Posts filed under ‘Infecciones osteo-articulares-musculares’

What Is the Role of Repeat Aspiration in the Diagnosis of Periprosthetic Hip Infection?

Journal of Arthropasty January 2019 V.34 N.1 P.126–131

Jeffrey D. Hassebrock, Michael G. Fox, Mark J. Spangehl, Matthew R. Neville, Adam J. Schwartz


The American Academy of Orthopedic Surgeons clinical practice guideline currently recommends repeat joint aspiration when workup of periprosthetic joint infection (PJI) reveals conflicting data. This guideline is based on a single study of 31 patients published 25 years ago. We sought to determine the correlation between first and second aspirations and factors that may play a role in variability between them.


Sixty patients with less than 90 days between aspirations and no intervening surgery were identified at our institution and classified by Musculoskeletal Infection Society (MSIS) criteria as infected, not infected, or not able to determine after both aspirations. Culture results from both aspirations were recorded. The rates of change and correlation in clinical diagnosis and culture results between aspirations were determined.


Repeat aspiration changed the diagnosis in 26 cases (43.3%, 95% confidence interval 31.6-55.9, kappa coefficient 0.32, P < .001), and the culture results in 25 cases (41.7%, 95% confidence interval 30.1-54.3, kappa coefficient 0.27, P < .01). Among patients initially MSIS negative, the proportion who changed to MSIS positive was greater for those with a history of prior PJI compared to those without (66.7% vs 0%, P < .05), and the first aspiration mean volume was higher for those changed to MSIS positive compared to those that remained MSIS negative (12.0 vs 3.0 mL, P < .01). Among patients initially MSIS positive, the proportion of patients who changed to MSIS negative was greater for those with a history of adverse local tissue reaction (ALTR) to metal debris compared to patients without suspicion of ALTR (100% vs 7.7%, P < .05).


Repeat aspiration is particularly useful in patients with conflicting clinical data and prior history of PJI, suspicion of ALTR, or with high clinical suspicion of infection.



January 12, 2019 at 10:54 am

Evaluation of Lipocalin-2 as a Biomarker of Periprosthetic Joint Infection

Journal of Arthropasty January 2019 V.34 N.1 P.123–125

Andrea Vergara, Mariana J. Fernández-Pittol, Ernesto Muñoz-Mahamud, Laura Morata, Jordi Bosch, Jordi Vila, Alex Soriano, Climent Casals-Pascual


Periprosthetic joint infection (PJI) remains a major clinical challenge. In this study, we evaluated the diagnostic performance of lipocalin-2 (LCN2), a well-characterized neutrophil protein, in synovial fluid to discriminate PJI and aseptic implant failure.


Synovial fluid from patients with acute or chronic PJI, aseptic failure, or controls was obtained during surgery. LCN2 was quantified using a modified enzyme immunoassay coupled with chemiluminescence (Architect Urine NGAL; Abbott Laboratories).


Synovial fluid was collected from 72 patients: 22 (30.6%) proven infections, 22 (30.6%) aseptic implant failures, and 28 (38.8%) controls. Synovial fluid was obtained from the hip in 18 (25%) and knee in 54 (75%) cases. Among infections, there were 16 (22.2%) acute and 6 (8.3%) chronic PJIs. The median (interquartile range) LCN2 concentration in synovial fluid was 1536.5 ng/mL (261.8-12,923) in the infection group, 87.0 (54.8-135) in the aseptic group, and 55 (45-67.8) in the control group (P < .001). LCN2 discriminated nearly perfectly between controls and confirmed infection (area under the receiver operating characteristic 0.98, 95% confidence interval 0.95-1.00). The optimal cut-off value for maximal sensitivity (86.3%) and specificity (77.2%) to discriminate aseptic failure versus proven infection was 152 ng/mL, with an area under the receiver operating characteristic of 0.92 (95% confidence interval 0.84-0.99).


LCN2 is a potential novel biomarker that may be helpful to inform surgical teams on the potential risk of PJI and optimize specific surgical interventions as it distinguishes between septic and aseptic failure of prosthesis with high sensitivity and specificity.


January 12, 2019 at 10:53 am

Sarcopenia as a Risk Factor for Prosthetic Infection After Total Hip or Knee Arthroplasty

Journal of Arthropasty January 2019 V.34 N.1 P.116–122

Jacob M. Babu, MD, MHA a, *, Saisanjana Kalagara b, Wesley Durand b,Valentin Antoci, MD, PhD a, Matthew E. Deren, MD c, Eric Cohen, MD a

a Division of Arthroplasty, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI

b Warren Alpert Medical School of Brown University, Providence, RI

c Division of Arthroplasty, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH


Sarcopenia, an age-related loss of muscle mass and function, has been previously linked to an increased risk of morbidity, mortality, and infection after a variety of surgical procedures. This study is the first to evaluate the impact of the psoas-lumbar vertebral index (PLVI), a validated marker for central sarcopenia, on determining post-arthroplasty infection status.


This is a case-control, retrospective review of 30 patients with prosthetic joint infection (PJI) diagnosed by the Musculoskeletal Infection Society criteria compared to 69 control patients who underwent a total hip or knee arthroplasty. All patients had a recent computed tomography scan of the abdomen/pelvis to calculate the PLVI. PLVI was evaluated alongside age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, and smoking status to determine the predictive value for infection.


Notably, the infected group had a large, significant difference in their average PLVI (0.736 vs 0.963, P < .001). The patient’s PLVI was a predictor of infection status, with a higher PLVI being protective against infection (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.109-0.715, P = .008). Additional predictors of infection status were higher American Society of Anesthesiologists score (OR 10.634, 95% CI 3.112-36.345, P < .001) and Charlson Comorbidity Index (OR 1.438, 95% CI 1.155-1.791, P = .001). Multivariate, binary logistic regression analysis confirmed that PLVI was a significant independent predictor of infection status (B = −0.685, P = .039).


PLVI, a marker for central sarcopenia, was demonstrated to be a risk factor for PJI. Further research and consideration of sarcopenia as a screening and optimizable risk factor for total joint arthroplasty must be explored.


January 12, 2019 at 10:51 am

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Journal of Infection January 2019 V.78 N.1 P.40–47 


  • Late acute prosthetic joint infection (LA PJI) treated with surgical debridement and implant retention have a high failure rate.
  • The exchange of mobile components during surgical debridement is the most potent predictor for treatment success.
  • There are several preoperative patient related variables that increase the risk for failure.
  • Treatment strategies for late acute PJIs should be individualized and optimized according to the preoperative risk for failing.


Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.


Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.


340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).


LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients’ age, comorbidity, clinical presentation and microorganism causing the infection.



January 12, 2019 at 10:02 am

Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

Journal of Infection January 2019 V.78 N.1 P.27–34

Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Beraud, Olivier Grossi, Nicolas Varache, Cédric Arvieux, Rozenn Le Berre, Pierre Tattevin, for the Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)


We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).


Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.


During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).


  1. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.



January 12, 2019 at 10:01 am

Candida auris Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Emerging Infectious Diseases January 2019 V.25  N.1

H. Heath et al.

In Australia in 2015, Candida auris sternal osteomyelitis was diagnosed in a 65-year-old man with a history of intensive care treatment in Kenya in 2012 and without a history of cardiac surgery.

The isolate was South Africa clade III.

Clinicians should note that C. auris can cause low-grade disease years after colonization.


December 26, 2018 at 3:48 pm

Culture-Negative Periprosthetic Joint Infection: An Update on What to Expect.

JB JS Open Access. 2018 July 12, 2018 V.3 N.3 e0060.

doi: 10.2106/JBJS.OA.17.00060. eCollection 2018 Sep 25.

Tan TL1, Kheir MM1, Shohat N1, Tan DD1, Kheir M1, Chen C1, Parvizi J1.

1 Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.



Culture-negative periprosthetic joint infection (PJI) is a challenging condition to treat. The most appropriate management of culture-negative PJI is not known, and there is immense variability in the treatment outcome of this condition. The purpose of this study was to elucidate the characteristics, outcomes, and risk factors for failure of treatment of culture-negative PJI.


A retrospective review of 219 patients (138 hips and 81 knees) who had undergone surgery for the treatment of culture-negative PJI was performed utilizing a prospectively collected institutional PJI database. PJIs for which the results of culture were unavailable were excluded. An electronic query and manual review of the medical records were completed to obtain patient demographics, treatment, microbiology data, comorbidities, and other surgical characteristics. Treatment failure was assessed using the Delphi consensus criteria.


The prevalence of suspected culture-negative PJI was 22.0% (219 of 996), and the prevalence of culture-negative PJI as defined by the Musculoskeletal Infection Society (MSIS) was 6.4% (44 of 688). Overall, the rate of treatment success was 69.2% (110 of 159) in patients with >1 year of follow-up. Of the 49 culture-negative PJIs for which treatment failed, 26 (53.1%) subsequently had positive cultures; of those 26, 10 (38.5%) were positive for methicillin-sensitive Staphylococcus aureus. The rate of treatment success was greater (p = 0.019) for patients who had 2-stage exchange than for those who underwent irrigation and debridement.


The present study demonstrates that culture-negative PJI is a relatively frequent finding with unacceptable rates of treatment failure. Every effort should be made to isolate the infecting organism prior to surgical intervention, including extending the incubation period for cultures, withholding antibiotics prior to obtaining culture specimens, and possibly using newly introduced molecular techniques.


Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.



December 20, 2018 at 7:27 pm

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