Characteristics and outcome of 16 periprosthetic shoulder joint infections

Achermann, Yvonne; Şahin, Fahri; Hk, Schwyzer; Kolling, Christoph; Wüst, J; Vogt, Markus

doi:10.1007/s15010-012-0360-4

Cited by 90 publications

(60 citation statements)

References 36 publications

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“…The implementation of algorithms seems beneficial to establish clinical recommendations that can be followed even by the non-expert. Even though established for hip and knee joint prostheses, and suggested for other PJI [29,30], very few data is available on the actual implementation in clinical routine [4,5,7,12]. We are therefore presenting the results of our PJI algorithm in clinical day-to-day routine on a collective of 147 cases without selection bias or exclusion criteria.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Wimmer

Randau

Petersdorf

et al. 2013

International Orthopaedics (SICOT)

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Purpose Current concepts in the treatment of prosthetic joint infections include prosthetic retention and exchange strategies according to published recommendations. A useful algorithm should fit for each type of prosthetic joint infection, even the most complicated situations. We present the outcome of 147 patients with prosthetic joint infections of the hip or the knee joint in an unselected population in clinical routine. Methods Between November 2006 and November 2009, 147 consecutive patients with prosthetic joint infections of the hip or knee were treated according to an algorithm based on the concept published by Zimmerli et al. in 2004. Causative organism, duration of infection, patient comorbidities, surgical treatment, antibiotic treatment, and outcome of treatment were analysed retrospectively. According to the criteria duration of infection, stability of prosthesis, local and systemic risk factors, and susceptibility of the causative pathogen, patients were treated either with debridement and retention or a longinterval two-stage procedure. Results A pathogen could be detected in 82.8 % of the patients, gram-positive cocci being most common. Twentyseven patients were treated with debridement and retention and 120 were treated with a two-stage procedure. In 68 cases difficult-to-treat pathogens could be detected, a polymicrobial infection was found in 51 patients. Definitely free of infection were 71.6 % after a two-stage procedure, and 70.4 % after debridement and retention. Conclusions Our data indicates that the applied algorithm is suitable to be applied as a day-to-day routine, and we confirmed that published results from the literature can be reproduced in an inhomogeneous patient cohort.

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Section: Discussionmentioning

confidence: 99%

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Wimmer

Randau

Petersdorf

et al. 2013

International Orthopaedics (SICOT)

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“…13-17 Shoulder ODRIs, however, may have higher Propionibacterium (P.) acnes prevalence, at up to 38%. 19 Recently, more attention has been focussed upon polymicrobial infections, which may account for 10%-20% of cases. 13,14,17 Furthermore, studies using molecular diagnostic techniques indicate that, in addition, there is a significant proportion (5%-34%) of culture-negative infections.…”

Section: The Clinical and Microbiological Challenges Of Modern Devicementioning

confidence: 99%

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

et al. 2016

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Orthopaedic and trauma device-related infection (ODRI) remains one of the major complications in modern trauma and orthopaedic surgery.Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, leading to infections that negatively impact clinical outcome and significantly increase healthcare expenditure.The following review summarises the microbiological profile of modern ODRI, the impact antibiotic resistance has on treatment outcomes, and some of the principles and weaknesses of the current systemic and local antibiotic delivery strategies.The emerging novel strategies aimed at preventing or treating ODRI will be reviewed. Particular attention will be paid to the potential for clinical impact in the coming decades, when such interventions are likely to be critically important.The review focuses on this problem from an interdisciplinary perspective, including basic science innovations and best practice in infectious disease. IntroductionOrthopaedic and trauma device-related infection (ODRI) remains a major complication in modern trauma and orthopaedic surgery. 1 Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, and can lead to infections that negatively impact clinical outcome and significantly increase healthcare expenditure. 2 Pre-operative and correctly-timed prophylactic antibiotic intervention is mandatory for a majority of orthopaedic procedures. However, despite this, the incidence of infection following elective orthopaedic surgery is in the range of 0.7% to 4.2%, 3-7 while the incidence can be much higher in trauma cases where infection rates range from approximately 1% after operative fixation of closed low-energy fractures, to more than 30% in complex open tibia fractures. 8,9 Treatment success rates vary, with between 57% and 88% often reported. [10][11][12] Current curative approaches (radical debridement, revision surgery and prolonged antibiotic therapy) often result in significant socioeconomic costs, not to mention the risk of life-long functional impairment for the patient. Against this background, and with the increasing issue of antibiotic-resistant bacteria, the problem of ODRI is set to continue to pose a challenge for practising clinicians in the coming decades. The clinical and microbiological challenges of modern device-related infectionsThe most prevalent species in ODRIs are Staphylococci. [13][14][15][16][17] Staphylococcus (S.) aureus accounts for between 20% and 30% of cases of infection after fracture fixation and prosthetic joint infections (PJI), with coagulase-negative staphylococci (CoNS) accounting for 20%-40% of cases, [13][14][15][16] including small colony variants. 18 Other Gram-positive cocci including Streptococci (1%-10%) and Enterococci (3%-7%) are less frequently encountered. Infections caused by Gram-negative bacilli, including Pseudomonas aeruginosa and Enterobacteriaceae account for approximately 6%-17%, [13][14][15][16...

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“…Penicillin and ceftriaxone are recommended first line therapies [1]. One study suggested that one-stage exchange of the prosthesis may be possible [53]. In an animal model study, the combination of daptomycin and rifampin was associated with a cure rate of 63% [72], which was higher than other agents used in conjunction with rifampin, including vancomycin, penicillin G, ceftriaxone, levofloxacin and clindamycin.…”

Section: Treatmentmentioning

confidence: 99%

Anaerobic prosthetic joint infection

et al. 2015

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Characteristics and outcome of 16 periprosthetic shoulder joint infections

Abstract: As recommended for hip and knee PJI, we suggest treating shoulder PJI with a low-grade infection by microorganisms such as P. acnes with an exchange of the prosthesis. Cohort studies are needed to verify our results.

Cited by 90 publications

References 36 publications

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

Anaerobic prosthetic joint infection

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