Infections in Hip and Knee Arthroplasty: Challenges to and Chances for the Microbiological Laboratory

Schäfer, Peter; Fink, Bernd; Sandow, D; Frommelt, Lars

doi:10.5772/26035

Cited by 2 publications

(3 citation statements)

References 84 publications

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“…Examples of media that promote fungal isolations are ChromAgar Candida and Sabouraud Dextrose Agar. 25 , 26 Especially if suspicion on fungal PJI is high and routine cultures are negative it may be reasonable to employ alternative test methods that are optimized to support the growth of fungi as well as to operatively collect tissue samples.…”

Section: Discussionmentioning

confidence: 99%

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review

et al. 2015

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Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). A standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. In this systematic review, we collected data from 36 studies with a total of 45 reported cases of a TKA complicated by a fungal PJI. Subsequently, an analysis focusing on diagnostic, medicaments and surgical procedures in the pre-, intra- and postoperative period was performed. Candida spp. accounts for about 80% (36 out of 45 cases) of fungal PJIs and is therefore the most frequently reported pathogen. A systemic antifungal therapy was administered in all but one patient whereas a local antifungal therapy, e.g. the use of an impregnated spacer, is of inferior relevance. Resection arthroplasty with delayed re-implantation (two-stage revision) was the surgical treatment of choice. However, in 50% of all reported cases the surgical therapy was heterogeneous. The outcome under a combined therapy was moderate with recurrent fungal PJI in 11 patients and subsequent bacterial PJI as a main complication in 5 patients. In summary, this systematic review integrates data from up to date 45 reported cases of a fungal PJI of a TKA. On the basis of the current literature strategies for the treatment of this devastating complication after TKA are discussed.

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Section: Discussionmentioning

confidence: 99%

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review

et al. 2015

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“…The possible destruction of planktonic bacteria is an issue that has not been raised systematically to date. There also may be an increased risk of contamination [165,166].…”

Section: Discussionmentioning

confidence: 99%

“…On one hand, RNA should be present only in viable bacteria and therefore indicate active infections more accurately than DNA. On the other hand, the much shorter half-life of RNA should make its presence as a contaminant less likely [165].…”

Section: Discussionmentioning

confidence: 99%

Η Κλινική Εφαρμογή Των Μοριακών Τεχνικών Στη Διάγνωση Της Ορθοπαιδικής Λοίμωξης

Zegaer¹,

Ζιγκαέρ²

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Intraoperative conventional bacteriological cultures were compared with different polymerasechain reaction (PCR) methods in patients with total joint arthroplasties. The isolated bacteria wereinvestigated for biofilm formation, and the biofilm forming strains, in their planktonic and biofilmforms, were further tested for their antimicrobial resistance against several clinically importantantimicrobials. Forty four bone and joint samples were included and classified as infected or noninfectedaccording to standard criteria for periprosthetic hip and knee infections. For thebacteriological diagnosis, conventional culture, two types of universal PCR and species specificPCR for three selected pathogens (S. aureus, S. epidermidis, and P. aeruginosa) were applied.Biofilm formation determination was performed by the tissue culture plate method. Antimicrobialsusceptibility of the planktonic bacteria was performed by the minimal inhibitory concentrationdetermination and, of the biofilm forms, by the minimal inhibitory concentration for bacterial regrowthfrom the biofilm. Twenty samples were culture positive, with S. epidermidis, S. aureus orP. aeruginosa. All PCR methods were very ineffective in detecting only one pathogen. All isolateswere biofilm positive and their biofilm forms were highly resistant. In this study, compared toPCR, culture remains the “gold standard”. The biofilm formation by the causative bacteria and theconcomitant manifold increased antimicrobial resistance may explain the clinical failure oftreatment in some cases and should be considered in the future for therapeutic planning.

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Infections in Hip and Knee Arthroplasty: Challenges to and Chances for the Microbiological Laboratory

Cited by 2 publications

References 84 publications

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review

Fungal periprosthetic joint infection in total knee arthroplasty: a systematic review

Η Κλινική Εφαρμογή Των Μοριακών Τεχνικών Στη Διάγνωση Της Ορθοπαιδικής Λοίμωξης

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