Infections of Tumor Prostheses: An Updated Review on Risk Factors, Microbiology, Diagnosis, and Treatment Strategies

Abstract

Several causes contribute to the high infection rate in tumor prostheses, including extensive tissue dissection and patients’ immunosuppression due to the neoplastic disease. Most of these infections develop within the first 2 years following surgery with 70% of them occurring during the first year, while they are often associated with a low pathogen burden. The pathogenesis of infections in tumor prostheses is linked to bacteria developing in biofilms. Approximately half of them are caused by Staphylococcus spp., followed by Streptococcus spp., Enterococcus spp., and Enterobacteriaceae spp., while multiple pathogens may be isolated in up to 25% of the cases, with coagulase-negative Staphylococci (CoNS) and Enterococccus spp. being the most frequent pair. Although early detection and timely management are essential for complete resolution of these challenging infections, prompt diagnosis is problematic due to the highly varying clinical symptoms and the lack of specific preoperative and intraoperative diagnostic tests. Surgical management with one- or two-stage revision surgery is the mainstay for successful eradication of these infections. The recent advances in laboratory diagnostics and the development of biofilm-resistant prostheses over the past years have been areas of great interest, as research is now focused on prevention strategies. The aim of this study is to review and consolidate the current knowledge regarding the epidemiology, risk factors, microbiology, and diagnosis of infections of tumor prostheses, and to review the current concepts for their treatment and outcomes.

Limb Salvage and Pelvic Reconstruction With Endoprosthesis After Pelvic Tumor Resection: A Narrative Review

“…Chemotherapy has been demonstrated to elevate the overall revision rate of prosthetic reconstruction by 30%, due to diminished osseointegration of the implants [ 20 ]. Nevertheless, it remains uncertain whether chemotherapy influences the infection rate subsequent to prosthetic reconstruction and whether chemotherapy-induced immunodeficiency constitutes a risk factor for infection [ 21 ]. Moreover, radiation therapy can render the surgical incision more vulnerable to breakdown, fostering subsequent infection.…”

Risk factors for peri-megaprosthetic joint infections in tumor surgery: A systematic review

“…-Cefuroxime for 5 days -Teicoplanin for 1 day -Amikacin; 2 doses -Ceftriaxone in children for 5 days status, prolonged hospitalization, and unfavorable functional outcomes and prognosis [31][32][33]. Novel surgical techniques and antibiotic regimens are also necessary to be implemented in order to successfully manage this complication [34][35][36][37].…”

“…Antibiotic-loaded cement is routinely used for implant fixation in megaprosthetic reconstructions. Nevertheless, the literature presents highly diverse findings concerning the correlation between infection rates and cemented or cementless fixation in tumor surgery [31]. Cemented fixation posed a higher risk of infection in two large-scale studies compared to cementless fixation [18,21].…”

The Impact of Enterococcus spp. in the Immunocompromised Host: A Comprehensive Review

“…The presence of an invasive device has previously been identified as a significant clinical risk factor for VRE invasive infections [134]. Invasive procedures such as catheter insertion, ventilation, and surgery increase the risk by providing entry routes for Enterococcus, which can form biofilms on medical devices, or merely serve as indicators of debilitation, prolonged hospital stays, and severe comorbidities [141][142][143][144]. Patients with hematological conditions and invasive devices, undergoing prolonged antibiotic therapy in the same ward, may have acted as VRE reservoirs.…”