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https://www.readbyqxmd.com/read/27925502/implementation-of-an-algorithm-for-prosthetic-joint-infection-deviations-and-problems
#1
Heinrich M L Mühlhofer, Karl-Georg Kanz, Florian Pohlig, Ulrich Lenze, Florian Lenze, Andreas Toepfer, Ruediger von Eisenhart-Rothe, Johannes Schauwecker
BACKGROUND: The outcome of revision surgery in arthroplasty is based on a precise diagnosis. In addition, the treatment varies based on whether the prosthetic failure is caused by aseptic or septic loosening. Algorithms can help to identify periprosthetic joint infections (PJI) and standardize diagnostic steps, however, algorithms tend to oversimplify the treatment of complex cases. We conducted a process analysis during the implementation of a PJI algorithm to determine problems and deviations associated with the implementation of this algorithm...
December 7, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27922947/microbiology-and-antimicrobial-challenges-of-prosthetic-joint-infection
#2
Douglas R Osmon
Research that leads to better strategies to diagnose and treat prosthetic joint infection (PJI) is critical because PJI is a devastating complication of total knee arthroplasty. A key to the diagnosis and management of PJI is defining the microbiology of PJI and improving the medical management of PJI utilizing both systemic and local antimicrobial therapy. In this review, the author will present his opinions on future research needs as they relate to the microbiology of PJI, including antimicrobial resistance and the antimicrobial treatment of PJI...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27919672/a-study-of-pre-operative-presence-of-micro-organisms-in-affected-knee-joints-of-rheumatoid-arthritis-patients-who-need-total-knee-arthroplasty
#3
Jiang-Ming Luo, Lin Guo, Hao Chen, Peng-Fei Yang, Ran Xiong, Yang Peng, Liu Yang
BACKGROUND: To evaluate, by way of intraoperative tissue culture and pathological study, the pre-operative presence of micro-organisms in knee joints of patients with rheumatoid arthritis (RA) who need total knee arthroplasty (TKA). METHODS: From November 2012 to January 2014, 47 patients with RA (53 knees) who needed TKA were included in this study. Patients received routine pre-operative examination and joint fluid routine and culture. Each RA patient was match-paired with one osteoarthritis (OA) patient...
December 2, 2016: Knee
https://www.readbyqxmd.com/read/27911455/functional-outcomes-of-infected-hip-arthroplasty-a-comparison-of-different-surgical-treatment-options
#4
Benjamin V Herman, Mark Nyland, Lyndsay Somerville, Steven J MacDonald, Brent A Lanting, James L Howard
BACKGROUND: Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) can be treated with irrigation and debridement with head and polyethylene exchange (IDHPE) or 2-stage revision (2SR). Few studies have compared patient-reported outcome measures (PROMs) in patients managed with these treatments. METHODS: A retrospective review identified 137 patients who had an infected primary THA between 1986-2013. Control cohorts were matched according to age and Charlton Comorbidity Index (CCI)...
November 28, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27876465/is-there-still-a-role-for-irrigation-and-debridement-with-liner-exchange-in-acute-periprosthetic-total-knee-infection
#5
Andrés F Duque, Zachary D Post, Rex W Lutz, Fabio R Orozco, Sergio H Pulido, Alvin C Ong
BACKGROUND: Periprosthetic joint infection (PJI) is an important cause of failure in total knee arthroplasty. Irrigation and debridement including liner exchange (I&D/L) success rates have varied for acute PJI. The purpose of this study is to present results of a specific protocol for I&D/L with retention of total knee arthroplasty components. METHODS: Sixty-seven consecutive I&D/L patients were retrospectively evaluated. Inclusion criteria for I&D/L were as follows: fewer than 3 weeks of symptoms, no immunologic compromise, intact soft tissue sleeve, and well-fixed components...
November 1, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27869063/screening-patients-undergoing-total-hip-or-knee-arthroplasty-with-perioperative-urinalysis-and-the-effect-of-a-practice-change-on-antimicrobial-use
#6
Samuel Bailin, Nicolas Noiseux, Jean M Pottinger, Birgir Johannsson, Ambar Haleem, Sarah Johnson, Loreen A Herwaldt
OBJECTIVE To identify predictors of treatment for urinary tract infections (UTI) among patients undergoing total hip (THA) or knee (TKA) arthroplasties and to assess an intervention based on these predictors. DESIGN We conducted a retrospective cohort study of 200 consecutive patients undergoing THA/TKA between February 21, 2011, and June 30, 2011, to identify predictors of treatment for UTI and a prospective cohort study of 50 patients undergoing these procedures between May 21, 2012, and July 17, 2012, to assess the association of signs or symptoms and UTI treatment...
November 21, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27855064/rifampin-based-combination-therapy-is-active-in-foreign-body-osteomyelitis-after-prior-rifampin-monotherapy
#7
Cassandra L Brinkman, Suzannah M Schmidt-Malan, Jayawant N Mandrekar, Robin Patel
Staphylococcal prosthetic joint infections (PJIs) are associated with biofilm formation, making them difficult to treat; if managed with débridement and implant retention, rifampin-based therapy is usually employed. Rifampin resistance potentially challenges PJI treatment. In investigating the effects of rifampin monotherapy on methicillin-resistant Staphylococcus aureus (MRSA) foreign body osteomyelitis in rats, we previously demonstrated that rifampin resistance was selected but that it disappeared 14 days following rifampin monotherapy (1) and that rifampin resistance occurred less frequently following two rounds than one round of rifampin monotherapy (2)...
November 14, 2016: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/27852674/focus-on-mrsa-sa-ssti%C3%A2-assay-failure-in-prosthetic-joint-infections-213-consecutive-patients-later
#8
Marie Titécat, Frédéric Wallet, Olivier Robineau, Michel Valette, Henri Migaud, Eric Senneville, Caroline Loïez
In prosthetic joint infection (PJI) cases (1), rapid detection of methicillin-resistant staphylococci (MRS) is the key to avoid the use of broad-spectrum antimicrobials such as vancomycin.….
November 16, 2016: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/27842584/risk-of-infection-in-primary-elective-total-hip-arthroplasty-with-direct-anterior-approach-or-lateral-transgluteal-approach-a-prospective-cohort-study-of-1104-hips
#9
Thomas Ilchmann, Werner Zimmerli, Lilianna Bolliger, Peter Graber, Martin Clauss
BACKGROUND: The direct anterior approach (DAA) is increasingly popular for hip replacement. However, the small incision and the location near to the groin might increase the risk of periprosthetic joint infection (PJI). We asked the questions (i) whether there is an increased risk of infection for this approach, and (ii) whether the spectrum of microorganisms differs between patients with DAA and those with lateral transgluteal approach (LAT). METHODS: All patients operated between 08/2006 and 12/2013 were followed prospectively in an in house register...
November 14, 2016: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/27834161/periprosthetic-infection-following-primary-hip-and-knee-arthroplasty-the-impact-of-limiting-the-postoperative-surveillance-period
#10
Virginia R Roth, Robyn Mitchell, Julie Vachon, Stéphanie Alexandre, Kanchana Amaratunga, Stephanie Smith, Mary Vearncombe, Ian Davis, Dominik Mertz, Elizabeth Henderson, Michael John, Lynn Johnston, Camille Lemieux, Linda Pelude, Denise Gravel
BACKGROUND Hip and knee arthroplasty infections are associated with considerable healthcare costs. The merits of reducing the postoperative surveillance period from 1 year to 90 days have been debated. OBJECTIVES To report the first pan-Canadian hip and knee periprosthetic joint infection (PJI) rates and to describe the implications of a shorter (90-day) postoperative surveillance period. METHODS Prospective surveillance for infection following hip and knee arthroplasty was conducted by hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) using standard surveillance definitions...
November 11, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27830274/silver-coated-endoprosthetic-replacement-of-the-proximal-humerus-in-case-of-tumour-is-there-an-increased-risk-of-periprosthetic-infection-by-using-a-trevira-tube
#11
Jan Schmolders, Sebastian Koob, Paul Schepers, Michael Kehrer, Sönke Percy Frey, Dieter Christian Wirtz, Peter Heinrich Pennekamp, Andreas Christian Strauss
BACKGROUND AND OBJECTIVES: The aim of our study was to evaluate if there is an increased risk of periprosthetic infection (PJI) in patients following replacement of the proximal humerus by using a modular tumour prosthesis in combination with a trevira tube. METHODS: Thirty patients were treated by using a modular tumour endoprosthesis (MUTARS®) following intra-articular resection of the proximal humerus. Fifteen patients received treatment by using a trevira tube...
November 9, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27829328/use-of-oritavancin-novel-new-lipoglycopeptide-in-the-treatment-of-prosthetic-joint-infections-pji-a-possible-alternative-novel-approach-to-a-difficult-problem
#12
Suresh Jude Antony, Leigh G Cooper
Prosthetic joint infections (PJI) result in significant morbidity, mortality and cost to patients and the health system. Traditional treatment involves a two-staged revision and occasionally a single staged revision along with intravenous antibiotics (IV) and or oral antibiotics for several weeks to months. The use of a single staged revision along with an antibiotic which has a prolonged half life and is bactericidal would be ideal. We present 2 patients who were treated successfully with a single stage revision/antibiotic spacer and a new novel long acting lipoglycopeptide called oritavancin...
November 8, 2016: Infectious Disorders Drug Targets
https://www.readbyqxmd.com/read/27825396/prosthetic-joint-infection-following-invasive-dental-procedures-and-antibiotic-prophylaxis-in-patients-with-hip-or-knee-arthroplasty
#13
Feng-Chen Kao, Yao-Chun Hsu, Wen-Hui Chen, Jiun-Nong Lin, Ying-Ying Lo, Yuan-Kun Tu
OBJECTIVES We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear. DESIGN Retrospective cohort study. PARTICIPANTS All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened. METHODS The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date...
November 9, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27818657/is-penicillin-plus-gentamicin-synergistic-against-clinical-group-b-streptococcus-isolates-an-in-vitro-study
#14
Corinne Ruppen, Agnese Lupo, Laurent Decosterd, Parham Sendi
Group B Streptococcus (GBS) is increasingly causing invasive infections in non-pregnant adults. Elderly patients and those with comorbidities are at increased risk. On the basis of previous studies focusing on neonatal infections, penicillin plus gentamicin is recommended for infective endocarditis (IE) and periprosthetic joint infections (PJI) in adults. The purpose of this study was to investigate whether a synergism with penicillin and gentamicin is present in GBS isolates that caused IE and PJI. We used 5 GBS isolates, two clinical strains and three control strains, including one displaying high-level gentamicin resistance (HLGR)...
2016: Frontiers in Microbiology
https://www.readbyqxmd.com/read/27817992/procalcitonin-and-%C3%AE-defensin-for-diagnosis-of-periprosthetic-joint%C3%A2-infections
#15
Kai Xie, Xinhua Qu, Mengning Yan
BACKGROUND: Current methods to diagnose periprosthetic joint infection (PJI) before revision surgery have limited diagnostic accuracy. This meta-analysis was performed to estimate the accuracy of procalcitonin (PCT) and α-defensin for the diagnosis of PJI. METHODS: Articles on the diagnostic value of PCT or α-defensin for PJI diagnosis were searched in the PubMed database. Sensitivity, specificity, diagnostic odds ratio, the area under the curve of summary receiver operating characteristic curves (AUC), the positive likelihood ratio, and the negative likelihood ratio were calculated to evaluate the diagnostic ability of PCT and the α-defensin test for the diagnosis of PJI...
October 13, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27816369/in-hospital-mortality-in-patients-with-periprosthetic-joint-infection
#16
Alisina Shahi, Timothy L Tan, Antonia F Chen, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: While periprosthetic joint infection (PJI) has a huge impact on patient function and health, only a few studies have investigated its impact on mortality. The purpose of this large-scale study was to (1) determine the rate and trends of in-hospital mortality for PJI and (2) compare the in-hospital mortality rate of patients with PJI and those undergoing revision arthroplasty for aseptic failure and patients undergoing other nonorthopedic major surgical procedures. METHODS: Data from the Nationwide Inpatient Sample from 2002 to 2010 were analyzed to determine the risk of in-hospital mortality for PJI patients compared with aseptic revision arthroplasty...
September 30, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27814684/remote-transient-lactobacillus-animalis-bacteremia-causing-prosthetic-hip-joint-infection-a-case-report
#17
R Somayaji, T Lynch, J N Powell, D Gregson
BACKGROUND: Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. CASE PRESENTATION: A case of chronic hip prosthetic joint infection (PJI) caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both isolates proved this PJI infection resulted from this remote bacteremia. CONCLUSIONS: We document that prosthetic joint infections may be a consequence of bacteremia as much as 3 years before the onset of symptoms...
November 4, 2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27807152/optimal-periprosthetic-tissue-specimen-number-for-diagnosis-of-prosthetic-joint-infection
#18
Trisha N Peel, Tim Spelman, Brenda L Dylla, John G Hughes, Kerryl E Greenwood-Quaintance, Allen C Cheng, Jayawant N Mandrekar, Robin Patel
We recently demonstrated improved sensitivity of prosthetic joint infection (PJI) diagnosis using an automated blood culture bottle system for periprosthetic tissue culture (mBio 7 (1):e01776-157, 2016, doi: 10.1128/mBio.01776-15). This study builds on the prior research, by examining the optimal number of periprosthetic tissue specimens required for accurate PJI diagnosis. Current guidelines recommend five to six, which is impractical. We applied Bayesian latent class modeling techniques for estimating diagnostic test properties of conventional culture techniques (aerobic and anaerobic agars and thioglycollate broth) compared to inoculation into blood culture bottles...
November 2, 2016: Journal of Clinical Microbiology
https://www.readbyqxmd.com/read/27803221/five-year-outcome-of-proximal-femoral-endoprosthetic-arthroplasty-for-non-tumour-indications
#19
G Grammatopoulos, A Alvand, H Martin, D Whitwell, A Taylor, C L M H Gibbons
OBJECTIVES: A possible solution for the management of proximal femoral bone loss is a modular femoral endoprosthesis (EPR). Although the outcome of EPRs in tumour surgery has been well described, the outcome of their use in revision hip surgery has received less attention. The aim of this study was to describe the outcome of using EPR for non-neoplastic indications. METHODS: A retrospective review of 79 patients who underwent 80 EPRs for non-neoplastic indications was performed, including the rates of complication and survival and the mean Oxford Hip Scores (OHS), at a mean of five years post-operatively...
November 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27789094/periprosthetic-joint-infections-caused-by-enterococci-have-poor-outcomes
#20
Michael M Kheir, Timothy L Tan, Carlos Higuera, Jaiben George, Craig J Della Valle, Mary Shen, Javad Parvizi
BACKGROUND: The definitive treatment and outcome of periprosthetic joint infection (PJI) caused by Enterococcus species is unknown. We performed a multi-institutional study to analyze the characteristics and treatment outcomes of patients with enterococcal PJI and to define an effective treatment protocol. METHODS: We retrospectively reviewed all PJIs at 3 institutions between 1999 and 2014 using an electronic query followed by manual chart review. We included patients who met the Musculoskeletal Infection Society's criteria for PJI and had at least 1 positive intraoperative culture for any Enterococcus species...
September 28, 2016: Journal of Arthroplasty
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