scholarly journals Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection

2020 ◽  
Vol 5 (2) ◽  
pp. 82-88
Author(s):  
Alberto V. Carli ◽  
Andy O. Miller ◽  
Milan Kapadia ◽  
Yu-fen Chiu ◽  
Geoffrey H. Westrich ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
International Consensus ◽  
Musculoskeletal Infection ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Comorbidity Index ◽  
Two Stages

Abstract. Background: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin.Methods: A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI. The primary endpoint was 2 year prosthesis retention. Univariate analyses and regression statistics were calculated.Results: 341 patients with staphylococcal PJI were analyzed. 154 two-stages (77%) and 74 DAIR procedures (52%) met criteria for treatment success at 2 years. 77 patients were treated with daptomycin, of which 34 two-stages (68%) and 15 DAIRs (56%) achieved treatment success. Pairwise and regression analysis found no association between treatment success and daptomycin use. Organism (DAIR only) and Charlson Comorbidity Index scores (DAIR and two-stage) were significantly associated with treatment outcome. Six daptomycin patients (7.8%) had adverse side effects.Discussion: Daptomycin fared no better or worse than comparable antibiotics in a retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy.Conclusion: The convenient dosing, safety, and potency of daptomycin make it an attractive antibiotic for staphylococcal PJI. However, these advantages must be weighed against higher costs and rare, but serious side effects.

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 187-192
Author(s):  
Jared A. Warren ◽  
Oliver Scotting ◽  
Hiba K. Anis ◽  
James Bircher ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Musculoskeletal Infection ◽  
Hip Hemiarthroplasty ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Prosthetic Joint ◽  
The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

scholarly journals Role of Universal 16S rRNA Gene PCR and Sequencing in Diagnosis of Prosthetic Joint Infection

2011 ◽  
Vol 50 (3) ◽  
pp. 583-589 ◽  
Author(s):  
M. Marin ◽  
J. M. Garcia-Lechuz ◽  
P. Alonso ◽  
M. Villanueva ◽  
L. Alcala ◽  
...  
Keyword(s):  
16S Rrna ◽  
16S Rrna Gene ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Rrna Gene ◽  
Prosthetic Joint

scholarly journals First results of a uniform regional treatment protocol and registration for acute prosthetic join infection in the South-East of the Netherlands

2019 ◽  
Vol 4 (3) ◽  
pp. 133-139 ◽  
Author(s):  
Maud C. Kamp ◽  
Robin W.T.M. van ◽  
Loes Janssen ◽  
M.C. (Marieke) van
Keyword(s):  
Joint Infection ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
The South ◽  
Musculoskeletal Infection ◽  
Regional Collaboration ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Definition Of ◽  
Regional Treatment

Abstract. Introduction: Prosthetic joint infection (PJI) is a relatively uncommon (average incidence 0.5-2%) but devastating complication, with significant morbidity and leading to tremendously increased health care costs. In 2013, delegates from nine hospitals covering a large region in the South-East Netherlands composed one combined treatment protocol for acute PJI of total hip and knee arthroplasty (THA and TKA). This protocol was based on the definition of acute PJI according to Workgroup of the American Musculoskeletal Infection Society (MSIS) and the principles of debridement, antibiotics, irrigation and retention (DAIR).Methods: Patients with a THA or TKA treated with DAIR because of suspicion of PJI were selected from the online PJI database. PJI was defined as at least two phenotypically identical pathogens, isolated in cultures from at least two separate tissues, obtained from the affected prosthetic joint. Acute PJIs, occurring within 90 days after primary implantation, between January 2014 and December 2016, were analyzed. We analyzed the PJI incidence rate, patient clinical and microbiological characteristics of PJI, outcome of the DAIR treatment and adherence to the regional protocol.Results: A total of 310 primary THA or TKA with a suspected PJI were registered in the regional PJI database, 236 met the definition of acute PJI, representing overall incidence of 1.12%. Following the regional treatment protocol replacement of exchangeable parts took place in 45% in 2014 to 70% in 2016. After 12 months follow-up, prosthesis retention was achieved in 87% and 3% of the patients died within one year after the primary surgery.Conclusion: Results of the regional cohort are in line with the available literature. Regional collaboration and regular feedback on registered data resulted in better adherence to the combined treatment protocol. Despite our attempts to improve PJI care, PJI remains a serious complication of THA and TKA with a significant mortality rate and burden for the patient.

scholarly journals Staphylococcus aureus Prosthetic Joint Infection Treated with Debridement and Prosthesis Retention

1997 ◽  
Vol 24 (5) ◽  
pp. 914-919 ◽  
Author(s):  
C. M. Brandt ◽  
W. W. Sistrunk ◽  
M. C. Duffy ◽  
A. D. Hanssen ◽  
J. M. Steckelberg ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthesis Retention ◽  
Prosthetic Joint

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.

Evaluation of synovial fluid neutrophil CD64 index as a screening biomarker of prosthetic joint infection

2020 ◽  
Vol 102-B (4) ◽  
pp. 463-469 ◽  
Author(s):  
Leilei Qin ◽  
Ning Hu ◽  
Xinyu Li ◽  
Yuelong Chen ◽  
Jiawei Wang ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Prosthetic Joint Infection ◽  
Bacterial Infections ◽  
Joint Infection ◽  
Polymorphonuclear Neutrophils ◽  
Musculoskeletal Infection ◽  
Neutrophil Cd64 ◽  
Prosthetic Joint ◽  
Significant Difference ◽  
Aseptic Failure

Aims Prosthetic joint infection (PJI) remains a major clinical challenge. Neutrophil CD64 index, Fc-gamma receptor 1 (FcγR1), plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The aim of this study is to compare the neutrophil CD64 index in synovial and blood diagnostic ability with the standard clinical tests for discrimination PJI and aseptic implant failure. Methods A total of 50 patients undergoing revision hip and knee arthroplasty were enrolled into a prospective study. According to Musculoskeletal Infection Society (MSIS) criteria, 25 patients were classified as infected and 25 as not infected. In all patients, neutrophil CD64 index and percentage of polymorphonuclear neutrophils (PMN%) in synovial fluid, serum CRP, ESR, and serum CD64 index levels were measured preoperatively. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were analyzed for each biomarker. Results Serum CD64 index showed no significant difference between the two groups (p = 0.091). Synovial fluid CD64 index and PMN% discriminated good differentiation between groups of PJI and aseptic failure with AUC of 0.946 (95% confidence interval (CI) 0.842 to 0.990) and 0.938 (95% CI 0.832 to 0.987) separately. The optimal threshold value of synovial CD64 index for the diagnosis of PJI was 0.85, with a sensitivity of 92.00%, a specificity of 96.00%, and diagnostic odds ratio (DOR) of 227.11. Conclusion The present study demonstrates that CD64 index in synovial fluid could be a promising laboratory marker for screening PJI. The cut-off values of 0.85 for synovial CD64 index has the potential to distinguish aseptic failure from PJI. Cite this article: Bone Joint J 2020;102-B(4):463–469.

scholarly journals Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review

2017 ◽  
Vol 2 (3) ◽  
pp. 127-135 ◽  
Author(s):  
Joshua M. Lawrenz ◽  
Nathan W. Mesko ◽  
Carlos A. Higuera ◽  
Robert M. Molloy ◽  
Claus Simpfendorfer ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
Clinical History ◽  
Iliopsoas Muscle ◽  
Oral Antibiotic ◽  
Treatment Protocols ◽  
Prosthetic Joint ◽  
Hip Infection ◽  
Iliacus Muscle

Abstract. Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges.In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months.This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.

The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty

2020 ◽  
Vol 102-B (3) ◽  
pp. 329-335 ◽  
Author(s):  
Bernd Fink ◽  
Philipp Schuster ◽  
Rüdiger Braun ◽  
Eli Tagtalianidou ◽  
Michael Schlumberger
Keyword(s):  
Antibiotic Therapy ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Predictive Value ◽  
Joint Infection ◽  
Diagnostic Value ◽  
Tissue Samples ◽  
Musculoskeletal Infection ◽  
Prosthetic Joint

Aims Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence. Methods A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS). Results In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%). Conclusion Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329–335

Long-Term Results of Acute Prosthetic Joint Infection Treated with Debridement and Prosthesis Retention: A Case-Control Study

2012 ◽  
Vol 35 (10) ◽  
pp. 908-912 ◽  
Author(s):  
Lluís Font-Vizcarra ◽  
Sebastián García ◽  
Guillem Bori ◽  
Juan Carlos Martinez-Pastor ◽  
Alonso Zumbado ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Case Control Study ◽  
Joint Infection ◽  
Case Control ◽  
Long Term Results ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Control Study
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