Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review

Prosthetic Joint Infection Due to Mycobacterium goodii/smegmatis

“…PJI. One hundred twenty cases were identified [3][4][5] . We limited our search to reported cases of mycobacterial PJIs associated with total hip and total knee arthroplasties only.…”

“…Immunosuppression or use of immunosuppressive medications should also be a considered as reasons to consider obtaining AFB cultures from periprosthetic joint fluid. Only 3 of the reviewed cases were identified as having M. smegmatis PJI and an additional 4 cases were associated with M. goodii, which were the organisms most closely related to the causative organism for our patient [3][4][5] . With these organisms, resolution of infection was noted to be accomplished almost exclusively through 2stage exchange, which involves the lengthy process of hardware removal, followed by insertion of an antibioticimpregnated spacer, targeted antibiotic therapy, and, eventually, reimplantation of the prosthesis once the infection was deemed clear.…”

“…Margaret Sims, MSPAS, PA-C 1,2 Kenneth L. Urish, MD, PhD 1,3 Neel B. Shah, MD 4 1 The Bone and Joint Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania…”

Mycobacterium biofilms

“…The presence of a foreign body or biomaterial is also a risk factor for some infections caused by NTM. Many different syndromes of biomaterial-related infections caused by NTM have been described, including catheter-related bacteremia and endocarditis [ 59 ], prosthetic joint infection [ 75 , 76 ], peritonitis associated with peritoneal dialysis [ 77 ], post-surgical infections [ 78 ], augmentation mammaplasty [ 79 ] and others. In all these cases, removal of the biomaterial is essential to cure the patients [ 80 , 81 ], because the antibiotic treatment alone is not able to eradicate the biofilm.…”

Cultures in periprosthetic joint infections, the imperfect gold standard?

“…In rare cases, latent TB may become manifest after invasive surgery and/or during an acute PJI caused by another microorganism. However, in most cases, TB or other mycobacteria, often present in a more chronic fashion ( 30 ). Granulomas found in histology sections might provide a clinical clue for mycobacterial infections but are not always present.…”