Analysis of postoperative and hematogenous prosthetic joint-infection microbiological patterns in a large cohort

Zeller, Valérie; Kerroumi, Younes; Meyssonnier, Vanina; Heym, Béate; Metten, Marie-Astrid; Desplaces, Nicole; Marmor, Simon

doi:10.1016/j.jinf.2017.12.016

Cited by 95 publications

(82 citation statements)

References 18 publications

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“…The presence of a fistula, with a pathway communicating between the joint and the external environment, could lead to superinfection through the fistula of an initially monomicrobial infection. The other reason could be the important frequency of the initially classified acute post-operative PHIs in which polymicrobial PHIs are frequently observed (41).…”

Section: Discussionmentioning

confidence: 99%

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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Background: Prosthetic hip infection (PHI) is a disastrous scenario after an arthroplasty. International guidelines contraindicate one-stage exchange arthroplasty for fistulizing chronic prosthetic hip infection (FCPHI), nevertheless few surgical teams, mostly from Europe, support one stage procedure for this indication. Questions/Purposes: Analysis of infection recurrence and implant failure of a series of FCPHIs treated with one stage arthroplasty. Patients and Methods: Sixty-six FCPHIs treated with one-stage exchange arthroplasty were prospectively followed up at least 2 years. Clinical, radiological and bacteriological signs suggestive of reinfection were sought, as well as implant failures and PHI related deaths. Results: Thirty-four females and thirty-two males with median age of 69.5 years [61-77] and BMI of 26 kg/m² [22-31] were included. Fistulae were productive in 50 patients (76%). Staphylococcus was responsible for 45% of PHI and 21% were polymicrobial. Twentynine patients (44%) received preoperative antibiotic therapy. After a median 60-month follow-up [35-82], 3 patients (4.5%) presented reinfection (two new infections, one relapse) and 3 patients experienced implant failure (1 femoral fracture, 1 stem breakage, 1 recurrent dislocation). One death was related to PHI. After a minimum of 2 years, the infection control rate was of 95.3% (±0.02). Conclusion: One-stage exchange arthroplasty for FCPHIs showed a good infection control rate similar to that of non-fistulizing PHI. Systematic preoperative microbiological documentation with joint aspiration and, in some specific cases, the use of preoperative antibiotic therapy are among the optimizations accounting for the success of the one-stage arthroplasty. In light of these results, and those of other studies, international recommendations could evolve. Level of Evidence: Descriptive therapeutic prospective cohort study. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

et al. 2020

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“…After a wound is healed, hematogenous contamination and direct spreading ("per continuitatem") of an artificial joint remain the only pathways for new access by pathogenic bacteria [191,192]. To prevent these PJIs, we should theoretically target all potentially dangerous sources of bacteria, but no one knows which these are.…”

Section: Measures Against Hematogenous and Directly Spreading Pjimentioning

confidence: 99%

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Gallo

Nieslanikova

2020

JCM

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A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

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“…The pathogenesis of acute infections encompasses early postoperative infection or hematogenous infection occurring at any time point . A previous large cohort study reported that the rate of hematogenous infection was 35% (348 of a total of 997 prosthetic hip, knee, and shoulder joint infections) . Several studies have shown that prosthetic joint infection occurs in 34% to 39% of patients who underwent joint replacement that was followed by S. aureus bacteremia .…”

Section: Discussionmentioning

confidence: 99%

Antibacterial Activity of Ag‐Hydroxyapatite Coating Against Hematogenous Infection by Methicillin‐ResistantStaphylococcus aureusin the Rat Femur

Kobatake

Miyamoto

Hashimoto

et al. 2019

Journal Orthopaedic Research

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Several antibacterial materials have been developed to prevent periprosthetic joint infection and thus prevent serious complications for patients and surgeons. However, no study has addressed the activity of antibacterial materials against hematogenous infection. The present study evaluated the antibacterial activity of a silver-containing hydroxyapatite-coated implant against methicillin-resistant Staphylococcus aureus (MRSA) hematogenous infection. Implants coated with hydroxyapatite and silver-hydroxyapatite were inserted into rats' right and left femurs, respectively, after which the animals were infected with S. aureus via a tail vessel. About 10 7 colony-forming units was the optimal bacterial number for the establishment of S. aureus hematogenous infection. Bacterial loads and C-reactive protein in the blood were measured to confirm bacteremia and inflammation. Fourteen days after the infection, bacterial loads were statistically lower in the femurs containing silver-hydroxyapatite-coated implants than in those with hydroxyapatite-coated implants (p = 0.022). Thus, silver-hydroxyapatite-coated implants might provide antibacterial activity against MRSA hematogenous infection in the postoperative period.

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Analysis of postoperative and hematogenous prosthetic joint-infection microbiological patterns in a large cohort

Cited by 95 publications

References 18 publications

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

Antibacterial Activity of Ag‐Hydroxyapatite Coating Against Hematogenous Infection by Methicillin‐ResistantStaphylococcus aureusin the Rat Femur

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