Mortality During Total Knee Periprosthetic Joint Infection

Lum, Zachary C.; Natsuhara, Kyle M.; Shelton, Trevor J.; Giordani, Mauro; Pereira, Gavin; Meehan, John P.

doi:10.1016/j.arth.2018.08.021

Cited by 175 publications

(85 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite the great efforts made to provide effective treatment for S. aureus PJIs, it has proven to be associated with high mortality rates 49 . Previous reports of PJI-related one-year mortality have ranged from 4% to 8% [50][51][52] . The one-year mortality rate in this present cohort was 15%, highlighting that S. aureus infections are serious complications of prosthetic joint surgery.…”

Section: Discussionmentioning

confidence: 99%

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

View full text Add to dashboard Cite

Staphylococcus aureus is a commensal colonizing the skin and mucous membranes. it can also act as a pathogen, and is the most common microorganism isolated from prosthetic joint infections (PJIs). The aim of this study was to explore the genomic relatedness between commensal and PJI S. aureus strains as well as microbial traits and host-related risk factors for treatment failure. Whole-genome sequencing (WGS) was performed on S. aureus isolates obtained from PJIs (n = 100) and control isolates from nares (n = 101). Corresponding clinical data for the PJI patients were extracted from medical records. No PJI-specific clusters were found in the WGS phylogeny, and the distribution of the various clonal complexes and prevalence of virulence genes among isolates from PJIs and nares was almost equal. Isolates from patients with treatment success and failure were genetically very similar, while the presence of an antibiotic-resistant phenotype and the use of non-biofilm-active antimicrobial treatment were both associated with failure.In conclusion, commensal and PJI isolates of S. aureus in arthroplasty patients were genetically indistinguishable, suggesting that commensal S. aureus clones are capable of causing PJIs. Furthermore, no association between genetic traits and outcome could be demonstrated, stressing the importance of patient-related factors in the treatment of S. aureus PJIs. Worldwide, millions of patients undergo arthroplasty surgery every year, with an expected increase in the coming years 1. Staphylococcus aureus is a major cause of both community-acquired and nosocomial infections, and is regularly reported to be the most common pathogen in prosthetic joint infections (PJIs) 2,3. Risk factors for developing PJIs are related to deficiencies in host defense due to age, obesity, previous surgery, smoking, and immune deficiencies (e.g. rheumatoid arthritis, diabetes mellitus), as well as exogenous factors such as timing and selection of antibiotic prophylaxis, extended operation time, and blood transfusions 4-8. Implant-sparing curative treatment of acute PJIs, whether occurring early in the postoperative period or later through hematogenous seeding, relies on a regimen of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) 9. This is possible, provided that the infection has not persisted for more than approximately three weeks and that the isolate is susceptible to biofilm-active antibiotic treatment (i.e. rifampin for staphylococcal infections) 10. However, there are reports suggesting an even shorter time to intervention is needed for a successful treatment 11,12. The impact of risk factors on outcome of treatment has not been fully explored, but recent reports have proposed new risk scores to better guide the choice of treatment 13-15. S. aureus is a commensal of the human skin, nares, and mucous membranes, but also a human pathogen due to its invasive capacity. S. aureus infections occur among both otherwise-healthy individuals and those with co-morbidities, and nasal carriage...

show abstract

Section: Discussionmentioning

confidence: 99%

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Wildeman

Tevell

Eriksson

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…The prevention, diagnosis, and treatment of PJI is still a global problem. Besides, it costs a tremendous amount of funds for treatment, increases mortality, and seriously affects the physical and mental health and quality of life of patients [6][7][8][9][10]. What's more, PJI will bring frightening sequelae to patients, such as a severe decline in joint function, depression, and even amputation [11].…”

Section: Introductionmentioning

confidence: 99%

The Global State and Development Trends of Research in Periprosthetic Joint Infection: A Bibliometric and Visualized Study

Zhang¹,

Fan²,

Xin³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Periprosthetic Joint Infection (PJI) remains a great challenge for joint orthopedic surgeons. The purpose of this study is to identify promising research directions by comprehensively analyze the global status and development trend of research in PJI based on bibliometrics and visual analysis.Methods: Overall the literature about PJI from 1994 to 2020 was searched from Web of Science Core Collection (WOSCC). The extracted data (author, journal, institution, country or region, research orientation, support fund, Cited situation) were analyzed by bibliometrics. VOSviewer was used for bibliographic coupling, co-citation, co-authorship, co-occurrence analysis. According to the results of visual analysis, this paper explores the global status and hot prediction direction of PJI.Results: A total of 2,283 eligible publications were retrieved. In terms of the trend of previous years, an increasing number of PJI publications will be published. Among the countries in the world, the United States has the largest contribution to the field of PJI. Although “Journal of Arthroplasty” has published the largest number of articles, the most influential journal is "Clinical Orthopaedics and Related Research”. Thomas Jefferson University has the largest number of publications of any organization. The study of PJI can be divided into four clusters: "Study on diagnosis", "Related risk factors", "Study on treatment", and "Study on anti-biofilm in vitro". The diagnosis and risk factors of PJI is considered to be a hot direction in the future direction.Conclusions: In recent years, the literature related to PJI has presented a continuous growth trend. The United States is the largest contributor to this field. More attention should be paid to the diagnostic and risk factors of PJI, which may be the future hot spots in this field.

show abstract

“…Total knee arthroplasty is a common surgical procedure, and the most common reason for failure is infection, termed periprosthetic joint infection (3, 4). S. aureus periprosthetic joint infection can be culture negative for prolonged periods (5, 6), has high failure rates above 50% once treatment is initiated (5), and a 5-year mortality of 20% (7–9), higher than many common cancers (10). Similar to other surgical implant associated infections, the challenge in treating this disease involves the ability of S. aureus to develop a chronic biofilm associated infection tolerant to antibiotics (11, 12).…”

Section: Introductionmentioning

confidence: 99%

The Toxin Antitoxin MazEF DrivesStaphylococcus aureusChronic Infection

Mandell

Donegan

et al. 2019

Preprint

View full text Add to dashboard Cite

48Staphylococcus aureus is the major organism responsible for surgical implant infections. 49Antimicrobial treatment of these infections often fails leading to expensive surgical intervention 50and increased risk of mortality to the patient. The challenge in treating these infections is 51 associated with the high tolerance of S. aureus biofilm to antibiotics. MazEF, a toxin-antitoxin 52 system, is thought to be an important regulator of this phenotype, but its physiological function 53 in S. aureus is controversial. Here, we examined the role of MazEF in developing chronic 54infections by comparing growth and antibiotic tolerance phenotypes in three S. aureus strains 55to their corresponding strains with disruption of mazF expression. Strains lacking mazF 56 production showed increased biofilm growth, and decreased biofilm antibiotic tolerance. 57Deletion of icaADBC in the mazF::tn background suppressed the growth phenotype observed 58with mazF-disrupted strains, suggesting the phenotype was ica-dependent. We confirmed 59 these phenotypes in our murine animal model. Loss of mazF resulted in increased bacterial 60 burden and decreased survival rate compared to its wild-type strain demonstrating that loss of 61the mazF gene caused an increase in S. aureus virulence. Although lack of mazF gene 62 expression increased S. aureus virulence, it was more susceptible to antibiotics in vivo. 63Combined, the ability of mazF to inhibit biofilm formation and promote biofilm antibiotic 64tolerance plays a critical role in transitioning from an acute to chronic infection that is difficult to 65 eradicate with antibiotics alone. 66 67Importance 68Surgical infections are one of the most common types of infections obtained in a hospital. 69Staphylococcus aureus is the most common pathogen associated with this infection. These 70infections are resilient and difficult to eradicate as the bacteria form a biofilm, a community of 71 bacteria held together by an extracellular matrix. Compared to bacteria floating in liquid, 72bacteria in a biofilm are more resistant to antibiotics. The mechanism behind how bacteria 73 develop this resistance and establish a chronic infection is unknown. We demonstrate that 74 mazEF, a toxin-antitoxin gene, inhibits biofilm formation and promotes biofilm antibiotic 75 tolerance which allows S. aureus to transition from an acute to chronic infection that cannot be 76 eradicated with antibiotics but is less virulent. This gene not only makes the bacteria more 77 tolerant to antibiotics but makes the bacteria more tolerant to the host. 78 79

show abstract

Mortality During Total Knee Periprosthetic Joint Infection

Cited by 175 publications

References 20 publications

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

Genomic characterization and outcome of prosthetic joint infections caused by Staphylococcus aureus

The Global State and Development Trends of Research in Periprosthetic Joint Infection: A Bibliometric and Visualized Study

The Toxin Antitoxin MazEF DrivesStaphylococcus aureusChronic Infection

Contact Info

Product

Resources

About