Archive for June 20, 2017

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.

Int J Infect Dis. Oct. 2016 V.51 P56-61.

Lourtet-Hascoët J1, Bicart-See A2, Félicé MP3, Giordano G4, Bonnet E2.

Author information

1 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France. Electronic address: julielourtet@hotmail.com

2 Infectious Diseases Mobile Unit, J. Ducuing Hospital, Toulouse, France.

3 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France.

4 Traumatology and Orthopaedic Surgery Department, J. Ducuing Hospital, Toulouse, France.

Abstract

OBJECTIVES:

The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis.

METHODS:

A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000-2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux).

RESULTS:

Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis.

CONCLUSION:

S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .

PDF

http://www.ijidonline.com/article/S1201-9712(16)31132-8/pdf

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June 20, 2017 at 7:44 pm

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. borg.leijtens@radboudumc.nl.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.

METHODS:

In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.

RESULTS:

In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.

CONCLUSION:

Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414295/pdf/12879_2017_Article_2429.pdf

June 20, 2017 at 7:11 pm

Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.

Open Orthop J. Nov. 30, 2016 V.30 N.10 P.636-645.

Mirza YH1, Tansey R1, Sukeik M2, Shaath M3, Haddad FS1.

Author information

1 Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.

2 Department of Trauma and Orthopaedics, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.

3 Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay’s Road, Crumpsall, M8 5RB, United Kingdom.

Abstract

An increasing demand for lower limb arthroplasty will lead to a proportionate increase in the need for revision surgery.

A notable proportion of revision surgery is secondary to periprosthetic joint infections (PJI). Diagnosing and eradicating PJI can form a very difficult challenge. An important cause of PJI is the formation of a bacterial biofilm on the implant surface.

Our review article seeks to describe biofilms; their definitions and formation, common causative bacteria, prophylactic and therapeutic antibiotic therapy.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398090/pdf/TOORTHJ-10-636.pdf

 

June 20, 2017 at 7:08 pm

Clinical and Microbiological Characteristics of Bacteroides Prosthetic Joint Infections.

J Bone Jt Infect. 2017 Mar 19;2(3):122-126.

Shah N1, Osmon D1, Tande AJ1, Steckelberg J1, Sierra R2, Walker R1, Berbari EF1.

Author information

1 Division of Infectious Disease, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract

Clinical and microbiological characteristics of patients with Bacteroides prosthetic joint infection (PJI) have not been well described in the literature.

The aim of this retrospective cohort study was to assess the outcome of patients with Bacteroides PJI and to review risk factors associated with failure of therapy.

Between 1/1969 and 12/2012, 20 episodes of Bacteroides PJI in 17 patients were identified at our institution. The mean age of the patients in this cohort at the time of diagnosis was 55.6 years; 59% (n=10) had knee involvement. Twenty four percent (n=4) had diabetes mellitus, and 24% had a history of either gastrointestinal (GI) or genitourinary (GU) pathology prior to the diagnosis of PJI. Thirty five percent (n=6) were immunosuppressed.

The initial medical/surgical strategy was resection arthroplasty (n=9, 50%) or debridement and implant retention (n=5, 28%). Thirty seven percent (n=7) were treated with metronidazole. Eighty percent (n=4) of patients that failed therapy had undergone debridement and retention of their prosthesis, as compared to none of those treated with resection arthroplasty. Seventy percent (n=14) of patient episodes were infection free at their last date of follow up.

In conclusion, a significant proportion of patients with Bacteroides PJI are immunosuppressed and have an underlying GI or GU tract pathology. Retention and debridement of the prosthesis is associated with a higher risk of treatment failure.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441143/pdf/jbjiv02p0122.pdf

June 20, 2017 at 5:39 pm

Candida Prosthetic Joint Infection. A Review of Treatment Methods.

J Bone Jt Infect. 2017 Feb 5;2(2):114-121.

Cobo F1, Rodríguez-Granger J1, Sampedro A1, Aliaga-Martínez L2, Navarro-Marí JM1.

Author information

1 Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain.

2 Department of Internal Medicine, Hospital Virgen de las Nieves, Granada, Spain.

Abstract

Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441142/pdf/jbjiv02p0114.pdf

June 20, 2017 at 2:24 pm

Use of Chlorhexidine Preparations in Total Joint Arthroplasty.

J Bone Jt Infect. 2017 Jan 1;2(1):15-22.

George J1, Klika AK1, Higuera CA1.

Author information

1 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423571/pdf/jbjiv02p0015.pdf

June 20, 2017 at 2:21 pm


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