Aim

Prosthetic joint infection (PJI) due to Candida spp. is a severe complication of arthroplasty but is little reported. This study describes Candida PJI epidemiology, management, and outcome.

Aims

To evaluate the place of the massive prostheses in the most complex periprosthetic infections cases (PJis).

Aim

Gram negative bacteria (GNB) are emerging pathogens in chronic post-traumatic osteomyelitis. However, data on multi-drug (MDR) and extensively drug resistant (XDR) GNB are sparse.

Aim

The aim of our study was to identify pathogens involved in septic knee arthritis after ACLR and to describe clinical features, treatment and outcome of infected patients.

Aim

Data on Prosthetic joint infection (PJI) caused by multi-drug resistant (MDR) or XDR (extensively drug resistant) Gram negative bacteria (GNB) are limited. Treatment options are also restricted. We conducted a multi-national, multi-center assessment of clinical data and factors of outcome for these infections.

Aim

In private healthcare facilities, the access to a specialized infectious disease (ID) advice is difficult. More, the lack of traceability is problematic and harmful for treatment and follow-up. We have tested an information technology (IT) application to improve medical transmission and evaluate an interdisciplinary ID activity.

Aim

Pre-operative distinction between prosthetic joint infections (PJI) and non-infectious causes of joint failure is particularly challenging, especially in chronic situations. Guidelines propose different algorithms using numerous preoperative tests. We evaluated place of serology.

Aim

European population is ageing concurrently with an increase number of arthroplasties. Prosthetic joint infection (PJI) in the elderly is considered more severe. The aim of this study is to describe PJI's management of patients over 79 years of age.

Aim

Ceftobiprole, a broad-spectrum cephalosporin, could be used for post-operative treatment of bone implant-associated infections. The aim of the study is to evaluate the in vitro susceptibility of bacteria isolated from bone implant-associated infections to ceftobiprole.

Aim

Prosthetic joint infections (PJI) due to Enterobacter cloacae are rare and often severe. The aim of this study is to describe cases with E. cloacae PJI.

Aim

When a prosthetic joint infection (PJI) is suspected, guidelines recommend performing periprosthetic samples, at least one for histopathological examination and 3 to 6 for microbiological culture. The diagnosis of infection is based on the presence of neutrophil granulocytes whose number and morphology can be variable, resulting in definition of “acute” inflammation. The acute inflammation of periprosthetic tissue is supportive of infection. Since 2007, in our hospital, for all patients with suspected PJI who underwent surgery, from each sample taken by the surgeon, one part has been sent to the pathologist and the other one to the microbiologist. Our aim was to compare histopathological to microbiological results from samples taken intraoperatively at the same site.

To evaluate the value of the use of massive prostheses in periprosthetic infections both in one stage and two stages procedures

Between 2008 and 2014, 236 revisions for PJI had been performed in our hospital by the same surgeon. For the most complex cases, we decided to introduce megaprostheses in our practice in 2011.

We report a prospective series of 33 infected patients treated between 2011 and the end of 2014, 14 male and 19 female with on average 67.9 years old (38–85) Infection involved TKA in 22 cases (17 TKA revisions, 4 primary TKA), THA in 9 cases (6 revisions, 3 primary THA), a femoral pseudo-arthrosis with posttraumatic gonarthrosis in one case and a septic humeral pseudoarthrosis in one case. We used a total femoral component for two patients: the first one for a hip PJI with extended diaphyseal bone loss and multiples sinus tracks, and the second one for a massive infected knee prosthesis used in a knee reconstruction for liposarcoma.

We used one stage procedures in 20 cases (8 hips, 12 knees, 1 shoulder) and two stages in 13 cases (12 knees and 1 hip). Additional technics included 3 massive extensor system allografts, two local flaps. Perioperative hyperbaric treatment was used for 2 patients.

The average follow up is 19.8 months (6–48 months). The most frequent complications were wound swelling and delayed healing in 8 cases;). In 3 cases of one stage surgery a complementary debridement was necessary in the three weeks after the surgery with always a good local and infectious evolution. VAC therapy was used in four cases with good results. We report one early postoperative dead.

In summary, the use of massive prostheses in PJI is a good option for complex cases. It can be a good alternative to knee arthrodesis. These components must be used preferentially for older patients, in cases of extreme bone loss or extensive osteomyelitis to secure the bone debridement and the quality of the reconstruction.

In our series, the one stage procedure is a validated option even by using complementary technics as bone allografts, extensor system allografts or flaps. We believe the two stages surgery is a secondary option, particularly when soft tissues status is compromised before or after the debridement, and mostly for the knees. The longevity of the implantation must be evaluate by a long term follow up.

Tc 99m labelled leukocytes scintigraphy (LLS) could be useful for the diagnosis of bone and joint infections. The aim of our study was to evaluate its performances specifically in the diagnosis of prosthetic joint infection (PJI).

We conducted a multicenter -7 year- retrospective study including 164 patients with suspected PJI who underwent surgical treatment. In each case, 5 intraoperative samples were taken. Diagnosis of infection was confirmed if two or more samples yielded the same microbial agent. LLS was considered as « positive » if an accumulation of leukocytes was observed in early stage and increased in late stage (24 hours). Among these patients, 123 had also a bone scintigraphy.

A total of 168 PJ were analyzed: 150 by in vitro polymorphonuclear labelled leukocytes scintigraphy (PLLS) and 18 by anti-granulocytes antibodies labelled leukocytes scintigraphy (LeukoScan®). Location of PJ were: hip (n = 63), knee (n = 71), miscellaneous (n = 4). According to microbiological criteria 62 hip prosthesis and 48 knee prosthesis were considered as infected. Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV) and Negative Predictive Value of PLLS were: 72%, 60%, 80% and 47%. Se of LLS was higher for knee PJI (87%) than for hip PJI (57%) [p = 0.002]. Although Sp was higher for hip PJI (75%) than for knee PJI (52%) [p = 0.002]. The lowest Se was found for coagulase negative staphylococci (70%) and the highest for streptococci (87.5%). However the difference of Se between bacteria was not significant. Regarding bone scintigraphy, Se, Sp, PPV and NPV were: 94%, 11%, 65% and 50%.

In our study, performances of LLS were rather low and varied according to the location of infection. Differences of LLS Se between bacteria was not significant. Bone scintigraphy has a high Se but lacks Sp.

To evaluate a innovate one stage procedure of the PJI knee treatment using computed assisted guidance. Our objectives; to increase the functional results by optimizing the anatomical joint reconstruction and to verifie if CAS help to simplifie and standardize these complex surgeries

It's a prospective, single surgeon study. Since septembre 2011, 41 patients treated for chronic knee PJI in a one stage revision (one of them had a ipsilateral chronic knee arthritis). For all of them, a computed assisted guidance, the ExactechGPS® system was used. This system offers the possibility to define specific profiles to performe primary TKA surgeries. A personnalized profile of revision was created.

All surgeries were performed with the same protocole; independently of the type of germ, with no use of tourniquet, no drainage by performing the same debridement procedure step by step and by using the same knee components

27 males, 14 female with 26 PJI of primary TKA, one infected unicompartimental prosthesis and 15 PJI of first revised TKA has been treated. The average age was 71 years old (55–87). The time of surgery was on average 135 mn (120 – 195 mn). The average time of hospitalization was 10 days (7–16). The average follow up was 20,9 months (6–47 months). The ROM were on average 114,7% (90°–130°), None post operative HKA outliers were reported.

3 patients presented a failure of the PJI treatment (one after a local open traumatism, one diabetic patient, one after a early revision for mechanical complication). None specific CAS complications and no failure of the CAS procedures are reported. As surgeon, CAS simplified the management of the bone loss after debridement and the control of the differents parameters (HKA, external femoral rotation, ligamentary balancing, lign joint…) by a real time feedback. we changed our practise by using more constraint condylar component instead hinge prostheses

With a rate of success of 92,7% at this follow up, the one stage option appears to be valided. Using CAS is a safe option with no specific complication. It increases the quality of the ROM, a earlier functional recovery and a better middle term clinical result. Both combined, It should be a optimal medicoeconomical solution.

compared revision using mechanical ancillary.

The objective was to compare susceptibility testing of all coagulase negative species (CNS) found in periprosthetic joint infections (PJI).

We conducted a multicentre retrospective study in a same area from 2011 to 2014, including 215 CNS strains.

Diagnosis of PJI was based on clinical, radiological and biological criteria. Microbiological criterion was at least 2 per-operative deep positive cultures with the same species of CNS. Identification and susceptibility testing were performed on automated Vitek2 (Biomérieux, France).

PJI localizations were 54% knees, 39% hips, 7% other sites.

CNS found in our study were by dicreasing order:

S. epidermidis (SE) 60%, S. capitis 11%, S. lugdunensis (SL) 10%, S. caprae 5%, S. warneri (SW) 4%, S. hominis (SHo) 3%, S. haemolyticus (SHa) 3%. Fifty two percent of CNS strains were meticillin (oxacillin) resistant and 31%, 33%, 41%, 20% were also resistant to clindamycin (CLI), trimethoprim-sulfamethoxazole (SXT), ofloxacin (OFX), rifampicin (RMP) respectively. Regarding CNS species, meticillin resistance was detected for 70% SE, 71% SHo and 71% SHa. SE was the most resistant species, with 34% of the strains resistant to CLI, SXT, OFX and RMP simultaneously. Half of SE and SHa were resistant to the reference treatment levofloxacin+rifampicin. Thirteen percent of CNS were resistant to teicoplanin and only 1% to vancomycin.

Susceptibility testing profiles are presented in table field.

In our study, S. epidermidis was the main species found in PJI. Emerging species like S. lugdunensis or S. caprae were found, with more susceptible antibiotic profiles. The most active antibiotics in vitro were daptomycin, linezolid, vancomycin and teicoplanin.

PJI du to Enterobacter cloacae are rare and often severe. The aim of our study is to define the history of patients with such infections and their outcome.

We conducted a retrospective monocentric study in an orthopedic unit where complex bone and joint infections are supported. From 2011 to 214 we selected patients with E. cloacae PJI based on data from the microbiology laboratory. In their files we collected information on their background, their medical and surgical history, antibiotics they received in the year before infection, the suspected portal of entry, the management and the outcome.

Twelve patients were included, 7 male and 5 female. PJI was located to the hip in 8 cases, the knee in 3 cases and the ankle in one case. The average time between the placing of the first prosthesis and infection was 3 years. Eleven patients had one or more surgery for previous PJI. The average time elapsed since the last surgery was 30 days. Eleven patients had been treated with antibiotic combinations for at least 6 weeks, in the year before E cloacae infection. A portal of entry was identified only two times: urinary tract infection in one patient and catheter-related infection in one patient. Antibiotics the more often prescribed were carbapenems (n = 5) and cefepime (n = 4), each combined with quinolones (n =4) or fosfomycin (n = 3). Two patients required an additional debridement within an average of 18 days. Infectious outcome was favorable in 8 cases (67%) with a median duration of follow-up of 26 months. Two patients had a recurrent infection, one due to Streptococcus oralis and one to Candida albicans. One patient had a relapse of E cloacae infection. One patient died from unknown cause.

PJI infections due to E.cloacae usually occur early after prosthetic surgery, typically in patients with complex surgical history. Despite a high rate of multi-resistance to antibiotics, outcome may be favorable in a large majority of patients.

Purpose of the study: Propionibacterium acnes (PBA) is an anaerobic Gram-positive commensal bacillus of human skin which can cause bone and joint infections (Lutz 2005, Zeller 200, Levy 2008). The purpose of this work was to evaluate over a given period the frequency of PBA infections and the reality of its role as a pathogenic organism.

Material and methods: A retrospective survey of activity from 2006 to 2008 using bacteriology laboratory data identified 34 patients (22 male and 12 female) with at least one sample collected during an orthopaedic or traumatology surgical procedure that was positive for PBA. The mean number of positive samples was 3.6; 17 from the thoracic limb, 17 from the pelvic limb, involving 16 arthroplasties (4 hips, 6 knees, 5 shoulders, 1 elbow), 13 osteosynthesis procedures, 3 cuff repairs and 1 acromioclavicular procedure. Six of 20 histology samples showed a septic granuloma.

Results: The PBA was the only germ isolated in 18 cases; it was associated with other bacteria in 16 cases. Other blood tests were abnormal (WBC 6800 leukocytes, CRP 25mg/L en average). According to the Lutz classification, three groups of infection could be identified: certain infection with clinical signs and at least two positive samples (n=12), possible with clinical signs but only one positive sample (n=5), and probable without clinical signs and one or more positive samples (n=17). Of the 12 patients in the first group, eight had material (three shoulder prostheses, three hips, one knee and one femoral nail), which had to be removed for six with use of a cemented spacer in four. Mean duration of antibiotics was five weeks. Four patients in this group have not yet achieved cure. In the second group, all samples were taken from a thoracic limb and had another germ in four cases; all patients have achieved cure. In the third group, the samples were systematic (two shoulder arthroplasties, two repeated cuff repairs, five revision prostheses, four nonunions and four material removal); only one sample was positive in ten cases and only five patients were given antibiotics; all achieve cure.

Discussion: This series is in agreement with the literature: frequent localization on a thoracic limb, association with another germ, questionable attribution to PBA. Patients meeting the criteria of the first group should be treated. If a PBA infection is suspected, samples should be repeated, with prolonged culture; this attitude should be validated prospectively.

Purpose: Prevention of post-trauma infections is basically aimed at streptococcal, staphylococcal and anaerobic germs. An increasing number of open fractures are however contaminated with Bacillus cereus leading to a multidisciplinary discussion involving infectious disease specialists, orthopaedic surgeons, and bacteriologists concerning the appropriate management. Bacillus is an ubiquitous genus of sporulated telluric Gram positive germs found in soil and plants. B. cereus can lead to local wound infection. This environmental (including hospital) bacterium is often a temporary host of the skin flora and its isolation can be taken as a simple contamination with no therapeutic consequence. B. cereus is sensitive to fluoroquinolones.

Material and methods: Between August 1995 and December 2000, B. cereus was isolated in 41 patients from surgical specimens taken from deep muscle and bone tissues. Ordinary medium was used for culture. Genomic analysis was used to type the Bacillus. Statistical analysis was conducted in cooperation with the epidemiology unit.

Results: In our unit, isolation of B. cereus was significantly associated with severe open leg fractures (Gustilo grades IIA and IIIB) with soil contamination. Samples were taken due to fever, wound discharge, elevation of C reactive protein despite antibiotic prophylaxis beyond 48 hours using the standard protocol of aminopenicillin + betalactamase inhibitor, constantly inactive against B. cereus. The strains identified presented different genomic types ruling out nosocomial contramination. One amputation, one chronic osteitis and one anteriolateral leg compartment necrosis resulted from B. cereus infection in this series.

Conclusion: Arguments developed here allow us to recall the importance of careful surgical debridement of open fractures and to emphasise the requirement for bacteriological samples and appropriate antibiotic therapy for 48 hours, combining, in agreement with the 1998 Consensus Conference, aminopenicillin + betalactamase inhibitor and gentamycin which is active against B. cereus. Severe open leg fractures which follow an unfavourable course should suggest possible B. cereus infection requiring early antibiotic therapy using a regimen with good bone diffusion including a fluoroquinolone which is always active against B. cereus.