Journal of Bone and Joint Infection最新文献

Introduction: This study aimed to evaluate infection-free survival and outcomes after two-stage revision surgery for hip periprosthetic joint infection (PJI) performed in a specialised arthroplasty unit over 20 years. Methods: We retrospectively identified 158 hips (154 patients) treated with two-stage revision surgery for hip PJI between 2001 and 2021. We analysed their data and presented their infection-free survival, re-operation rate, mortality, risk factors and complications. Results: The mean follow-up time was 9 (2 to 21.7) years. A total of 22 hips (13.9 %) were re-infected. The infection-free survival was 94.4 % at 2 years, 89.3 % at 5 years, 84.2 % at 10 years, and 82.6 % at 15 and 20 years. The re-operation rate for aseptic causes was 12 %, and the most common cause of re-operation was dislocation (7 %). The cumulative survival for re-operation for aseptic causes was 93.6 % at 2 years, 89.7 % at 5 years, 88.8 % at 10 years, and 82.8 % at 15 and 20 years. The cumulative survival for all-cause re-revision was 88.8 % at 2 years, 80.8 % at 5 years, 74.9 % at 10 years, and 68 % at 15 and 20 years. The mean Western Ontario and McMaster Universities Arthritis Index (WOMAC) hip score significantly improved from 68.3 at the pre-operative stage to 35.9 at 2.1 (2 to 3.3) years, 35.3 at 5.3 (5 to 8.4) years, 38.3 at 11.3 (10-15) years and 43.8 at 18.7 (16.5 to 21.7) years ( $p<0.01$ ). Duration of antibiotics and gram-negative infection were the only predictive risk factors for re-infection. Conclusion: Our results of the two-stage revision protocol for hip PJI were satisfactory and comparable with the best reported outcomes.

Background: Prior studies have indicated that administration of prolonged courses of oral antibiotics after Stage 2 reimplantation surgery for periprosthetic joint infection (PJI) results in a lower rate of recurrent PJI. However, there is concern that this antibiotic usage results in an increased risk of antibiotic resistance in any subsequent PJI that does occur. Methods: We retrospectively reviewed patients who underwent Stage 2 reimplantation surgery for PJI within the national Veterans Affairs hospital system of the United States. We compared those who received at least 2 weeks of oral antibiotics after Stage 2 reimplantation to those who did not. The primary outcome was the proportion of organisms resistant to four classes of antibiotics (tetracyclines, fluoroquinolones, oral beta-lactams, and sulfonamides) in recurrent PJI. Secondary outcomes included recurrent PJI and death. Results: Of the 605 patients who underwent Stage 2 reimplantation for PJI, 154 patients received at least 14 d of antibiotics after surgery and 451 patients did not. Bacteria causing recurrent PJI in patients who received prolonged antibiotics were more likely to be resistant to tetracyclines and trimethoprim-sulfamethoxazole but not oral beta-lactams or fluoroquinolones. There was no difference in risk of recurrent PJI or death between the two groups. Conclusions: Prolonged oral antibiotic treatment after Stage 2 reimplantation increases the risk of antibiotic resistance to some antibiotics in subsequent PJI. We recommend further research to identify the best choice of antibiotic and duration after Stage 2 reimplantation, to maximize benefits while minimizing risks.

In 2018, the Centrum fOr translational Medicine on Bone and joint INfEctions (COMBINE) was created to facilitate collaboration among Danish scientists and researchers dedicated to bone and joint infection research. The COMBINE approach was developed to ensure successful collaboration, and this publication aims to share this successful approach.

We report a case of post-traumatic Metamycoplasma hominis fracture-related infection of the right femur in a young male with no identified immunodeficiency. Treatment required multiple washouts and femoral nail revision, combined with 10 weeks of treatment with doxycycline and clindamycin.

Background: Antibiotic-laden polymethyl methacrylate (PMMA)-coated intramedullary nails (IMNs) are an effective treatment for osteomyelitis, but they pose multiple disadvantages. Antibiotic-loaded resorbable calcium sulfate (ARCS) paste is an alternative option to deliver a local antibiotic depot around IMNs, but such use has been minimally investigated. This study aimed to define the immediate covering and filling characteristics of ARCS around IMNs by using anatomic bone models. Method: Five tibia models (foam with cortical shell) were prepared by reaming a uniform 13 mm cylindrical path. Three 40 cc kits of ARCS (STIMULAN, Biocomposites Ltd, Keele, UK) were mixed with 3 g vancomycin and 1.2 g tobramycin powder and injected into the intramedullary canal while wet, completely filling the canal. A 10 mm $\times$ 345 mm tibial IMN was immediately inserted without interlocking screws and allowed to completely cure for 2 h. The models were then longitudinally cut without disrupting the dry ARCS covering on the nail. The ARCS was removed from the nail at five equidistant locations along the nail. The thickness of the ARCS was measured with a caliper. A repeated-measures ANOVA test was used to compare the mean width of each segment for each model. Results: In all five trials, the tibial canal volume surrounding the nail remained completely filled. The ARCS paste was confluent along the length of the IMN. There were no gaps or air pockets between the paste and reamed model bone. There was no statistically significant difference among the five samples at each location ( $p=0.913$ ) or among the five locations along the bone ( $p=0.210$ ). Conclusion: In a model setting, ARCS fully fills the intramedullary canal of a tibia and covers an IMN uniformly. Study of the in vivo material properties of ARCS may further elucidate the bone penetration as well as the clinical utility of this antibiotic depot technique.

Orthopedic-device-related infections (ODRIs) are challenging clinical complications that are often exacerbated by antibiotic resistance and biofilm formation. This review explores the efficacy of naturally occurring antimicrobials - including agents sourced from bacteria, fungi, viruses, animals, plants and minerals - against pathogens common in ODRIs. The limitations of traditional antibiotic agents are presented, and innovative naturally occurring antimicrobials, such as bacteriophage therapy and antimicrobial peptides, are evaluated with respect to their interaction with conventional antibiotics and antibiofilm efficacy. The integration of these natural agents into clinical practice could revolutionize ODRI treatment strategies, offering effective alternatives to conventional antibiotics and mitigating resistance development. However, the translation of these compounds from research into the clinic may require the substantial investment of intellectual and financial resources.

Acute soft tissue defects, such as persistent drainage, wound dehiscence, or necrosis, following total knee arthroplasty (TKA) can lead to the devastating complication of deep infection. Typically, when a medium-sized defect is present, a gastrocnemius flap is widely employed for soft tissue reconstruction due to its low morbidity and favourable functional outcomes. When facing this situation, we should consider associating the coverage treatment with a debridement, antibiotics, and implant retention (DAIR) surgery procedure, in order to treat a possible acute infection, even when the diagnosis of infection is not clear. We performed a retrospective study to compare TKA outcomes in patients with DAIR and flap procedures in the same surgical act against those who had received an isolated flap procedure for soft tissue reconstruction after an acute surgical wound defect. Patients had been identified from a prospectively collated TKA database. Between 2005 and 2021, 18 patients met our inclusion criteria, with a mean follow-up of approximately 8 years. A medial gastrocnemius flap procedure was performed for 15 patients (83 %). We compared the rates of infection clearance between the two groups. No differences in comorbidities or risk factors were observed between both groups. In the combination treatment group, 66.6 % of patients healed after treatment compared to 33.3 % in the isolated flap group. Although no significant statistical differences were found, the association of DAIR with the muscle flap procedure is highly recommended in the treatment of acute soft tissue defects after TKA. Further studies with larger sample sizes are necessary to extrapolate these findings to the general population.

Introduction: Prediction models for periprosthetic joint infections (PJIs) are gaining interest due to their potential to improve clinical decision-making. However, their external validity across various settings remains uncertain. This study aimed to externally validate promising preoperative PJI prediction models in a recent multinational European cohort. Methods: Three preoperative PJI prediction models - by Tan et al. (2018), Del Toro et al. (2019), and Bülow et al. (2022) - that have previously demonstrated high levels of accuracy were selected for validation. A retrospective observational analysis of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at centers in the Netherlands, Portugal, and Spain between January 2020 and December 2021 was conducted. Patient characteristics were compared between our cohort and those used to develop the models. Performance was assessed through discrimination and calibration. Results: The study included 2684 patients, 60 of whom developed a PJI (2.2 %). Our cohort differed from the models' original cohorts with respect to demographic variables, procedural variables, and comorbidity prevalence. The overall accuracies of the models, measured with the $c$  statistic, were 0.72, 0.69, and 0.72 for the Tan, Del Toro, and Bülow models, respectively. Calibration was reasonable, but the PJI risk estimates were most accurate for predicted infection risks below 3 %-4 %. The Tan model overestimated PJI risk above 4 %, whereas the Del Toro model underestimated PJI risk above 3 %. Conclusions: The Tan, Del Toro, and Bülow PJI prediction models were externally validated in this multinational cohort, demonstrating potential for clinical application in identifying high-risk patients and enhancing preoperative counseling and prevention strategies.

Moraxella catarrhalis commonly colonizes the upper respiratory tract of humans, but infection caused by M. catarrhalis after orthopedic surgery is rare. Here, we report the first case of septic arthritis of the shoulder caused by an M. catarrhalis infection and outline the diagnosis and treatment steps as well as differences compared with other cases.

Introduction: At our tertiary orthopaedic centre, mycobacterial cultures are routinely performed on bone and joint samples sent for bacterial culture. Methods: From laboratory records, we ascertained the number of mycobacterial cultures performed, the number positive for Mycobacterium tuberculosis complex (MTBC) and/or non-tuberculous mycobacteria (NTM), and the characteristics of individuals from whom mycobacteria were isolated. We collected the same data from 100 individuals with negative mycobacterial cultures. Results: Excluding sample types that were not bone or joint samples, 6162 mycobacterial cultures were performed between 4 July 2017 and 30 September 2022. A total of 22 patients had MTBC and 6 patients had NTM newly isolated from bone or joint samples placed in mycobacterial culture, while a further 1 patient had both Mycobacterium tuberculosis and Mycobacterium avium isolated. To identify one new mycobacterial infection of bone or joint (MTBC or NTM) that would not have been detected with routine bacterial cultures alone, 229 (95 % CI of 158-347) mycobacterial cultures were needed. Mycobacterial cultures were much less likely to be positive in samples taken from prosthetic joints. They were more likely to be positive in spinal samples and in samples taken from patients with suspected sarcoma. In patients from whom MTBC had been isolated, granulomatous inflammation was reported in 86 % (18 of 21) of contemporaneous histological specimens. Conclusions: Targeted, rather than routine, mycobacterial culture of bone and joint specimens should be considered in settings with a low burden of tuberculosis.