A protocol for periprosthetic joint infections from the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands

Zijlstra, Wierd P; Ploegmakers, Joris J. W.; Kampinga, Greetje A.; Toren-Wielema, Marlous; Ettema, Harmen B.; Knobben, Bas A S; Jutte, Paul C.; Wouthuyzen-Bakker, Marjan

doi:10.1186/s42836-022-00116-9

Cited by 13 publications

(5 citation statements)

References 28 publications

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“…This trial supports the early switch to oral antibiotics, even in complex orthopedic implant-related infections, provided that adequate surgical debridement has been achieved and an oral antibiotic with antibiofilm properties and sufficient bioavailability is available. Guidelines on the type of targeted antibiotics and corresponding dosage have been previously described [ 45 , 46 ].…”

Section: When Is It Safe To Switch To Oral Therapy?mentioning

confidence: 99%

Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

2023

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The antibiotic treatment of periprosthetic joint infections (PJI) is complicated by the presence of biofilm produced by bacteria on the abiotic surface of the implant. Bacteria within the deeper layers of the biofilm become metabolically less active, resulting in antibiotic tolerance due to several mechanisms. This review describes the basic principles of antibiotic treatment in PJI in relation to the behavior of bacteria within the biofilm. The concept of biofilm-active antibiotics will be explained from an in vitro as well as in vivo perspective. Evidence from clinical studies on biofilm-active antibiotics in PJI will be highlighted, mainly focusing on the role of rifampicin for Gram-positive microorganisms and fluoroquinolones for Gram-negative microorganisms. The optimal treatment duration will be discussed as the timing of switching to oral antibiotic therapy.

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Section: When Is It Safe To Switch To Oral Therapy?mentioning

confidence: 99%

Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

2023

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“…The treatment, both surgical and antibiotic, of PJI must be individualized. Surgical treatment includes debridement and implant retention (DAIR), one-stage implant replacement, and two-stage revision [ 30 ]. Debridement and implant retention (DAIR) involves the following: (1) excision of the fistulous tracts and the areas affected by them, (2) open arthrotomy with excision of the old scar, (3) a minimum of five biopsies are performed (pus, capsule, tissue periprosthetic, bone, joint fluid, muscle tissue, etc.…”

Section: Reviewmentioning

confidence: 99%

Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections

Creţu¹,

Iordache²,

Cursaru³

et al. 2023

Cureus

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Periprosthetic joint infection (PJI) after arthroplasty is a major complication, which requires significant resources, resulting in high costs for the medical system. In recent years, significant progress has been made in the diagnosis and treatment of periprosthetic infections, the identification of the pathogen being the central element in the establishment of targeted antibiotic therapy. Next-generation sequencing (NGS) or metagenomic NGS (mNGS) represents a promising, fast alternative, with increased specificity and sensitivity compared to identification methods using conventional culture media, thus enabling an increased rate of identification of pathogenic microorganisms and antibiotic resistance genes (ARG). The purpose of this article was to highlight new molecular diagnostic methods for periprosthetic joint infections and their involvement in treatment efficiency. NGS technologies are cutting-edge techniques that may challenge the PJI diagnostic model.

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“…The four hospitals participating in this study are part of the Northern Infection Network Joint Arthroplasty in the Netherlands and use a standard diagnostic workup [14]. However, 77 patients were excluded from the analysis because an insufficient number of cultures were obtained during cup revision.…”

Section: Biasmentioning

confidence: 99%

Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

Ottink,

Dorleijn,

Spierenburg

et al. 2023

Clin Orthop Relat Res

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Background Positive intraoperative cultures (PICs) are encountered in some patients undergoing revision of the acetabular cup after a previous THA. It is unknown whether PIC of the cup indicates whether the stem is infected as well and what happens to the stem during follow-up. Questions/purposes (1) What proportion of patients undergoing THA who undergo cup revision have PICs? (2) What is the survival of the stem during follow-up in cup revisions with PICs versus that of those with negative cultures? (3) Does antibiotic treatment of PIC of the cup prevent revision THA during follow-up? Methods In this retrospective, comparative multicenter study, five surgeons at four centers performed 338 acetabular cup revisions between January 2015 and December 2017. After evaluating the data, we excluded one patient because of an incomplete dataset and 77 patients because fewer than three intraoperative cultures were obtained during surgery, leaving 260 patients for analysis. Follow-up was 2 years. Patients were stratified into three cohorts: no PIC, one PIC, and two or more PICs. Results The proportion of patients with one or more PIC was 15% (39 of 260). A total of 8% (21 of 260) had one and 7% (18 of 260) had two or more PICs. Stem survival was lower in patients with two or more PICs, but stem revision for periprosthetic joint infection was similar between groups. Two-year survival, which was defined as freedom from revision for any cause or infection, was 97% (95% confidence interval 95% to 99%) in the group without PICs, 100% (95% CI 95% to 100%) in the group with one PIC, and 86% (95% CI 68% to 100%; p = 0.08) in the group with two or more PICs. None of the patients in the no PIC and one PIC groups were treated with antibiotics. In the two or more PICs cohort, 12 of 18 patients were treated. The stem survived in one of 12 patients treated with antibiotics versus two of six patients who were not treated with antibiotics. Conclusion When treated with antibiotics, more than two PICs isolated during cup revision surgery do not have a major impact on survival of the stem during follow-up. A larger cohort of patients with PICs during cup revision might confirm these findings. Level of Evidence Level III, therapeutic study.

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A protocol for periprosthetic joint infections from the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands

Cited by 13 publications

References 28 publications

Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections

Positive Intraoperative Cultures in Cup Revisions of THA: What Happens to the Stem?

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