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Oliveira BGD, Costa VHRD, Gama IR, Beskow MH, Santos ERSD. Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature. Rev Bras Ortop 2024; 59:e21-e28. [PMID: 38524719 PMCID: PMC10957261 DOI: 10.1055/s-0043-1776019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/08/2022] [Indexed: 03/26/2024] Open
Abstract
Hip arthroplasties are surgical procedures widely performed all over the world, seeking to return functionality, relieve pain, and improve the quality of life of patients affected by osteoarthritis, femoral neck fractures, osteonecrosis of the femoral head, among other etiologies. Periprosthetic joint infections are one of the most feared complications due to the high associated morbidity and mortality, with a high number of pathogens that may be associated with its etiology. The aim of the present study was to analyze aspects correlated with the occurrence of infection, diagnosis and prevention of periprosthetic joint infections in the hip associated with Staphylococcus aureus after corrective surgery for hip fractures. This is a systematic review of the literature carried out in the databases indexed in the Medical Literature Analysis and Retrieval System Online (MEDLINE) carried out in accordance with the precepts established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Twenty studies that addressed the diagnosis and prevention of periprosthetic joint infections after hip fractures were selected for analysis. It is observed that there is no consensus in the literature on preventive measures for the occurrence of such infectious processes. Among the risk factors for the occurrence and severity of infections by S. aureus after hip arthroplasties, obesity, longer surgical time, older age, immunosuppression, recent use of antibiotics, and multicomorbidities were mentioned. The use of biomarkers for early diagnosis, as well as screening, decolonization, and antibiotic prophylaxis processes are among the preventive procedures proposed in the literature.
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Affiliation(s)
- Bianca Gabriella de Oliveira
- Departamento da Liga Acadêmica de Ortopedia e Traumatologia da UNIFACS, Universidade Salvador (UNIFACS), Salvador, BA, Brasil
| | | | - Igor Rodrigues Gama
- Serviço de Ortopedia e Traumatologia, Hospital Universitário de Canoas, Canoas, RS, Brasil
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Shichman I, Ward SA, Lu L, Garceau S, Piuzzi NS, Seyler TM, Schwarzkopf R. Failed 2-Stage Revision Knee Arthroplasty for Periprosthetic Joint Infection-Patient Characteristics and Outcomes. J Arthroplasty 2023; 38:2177-2182. [PMID: 37179023 DOI: 10.1016/j.arth.2023.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Chronic prosthetic joint infection (PJI) is most frequently treated with 2-stage revision in conjunction with antibiotic treatment. The aims of this study were 1) to investigate the characteristics of patients who have recurrent infection following 2-stage revision for PJI and 2) to identify risk factors associated with treatment failure. METHODS A multicenter retrospective review of 90 total knee arthroplasty (TKA) patients who underwent 2-stage revision for treatment of PJI from March 1, 2003 to July 31, 2019, and had recurrent PJI was conducted. The minimum follow-up was 12 months (median follow up of 2.4 years). Microorganisms, subsequent revision, PJI control status, and final joint status were collected. The infection-free survival after initial 2-stage revision was plotted utilizing the Kaplan-Meier method. RESULTS Mean survival time to reinfection was 21.3 months (range, 0.3 to 160.5). There were 14 recurrent infections that were acute PJIs treated with debridement, antibiotics, and implant retention (DAIR), while 76 were chronic and treated with repeat 2-stage revision. The most common pathogen identified for both index and recurrent PJI was coagulase-negative Staphylococci. Pathogen persistence was observed in 14 (22.2%) of recurrent PJIs. In total, 61 (67.8%) patients possessed a prosthetic reimplantation at their most recent follow-up, and 29 (35.6%) patients required intervention following repeat 2-stage. CONCLUSION Overall, 31.1% of the patients obtained infection control after treatment of a failed 2-stage revision due to PJI. The high rate of pathogen persistence and the relatively low survival time to recurrence suggests a need to more closely monitor PJIs cases within 2 years.
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Affiliation(s)
- Ittai Shichman
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, New York; Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Spencer A Ward
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Laura Lu
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon Garceau
- Division of Orthopedics, Ottawa University Hospital, Ottawa, Ontario, Canada
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ran Schwarzkopf
- Division of Adult Reconstruction, Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Saade A, Urvoy JM, Luque Paz D, Baldeyrou M, Common H, Ropars M, Tattevin P, Jolivet-Gougeon A, Arvieux C. Microbiology and antibiotics after second-stage revision of periprosthetic joint infections: A two-year follow-up cohort. Infect Dis Now 2022; 52:358-364. [DOI: 10.1016/j.idnow.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
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George R, Hariharan TD, Arunshankar A, Elangovan D, Lal B, Chandy VJ, Oommen AT, Poonnoose PM. Is it safe to do a single-stage implant exit and primary hip replacement? clinical and microbiological profiling. Indian J Med Microbiol 2019; 37:531-535. [PMID: 32436876 DOI: 10.4103/ijmm.ijmm_20_40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A single-stage implant revision for failed fixation of proximal femoral fractures is performed only when there is no evidence of infection. Else, a two-staged revision is preferred - where the definitive revision surgery is done a few months after the implant exit. This study aims to audit the safety and incidence of culture positivity in single-stage revisions. Materials and Methods Forty one of 284 patients that presented over the last 12 years for implant exchange of the hip, had a single stage revision surgery for failed fixation of a fracture of the hip, as there was no obvious evidence of infection at the time of implant exit. Results Micro-organisms were grown in 51% of the 41 hips. 76% were gram positive, of which 63% were Coagulase negative staphylococci (CoNS). 50% of CoNS and 75% of S. aureus were resistant to oxacillin, but susceptible to Vancomycin. Of the gram negative organisms, 2 (Enterobacter sp) were resistant to carbapenam, while others were susceptible. Preoperative ESR and CRP, individually, had low specificity - 50% for ESR >30mm at 1 hour and 62% for CRP>10. The combined use of ESR > 30mm and CRP>10 increased the specificity to 90%. 12% of the patients had immediate postoperative complications that required a wash out in theatre. The long term clinical follow up of these patients is limited. Conclusion This study suggests that implant exit and simultaneous arthroplasty for failed fracture fixation should be done with caution due to the high possibility of infection. It may be prudent to opt for a 2 stage revision.
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Affiliation(s)
- Rahul George
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - T D Hariharan
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Arunshankar
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binesh Lal
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V J Chandy
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - A T Oommen
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
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Arunshankar A, Chandy VJ, Elangovan D, Hariharan TD, Jude Prakash JA, George R, Oommen AT, Poonnoose PM. Microbiological profile of infections of the hip joint: An Indian perspective. Indian J Med Microbiol 2019; 37:509-513. [PMID: 32436872 DOI: 10.4103/ijmm.ijmm_20_31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Knowledge of the local microbiological epidemiology helps in formulating protocols for appropriate treatment of hip infections. The aim of this study was to profile the organisms cultured from infected hips. Methods The microbiological profile and sensitivity pattern of organisms in eighty infected hips were reviewed. Results Infection was secondary to arthroplasty in 35, fracture surgery in 34 and primary septic arthritis in 11. Twenty percent of the infections were polymicrobial, whereas the rest were monomicrobial. Fifty-five percent were Gram-positive, of which 45% were Staphylococcus species (36% methicillin-sensitive Staphylococcus aureus, 20% methicillin-resistant S. aureus, and 44% coagulase sensitive Staphylococcal species). All Staphylococcus species were sensitive to vancomycin, but 20% of Enterococcus species were resistant to vancomycin. One-third of the Enterococcus species and 2% of Staphylococcus species were resistant to teicoplanin. Escherichia coli (n = 10) and Pseudomonas sp. (n = 13) were the most common Gram-negative organism. Although 18% of the Gram-negative organisms were carbapenem resistant, all were sensitive to colistin. Conclusion Staphylococcus sp. was the most common pathogen found in hip infections. However, the high incidence of Gram-negative infection requires that prophylactic antibiotics cover these organisms as well. The high resistance to first-line antibiotics should be taken into consideration while making protocols. The knowledge of the microbial profile is especially important when considering arthroplasty for arthritis secondary to hip infections.
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Affiliation(s)
- A Arunshankar
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - V J Chandy
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - T D Hariharan
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Rahul George
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anil T Oommen
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pradeep M Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
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