The unsuspected prosthetic joint infection

Jacobs, Anouk M E; Bénard, Menno R.; Meis, Jacques F.; Hellemondt, Gijs van; Goosen, Jon H. M.

doi:10.1302/0301-620x.99b11.bjj-2016-0655.r2

Cited by 76 publications

(50 citation statements)

References 21 publications

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“…However, this is consistent with the absence of clinical radiographic findings associated with S. epidermidis implant-associated bone infections, 35 and aseptic loosening of total joint replacements. 12,13 These observations are also consistent with the findings of Lankinen et al, who demonstrated similar bone destruction tendencies to our results with a rabbit model. 36 On SEM analysis, RP62A produced less biofilm compared with USA300.…”

supporting

confidence: 94%

“…However, S. epidermidis is also considered to be an opportunistic pathogen, as it causes infections in immunocompromised patients with implants . S. epidermidis is also present on prosthetic joint infection (PJI), and implants removed for aseptic prosthesis loosening . Interestingly, late‐start chronic (low‐grade) PJI, which are challenging to diagnose from unspecific clinical signs, false‐negative cultures, and low values of serum biomarkers, often contain CNS as the hidden pathogen .…”

mentioning

confidence: 99%

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Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model

Tomizawa

Ishikawa

Bello-Irizarry

et al. 2019

Journal Orthopaedic Research

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Despite its presence in orthopaedic infections, Staphylococcus epidermidis's ability to directly induce inflammation and bone destruction is unknown. Thus, we compared a clinical strain of methicillin‐resistant biofilm‐producing S. epidermidis (RP62A) to a highly virulent and osteolytic strain of methicillin‐resistant Staphylococcus aureus (USA300) in an established murine implant‐associated osteomyelitis model. Bacterial burden was assessed by colony forming units (CFUs), tissue damage was assessed by histology and micro‐computed tomography, biofilm was assessed by scanning electron microscopy (SEM), host gene expression was assessed by quantitative polymerase chain reaction, and osseous integration was assessed via biomechanical push‐out test. While CFUs were recovered from RP62A‐contaminated implants and surrounding tissues after 14 days, the bacterial burden was significantly less than USA300‐infected tibiae (p < 0.001). In addition, RP62A failed to produce any of the gross pathologies induced by USA300 (osteolysis, reactive bone formation, Staphylococcus abscess communities, marrow necrosis, and biofilm). However, fibrous tissue was present at the implant‐host interface, and rigorous SEM confirmed the rare presence of cocci on RP62A‐contaminated implants. Gene expression studies revealed that IL‐1β, IL‐6, RANKL, and TLR‐2 mRNA levels in RP62A‐infected bone were increased versus Sterile controls. Ex vivo push‐out testing showed that RP62A‐infected implants required significantly less force compared with the Sterile group (7.5 ± 3.4 vs. 17.3 ± 4.1 N; p < 0.001), but required 10‐fold greater force than USA300‐infected implants (0.7 ± 0.3 N; p < 0.001). Taken together, these findings demonstrate that S. epidermidis is a commensal pathogen whose mechanisms to inhibit osseous integration are limited to minimal biofilm formation on the implant, and low‐grade inflammation. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:852‐860, 2020

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supporting

confidence: 94%

mentioning

confidence: 99%

Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model

Tomizawa

Ishikawa

Bello-Irizarry

et al. 2019

Journal Orthopaedic Research

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“…This picture can be seen when positive intraoperative cultures are obtained in revision surgeries due to clinical suspicion of aseptic causes, especially if performed < 5 years after the index procedure, and if mechanical or functional causes could not be identified by conventional investigations. 15…”

Section: Clinical Diagnosis Of Periprosthetic Joint Infection (Signs mentioning

confidence: 99%

“…É o que pode acontecer na circunstância de culturas positivas intraoperatórias em cirurgias de revisão com suspeita clínica de causas presumivelmente assépticas, sobretudo quando realizadas em cirurgias com um seguimento < 5 anos após a cirurgia de base, e nas quais causas mecânicas ou funcionais não podem ser identificadas por investigações convencionais. 15…”

Section: Diagnóstico Clínico Da Infecção Articular Periprotética (Sinunclassified

Diagnóstico precoce da infecção articular periprotética do quadril – situação atual, avanços e perspectivas

Gomes

2019

Rev Bras Ortop

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ResumoA infecção articular periprotética (IAP) tem consequências devastadoras sobre a função articular e sobre a taxa de morbimortalidade dos pacientes vitimados por esta grave complicação. Ainda que o diagnóstico precoce seja um dos consensos com importância bem estabelecida, as rotinas de investigação são ainda conduzidas de forma empírica, inconsistente e pouco objetiva em muitos centros de todo o mundo. O presente artigo busca contextualizar a situação atual dos conhecimentos sobre o diagnóstico precoce das infecções articulares periprotéticas, assim como discutir os avanços e perspectivas, dentro de um cenário de sua aplicabilidade rotineira pela equipe médica responsável pelo manejo desta temida complicação.

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“…The widespread gram-negative agents are Pseudomonas aeruginosa , Acinetobacter baumanii , Klebsiella pneumoniae , Proteus spp., Enterobacter spp., Escherichia coli [2], [3], [4]. Despite recent technological advances in cultural methods, an overwhelming 10% to 42% microbial causes of all periprosthetic infections remain unidentified [5], [6].…”

Section: Introductionmentioning

confidence: 99%

Challenging Diagnostics of Biofilm Associated Periprosthetic Infection in Immunocompromised Patient: A Clinical Case

Науменко¹,

Силантьева²,

Ермаков³

et al. 2019

Open Access Maced J Med Sci

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Abstract BACKGROUND: Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty. The identification of microorganisms in biofilm-related PJI is challenging yet significant stage of the treatment process. Medical microbiology methods, such as pure culture isolation, remain the gold standard. However, the error rate of classical methods may vary from 10% to as high as 42% due to the inability to detect bacteria growing within biofilms. Other methods of detection are being explored to improve the management of PJI. AIM: Accurate identification of PJI contributing microorganisms in a patient with acute postoperative PJI after total hip joint arthroplasty and systemic lupus erythematosus in anamnesis. METHODS: We used microbial culture methods followed by scanning electron microscopy (SEM). RESULTS: Perioperative an intraoperative cultural analysis of 8 different culture samples of tissue and prosthetic origin was insufficient for bacterial or fungal detection. Scanning electron microscopy revealed detailed biofilm visualisation on the surface of the prosthetic component. The biofilm exterior was composed of microbial clusters made of 10 or more cells with either pear- or bottle-shaped morphology, 3-6 mcm in length and 1.5-3 mcm in diameter. Rod-shaped microorganisms of 0.7-1 mcm length and up to 0.5 mcm in diameter were found adjacent to these clusters. CONCLUSION: Additional methods for PJI agents’ detection are time-and cost-effective in the case of the challenging diagnostics of biofilm-related PJI, particularly in immunocompromised patients. Using combined diagnostic approaches increases the accuracy of detection, justifies treatment strategies and improves clinical outcomes.

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The unsuspected prosthetic joint infection

Cited by 76 publications

References 21 publications

Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model

Biofilm Producing Staphylococcus epidermidis (RP62A Strain) Inhibits Osseous Integration Without Osteolysis and Histopathology in a Murine Septic Implant Model

Diagnóstico precoce da infecção articular periprotética do quadril – situação atual, avanços e perspectivas

Challenging Diagnostics of Biofilm Associated Periprosthetic Infection in Immunocompromised Patient: A Clinical Case

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