Implant-associated mycobacterium tuberculosis infection following surgical management of fractures

Mahale, Yashwant; Aga, Naoko

doi:10.1302/0301-620x.97b9.35227

Cited by 14 publications

(5 citation statements)

References 20 publications

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“…This may not be the case in infections caused by multidrug‐resistant Gram‐negative bacilli or fungi. However, implant‐associated Mycobacterium tuberculosis infection is not considered as difficult‐to‐treat and has a good prognosis in this respect . Last but not least, the surgical intervention must target the best possible functional outcome.…”

Section: Implant‐associated Osteomyelitis Of Long Bonesmentioning

confidence: 99%

Orthopaedic biofilm infections

Zimmerli

Sendi

2017

APMIS

257

200

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Zimmerli W, Sendi P. Orthopaedic biofilm infections. APMIS 2017; 125: 353-364. Many infections of the musculoskeletal system are biofilm infections that develop on non-living surfaces. Microorganisms adhere either on dead bone (sequesters) or implants. As a rule for a curative concept, chronic osteomyelitis or implant-associated bone infection must be treated with a combination of surgery and antimicrobial therapy. If an implant is kept in place, or a new device is implanted before complete healing of infection, a biofilm-active antibiotic should be used. Rifamycins are active against biofilms of staphylococci, and fluoroquinolones against those of Gramnegative bacilli. In this review, the management of chronic osteomyelitis, periprosthetic joint infection and implantassociated osteomyelitis of long bones is presented.

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Section: Implant‐associated Osteomyelitis Of Long Bonesmentioning

confidence: 99%

Orthopaedic biofilm infections

Zimmerli

Sendi

2017

APMIS

257

200

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“…[98][99][100] Mycobacterium tuberculosis 101,102 is rare even in endemic countries. 103 When atypical slow-growing pathogens are identified, a pre-existing bone infection, pathological fracture and an immunocompromised state must be suspected. [104][105][106][107]…”

Section: Microbiologymentioning

confidence: 99%

Infection after fracture osteosynthesis – Part I

Fang

Wong

Lau

et al. 2017

J Orthop Surg (Hong Kong)

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Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.

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“…If a patient has a weakened immune system, tuberculosis can recur. Some studies have shown that M. tuberculosis in granulomas can be hematogenously spread to distant sites and that surgical trauma is conducive to colonization by these organisms 46,47 . Marmor reported a patient with osteoarthritis who demonstrated joint swelling, pain, and fever, 2 months after TKA; M. tuberculosis was cultured in the patient's joint fluid and blood 15 .…”

Section: Mechanism Of Tuberculosis Infection After Tkamentioning

confidence: 99%

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

Wei

Sun²,

Zhang

et al. 2020

Orthopaedic Surgery

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Objectives: To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). Methods: Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. Results: In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. Conclusions: Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.

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Implant-associated mycobacterium tuberculosis infection following surgical management of fractures

Cited by 14 publications

References 20 publications

Orthopaedic biofilm infections

Orthopaedic biofilm infections

Infection after fracture osteosynthesis – Part I

Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature

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