement and retention of the implant (DAIR). Methods In this multicentre randomized controlled trial, 99 patients with PJI after hip and knee arthroplasties were enrolled. They were randomly assigned to receive rifampin or not in addition to standard antimicrobial treatment with cloxacillin, or vancomycin in case of methicillin resistance. The primary end point was no signs of infection after 2 years follow-up. Results 48 patients were included in the final analyses. There were no differences in patient characteristics or co-morbidities between the two groups. There was no significant difference in remission rate between the rifampin combination group (17 of 23 (74%)) and the monotherapy group (18 of 25 (72%), relative risk 1,03, 95% confidence interval 0,73 to 1,45, p=0.88). Conclusion Our study has not proven a statistically significant advantage by adding rifampin to the antibiotic treatment in staphylococcal PJIs.

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