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Journal of Bone and Joint Infection

Thomas Colding-Rasmussen, Peter Horstmann, Michael Mørk Petersen, Werner Hettwer
Introduction: Locally implanted antibiotic-eluting carriers may be a valuable adjuvant to the management of prosthetic joint infections. Aim: to assess local and plasma antibiotic concentrations as well as cumulative antibiotic urine excretion associated with clinical use of a gentamicin - or vancomycin-loaded mineral composite antibiotic carrier. Methods: 32 patients (male/female=19/13, mean age=56; 21-82 years) were prospectively followed after implantation of gentamicin (n=11), vancomycin (n=15), or a combination (n=7), using an antibiotic carrier (CERAMENT™|G or CERAMENT™|V, mean amount 11 (3-20) mL) during resection arthroplasty of the hip/knee...
2018: Journal of Bone and Joint Infection
Joanna Kedra, Valérie Zeller, Beate Heym, Philippe Lehours, Vanina Meyssonnier, Sylvie Lariven, Lucie Bruhl-Bénéjat, Simon Marmor, Jean-Marc Ziza
We describe the case of an HIV-infected man who developed twice a Helicobacter cinaedi prosthetic joint infection. In our knowledge, it is the first case to date. Furthermore, it illustrates the fact that this bacterium is difficult to isolate and that recurrences can occur even after apparently successful treatment.
2018: Journal of Bone and Joint Infection
Markus Rupp, Gero Knapp, David Weisweiler, Christian Heiss, Volker Alt
Necrotizing fasciitis is an uncommon but often fatal disease. Given the various causes of necrotizing fasciitis, we report a case of sigmoid colon perforation caused by a toothpick subsequently resulting in fulminant necrotizing fasciitis of the retroperitoneum and right thigh successfully treated by hemipelvectomy and Hartmann´s procedure.
2018: Journal of Bone and Joint Infection
Marjan Wouthuyzen-Bakker, Jaime Lora-Tamayo, Eric Senneville, Matthew Scarbourough, Tristan Ferry, Ilker Uçkay, Mauro J Salles, Karina O'Connell, Josean A Iribarren, Dace Vigante, Rihard Trebse, Cedric Arvieux, Alex Soriano, Javier Ariza
We describe a case of a 60-year old male who developed an acute prosthetic joint infection (PJI) of the knee, secondary to erysipelas of the lower leg due to beta-hemolytic Group G streptococci. As it is unknown how often this phenomenon occurs in patients with prosthetic implants and which patients are most prone to develop this complication, we analyzed: i) the incidence of the development of a PJI in these patients and ii) the clinical characteristics of streptococcal PJI during an episode of erysipelas/cellulitis...
2018: Journal of Bone and Joint Infection
Peter Wahl, Karolin Rönn, Marc Bohner, Laurent A Decosterd, Christoph Meier, Michel Schläppi, Sandrine Festa, Emanuel Gautier
INTRODUCTION: Local application of antibiotics provides high concentrations at the site of interest, with minimal systemic toxicity. Carrier materials might help manage dead space. Calcium sulphate (CaSO4 ) has a dissolution time that only slightly exceeds the usually recommended duration of systemic antibiotic treatments. This in vitro study evaluates compatibility, release kinetics and antibacterial activity of new combinations of antibiotics with CaSO4 as carrier material. METHODS: CaSO4 pellets added with 8% w/w antibiotic powder were exposed once in phosphate-buffered saline (PBS) solution and once in bovine plasma, in an elution experiment run over 6 weeks at 37 °C...
2018: Journal of Bone and Joint Infection
Gonzalo Luengo, Jaime Lora-Tamayo, Diana Paredes, Irene Muñoz-Gallego, Antonio Díaz, Emilio Delgado
The highly active anti-biofilm combination of daptomycin plus fosfomycin was successfully used in a difficult-to-treat infection of a total femoral replacement caused by multi-drug resistant Staphylococcus epidermidis in a 79-year-old woman. There was no need to remove the orthopedic hardware, and the patient is currently pain free and able to walk.
2018: Journal of Bone and Joint Infection
Walter van der Weegen, Cees M Verduin, Miriam Graumans, Henk J Hoekstra
According to the relevant literature, prosthetic joint infections caused by Listeria monocytogenes require two stage revision surgery or prosthesis removal for a successful outcome. We present the case of a patient who suffered such an infection after Total Knee Replacement surgery and was successfully treated with antibiotics, joint lavage, debridement and retention of the prosthesis.
2018: Journal of Bone and Joint Infection
Arnaldo Sousa, André Carvalho, Cláudia Pereira, Ernestina Reis, Ana Cláudia Santos, Miguel Abreu, Daniel Soares, Ricardo Fragoso, Susana Ferreira, Marcio Reis, Ricardo Sousa
Introduction: Prosthetic infection is a devastating complication of arthroplasty and carries significant economic burden. The objective of this study was to analyze the economic impact of prosthetic hip and knee infection in Portuguese National Health System. Material and Methods: Case-control study carried out from January 2014 to December 2015. The mean costs of primary arthroplasties and prosthetic revision surgeries for non-infectious reasons were compared with the costs of prosthetic infections treated with debridement and preservation of the prosthesis or with two-stage exchange arthroplasty...
2018: Journal of Bone and Joint Infection
Grahmm A Funk, Jonathan C Burkes, Kimberly A Cole, Mohamed N Rahaman, Terence E McIff
Introduction: Local delivery of antibiotics using bone cement as the delivery vehicle is an established method of managing implant-associated orthopedic infections. Various fillers have been added to cement to increase antibiotic elution, but they often do so at the expense of strength. This study evaluated the effect of adding a borate bioactive glass, previously shown to promote bone formation, on vancomycin elution from PMMA bone cement. Methods: Five cement composites were made: three loaded with borate bioactive glass along with 0, 1, and 5 grams of vancomycin and two without any glass but with 1 and 5 grams vancomycin to serve as controls...
2018: Journal of Bone and Joint Infection
Zoé Cavalli, Agathe Becker, Alexie Bosch, Anne Conrad, Claire Triffault-Filit, Florent Valour, Frederic Laurent, Sabine Cohen, Christian Chidiac, Tristan Ferry
We reviewed all outpatients with bone and joint infection treated with cefoxitin in continuous intravenous infusion using mobile elastomeric infusors in our regional reference center between 2014 and 2017. The stability of cefoxitin provides an interesting and well-tolerated alternative for continuous infusion in outpatients with polymicrobial bone and joint infection.
2018: Journal of Bone and Joint Infection
Jolien Onsea, Melissa Depypere, Geertje Govaert, Richard Kuehl, Thomas Vandendriessche, Mario Morgenstern, Martin McNally, Andrej Trampuz, Willem-Jan Metsemakers
Introduction: Intraoperatively obtained peri-implant tissue cultures remain the standard for diagnosis of fracture-related infection (FRI), although culture-negative cases may complicate treatment decisions. This paper reviews the evidence on sonication fluid and tissue sampling for the diagnosis of FRI. Methods: A comprehensive search in Pubmed, Embase and Web-of-Science was carried out on April 5, 2018, to identify diagnostic validation studies regarding sonication fluid and tissue sampling for FRI. Results: Out of 2624 studies, nine fulfilled the predefined inclusion criteria...
2018: Journal of Bone and Joint Infection
James X Liu, Jordan Werner, Thorsten Kirsch, Joseph D Zuckerman, Mandeep S Virk
Introduction: Chlorhexidine gluconate (CHX) is widely used as a preoperative surgical skin-preparation solution and intra-wound irrigation agent, with excellent efficacy against wide variety of bacteria. The cytotoxic effect of CHX on local proliferating cells following orthopaedic procedures is largely undescribed. Our aim was to investigate the in vitro effects of CHX on primary fibroblasts, myoblasts, and osteoblasts. Methods: Cells were exposed to CHX dilutions (0%, 0.002%, 0.02%, 0.2%, and 2%) for either a 1, 2, or 3-minute duration...
2018: Journal of Bone and Joint Infection
Giovanni Riccio, Luca Cavagnaro, Wassim Akkouche, Giuliana Carrega, Lamberto Felli, Giorgio Burastero
Introduction: Biomarkers such as α-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for α-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the α-defensin test (SynovasureTM ) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit. Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM ...
2018: Journal of Bone and Joint Infection
Sean Dx Duffy, Nathanael Ahearn, Elizabeth Sr Darley, Andrew J Porteous, James R Murray, Nicholas R Howells
Background: Debridement, antibiotics and implant retention (DAIR) forms the primary treatment modality for early prosthetic joint infection (PJI). The KLIC score has been proposed as a risk stratification tool for use in predicting outcome of prosthetic knee infections. Our aim was to determine the accuracy of this scoring system at an independent tertiary PJI centre in a typical DAIR population. Methods: Between 2008 and 2015, patients with infected knee prostheses treated with DAIR were identified. The patient notes and blood tests were reviewed retrospectively and the 'KLIC-score' was calculated and correlated with outcome...
2018: Journal of Bone and Joint Infection
Jesse W P Kuiper, Christine M E Rustenburg, Jore H Willems, Steven J Verberne, Edgar J G Peters, Rachid Saouti
Background : Little is known about functional outcome and quality of life (QoL) after one-stage revision for periprosthetic joint infection (PJI) of the hip. Methods : a cohort of 30 subjects treated with one-stage revision between 2011 and 2015 was identified, and questionnaires on functional outcome and QoL were distributed. Results : 28 subjects were successfully treated (93%). Most subjects were referred from other hospitals. Coagulase-negative Staphylococcus was found in 50% of the cases, and 40% of all cultured bacteria were multidrug-resistant...
2018: Journal of Bone and Joint Infection
Viktor Janz, Georgi I Wassilew, Carsten F Perka, Michael Müller
Aims: In cases of a two-stage septic total hip arthroplasty (THA) exchange a femoral osteotomy with subsequent cerclage stabilization may be necessary to remove a well-fixed stem. This study aims to investigate the rate of bacterial colonization and risk of infection persistence associated with in situ cerclage hardware in two-stage septic THA exchange. Patients and Methods: Twenty-three patients undergoing two-stage THA exchange between 2011 and 2016 were included in this retrospective cohort study. During the re-implantation procedure synovial fluid, periprosthetic tissue samples and sonicate fluid cultures (SFC) of the cerclage hardware were acquired...
2018: Journal of Bone and Joint Infection
Paul Bosch, Janna van den Kieboom, Joost D J Plate, Frank F A IJpma, R Marijn Houwert, Albert Huisman, Falco Hietbrink, Luke P H Leenen, Geertje A M Govaert
Introduction : Diagnosing Fracture-Related Infections (FRI) based on clinical symptoms alone can be challenging and additional diagnostic tools such as serum inflammatory markers are often utilized. The aims of this study were 1) to determine the individual diagnostic performance of three commonly used serum inflammatory markers: C-Reactive Protein (CRP), Leukocyte Count (LC) and Erythrocyte Sedimentation Rate (ESR), and 2) to determine the diagnostic performance of a combination of these markers, and the additional value of including clinical parameters predictive of FRI...
2018: Journal of Bone and Joint Infection
Ben Tyas, Martin Marsh, Tamsin Oswald, Ramsay Refaie, Catherine Molyneux, Mike Reed
Objectives: The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of antibiotic resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile...
2018: Journal of Bone and Joint Infection
Lieke M A de Vries, William C Neve, Jeroen Steens
Background : A prosthetic joint infection (PJI) is a serious complication and specifically a burden for patients after hip fracture surgery, as they are mostly frail elderly patients with multiple comorbidities. Since treatment protocols are lacking there is a need to evaluate current practice. Aim: To evaluate the difference in prosthesis retention after an infected primary total hip replacement (THR) compared to PJI after hip prosthesis surgery performed for a hip fracture. Methods: We retrospectively collected data of patients who developed PJI after primary THR or after hip fracture surgery (THR or hemiarthroplasty) in the Westfriesgasthuis Hospital between 1998 and 2015...
2018: Journal of Bone and Joint Infection
Ricardo Sousa, Miguel Araújo Abreu
Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative. There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome...
2018: Journal of Bone and Joint Infection
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