Mycobacterial periprosthetic joint infection after primary total knee arthroplasty

Hwang, Bo-Hyun; Lee, Su-Chan; Ong, Alvin; Ahn, Hye-Sun; Moon, Seong-Hwan

doi:10.1007/s00264-021-05029-x

Cited by 4 publications

(9 citation statements)

References 33 publications

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“…There were 58 RGM infections recorded, with M. fortuitum ( n = 28) and M. abscessus ( n = 18) being the most common. In a retrospective study, M. fortuitum was also found to be a common causative RGM after TJA 54 . In this study, the average age of patients with NTM infection was 65.9 years, and these patients also had diabetes, hypertension, or cardiovascular disease.…”

Section: Discussionmentioning

confidence: 63%

“…Some studies have also suggested 6 weeks of intravenous antimicrobial therapy followed by 3 to 6 months of oral treatment with delayed reimplantation for PJI 61 . The antibiotic regimen of Hwang et al was intravenous cefoxitin and amikacin for at least 6 weeks to eradicate the infection before reimplantation, followed by intravenous amikacin for 6 weeks and oral clarithromycin for 3 months 54 . Our study indicated that patients underwent reimplantation after a mean of 5.5 months following spacer implantation.…”

Section: Discussionmentioning

confidence: 64%

“…In a retrospective study, M. fortuitum was also found to be a common causative RGM after TJA. 54 In this study, the average age of patients with NTM infection was 65.9 years, and these patients also had diabetes, hypertension, or cardiovascular disease. Winthrop et al 68 showed that pulmonary NTM was more prevalent in elderly men (mean age 66 years).…”

Section: Ntm Infection In Pjimentioning

confidence: 71%

“…We reviewed 39 articles, including 68 patients with PJI caused by NTM [18,21‐58]. Subsequently, all 68 patients were analyzed in detail.…”

Section: Literature Reviewmentioning

confidence: 99%

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Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

Maimaiti,

Li,

et al. 2023

Orthopaedic Surgery

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Objective: Periprosthetic joint infection (PJI) caused by non-tubercular mycobacteria (NTM) is uncommon but catastrophic. However, conclusive clinical data on PJI caused by NTM are lacking. In this case series and systematic review, the clinical manifestations, diagnosis, and management of NTM PJI are summarized and analyzed. Methods:From 2012 to 2020, we retrospectively analyzed consecutive PJI cases caused by NTM in our institution.A literature review was also conducted from January 2000 to December 2021, utilizing the PubMed, MEDLINE, Cochrane Library, and EMBASE databases to identify all reported NTM-induced PJI cases. The clinical characteristics, demographics, pathogen identification, treatment protocols, and prognosis of NTM PJI were summarized and analyzed. Results:In this retrospective analysis, seven patients infected with NTM following total joint arthroplasty at our institution were included, including six cases of PJI caused by NTM and one case of septic arthritis (SA) caused by NTM. There were six men and one woman, and their average age was 62.3 years. The average interval between TJA and PJI onset was 4 months. The preoperative serological markers, including the mean ESR (51 mm/h), CRP (4.0 mg/dL), fibrinogen (5.7 g/L), and D-dimer (1.1 g/L), were increased. Six patients underwent staged revision surgery, and one patient with SA received antibiotic-loaded bone cement beads to treat the infection. After an average of 33 months of observation following surgical intervention, none of the patients showed any symptoms of infection recurrence. From 2000 to 2021, 68 patients with NTM PJI were found in 39 studies in the published literature. Reinfections occurred within 1 year after arthroplasty in more than half (53.2%) of the patients. M. fortuitum and M. abscesses were the most prevalent rapidly growing mycobacteria (RGM) in all PJI patients, whereas Mycobacterium avium intracellulare (MAC) was the most prevalent slowly growing mycobacterium (SGM). The corresponding antibiotics were amikacin and ethambutol. The rate of culture-negative without specific clinical symptoms was as high as 36.4% (12/33), while 45% (18/40) utilized additional diagnostic techniques such as NGS. A final clinical follow-up record was available for 59 patients (86.7%; mean follow-up period, 29 months), and 10.1% of patients failed to respond to treatment. Conclusion:Orthopaedic surgeons should consider NTM in patients with negative routine cultures who are at risk for Mycobacterium infection. Treatment options rely on the accurate result of microbiologic identification and drug sensitivity testing, and to achieve this, it may be necessary to send multiple culture specimens, extend the culture time, and change the culture medium. Every effort should be made to identify NTM and its various subtypes through modern diagnostic tools if necessary.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 64%

Section: Ntm Infection In Pjimentioning

confidence: 71%

“…We reviewed 39 articles, including 68 patients with PJI caused by NTM [18,21‐58]. Subsequently, all 68 patients were analyzed in detail.…”

Section: Literature Reviewmentioning

confidence: 99%

See 2 more Smart Citations

Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

Maimaiti,

Li,

et al. 2023

Orthopaedic Surgery

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“…According to our literature review, prolonged antibiotic treatment for complete remission of infections induced by NTM is necessary before reimplantation, but the optimal duration is still not well defined. 8,12,13,24,25 The review also indicated that a longer delay in reimplantation (>6 months) may also result in a more favorable outcome. However, in our experience, reimplantation within 6 months could also be successful once the infection has resolved, as indicated by normal CRP and negative culture results.…”

Section: Discussionmentioning

confidence: 99%

Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty

Peng

Lee

Chen

et al. 2022

J Orthop Surg (Hong Kong)

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Purpose Nontuberculous mycobacteria periprosthetic joint infection (NTMPJI) is a rare complication of hip or knee joint arthroplasty. The experience for outcomes of NTMPJI treatment is still limited. The objective of this study was to investigate the outcome of hip or knee nontuberculous mycobacteria periprosthetic joint infection following treatment with two-stage exchange arthroplasty. Material and Methods From 1995 to 2020, 12 patients with NTMPJI were treated with two-stage exchange arthroplasty at our institution. We collected and analyzed variables including demographic data, comorbidity, microbiological data, treatment outcome and antibiotic formula in bone cement. Results Mycobacterium abcessus ( n = 6) and Mycobacterium chelonae ( n = 2) constitute the majority of the cases. Five patients had early-onset PJIs and the other seven patients were late onset. The success rate of two-stage exchange arthroplasty was 66.7% (8 of 12). Three patients experienced infection relapse, and one patient had soft tissue compromise complication. Post-operative antibiotic therapy may not improve the success rate (4 of 6 cases, 66.7%). Based on in vitro study, the most commonly used effective antibiotic in bone cement spacer for nontuberculous mycobacteria was amikacin. Conclusions nontuberculous mycobacteria is a rare cause of PJIs and should be suspected especially in relatively immunocompromised patients. Resection arthroplasty with staged reimplantation is the preferred approach. Prolonged post-operative antibiotic therapy before reimplantation may not improve the success rate. Delayed revision surgery may not be needed and can be performed once C-reactive protein level is normal after a drug holiday.

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Delayed Diagnosis of Mycobacterium bovis bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty

Pelt,

Shakir,

Cahill

et al. 2024

Arthroplasty Today

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Mycobacterial periprosthetic joint infection after primary total knee arthroplasty

Cited by 4 publications

References 33 publications

Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

Non‐Tuberculosis Mycobacterium Periprosthetic Joint Infections Following Total Hip and Knee Arthroplasty: Case Series and Review of the Literature

Nontuberculous mycobacteria peri-prosthetic joint infection: An outcome analysis for two stage revision arthroplasty

Delayed Diagnosis of Mycobacterium bovis bacillus Calmette-Guérin Periprosthetic Joint Infection Following Total Knee Arthroplasty

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