Management of Periprosthetic Joint Infection

Lora‐Tamayo, Jaime; Murillo, Óscar

doi:10.1007/978-3-319-65250-4_4

Cited by 6 publications

(7 citation statements)

References 162 publications

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“…Experts recommend delaying reimplantation until 6 weeks or longer for Gram-negative infections, as was the case in this patient [5,7,29]. In the literature, treatment success for two-stage exchange from cohort and case series is estimated at 82e100% [7,11].…”

Section: Discussionmentioning

confidence: 85%

“…Rifampicin and ciprofloxacin are associated with known side effects. A second antimicrobial must be administered with rifampicin, as monotherapy is associated with risk of emergence of resistance [11,25,26]. In addition, rifampicin is a potent inducer of the hepatic cytochrome P450 enzyme system and interacts with many medications, such as warfarin and other direct-acting oral anticoagulants, glucocorticoids and other immunosuppressant medications, and other antimicrobials [25].…”

Section: Therapeutic Algorithmmentioning

confidence: 99%

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How to manage treatment failure in prosthetic joint infection

Peel

Steiger

2020

Clinical Microbiology and Infection

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Background: Management for prosthetic joint infections remains a challenging area for both infectious diseases and orthopaedic surgery, particularly in the setting of treatment failure. This is compounded by a lack of level 1 evidence to guide approaches. The optimal management of prosthetic joint infections requires a multi-disciplinary approach combined with shared decision making with the patient. Aims: This article describes the approach to prosthetic joint infections in the setting of treatment failure. Sources: Narrative review based on literature review from PubMed. There was no time limit on the studies included. In addition, the reference list for included studies were reviewed for literature saturation with manual searching of clinical guidelines. Management approaches described incorporate evidence-and eminence-based recommendations from expert guidelines and clinical studies, where applicable. Content: The surgical and antimicrobial approaches for prosthetic joint infections are described for firstline treatment of prosthetic joint infections and approaches in the event of treatment failure. Management approaches are based on an understanding of the role the biofilm plays in the pathogenesis of prosthetic joint infections. The management of these infections aims to fulfil two key goals: to eradicate the biofilm-associated microorganisms and, to maintain a functional joint and quality of life. In treatment failure, these goals are not always feasible, and the role of the multi-disciplinary team and shareddecision making are prominent. Implications: Prosthetic joint surgery is a high-volume surgery, and the demand for this surgery is continually increasing. With this, the number of infections requiring expert care will also increase. Eminence-based management approaches have been established to guide treatment failure until knowledge gaps in optimal management are addressed by well-designed, clinical trials.

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Section: Discussionmentioning

confidence: 85%

Section: Therapeutic Algorithmmentioning

confidence: 99%

How to manage treatment failure in prosthetic joint infection

Peel

Steiger

2020

Clinical Microbiology and Infection

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“…Cases involving completed biofilm formation on spinal implants (chronic infections) 44 and specific microbes that cannot be eradicated by antimicrobial therapy alone (difficult to treat (DTT) microbes) 6 should undergo implant exchange due to high failure rates. 45,46 DTT microbes are considered microbes resistant to biofilm active antimicrobial therapy, and include Rifampin resistant gram-positive bacteria, fluroquinolone resistant gram-negative bacteria, and fungi/candida. 6 The spinal stability is the critical factor limiting complete and multilevel implant removal, especially considering instable fractures and the following patient mobilization.…”

Section: Resultsmentioning

confidence: 99%

Postoperative Spinal Implant Infections (PSII)—A Systematic Review: What Do We Know So Far and What is Critical About It?

Karczewski

Schnake

Osterhoff

et al. 2021

Global Spine Journal

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Study Design: Systematic review. Objectives: Postoperative spinal implant infections (PSII) are an increasing challenge in the daily clinical routine. This review summarizes existing knowledge in the field of PSII, including definitions, epidemiology, classifications, risk factors, pathogenesis, symptoms, diagnosis, and treatment. Methods: A systematic review was performed using a structured PubMed analysis, based on the PRISMA criteria. The search terminology was set as: “spinal implant associated infection OR spinal implant infection OR spinal instrumentation infection OR peri spinal implant infection.” PubMed search was limited to the categories randomized controlled trials (RCT), clinical trials, meta-analysis and (systematic) reviews, whereas case reports were excluded. Studies from January 2000 to December 2020 were considered eligible. A total of 572 studies were identified, 82 references included for qualitative synthesis, and 19 for detailed sub analysis (12 meta-analysis, 7 prospective RCT). Results: Structural problems in the field of PSII were revealed, including (1) limited level of evidence in clinical studies (missing prospective RCT, metanalyzes), (2) small patient numbers, (3) missing standardized definitions, (4) heterogeneity in patient groups, and (5) redundancy in cited literature. Conclusion: Evidence-based knowledge about spinal implant-associated infections is lacking. All involved medical fields should come together to define the term PSII and to combine their approaches toward research, training, and patient care.

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“…Streptococcal PJIs are generally thought to have a relatively low rate of treatment failure. However, recent studies have indicated an alarming trend of increasing failure rates, ranging from 11% to as high as 42% among the studies (8)(9)(10)(11). Alphahaemolytic and beta-haemolytic streptococci differ in virulence, with the latter being both more virulent and more prevalent in PJIs (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

“…There are several different types of betahaemolytic streptococci. Those most frequently seen in PJIs include Streptococcus pyogenes, Streptococcus agalactiae and Streptococcus dysgalactiae, corresponding to group A (GAS), group B (GBS) and groups C and G (GCS and GGS), respectively, according to the Lancefield classification (5,(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Genomic characterization of beta‐haemolytic streptococci isolated from prosthetic joint infections

Löwbeer

Stegger

Söderquist

2023

APMIS

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Prosthetic joint infection (PJI) is an increasing concern for the medical profession, as higher numbers of arthroplasty surgeries lead to rising PJI‐related costs. Streptococcal PJIs constitute approximately 10% of PJIs, but their genetic features and characteristics remain largely unexplored. Little is known about antimicrobial resistance (AMR) rates, whether some sequence types (ST) dominate, and whether certain virulence‐associated genes are overrepresented. We used whole‐genome sequencing of Streptococcus dysgalactiae (n = 22), Streptococcus agalactiae (n = 10) and S. pyogenes (n = 1) to elicit genomic data on 33 beta‐haemolytic streptococci isolated from PJIs in Region Örebro county, Sweden. Relatedness was inferred based on single nucleotide polymorphisms in S. dysgalactiae and S. agalactiae. The genomic data were screened for virulence‐associated genes available in the Virulence Factor Database. All isolates were screened for both phenotypic and genotypic resistance. The S. dysgalactiae and S. agalactiae isolates were genetically diverse, although 32% of S. dysgalactiae isolates (n = 7) were ST20. The speS and PI‐2A genes were less represented in these isolates among virulence‐associated genes, and AMR was more frequently observed in S. agalactiae. We conclude that PJIs caused by beta‐haemolytic streptococci are not dominated by genetically similar beta‐haemolytic streptococci. There were distinct inter‐species differences in AMR between S. agalactiae and S. dysgalactiae.

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Management of Periprosthetic Joint Infection

Cited by 6 publications

References 162 publications

How to manage treatment failure in prosthetic joint infection

How to manage treatment failure in prosthetic joint infection

Postoperative Spinal Implant Infections (PSII)—A Systematic Review: What Do We Know So Far and What is Critical About It?

Genomic characterization of beta‐haemolytic streptococci isolated from prosthetic joint infections

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