Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Abstract

Background Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined. Questions/Purposes We asked (1) what is the proportion of enterococcal PJI in our institutes; and (2) what is the rate of infection control in these cases? Methods We respectively identified 22 and 14 joints with monomicrobial and polymicrobial PJI, respectively, caused by enterococcus. The diagnosis of PJI was made based on the presence of sinus tract or two positive intraoperative cultures. PJI was also considered in the presence of one positive intraoperative culture and abnormal serology. We determined the proportion of enterococcal PJI and management and control of infection in these cases. Minimum followup was 1.5 years (mean, 3.2 years). Results The proportion of monomicrobial enterococcal PJI was 2.3% (22 of 955 cases of PJI). Mean number of surgeries was two (range, 1-4). Initial irrigation and débridement was performed in 10 joints and eight patients needed reoperation. Seven of the 16 joints were initially managed using two-stage exchange arthroplasty and did not need further operation. Six patients had a definitive resection arthroplasty. Salvage surgeries (fusion and above-knee amputation) were performed in three cases (8%). The infection was ultimately controlled in 32 of the 36 patients.

Daptomycin in the treatment of prosthetic joint infection by Enterococcus faecalis: safety and efficacy of high-dose and prolonged therapy

“…1,2 In this case, we identified the pathogen in three periprosthetic biopsies and in two joint fluid samples, which confirmed its direct involvement in the infection.…”

“…1,5 This is the first published case to show the clinical efficacy and safety of treatment with a high dose of daptomycin (10 mg/kg/day) over a prolonged time (12 weeks) in a patient with a PJI caused by E. faecalis. Although daptomycin is not the initial drug of choice for PJI, it should be considered as a valid therapeutic option given its potent bactericidal activity maintained in biofilms, its good safety profile, and the possibility of administration on an outpatient basis.…”

“…Gram-positive bacteria, particularly Staphylococcus spp, are the most relevant microorganisms, and enterococci are involved in 2.3% of cases. 1 In penicillin-susceptible microorganisms and in the absence of high-level resistance to aminoglycosides, the preferred treatment for Enterococcus faecalis infections is the combination of ampicillin and aminoglycoside. Daptomycin is a novel cyclic lipopeptide antibiotic that exhibits a rapid bactericidal concentration-dependent action, killing cells through membrane lysis.…”

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips

“…Cases with identified difficult-to-treat bacteria were stratified for two-stage procedures [22,23], as were all cases with severe soft-tissue destruction, since the risk for failure with direct exchange is increased in these patients. In staphylococcal infections, a rifampin-containing regimen, and in Gram-negative infections, fluoroquinolone, was administered [19].…”

Características microbiológicas y patrones de resistencia en infecciones de prótesis articular en un hospital de referencia

“…Aunque no es un patógeno común para las infecciones ortopédicas, hay un número importante de informes que demuestran un incremento de las infecciones ortopédicas por Enterococcus spp. 23 Tornero E et al 24 realizaron un estudio multicéntrico para describir las características clínicas y microbiológicas de IPA por Enterococcus spp. en el estudio se muestra que aproximadamente el 9.3% de las IPA son causadas por estos microorganismos, siendo E. faecalis y Enterococcus faecium las especies que más se aíslan, principalmente en IPA polimicrobianas.…”