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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 2 - 2
1 Dec 2018
Jacobs A Valkering L Benard M Meis JF Goosen J
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Aim

Prosthetic Joint Infection (PJI) remains one of the leading cause for revision arthroplasty.1,2 Early recognition and appropriate initial treatment of early PJI with debridement, antibiotics and implant retention (DAIR) can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after one year of patients who were treated for an early PJI after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) with DAIR. Furthermore, we determined preoperative infection markers, microbiology, and treatment factors related to treatment failure after DAIR procedure.

Method

A retrospective cohort study was assembled with 91 patients undergoing DAIR after primary TKA or THP with a high suspicion of an early PJI. For all patients intraoperative cultures were obtained. Records were reviewed for demographic details, preoperative laboratory results, microbiological data, given treatment and postoperative follow-up. The primary outcome measure was infection-free implant survival at one year. Repeated DAIR was not considered as treatment failure.


The Bone & Joint Journal
Vol. 99-B, Issue 11 | Pages 1482 - 1489
1 Nov 2017
Jacobs AME BĂ©nard M Meis JF van Hellemondt G Goosen JHM

Aims

Positive cultures are not uncommon in cases of revision total knee and hip arthroplasty (TKA and THA) for presumed aseptic causes. The purpose of this study was to assess the incidence of positive intra-operative cultures in presumed aseptic revision of TKA and THA, and to determine whether the presence of intra-operative positive cultures results in inferior survival in such cases.

Patients and Methods

A retrospective cohort study was assembled with 679 patients undergoing revision knee (340 cases) or hip arthroplasty (339 cases) for presumed aseptic causes. For all patients three or more separate intra-operative cultures were obtained. Patients were diagnosed with a previously unsuspected prosthetic joint infection (PJI) if two or more cultures were positive with the same organism. Records were reviewed for demographic details, pre-operative laboratory results and culture results. The primary outcome measure was infection-free implant survival at two years.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 3 - 3
1 Dec 2016
Jacobs A Menno B Meis JF Van Hellemondt G Goosen J
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Aim

Despite a preoperative workup with no evidence to suspect a prosthetic joint infection (PJI) before revision surgery, routinely obtained intraoperative cultures still can be unexpectedly positive. The purpose of this study was (1) to assess the incidence of unexpected positive intraoperative cultures in presumed aseptic knee and hip revisions and (2) to determine whether a difference exists between the infection-free implant survival rate of patients with and without unexpected positive intraoperative cultures.

Method

We selected patients who underwent a one-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for different reasons. Three or more separate intraoperative cultures were obtained during each procedure. A negative result was defined as less than two positive cultures with the same microorganism. An unsuspected PJI was defined as having two or more positive cultures with the same microorganism. Patients’ medical records were reviewed to collect demographics, preoperative laboratory results, culture results, and the occurrence of infection during follow-up.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 337 - 337
1 Jul 2011
Verhulst FV Meis JF De Man FH
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Background: Proprionibacterium acnes (P. acnes) is a skin commensal which is often interpreted as a contaminant when found in cultures of surgical specimens. However, recent reports suggest that P. acnes can be identified as the causative micro-organism of infection. Furthermore P. acnes infections occur more often after shoulder surgery than after surgery of the lower extremities or spine. The aim of this study was to identify how frequent P. acnes was responsible for infection after orthopaedic surgery of the shoulder, lower extremity and spine in a single centre.

Patients and Methods: Inclusion criteria were the occurrence of infection after surgery of the shoulder, lower extremity (hip and knee), or spine in a 100-bed orthopaedic hospital. The inclusion period was between January 2000 and May 2008. Infection was defined when two or more cultures were positive with the same microorganism in the presence of clinical signs and symptoms. The first goal was to identify the incidence of infection due to P. acnes amongst all infections. The secondary outcome was the incidence of infection versus contamination amongst all cases with positive cultures for P. acnes. Both outcomes were compared for surgery of the shoulder, lower extremity and spine.

Results: A total of 3703 surgeries of the shoulder were performed, compared to 19906 lower extremity- and 5687 spine surgeries. The incidence of infection after surgery of the shoulder was 1.4% (52 cases; prosthesis [n=23], fractures [n=5], soft tissue surgery [n=16] and others [n=8]). After surgery of the lower extremity and spine this was 2.8% (548 cases) and 3.1% (177 cases), respectively. The incidence of infection due to P. acnes after shoulder surgery (23%) was significantly greater then after surgery of the lower extremity (1.3%; p < 0.001) or spine (0%; p < 0.001). Furthermore, in cases where P. acnes was cultured after surgery of the shoulder it was more often identified as the causative pathogen of infection than when P. acnes was cultured after surgery of the lower extremity or spine (71% vs 22%; p < 0.05 and 71% vs 0%; p < 0.01).

Conclusion: The low virulent P. acnes can cause orthopaedic surgical infections and should not be regarded a priori as a contaminant in cultures. This is especially true for shoulder surgery, where P. acnes infections occur frequently and significantly more often than in surgery of other joints.