Periprosthetic joint infection (PJI) is a difficult complication requiring a comprehensive eradication protocol. Cure rates have essentially stalled in the last two decades, using methods of antimicrobial cement joint spacers and parenteral antimicrobial agents. Functional spacers with higher-dose antimicrobial-loaded cement and antimicrobial-loaded calcium sulphate beads have emphasized local antimicrobial delivery on the premise that high-dose local antimicrobial delivery will enhance eradication. However, with increasing antimicrobial pressures, microbiota have responded with adaptive mechanisms beyond traditional antimicrobial resistance genes. In this review we describe adaptive resistance mechanisms that are relevant to the treatment of PJI. Some mechanisms are well known, but others are new. The objective of this review is to inform clinicians of the known adaptive resistance mechanisms of microbes relevant to PJI. We also discuss the implications of these adaptive mechanisms in the future treatment of PJI. Cite this article:
Introduction. Two-stage reimplantation for prosthetic joint infection (PJI) of the hip is the standard of care with a 5–10% recurrence at a minimum two-year follow-up. Compiling outcomes data for this standard of care is necessary in order to characterize long-term reinfection risk and the culpable microbiology. The purpose of this study was to determine the long-term success of two-stage reimplantation and identify the factors that affected the success. Methods. We performed a systematic review of randomized control trials, cohort studies, and case series through May 2019, searching Embase, Medline via PubMed, and Cochrane Library for the concept of two-stage reimplantation for the treatment of hip and knee PJIs, yielding 464 unique citations for abstract review, of which 135 were reviewed in full. Our parameters of interest included: reinfection and mortality events following successful reimplantation, the timing of these events, and the microbiology of index and recurrent infections. Results. Meeting our criteria were 59 studies with 4,494 patients (1,842 hips) who had completed reimplantation. Among successfully reimplanted hips, 4.76% (95% CI, 2.00–8.41) were reinfected by 24 months, 6.84% (4.92–9.02) were reinfected by final follow-up, 1.6% (0.32–3.52) were reinfected with an identical
Introduction. Despite recent advances in the diagnosis of periprosthetic joint infection(PJI), identifying the infecting organism continues to be a challenge, with up to a third of PJIs reported to have negative cultures. Current molecular techniques have thus far been unable to replace culture as the gold standard for isolation of the infecting pathogen. Next- generation sequencing(NGS) is a well-established technique for comprehensively sequencing the entire pathogen DNA in a given sample and has recently gained much attention in many fields of medicine. Our aim was to evaluate the ability of NGS in identifying the causative
Aim. The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for prosthetic joint infection (PJI) has been associated with an increased risk of acute kidney injury (AKI), leading to propose cefepim as an alternative since 2017 in our reference center. The present study compared microbiological efficacy and tolerance of these two EAT strategies. Method. All patients with PJI empirically treated by vancomycin-cefepim (n=90) were prospectively enrolled in an observational study, and compared with vancomycin-piperacillin/tazobactam-treated historical controls (n=117), regarding: i) the proportion efficacious empirical regimen (i.e., at least one of the two molecules active against the identified
Periprosthetic joint infection (PJI) remains a challenging complication following Total Hip Arthroplasty (THA). It is associated with high levels of morbidity, mortality and is time consuming and expensive to treat. Our management generally relies on identification of the infecting
The infected joint arthroplasty continues to be a very challenging problem. Its management remains expensive, and places an increasing burden on health care systems. It also leads to a long and difficult course for the patient, and frequently a suboptimal functional outcome. The choice of a particular treatment program will be influenced by a number of factors. These include the acuteness or chronicity of the infection; the infecting
Next-generation sequencing (NGS) is a well-established technique for amplification and sequencing of DNA and has recently gained much attention in many fields of medicine. Our aim was to evaluate the ability of NGS in identifying the causative
The infected joint arthroplasty continues to be a very challenging problem. Its management remains expensive, and places an increasing burden on health care systems. It also leads to a long and difficult course for the patient, and frequently a suboptimal functional outcome. The choice of a particular treatment program will be influenced by a number of factors. These include the acuteness or chronicity of the infection; the infecting
The infected joint arthroplasty continues to be a very challenging problem. Its management remains expensive, and places an increasing burden on health care systems. It also leads to a long and difficult course for the patient, and frequently a suboptimal functional outcome. The choice of a particular treatment program will be influenced by a number of factors. These include the acuteness or chronicity of the infection; the infecting
Aim. To describe the epidemiology, clinical features and outcomes of native joint septic arthritis in adults admitted to Middlemore Hospital in Auckland, New Zealand. Method. Single-centre retrospective cohort study from 2009 to 2014. Patients ≥16 years of age were identified using ICD-10AM coding data. Electronic records were reviewed for demographic, clinical, laboratory, treatment and outcome data. Total and hemi-arthroplasty infections were excluded. Results. 543 episodes in 521 patients were included, with 90% fulfilling Modified Newman's criteria. Septic arthritis incidence was 26/100,000 patient years and was unchanged over the study period. Incidence correlated strongly with age (R. 2. =0.79) and socioeconomic deprivation (R. 2. =0.76). Median age was 49 years, and gender 70% male. Ethnicity was Pacific Island in 36% (22.8% of catchment population). The most commonly involved joints were hand interphalangeal (19%), knee (19%), metacarpophalangeal (17%) and glenohumeral (11%). Arthritis was monoarticular in 93%. Underlying conditions included current smoking (42%), osteoarthritis (29%), diabetes (22%) and gout (15%). Rheumatoid and seronegative arthritis were uncommon (each 2%). Skin/soft tissue infection occurred within 3 months prior in 38%. Osteomyelitis occurred in 26%. Sources of infection included haematogenous (42%), traumatic (34%), and iatrogenic (17%). Causative
Purpose: Prophylactic antibiotics are frequently withheld until cultures are obtained in revision TKA. A prospective study was undertaken to determine whether prophylactic pre-operative IV antibiotics would affect the results of cultures obtained intra-operatively. Method: A consecutive series of 25 TKA’s with a known infecting organism were enrolled over 36 months. Inclusion criteria: clinically infected TKA, a known preoperative infecting organism, and no recent antibiotic therapy. Re-aspiration of the infected TKA was performed following anesthesia and sterile prep. IV antibiotic prophylaxis was then administered and the tourniquet was then inflated. Intra-operative culture swabs and tissue were obtained at arthrotomy. The timing of events was recorded. Pre/post antibiotic culture data were analyzed to determine the effect of IV preoperative prophylactic antibiotics on cultures obtained intra-operatively. Results: Mean time from end of antibiotic infusion to tourniquet inflation was 15 minutes; to arthrotomy culture was 25 minutes. In all 25 knees the
The infected joint arthroplasty continues to be a very challenging problem. Its management remains expensive, and places an increasing burden on health care systems. It also leads to a long and difficult course for the patient, and frequently a suboptimal functional outcome. The choice of a particular treatment program will be influenced by a number of factors. These include the acuteness or chronicity of the infection; the infecting
The infected joint arthroplasty continues to be a very challenging problem. Its management remains expensive, and places an increasing burden on health care systems. It also leads to a long and difficult course for the patient, and frequently a sub optimal functional outcome. The choice of a particular treatment program will be influenced by a number of factors. These include the acuteness or chronicity of the infection; the infecting
Introduction: Intraoperative tissue culture remains the “gold standard” in diagnosing periprosthetic infection (PPI). However, an organism is not always cultured and this has been attributed to the fact that preoperative antibiotics were administered. This study intends to examine if preoperative antibiotics prevent isolation of intraoperative organisms. Methods: 91 total joint arthroplasty patients diagnosed with PPI during (1999–2005) and who had positive aspiration culture were included in the study. All intravenous antibiotics that were given to the patient within seven days of surgery were documented. The total number of positive intraoperative fluid and tissue samples of patients who did and did not receive antibiotics was calculated. Susceptibility of the
The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined.Aims
Methods
An acute infection in the first few weeks postoperatively or an acute haematogenous infection in a previously well functioning and well-fixed prosthesis can be managed with open debridement and postoperative intravenous antibiotics for 4 to 6 weeks. Infrequently, elderly patients with a well-fixed prosthesis, absence of drainage, and acceptable pain can be treated with aspiration and chronic oral antibiotic suppression. Treatment of chronic infection requires implant removal and assessment of functional requirements, soft-tissue envelope status, extent of bone loss, and the integrity of the extensor mechanism. Disruption of the extensor mechanism or a poor soft-tissue envelope usually suggests arthrodesis. Definitive resection arthroplasty or above-the-knee amputation is rarely required. If the decision is made to proceed with reimplantation, a delayed two-stage approach is preferred and strongly recommended. After resection, antibiotic-impregnated spacers are implanted using an antibiotic that will be effective for the offending organism. The most common antibiotics used include a combination of vancomycin and tobramycin in a ratio of 3 g of vancomycin and 3.6 g of tobramycin powder per 40 g batch of bone cement. Most patients are treated with a 4–6 week course of intravenous antibiotics and also receive erythropoeitin alpha to improve their haemoglobin level between the time of resection arthroplasty and reimplantation. Reimplantation of another prosthesis is performed as soon as it is convenient after the conclusion of the intravenous antibiotics. If there is concern about persistent infection, aspiration or debridement for retrieval of tissue culture, with delayed implantation until culture results are available, can be performed. Most patients are empirically reimplanted based on the appearance of tissues at revision surgery and histological analysis of fresh-frozen tissue samples. Antibiotic-impregnated bone cement is used for prosthesis fixation with the antibiotic choice based on sensitivity tests from the original offending
Periprosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). Two-stage revision has traditionally been considered the gold standard of treatment for established infection, but increasing evidence is emerging in support of one-stage exchange for selected patients. The objective of this study was to determine the outcomes of single-stage revision TKA for PJI, with mid-term follow-up. A total of 84 patients, with a mean age of 68 years (36 to 92), underwent single-stage revision TKA for confirmed PJI at a single institution between 2006 and 2016. In all, 37 patients (44%) were treated for an infected primary TKA, while the majority presented with infected revisions: 31 had undergone one previous revision (36.9%) and 16 had multiple prior revisions (19.1%). Contraindications to single-stage exchange included systemic sepsis, extensive bone or soft-tissue loss, extensor mechanism failure, or if primary wound closure was unlikely to be achievable. Patients were not excluded for culture-negative PJI or the presence of a sinus.Aims
Methods