Clinical features of anaerobic orthopaedic infections

Abstract

Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe. By multivariate analysis, the presence of fracture fixation plates was the variable most strongly associated with anaerobic infection (odds ratio: 2.1, 95% CI: 1.3-3.5). Anaerobes were also associated with spondylodesis and polymicrobial infections. In contrast, it revealed less likely in native bone or prosthetic joint infections and was not related to prior antibiotic use. In conclusion, obligate anaerobes in our case series of orthopaedic infections were rare, and mostly encountered in infections related to trauma with open-fracture fixation devices rather than clean surgical site infection. Anaerobes were often co-pathogens, and cultures most frequently recovered P. acnes. These observations thus do not support changes in current practices such as broader anaerobe coverage for perioperative prophylaxis.

Diagnosis of orthopaedic-implant-associated infections caused by slow-growing Gram-positive anaerobic bacteria – a clinical perspective

“…Finegoldia magna (previously Peptostreptococcus magnus): this Gram-positive anaerobic coccus is part of the commensal flora, found on healthy human skin and as a part of the gut microbiota (Söderquist et al, 2017;Levy et al, 2009). Although less frequent than Cutibacterium species, PJIs of hip, shoulder, knee, and foot, as well as osteosynthesisrelated IAI due to F. magna, have been reported (Levy et al, 2009;Söderquist et al, 2017;Renz et al, 2018a;Achermann et al, 2013;Walter et al, 2014;Richards et al, 2014;Kamme et al, 1974;Puchner et al, 2017;Akgun et al, 2020;Rieber et al, 2020;Anagnostakos et al, 2021).…”

Prosthetic Joint Infection due to Actinomyces species: A case series and review of literature

“…Anaerobic PJIs are uncommon 1, 2. The most frequent anaerobes reported to cause PJI include Cutibacterium acnes and Bacteriodes spp 1. PJIs due to Actinomyces spp.…”

Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay?

“…In 25 episodes, the infection occurred in the foot. Our laboratory detected 84 different microbiological constellations with the five most frequently identified pathogens being Staphylococcus aureus ( n = 166), streptococci (46), Gram-negatives [ 6 ] (140; with 80 non-fermenters including 42 Pseudomonas aeruginosa cases, and 24 anaerobes [ 28 ]), enterococci [ 5 ] (33), S. lugdunenssis [ 16 ] (9), and skin commensals (134) . In 100 cases, SSI were polymicrobial and in 35 cases culture-negative [ 29 ].…”

“…In contrast, the literature is full of opinion papers and retrospective studies investigating the possibility of better outcomes with broader prophylaxis. The propositions of the authors differ from one paper to another and focus on different strategies which are: continuing the prophylaxis beyond a single dose [ 31 , 32 ], augmenting of doses [ 19 ], combining with local prophylaxis [ 33 , 34 ] (especially local vancomycin in spine surgery [ 35 ]), double prophylaxis [ 36 ] against Gram-negative [ 37 ], Gram-positive [ 38 , 39 ], methicillin-resistant strains [ 4 ] and anaerobes [ 28 ], or by investigating the performance of universal glycopeptid prophylaxis [ 40 – 42 ]. In summary, the majority of these enhancements failed to reduce SSI risk, at least not in orthopedic surgery [ 34 , 39 – 42 ].…”