The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management—A multicenter retrospective study

Mahieu, Rafaël; Dubée, Vincent; Seegers, Valérie; Lemarié, Carole; Ansart, Séverine; Bernard, Louis; Moal, G. Le; Asseray, Nathalie; Arvieux, Cédric; Ramanantsoa, Céline; Cormier, H.; Legrand, Érick; Abgueguen, P.

doi:10.1016/j.ijid.2019.06.012

Cited by 31 publications

(35 citation statements)

References 35 publications

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“…Clinically, this is a very important finding as the optimal treatment for GBS implant‐associated infection remains unclear. While current guidelines recommend antibiotic treatment with penicillin G and amoxicillin, 53 many patients are treated with rifampicin combinations to improve eradication of bacterial biofilms on implant surfaces 25,54 despite contradicting evidence that it does not improve outcomes 55 . Further, it is unclear whether patients have equivalent outcomes with a less invasive debridement and implant retention procedure versus a more invasive removal of the existing implant for a staged procedure 54 .…”

Section: Discussionmentioning

confidence: 99%

“…The second most common microbial genus isolated from PJI's is Streptococcus, 22,23 with S. agalactiae, also known as Group B Streptococcus (GBS), being the most common species. 24,25 S. agalactiae is a commensal organism that colonizes the intestinal and vaginal flora.…”

Section: Introductionmentioning

confidence: 99%

“…28 In the context of orthopaedic infection, the pathophysiology of S. agalactiae-induced osteomyelitis has not been investigated. Within cases of streptococcal PJI, S. agalactiae has been reported as an independent risk factor for poorer outcomes, 23,25 as well as comorbidities 29 and duration of symptoms. 30 Clinically, there have been conflicting reports related to the specific treatment of S. agalactiae orthopaedic infection.…”

Section: Introductionmentioning

confidence: 99%

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Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

Masters

Hao

Kenney

et al. 2020

Journal Orthopaedic Research

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Osteomyelitis is a devastating complication of orthopaedic surgery and commonly caused by Staphylococcus aureus (S. aureus) and Group B Streptococcus (GBS, S. agalactiae). Clinically, S. aureus osteomyelitis is associated with local inflammation, abscesses, aggressive osteolysis, and septic implant loosening. In contrast, S. agalactiae orthopaedic infections generally involve soft tissue, with acute lifethreatening vascular spread. While preclinical models that recapitulate the clinical features of S. aureus bone infection have proven useful for research, no animal models of S. agalactiae osteomyelitis exist. Here, we compared the pathology caused by these bacteria in an established murine model of implant-associated osteomyelitis. In vitro scanning electron microscopy and CFU quantification confirmed similar implant inocula for both pathogens (~10 5 CFU/pin). Assessment of mice at 14 days post-infection demonstrated increased S. aureus virulence, as S. agalactiae infected mice had significantly greater body weight, and fewer CFU on the implant and in bone and adjacent soft tissue (p < 0.05). X-ray, µCT, and histologic analyses showed that S. agalactiae induced significantly less osteolysis and implant loosening, and fewer large TRAP + osteoclasts than S. aureus without inducing intraosseous abscess formation. Most notably, transmission electron microscopy revealed that although both bacteria are capable of digesting cortical bone, S. agalactiae have a predilection for colonizing blood vessels embedded within cortical bone while S. aureus primarily colonizes the osteocyte lacuno-canalicular network. This study establishes the first quantitative animal model of S. agalactiae osteomyelitis, and demonstrates a vasculotropic mode of S. agalactiae infection, in contrast to the osteotropic behavior of S. aureus osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

Masters

Hao

Kenney

et al. 2020

Journal Orthopaedic Research

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“…26 Several factors have been associated with its failures: patient's own immune deficiency and a high ASA score, the presence of methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus agalactiae or Pseudomonas aeruginosa species, a poor local tissues viability, the presence of rheumatologic disease, delayed presentation from the original surgery and erythrocyte sedimentation rate above 60mm/h at presentation. [27][28][29] Historically, in front of a PJI, timing of the treatment is crucial in terms of obtaining a satisfactory outcome: a prompt treatment in acute PJIs may reach 100% of eradication while the success rate in chronic PJI has been reported between 28% and 62%. 30 The current authors established the described stringent timing criteria for DAPRI according to the current literature on biofilm biology and the results of other implant preservation techniques.…”

Section: Discussionmentioning

confidence: 99%

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

et al. 2020

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In this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12-week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI.

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“…Prevalence of PJI is steadily increasing, mostly due to more frequent usage of prosthetic joints [ 1 , 2 ]. Given the projected increase of joint replacement over the coming decades turned into a challenging issue, such as diagnosis challenges, high morbidity, the economic burden for patients and healthcare costs [ 5 , 8 , 9 ]. In managing PJI, one of the most important aspects is a prompt and definitive diagnosis of the causative organisms for the selection of appropriate treatment options and avoiding unnecessary multiple surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of 16S rRNA variable regions high-resolution melt analysis for bacterial pathogens identification in periprosthetic joint infections

et al. 2021

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Background Accurate and rapid identification of microorganisms causing periprosthetic joint infections (PJIs) are necessary for choosing an appropriate antibiotic therapy. Therefore, molecular techniques are suggested for diagnosis in suspected PJIs. The Broad-range PCR and High-Resolution Melt Analysis (HRMA) were evaluated for the identification of causative organisms of PJIs in this study. Results For 47 of 63 specimens, both the culture and broad-range PCR were positive. The culture was found to be able of organism’s detection in 74.6% (47/63) of patients. Of 47 positive cultures, 11 (23.4%) were polymicrobial and 36 (76.59%) were monomicrobial cultures, in which 34 (91.89%) cases were detected by HRM assay. The sensitivity, specificity of HRMA vs monomicrobial culture were 91.89, 93.75%, respectively. The sensitivity, specificity of total HRMA (mono + poly) vs culture were 82.92, 93.75%. Conclusions HRM assay coupled with broad-range PCR are effective screening, rapid, and relatively cost-effective methods for discrimination of PJIs especially in aiding culture method. Using computer programs such as the Matlab-2018b program for HRM data analysis is also valuable and helpful in diagnosis.

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The prognosis of streptococcal prosthetic bone and joint infections depends on surgical management—A multicenter retrospective study

Cited by 31 publications

References 35 publications

Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty

Efficacy of 16S rRNA variable regions high-resolution melt analysis for bacterial pathogens identification in periprosthetic joint infections

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