Therapie der periprothetischen Infektion

Renner, Lisa; Perka, Carsten; Trampuž, Andrej; Renz, Nora

doi:10.1007/s00104-016-0255-5

Cited by 22 publications

(17 citation statements)

References 46 publications

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“…While two-stage exchange of an infected prosthesis is considered the gold standard and is the dominant option in the USA, single-stage exchange is favoured in some European countries. Onestage exchange may not be an option in patients with signs of systemic sepsis, extensive comorbidities, infection with resistant organisms, culture-negative infections, and poor soft tissue coverage [59][60][61]. With proper selection of surgery, success rates of PJI treatment can exceed 80-90% [59].…”

Section: Failure To Individualize Treatmentmentioning

confidence: 99%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.

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Section: Failure To Individualize Treatmentmentioning

confidence: 99%

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Renz

Trampuž

et al. 2019

International Orthopaedics (SICOT)

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“…NOTE: Antibiotics can then be given. The choice of the correct antibiotics is essential and must be an individualized decision 25 26 . Therapeutic concepts must be decided on by an interdisciplinary panel of surgeons and microbiologists beforehand.…”

Section: Protocolmentioning

confidence: 99%

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Hischebeth

Gravius

Buhr

et al. 2017

JoVE

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In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

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“…However, because of the drug holiday and the time until final results of the SFC are available, IA extends the duration until the second stage can be performed. A shorter interval to planned reimplantation may decrease soft tissue contraction, shorten immobilisation, and ultimately improve quality of life [ 10 ]. Thus, the routine implementation of the IA into the TSE has regained controversy [ 11 ], especially since recent studies showed a questionable clinical value.…”

Section: Introductionmentioning

confidence: 99%

Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee

Boelch

Roth

Arnholdt

et al. 2018

BioMed Research International

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Purpose Detection of infection persistence during the two-stage exchange of the knee for periprosthetic joint infection is challenging. Synovial fluid culture (SFC) and synovial white blood cell count (SWBCC) before joint reimplantation are widespread diagnostic means for this indication. The sensitivity and specificity of SFC and of SWBCC for infection persistence before planned reimplantation were evaluated. Methods 94 two-stage exchanges of the knee with synovial fluid aspiration performed after a drug holiday of at least 14 days and before reimplantation or spacer exchange (planned reimplantation) were retrospectively analyzed. Only cases with at least 3 intraoperative samples at planned reimplantation were included. SFC and SWBCC were compared to pathogen detection (SFC(culture)/SWBCC(culture)) and to histopathological signs of infection persistence (SFC(histo)/SWBCC(histo)) from intraoperative samples at planned reimplantation. For SFC, the sensitivity and specificity were calculated. For SWBCC, the optimal cut-off value with its sensitivity and specificity was calculated with the Youden-Index. Results Sensitivity and specificity of SFC(culture) were 0.0% and 98.9%. Sensitivity and specificity of SFC(histo) were 3.4% and 100%. The optimal cut-off value for SWBCC(culture) was 4450 cells/μl with a sensitivity of 50.0% and a specificity of 86.5%. The optimal cut-off value for SWBCC(histo) was 3250 cells/μl with a sensitivity of 35.7% and a specificity of 92.9%. Conclusion The detection of infection persistence remains challenging and a consented approach is lacking. The results do not warrant the routine performance of SFC during the two-stage exchange at the knee. SWBCC can be used to confirm infection persistence at high cut-offs, but they only occur in few patients and are therefore inappropriate for the routine use.

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Therapie der periprothetischen Infektion

Cited by 22 publications

References 46 publications

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Twenty common errors in the diagnosis and treatment of periprosthetic joint infection

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee

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