Corrigendum to “Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort” [Journal of Infection 83 (2021) 542–549]

Mancheño‐Losa, Mikel; Lora‐Tamayo, Jaime; Fernández-Sampedro, Marta; Rodríguez-Pardo, Dolors; Muñoz-Mahamud, Ernesto; Soldevila, Laura; Palou, Mariona; Toro, María Dolores del; Iribarren, José-Antonio; Benito, Natividad; Rico-Nieto, Alicia; Guío-Carrión, Laura; Gómez, Lucía; Escudero-Sánchez, Rosa; García-Pais, María José; Jover-Saénz, Alfredo; Praena, Julia; Baraia-Etxaburu, Josu; Auñón, Álvaro; Múñez-Rubio, Elena; Murillo, Óscar

doi:10.1016/j.jinf.2022.01.021

Cited by 3 publications

(5 citation statements)

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“…These findings are in accordance with data from revision procedures. Although studies show worse survival in patients with only one PIC than in patients with negative culture results [6, 8], other studies demonstrated that a single PIC did not result in a subsequent infection caused by the same microorganism [3, 9, 13]. Our data confirm that only one PIC is not clinically relevant; none of our patients with one PIC were treated with antibiotics, and there was no difference in survival compared with patients without PICs.…”

Section: Discussionsupporting

confidence: 70%

“…In these cases, patients often had inadequate surgical debridement; additionally, these unexpectedly positive cultures often resulted in a delay of antibiotic treatment. Although one might expect a higher failure rate of the implant during followup, studies are inconsistent [6,8]. Partial revision is a risk factor for failure in patients with unexpectedly positive cultures during revision surgery [6].…”

Section: Introductionmentioning

confidence: 99%

“…Although one might expect a higher failure rate of the implant during followup, studies are inconsistent [6,8]. Partial revision is a risk factor for failure in patients with unexpectedly positive cultures during revision surgery [6]. A partial revision of the acetabular component of the hip (cup revision) may be indicated for multiple reasons, most often septic or aseptic loosening, malposition, or dislocation and fracture.…”

Section: Introductionmentioning

confidence: 99%

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Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Ottink,

Dorleijn,

Spierenburg

et al. 2023

Clin Orthop Relat Res

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Background Positive intraoperative cultures (PICs) are encountered in some patients undergoing revision of the acetabular cup after a previous THA. It is unknown whether PIC of the cup indicates whether the stem is infected as well and what happens to the stem during follow-up. Questions/purposes (1) What proportion of patients undergoing THA who undergo cup revision have PICs? (2) What is the survival of the stem during follow-up in cup revisions with PICs versus that of those with negative cultures? (3) Does antibiotic treatment of PIC of the cup prevent revision THA during follow-up? Methods In this retrospective, comparative multicenter study, five surgeons at four centers performed 338 acetabular cup revisions between January 2015 and December 2017. After evaluating the data, we excluded one patient because of an incomplete dataset and 77 patients because fewer than three intraoperative cultures were obtained during surgery, leaving 260 patients for analysis. Follow-up was 2 years. Patients were stratified into three cohorts: no PIC, one PIC, and two or more PICs. Results The proportion of patients with one or more PIC was 15% (39 of 260). A total of 8% (21 of 260) had one and 7% (18 of 260) had two or more PICs. Stem survival was lower in patients with two or more PICs, but stem revision for periprosthetic joint infection was similar between groups. Two-year survival, which was defined as freedom from revision for any cause or infection, was 97% (95% confidence interval 95% to 99%) in the group without PICs, 100% (95% CI 95% to 100%) in the group with one PIC, and 86% (95% CI 68% to 100%; p = 0.08) in the group with two or more PICs. None of the patients in the no PIC and one PIC groups were treated with antibiotics. In the two or more PICs cohort, 12 of 18 patients were treated. The stem survived in one of 12 patients treated with antibiotics versus two of six patients who were not treated with antibiotics. Conclusion When treated with antibiotics, more than two PICs isolated during cup revision surgery do not have a major impact on survival of the stem during follow-up. A larger cohort of patients with PICs during cup revision might confirm these findings. Level of Evidence Level III, therapeutic study.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Ottink,

Dorleijn,

Spierenburg

et al. 2023

Clin Orthop Relat Res

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“…In a retrospective, observational, multicenter study involving 203 cases, treatment with biofilm-active antibiotics (rifampicin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and Gram-negative bacteria. For example, the combination fluoroquinolone/rifampicin for staphylococcal infections significantly reduced implant failure (2% compared to 11% in the control group) (168). However, despite these observations, no association between MBEC values (for oxacillin, daptomycin, levofloxacin, rifampicin and levofloxacin/rifampicin combinations) and clinical outcome was observed in a study with 88 patients with a S. aureus prosthetic joint infection (169).…”

Section: Prosthetic Joint Infectionsmentioning

confidence: 98%

Biofilm antimicrobial susceptibility testing: where are we and where could we be going?

Coenye

2023

Clin Microbiol Rev

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SUMMARY Our knowledge about the fundamental aspects of biofilm biology, including the mechanisms behind the reduced antimicrobial susceptibility of biofilms, has increased drastically over the last decades. However, this knowledge has so far not been translated into major changes in clinical practice. While the biofilm concept is increasingly on the radar of clinical microbiologists, physicians, and healthcare professionals in general, the standardized tools to study biofilms in the clinical microbiology laboratory are still lacking; one area in which this is particularly obvious is that of antimicrobial susceptibility testing (AST). It is generally accepted that the biofilm lifestyle has a tremendous impact on antibiotic susceptibility, yet AST is typically still carried out with planktonic cells. On top of that, the microenvironment at the site of infection is an important driver for microbial physiology and hence susceptibility; but this is poorly reflected in current AST methods. The goal of this review is to provide an overview of the state of the art concerning biofilm AST and highlight the knowledge gaps in this area. Subsequently, potential ways to improve biofilm-based AST will be discussed. Finally, bottlenecks currently preventing the use of biofilm AST in clinical practice, as well as the steps needed to get past these bottlenecks, will be discussed.

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“…When the intraoperative culture is unexpectedly positive-a fact that may not be known until days after the incision has been closed and the patient may already be home-the surgeon is faced with a dilemma: what to do with this bit of unwanted information. This is a practical and common situation that carries high stakes, because it may presage a repeat revision, this time for infection [3].…”

mentioning

confidence: 99%

CORR Insights®: Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Drew

2023

Clin Orthop Relat Res

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Corrigendum to “Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort” [Journal of Infection 83 (2021) 542–549]

Cited by 3 publications

References 0 publications

Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Biofilm antimicrobial susceptibility testing: where are we and where could we be going?

CORR Insights®: Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

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