Polymicrobial Periprosthetic Joint Infections: Outcome of Treatment and Identification of Risk Factors

Tan, Timothy L.; Kheir, Michael M.; Tan, Dean D.; Parvızı, Javad

doi:10.2106/jbjs.15.01450

Cited by 77 publications

(47 citation statements)

References 12 publications

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“…While the preferred method of treatment for PJI when routine cultures are negative has not been determined, several studies have investigated treatment outcomes following culture-negative PJI 5 , 9 , 22 - 24 . Choi et al found that infection control was actually greater for a group of 40 PJIs that had negative cultures of specimens from at least 3 separate areas than it was for 135 PJIs that had positive cultures (p = 0.006) 22 .…”

Section: Discussionmentioning

confidence: 99%

Culture-Negative Periprosthetic Joint Infection

Tan

Kheir

Shohat

et al. 2018

JBJS OA

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207

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Background:Culture-negative periprosthetic joint infection (PJI) is a challenging condition to treat. The most appropriate management of culture-negative PJI is not known, and there is immense variability in the treatment outcome of this condition. The purpose of this study was to elucidate the characteristics, outcomes, and risk factors for failure of treatment of culture-negative PJI.Methods:A retrospective review of 219 patients (138 hips and 81 knees) who had undergone surgery for the treatment of culture-negative PJI was performed utilizing a prospectively collected institutional PJI database. PJIs for which the results of culture were unavailable were excluded. An electronic query and manual review of the medical records were completed to obtain patient demographics, treatment, microbiology data, comorbidities, and other surgical characteristics. Treatment failure was assessed using the Delphi consensus criteria.Results:The prevalence of suspected culture-negative PJI was 22.0% (219 of 996), and the prevalence of culture-negative PJI as defined by the Musculoskeletal Infection Society (MSIS) was 6.4% (44 of 688). Overall, the rate of treatment success was 69.2% (110 of 159) in patients with >1 year of follow-up. Of the 49 culture-negative PJIs for which treatment failed, 26 (53.1%) subsequently had positive cultures; of those 26, 10 (38.5%) were positive for methicillin-sensitive Staphylococcus aureus. The rate of treatment success was greater (p = 0.019) for patients who had 2-stage exchange than for those who underwent irrigation and debridement.Conclusions:The present study demonstrates that culture-negative PJI is a relatively frequent finding with unacceptable rates of treatment failure. Every effort should be made to isolate the infecting organism prior to surgical intervention, including extending the incubation period for cultures, withholding antibiotics prior to obtaining culture specimens, and possibly using newly introduced molecular techniques.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

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Section: Discussionmentioning

confidence: 99%

Culture-Negative Periprosthetic Joint Infection

Tan

Kheir

Shohat

et al. 2018

JBJS OA

Self Cite

207

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“…Multispecies biofilm-like communities are responsible for causing persistent infections in a wide range of body sites, including the lung (24)(25)(26)(27)(28)(29)(30)(31), oral cavity (32,33), middle ear (34)(35)(36), urinary tract (37)(38)(39), and both surgical and chronic wounds (40)(41)(42)(43)(44)(45). In several disease settings, polymicrobial infections have been reported to cause worse outcomes than single-species infections (46)(47)(48)(49)(50)(51)(52)(53)(54). In particular, polymicrobial bloodstream infections are associated with higher rates of mortality than monospecies infections (46)(47)(48)(49)(50).…”

Section: The Etiology Of Most Chronic Infections Is Polymicrobialmentioning

confidence: 99%

“It Takes a Village”: Mechanisms Underlying Antimicrobial Recalcitrance of Polymicrobial Biofilms

2019

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Chronic infections are frequently caused by polymicrobial biofilms. Importantly, these infections are often difficult to treat effectively in part due to the recalcitrance of biofilms to antimicrobial therapy. Emerging evidence suggests that polymicrobial interactions can lead to dramatic and unexpected changes in the ability of antibiotics to eradicate biofilms and often result in decreased antimicrobial efficacy in vitro.

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“…spacers, beads, coated rods/wires) and additional systemic antibiotics remain a mainstay of this treatment concept [ 6 ]. While polymicrobial infections in PJI are expected to complicate treatment and outcome [ 7 , 8 ], pathogen patterns in diagnosing infected nonunion have not been investigated yet. Several factors such as prior fracture treatment with prophylactic and in case of open fractures often prolonged use of broad-spectrum antibiotics might influence the germ spectrum and occurrence of polymicrobial infections in infected nonunions.…”

Section: Introductionmentioning

confidence: 99%

Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

et al. 2020

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Background Frequencies of polymicrobial infection and pathogens evidenced in course of infected nonunion treatment are largely unknown. Therefore, this study aims at investigating microbial patterns in infected nonunions. Methods Surgically treated patients with long bone infected nonunion admitted between January 2010 and March 2018 were included in the study. Microbiological culture and polymerase-chain-reaction results of tissue samples of initial and follow-up revision surgeries were assessed and compared with patient and treatment characteristics. Results Forty two patients with a mean age of 53.9 ± 17.7 years were included. In six patients (14.3%) polymicrobial infection was evident. A change of pathogens evidenced in course of the treatment occurred in 21 patients (50%). In 16 patients (38.1%) previously detected bacteria could be determined by microbial testing after further revision surgery. Staphylococcus aureus was most often detected (n = 34, 30.6%), followed by Enterococcus spp. (n = 25, 22.5%) and Staphylococcus epidermidis (n = 18, 16.2%). Five Staphylococcus aureus were resistant to methicillin (MRSA). In patients without polymicrobial infection or further germ detection in course of the treatment, 86.4% of the infections were due to Staphylococcus spp.. Infections due to Streptococcus spp. and gram-negative bacteria were only present in patients with polymicrobial infection and germ-change in course of the treatment. Conclusion A low rate of polymicrobial infections was evidenced in the present study. Germ-change often occurs in course of revision surgeries. Prospective studies with more sensitive diagnostic tools are necessary to elucidate the therapeutical relevance of microbiological testing results for surgical as well as medical treatment in infected nonunions.

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Polymicrobial Periprosthetic Joint Infections: Outcome of Treatment and Identification of Risk Factors

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 77 publications

References 12 publications

Culture-Negative Periprosthetic Joint Infection

Culture-Negative Periprosthetic Joint Infection

“It Takes a Village”: Mechanisms Underlying Antimicrobial Recalcitrance of Polymicrobial Biofilms

Polymicrobial infections and microbial patterns in infected nonunions – a descriptive analysis of 42 cases

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