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Santoso A, Phatama KY, Rhatomy S, Budhiparama NC. Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review. World J Orthop 2022; 13:503-514. [PMID: 35633748 PMCID: PMC9125004 DOI: 10.5312/wjo.v13.i5.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/07/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.
AIM To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.
METHODS A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.
RESULTS Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.
CONCLUSION At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.
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Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Surakarta and Prof. Dr. R. Soeharso Orthopaedic Hospital, Sukoharjo 57162, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedic and Traumatology, Universitas Brawijaya, Saiful Anwar General Hospital, Malang 65112, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Universitas Gadjah Mada, Yogyakarta and Dr. Soeradji Tirtonegoro General Hospital, Klaten 57424, Indonesia
| | - Nicolaas Cyrillus Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jakarta 12950, Indonesia
- Faculty of Medicine, Universitas Airlangga, Jawa Timur 60132, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden 2333, Netherlands
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2
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Fix WC, Sheth NP, Braffman MN. Mycobacterium fortuitum Prosthetic Joint Infection After Total Hip Arthroplasty: A Case Report. JBJS Case Connect 2021; 10:e0343. [PMID: 32649134 DOI: 10.2106/jbjs.cc.18.00343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CASE A 57-year-old man presented with a Mycobacterium fortuitum prosthetic joint infection (PJI) after right total hip arthroplasty refractory to the initial revision surgery and cement spacer placement. The patient was subsequently treated with 2-stage total joint arthroplasty revision surgery using an antibiotic-laden spacer customized to include meropenem and delayed reimplantation to allow for prolonged, systemic antimicrobial treatment with multiple antimicrobials, including levofloxacin and linezolid. CONCLUSIONS There is little evidence to guide practitioners in the diagnosis and treatment of PJI caused by rare, rapidly growing mycobacteria (RGM) such as M. fortuitum. This case demonstrates a successful strategy for the treatment of RGM PJI.
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Affiliation(s)
- William C Fix
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 2Department of Orthopaedic Surgery, Adult Hip and Knee Reconstruction, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 3Section of Infectious Diseases, Pennsylvania Hospital, Philadelphia, Pennsylvania
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3
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019. [PMID: 31107224 PMCID: PMC6537735 DOI: 10.3201/eid2506.181041] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Early identification and aggressive treatment are crucial for patients with these
infections. Nontuberculous mycobacteria represent an uncommon but important cause of
infection of the musculoskeletal system. Such infections require aggressive
medical and surgical treatment, and cases are often complicated by delayed
diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous
mycobacterial musculoskeletal infections treated over 6 years by orthopedic
surgeons at a university-affiliated tertiary referral center. All patients
required multiple antimicrobial agents along with aggressive surgical treatment;
13 of 14 patients ultimately achieved cure. Four patients required amputation to
control the infection. Half these patients were immunosuppressed by medications
or other medical illness when they sought care at the referral center. Six cases
involved joint prostheses; all ultimately required hardware removal and
placement of an antimicrobial spacer for eradication of infection. Our findings
highlight the importance of vigilance for nontuberculous mycobacterial
musculoskeletal infection, particularly in patients who are immunosuppressed or
have a history of musculoskeletal surgery.
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Goldstein N, St Clair JB, Kasperbauer SH, Daley CL, Lindeque B. Nontuberculous Mycobacterial Musculoskeletal Infection Cases from a Tertiary Referral Center, Colorado, USA. Emerg Infect Dis 2019; 25:1075-1083. [PMID: 31107224 DOI: 10.3201/eid2406.181041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Nontuberculous mycobacteria represent an uncommon but important cause of infection of the musculoskeletal system. Such infections require aggressive medical and surgical treatment, and cases are often complicated by delayed diagnosis. We retrospectively reviewed all 14 nonspinal cases of nontuberculous mycobacterial musculoskeletal infections treated over 6 years by orthopedic surgeons at a university-affiliated tertiary referral center. All patients required multiple antimicrobial agents along with aggressive surgical treatment; 13 of 14 patients ultimately achieved cure. Four patients required amputation to control the infection. Half these patients were immunosuppressed by medications or other medical illness when they sought care at the referral center. Six cases involved joint prostheses; all ultimately required hardware removal and placement of an antimicrobial spacer for eradication of infection. Our findings highlight the importance of vigilance for nontuberculous mycobacterial musculoskeletal infection, particularly in patients who are immunosuppressed or have a history of musculoskeletal surgery.
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5
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Abstract
Infected total knee arthroplasty (TKA) due to Mycobacterium abscessus is very rare with only three such cases described in literature. Only one case was managed successfully, however, with a prolonged course of anti tubercular therapy. In this case report, we present an elderly lady with infected TKA after 2 years of the primary procedure. Although initially it grew different bacteriae, M. abscessus was isolated during the second debridement. She was successfully treated with total of 5 months of second line anti tubercular drugs with revision prosthesis performed during chemotherapy. Two years followup revealed satisfactory outcome with no relapse.
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Affiliation(s)
- Priyadarshi Amit
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India,Address for correspondence: Dr. Priyadarshi Amit, 481, NK-1, Indirapuram, Ghaziabad - 201 010, Uttar Pradesh, India. E-mail:
| | - Sumeet Rastogi
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India
| | - SKS Marya
- Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India
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6
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Henry MW, Miller AO, Kahn B, Windsor RE, Brause BD. Prosthetic joint infections secondary to rapidly growing mycobacteria: Two case reports and a review of the literature. Infect Dis (Lond) 2016; 48:453-60. [PMID: 27030918 DOI: 10.3109/23744235.2016.1142673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Rapidly growing mycobacteria (RGM) are a rare but treatable cause of prosthetic joint infections. This study reports on two patients comprising three prosthetic joint infections caused by RGM successfully treated at the institution. With removal of the infected prosthetic joint and judicious use of prolonged courses of antibiotics, patients with prosthetic joint infections secondary to RGM can both be cured and retain function of the affected joint. In addition, this study identified 40 additional cases reported during an extensive review of the literature and provide a summary of these cases. These infections can present within days of arthroplasty or can develop only decades after the index surgery. The clinical presentations often mimic those of more routine bacterial prosthetic joint infections.
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Affiliation(s)
- Michael W Henry
- a Division of Infectious Diseases, Department of Medicine , Weill Cornell Medical Center , New York , NY , USA ;,b Hospital for Special Surgery , New York , NY , USA
| | - Andy O Miller
- a Division of Infectious Diseases, Department of Medicine , Weill Cornell Medical Center , New York , NY , USA ;,b Hospital for Special Surgery , New York , NY , USA
| | - Barbara Kahn
- c Department of Orthopedics , Hospital for Special Surgery , New York , NY , USA
| | - Russel E Windsor
- c Department of Orthopedics , Hospital for Special Surgery , New York , NY , USA
| | - Barry D Brause
- a Division of Infectious Diseases, Department of Medicine , Weill Cornell Medical Center , New York , NY , USA ;,b Hospital for Special Surgery , New York , NY , USA
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7
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Porat MD, Austin MS. Bilateral knee periprosthetic infection with Mycobacterium fortuitum. J Arthroplasty 2008; 23:787-9. [PMID: 18534520 DOI: 10.1016/j.arth.2007.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 07/25/2007] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic infections after total joint arthroplasty are infrequent but potentially devastating complications. Gram-positive bacteria is the typical causative organism. However, uncommon sources such as Mycobacterium fortuitum have been documented in the literature. We report a case, the first to our knowledge, of bilateral infections involving this organism after total knee arthroplasty. M. fortuitum is notoriously resistant to many standard antibacterial medications, and a delay in initial diagnosis due to inadequate incubation time has been reported. In poor surgical candidates, long-term antibiotic suppression may be a viable alternative.
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Affiliation(s)
- Manny D Porat
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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8
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Infection of total hip prosthesis by Mycobacterium tuberculosis and Mycobacterium chelonae in a patient with rheumatoid arthritis. Clin Rheumatol 2007; 27:543-5. [DOI: 10.1007/s10067-007-0788-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Accepted: 10/21/2007] [Indexed: 01/12/2023]
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9
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Eid AJ, Berbari EF, Sia IG, Wengenack NL, Osmon DR, Razonable RR. Prosthetic joint infection due to rapidly growing mycobacteria: report of 8 cases and review of the literature. Clin Infect Dis 2007; 45:687-94. [PMID: 17712751 DOI: 10.1086/520982] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 06/09/2007] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) due to rapidly growing mycobacteria (RGM) is only occasionally encountered in clinical practice. Therefore, the optimal clinical management for this condition is unknown. METHODS The medical records of patients who had PJI due to RGM during 1969-2006 were reviewed to summarize its clinical characteristics, treatment, and outcome. RESULTS Eight patients developed 9 episodes of PJI (7 episodes involving the knee and 1 each involving the hip or elbow) due to RGM at a median of 312 weeks (range, 1-170 weeks) after prosthesis implantation. Patients presented with joint pain (7 patients), joint swelling (7 patients), and fever (3 patients), accompanied by an elevated erythrocyte sedimentation rate (median, 70.5 mm/h) and C-reactive protein level (median, 6 mg/dL). Mycobacterium chelonae (n=3), Mycobacterium abscessus (n=2), Mycobacterium fortuitum (n=3), and Mycobacterium smegmatis (n=1) were isolated from the 9 infected joints. Seven of 9 prostheses were resected, whereas 2 were retained after surgical debridement. Six of 8 patients received > or = 1 active antimicrobial agent for at least 6 months. During a median follow-up period of 33 weeks (range, 2.6-326 weeks) after surgical intervention, no clinical or microbiological relapses were observed. Reimplantation was performed successfully for 2 of 6 patients who underwent resection arthroplasty. The 2 patients with retained prosthesis continued to receive prolonged courses of suppressive antimicrobial therapy. CONCLUSIONS RGM is a rare cause of PJI that should be suspected in patients with negative results of routine bacterial cultures. The combination of resection arthroplasty and antimicrobial therapy is the preferred approach. However, in cases involving retained prosthetic components, RGM infection may be suppressed with lifelong courses of effective antibiotic therapy.
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Affiliation(s)
- Albert J Eid
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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10
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Marculescu CE, Berbari EF, Cockerill FR, Osmon DR. Fungi, mycobacteria, zoonotic and other organisms in prosthetic joint infection. Clin Orthop Relat Res 2006; 451:64-72. [PMID: 16906078 DOI: 10.1097/01.blo.0000229337.21653.f2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A systematic review of the presentation and management of prosthetic joint infection (PJI) due to zoonotic microorganisms, fungi, mycobacteria and other unusual microorganisms is not available. We therefore sought to provide a resource for the practicing orthopaedic surgeon which will serve as a guide for making appropriate decisions in managing such rare, but potentially problematic conditions. We conducted a Medline search of all case reports of PJI due to these unusual microorganisms. Our review of the current literature showed the diagnosis of PJI due to zoonotic microorganisms, fungi, mycobacteria and other unusual microorganisms typically necessitates specialized diagnostic tests. Maintaining a high index of suspicion in diagnosis of such unusual microorganisms and requesting the appropriate laboratory tests at the time of surgical débridement is crucial for determining the microbiologic etiology of these infections. The appropriate medical and surgical management of such infections is complex and often requires the use of special antimicrobials with which the orthopaedist may not be familiar. Collaboration with an infectious disease specialist is advisable when treating these infections.
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11
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Abstract
Physicians can expect to see more mycobacterial bone and joint disease in North America as a result of increased travel, immigration, and use of immunosuppressive medications. The first step in treating infections caused by these organisms is to consider the diagnosis early in the course of illness. Long-standing untreated mycobacterial infections typically cause significant bone destruction and loss of function. The treatment of mycobacterial bone and joint infection requires prolonged antibiotic therapy, often in conjunction with surgical intervention, particularly for spinal tuberculosis.
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Affiliation(s)
- Michael Gardam
- Tuberculosis Clinic, Toronto Western Hospital, Toronto, ON, Canada.
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12
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Abstract
OBJECTIVE Tenosynovitis of the hand due to atypical mycobacteria is an uncommon condition. We present a case of tenosynovitis of the hand due to Mycobacterium chelonae in a patient without a recognized penetrating injury, who was treated successfully with clarithromycin and antituberculous medications and without debridement. We reviewed the available literature to summarize the experience with this infectious entity. METHODS Case report and review of the literature (MEDLINE 1976-2003). Only cases that were sufficiently detailed were included. RESULTS Twelve cases of upper extremity infection due to M. chelonae have been reported: hand tenosynovitis in most and arthritis in a few. These infections resulted from percutaneous inoculation or hematogenous seeding. The clinical course was indolent initially but insidiously destructive. Previously, treatment always included surgical excision of the infected tissues and antibiotic therapy. This is the first case of M. chelonae musculoskeletal infection that resolved with only antimicrobial therapy. CONCLUSIONS Musculoskeletal infections by nontuberculous mycobacteria are clinically indistinguishable from those of tuberculosis and diagnosis is usually delayed. Prompt diagnosis of atypical mycobacteria with appropriate antimicrobial treatment may avoid the need for surgical debridement. Relevance We recommend a trial of antibiotics for M. chelonae before surgical debridement.
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Affiliation(s)
- Lourdes Mateo
- Rheumatology Unit, CAP Just Oliveras, L'Hospitalet de Llobregat, Barcelona, Spain
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13
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Abstract
Infection following total knee arthroplasty is a major cause of implant failure, with an incidence of infections between 1 and 12%. Although there have been no previously reported cases of infection with Mycobacterium chelonae following total knee arthroplasty, this mycobacterium appears to be a potential pathogen in arthroplasty. When infection following total knee arthroplasty is evident but standard cultures come back negative, atypical mycobacterium infection should be considered. Mycobacterium chelonae does not grow in the normally allotted culture time, so false negative results are common. Once identified, M. chelonae is difficult to treat because of its resistance to standard drug therapies. Details of the first reported successful diagnosis and treatment of an infection with M. chelonae following a total knee arthroplasty are reported.
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Affiliation(s)
- M Pring
- Department of Orthopaedics, University of Colorado Health Sciences, Center, Denver 80262, USA
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14
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Gravallese EM, Weissman BN, Brodsky G, Maguire J. Loosening of a revision total hip replacement in a 60-year-old woman with longstanding rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1995; 38:1315-24. [PMID: 7575727 DOI: 10.1002/art.1780380920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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