Outcome of Enterococcal Prosthetic Joint Infection: Is Combination Systemic Therapy Superior to Monotherapy?

Helou, Odette C. El; Berbari, Elie F.; Marculescu, Camelia; Atrouni, Wissam I. El; Razonable, Raymund R.; Steckelberg, James M.; Hanssen, Arlen D.; Osmon, Douglas R.

doi:10.1086/591536

Cited by 61 publications

(80 citation statements)

References 24 publications

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“…Although in patients with PJI the most frequently cultured microorganisms are coagulase-negative Staphylococci and Staphylococcus aureus, which are seen in 30% to 43% and 12% to 23% of cases, respectively [21], it is estimated that Enterococcus species are responsible for approximately 3% of all PJIs [3]. Enterococcus is a Gram-positive, facultatively anaerobic organism, which used to classify as Group D Streptococcus.…”

Section: Introductionmentioning

confidence: 99%

“…Although it is not a common pathogen for orthopaedic infections, there is a growing number of reports showing an increase in frequency of orthopaedic infection caused by Enterococcus [14,18]. Probably as a result of the low frequency of enterococcal PJIs, these cases are usually reported in series of PJIs caused by other pathogens [3]. Two studies [3,18] focused on the treatment of patients with enterococcal PJI.…”

Section: Introductionmentioning

confidence: 99%

“…Probably as a result of the low frequency of enterococcal PJIs, these cases are usually reported in series of PJIs caused by other pathogens [3]. Two studies [3,18] focused on the treatment of patients with enterococcal PJI. The first study was performed by El Helou et al [3] in which 50 episodes of enterococcal PJI were evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…Two studies [3,18] focused on the treatment of patients with enterococcal PJI. The first study was performed by El Helou et al [3] in which 50 episodes of enterococcal PJI were evaluated. They found no difference between outcome of patients with enterococcal PJIs receiving combination therapy and those receiving monotherapy [3].…”

Section: Introductionmentioning

confidence: 99%

“…The first study was performed by El Helou et al [3] in which 50 episodes of enterococcal PJI were evaluated. They found no difference between outcome of patients with enterococcal PJIs receiving combination therapy and those receiving monotherapy [3]. They also estimated survival free of treatment failure for various surgical approaches in the studied patients at 2 and 5 years [3].…”

Section: Introductionmentioning

confidence: 99%

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Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Rasouli

Tripathi

Kenyon

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Rasouli

Tripathi

Kenyon

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Oral Antibiotic Therapy

2014

Journal Orthopaedic Research

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TLR4 (not TLR2) dominate cognate TLR activity associated with CoCrMo implant particles

et al. 2016

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Innate immune reactions to orthopedic implant debris are the primary cause of total joint replacement (TJR) failure over the long term (15-20 years). The role of pathogen associated pattern recognition receptors (i.e., TLRs) in regulating immune reactivity to metal implant particles remains controversial. Do different TLRs (i.e., TLR2 vs. TLR4) activated by their respective ligands in concert with metal implant debris elicit equivalent innate immune responses? In this investigation, our in vitro and in vivo data indicate that Gram-negative PAMPs are more pro-inflammatory than Gram-positive PAMPs. In vitro results indicated TLR4 activation in concert with CoCrMo orthopedic implant debris (CoCrMo/LPS+) challenged primary macrophages resulted in significantly greater inflammatory responses than CoCrMo/PAM3CSK+ (TLR2). Similarly, in vivo results indicated CoCrMo/LPS+ TLR4 challenge induced a twofold increase in inflammation-induced bone resorption (osteolysis) than CoCrMo/PAM3CSK+ (p < 0.01) or CoCrMo (p < 0.03) alone in an established murine calvaria model. This points to a more potent TLR4-based effect of CoCrMo/LPS+ on innate immune responses, that is, IL-1ß, TNF-α, and resulting osteolysis. Differential CoCrMo/LPS+ induced osteolysis compared to CoCrMo/PAM3CSK+, reveals inherent differences in TLR4 versus TLR2 activation which are relevant to (i) how different types of implant debris elicit differential reactivity, (ii) how TLR2 Gram-positive bacteria benefits from less immune activation possibly due to the down-regulation of TLR2 surface expression, that subsequently impacts Gram-positive infections in TJRs, and (iii) how using TLR4 LPS (a Gram-negative agonist) may not accurately model Gram-positive bacteria responses, alone and/or with specific types of implant particles, particularly CoCrMo alloy. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1007-1017, 2017.

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Outcome of Enterococcal Prosthetic Joint Infection: Is Combination Systemic Therapy Superior to Monotherapy?

Cited by 61 publications

References 24 publications

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Oral Antibiotic Therapy

TLR4 (not TLR2) dominate cognate TLR activity associated with CoCrMo implant particles

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