1
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Mahnic A, Rak M, Trebše R, Rupnik M, Cőr A. Identification of prosthetic joint infections with 16S amplicon metagenomic sequencing - comparison with standard cultivation approach. Diagn Microbiol Infect Dis 2024; 109:116188. [PMID: 38340614 DOI: 10.1016/j.diagmicrobio.2024.116188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
Prosthetic joint infections (PJIs) are commonly diagnosed via culture-based methods, which may miss hard-to-grow pathogens. This study contrasts amplicon metagenomic sequencing (16S AS) with traditional culture techniques for enhanced clinical decision-making. We analyzed sonicate fluid from 27 patients undergoing revision arthroplasty using both methods, emphasizing the distinction between contaminants and true positives. Our findings show moderate agreement between the two methods, with a Cohen's kappa of 0.490, varying across bacterial genera (Cohen's kappa -0.059 to 1). The sensitivity of 16S AS compared to culture was 81% (95% CI, 68% to 94%). Sequencing revealed greater microbial diversity, including anaerobic genera like Anaerococcus and Citrobacter. Interestingly, several culture-negative PJI samples showed diverse bacteria via 16S AS. Despite rigorous controls and algorithms to eliminate contaminants, confirming bacteria presence with 16S AS remains a challenge. This highlights the need for improved PJI diagnostic methods, while also pointing out the limitations of next-generation sequencing (NGS) as a clinical diagnostic tool.
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Affiliation(s)
- Aleksander Mahnic
- National Laboratory of Health, Environment and Food, Department for Microbiological Research, Maribor, Slovenia.
| | - Mitja Rak
- National Laboratory of Health, Environment and Food, Medical Microbiology Department, Koper, Slovenia
| | - Rihard Trebše
- Orthopaedic Hospital Valdoltra, Ankaran, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia
| | - Maja Rupnik
- National Laboratory of Health, Environment and Food, Department for Microbiological Research, Maribor, Slovenia; Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Andrej Cőr
- Orthopaedic Hospital Valdoltra, Ankaran, Slovenia; University of Primorska, Faculty of Health Sciences, Izola, Slovenia
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2
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Jetanalin P, Raksadawan Y, Inboriboon PC. Orthopedic Articular and Periarticular Joint Infections. Emerg Med Clin North Am 2024; 42:249-265. [PMID: 38641390 DOI: 10.1016/j.emc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.
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Affiliation(s)
- Pim Jetanalin
- Department Medicine, Division of Rheumatology, University of Illinois at College of Medicine, 818 South Wolcott Avenue, 6th Floor, MC 733, Chicago, IL 60612, USA.
| | - Yanint Raksadawan
- Department of Medicine, Weiss Memorial Hospital, Medical Education, 4646 N. Marine Drive, Chicago, IL 60640, USA
| | - Pholaphat Charles Inboriboon
- Department of Emergency Medicine, University of Illinois at College of Medicine, 808 South Wood Street MC 724, Chicago, IL, USA
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3
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Takken R, Mol S, Guillen S, Volkers NA. [Septic sacroiliitis: early diagnosis due to specific physical examination]. Ned Tijdschr Geneeskd 2024; 168:D7990. [PMID: 38661184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Septic sacroiliitis is an uncommon disease which represents approximately 1-4% of all joint infections, therefore it is difficult to make the right diagnosis and to start early treatment. CASE REPORT A 18 year old woman was admitted to the emergency room with a fever and pain in the left gluteal region. The patient was considered healthy and had no risk factors for septic arthritis. Edema and a small abscess was found in and around the left sacroiliac joint on pelvic MRI. The patient had positive blood cultures with Staphylococcus Aureus. Antibiotic treatment was initiated and lasted 7 weeks. She recovered completely and had no remaining complaints. CONCLUSION Physical exam and clinical suspicion are important to consider the diagnosis of septic sacroiliitis. In addition a MRI of the pelvic is the best radiographic exam to conform the diagnosis.
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Affiliation(s)
- Romy Takken
- Franciscus Gasthuis en Vlietland, Rotterdam. Afd. Spoedeisende Hulp
| | - Sander Mol
- Franciscus Gasthuis en Vlietland, Rotterdam. Afd. Spoedeisende Hulp
- Contact:
| | - Samara Guillen
- Franciscus Gasthuis en Vlietland, Rotterdam. Afd. Interne Geneeskunde
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4
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Jazmati N, Liebold C, Offerhaus C, Volkenand A, Grote S, Pöpsel J, Körber-Irrgang B, Hoppe T, Wisplinghoff H. Rapid high-throughput processing of tissue samples for microbiological diagnosis of periprosthetic joint infections using bead-beating homogenization. J Clin Microbiol 2024; 62:e0148623. [PMID: 38415637 PMCID: PMC11005376 DOI: 10.1128/jcm.01486-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/07/2024] [Indexed: 02/29/2024] Open
Abstract
Enrichment of periprosthetic tissue samples in blood culture bottles (BCBs) for microbiological diagnosis of periprosthetic joint infections (PJI) is more reliable than the use of an enrichment broth. Nevertheless, the extremely time-consuming homogenization of the samples for BCB processing has so far limited its use, especially in high-throughput settings. We aimed to establish a highly scalable homogenization process of tissue samples for long-term incubation in BCBs. A protocol for homogenization of tissue samples using bead beating was established and validated. In a second step, the use of the homogenate for enrichment in BCBs was compared to the use of thioglycolate broth (TB) in terms of diagnostic accuracy using clinical tissue samples from 150 patients with suspected PJI. Among 150 analyzed samples, 35 samples met the microbiological criteria for PJI. Using BCB, 32 of 35 (91.4%) PJI were detected compared to 30 of 35 (85.7%) by TB. The use of BCB had a lower secondary contamination rate (2/115; 1.7% vs 4/115; 3.5%) but the trend was not significant due to low numbers of samples (P = 0.39). The time to process a batch of 12 samples using the established homogenization method was 23 ± 5 min (n = 10 batches). We established and validated a homogenization workflow that achieves the highest sensitivity in the microbiological diagnostic of PJI. The enrichment of the tissue homogenate in BCBs showed equally good results as the use of enrichment broth and allows semi-automated high-throughput processing while demonstrating lower contamination rates in our study.
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Affiliation(s)
- Nathalie Jazmati
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | | | - Christoph Offerhaus
- Department of Orthopedic Surgery and Sports Traumatology, Witten/Herdecke University, Witten, Germany
- Sana Medical Centre, Cologne, Germany
| | | | - Stefan Grote
- Department of Orthopedic, Trauma and Handsurgery, Brother of Mercy Hospital St. Elisabeth Straubing GmbH, Straubing, Germany
| | | | | | | | - Hilmar Wisplinghoff
- Wisplinghoff Laboratories, Cologne, Germany
- Institute for Virology and Microbiology, Witten/Herdecke University, Witten, Germany
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5
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Deans CF, Kildow BJ, Garvin KL. Recurrent Periprosthetic Joint Infections: Diagnosis, Management, and Outcomes. Orthop Clin North Am 2024; 55:193-206. [PMID: 38403366 DOI: 10.1016/j.ocl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Periprosthetic joint infection (PJI) remains one of the most common complications after total joint arthroplasty. It is challenging to manage, associated with significant morbidity and mortality, and is a financial burden on the health care system. Failure of 2-stage management for chronic PJI is not uncommon. Repeat infections are oftentimes polymicrobial, multiple drug-resistant microorganisms, or new organisms. Optimizing the success of index 2-stage revision is the greatest prevention against failure of any subsequent management options and requires a robust team-based approach.
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Affiliation(s)
- Christopher F Deans
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Beau J Kildow
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kevin L Garvin
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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6
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Gray CF. CORR Insights®: Neutrophil Extracellular Trap-related Biomarkers Are Increased in the Synovial Fluid of Patients With Periprosthetic Joint Infections. Clin Orthop Relat Res 2024; 482:734-736. [PMID: 38231019 PMCID: PMC10936967 DOI: 10.1097/corr.0000000000002971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Chancellor F Gray
- Orthopaedic Surgeon, Florida Orthopaedic Institute, Gainesville, FL, USA
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7
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Danieli MV, Fernandes Guerreiro JP. Extraarticular infection 9 years after anterior cruciate ligament reconstruction. Case report. J ISAKOS 2024; 9:211-214. [PMID: 38081388 DOI: 10.1016/j.jisako.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/29/2023]
Abstract
Extraarticular infection after anterior cruciate ligament reconstruction (ACLr) is a rare condition with challenging diagnosis because the symptoms are milder and more insidious when compared to septic arthritis. When late (>2 months after surgery), it tends to be associated with osteomyelitis, requiring more extensive surgical debridement and hardware removal. We report a case of extraarticular infection after ACLr, in the acute phase affecting the tibial site and 9 years after index surgery affecting around the femur site. There was no progression to osteomyelitis at any of the sites. The infection developed a large posterolateral encapsulated abscess, with the endobutton plate loose inside it with its loop intact. In addition to the absence of osteomyelitis progression, there was no sinus tract formation, graft or joint involvement. With open debridement and antibiotic therapy, the patient returned to his activities without limitations. The reported case highlights that extraarticular infection after ACLr, while rare, can be challenging to diagnose and treat. However, with appropriate treatment, it can lead to good results with no functional limitations.
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Affiliation(s)
- Marcus Vinicius Danieli
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
| | - João Paulo Fernandes Guerreiro
- Unort.E Hospital de Ortopedia, Av. Higienópolis nº 2600, Londrina, PR CEP 86050-000, Brazil; Pontifícia Universidade Católica PUC, Paraná - Campus de Londrina, Av. Jockey Club, 485, Hípica, Londrina, PR CEP 86067-000, Brazil.
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8
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Fernández González R, Fernández Rodríguez R, Prieto Casal PL, Salgado E. Mycobacterium malmoense wrist septic arthritis. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:221-223. [PMID: 38262877 DOI: 10.1016/j.eimce.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 01/25/2024]
Affiliation(s)
- Raquel Fernández González
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Ourense, Orense, Spain.
| | - Ricardo Fernández Rodríguez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Ourense, Orense, Spain
| | | | - Eva Salgado
- Servicio de Reumatología, Hospital Universitario de Ourense, Orense, Spain
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9
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Nocera I, Sgorbini M, Meucci V, Gracia-Calvo LA, Tapio H, Camisi M, Sala G, Citi S. Procalcitonin and carbonylated protein concentrations in equine synovial fluid. Vet Res Commun 2024; 48:1263-1269. [PMID: 38127161 DOI: 10.1007/s11259-023-10280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Early diagnosis of joint diseases is fundamental for prompt and appropriate management, particularly in septic arthritis. Procalcitonin (PCT) and protein carbonylated content (PCC) have been investigated in both human and veterinary medicine. An increase in PCT has been shown in infectious bacterial diseases, while higher levels of PCC have been shown in inflammatory pathologies characterized by oxidative damage. This study evaluated PCT and PCC in plasma and synovial fluid (SF), in healthy and pathological equine joints, affected by different types of arthropathy. Twenty-nine joints were evaluated and underwent orthopedic, radiographic, ultrasonographic and SF evaluation. The joints were divided in three groups: healthy, septic, and non-septic arthritis. PCT and PCC were measured in horse plasma and SF. Data distribution was evaluated and results were expressed as median, quartile values. Statistical differences in SF values among groups and correlations were assessed between plasma and SF of both PCT and PCC. The groups of joint disease included: 8/29 healthy, 13/29 non-septic and 8/29 septic. Significant differences were obtained for SF PCC and plasma PCT between healthy and septic joints, while no differences were found for plasma PCC and SF PCT. A positive correlation was found between plasma and SF PCT. To the best of our knowledge, this is the first study reporting PCT in equine SF. SF PCC could be a useful biomarker to differentiate between septic and healthy joints.
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Affiliation(s)
- Irene Nocera
- Institute of Health Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy.
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy.
| | - Micaela Sgorbini
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | - Valentina Meucci
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | | | - Heidi Tapio
- Veterinary Teaching Hospital, University of Helsinki, Helsinki, Finland
| | - Marcello Camisi
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | - Giulia Sala
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | - Simonetta Citi
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
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10
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Mercer HL, Rodriguez D, Rivas R, Rivenbark E, Mikola E, Mercer D. Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies. Orthop Clin North Am 2024; 55:273-283. [PMID: 38403373 DOI: 10.1016/j.ocl.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
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Affiliation(s)
- Heather L Mercer
- Institute of Microbiology and Infection, School of Biosciences, Univeristy of Birmingham, Edgbaston, B15 2TT, England
| | - Diego Rodriguez
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Rhiana Rivas
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Rivenbark
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Mikola
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Deana Mercer
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA.
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11
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Moore-Lotridge SN, Hou BQ, Hajdu KS, Anand M, Hefley W, Schoenecker JG. Navigating the Enigma of Pediatric Musculoskeletal Infections: A Race Against Time. Orthop Clin North Am 2024; 55:217-232. [PMID: 38403368 DOI: 10.1016/j.ocl.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Musculoskeletal infection (MSKI) in children is a critical condition in pediatric orthopedics due to the potential for serious adverse outcomes, including multiorgan dysfunction syndrome, which can lead to death. The diagnosis and treatment of MSKI continue to evolve with advancements in infectious organisms, diagnostic technologies, and pharmacologic treatments. It is imperative for pediatric orthopedic surgeons and medical teams to remain up to date with the latest MSKI practices.
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Affiliation(s)
- Stephanie N Moore-Lotridge
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian Q Hou
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine S Hajdu
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Malini Anand
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Hefley
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan G Schoenecker
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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12
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Mercer HL, Rodriguez D, Mikola E, Mercer D. The Septic Elbow Joint: Treatment Approaches for Improved Patient Outcomes. Orthop Clin North Am 2024; 55:247-255. [PMID: 38403370 DOI: 10.1016/j.ocl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow. The aim of this review is to optimize patient care and outcomes.
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Affiliation(s)
- Heather L Mercer
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, B15 2TT, Birmingham, England, United Kingdom
| | - Diego Rodriguez
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, Albuquerque, New Mexico 87131, USA
| | - Elizabeth Mikola
- Department of Orthopaedics and Rehabilitation, University of New Mexico Health Sciences Center, MSC10 5600, Albuquerque, New Mexico 87131, USA
| | - Deana Mercer
- University of New Mexico Health Sciences Center, 1 University of New Mexico MSC 10-5600, Albuquerque, New Mexico 87131, USA.
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13
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de Sandes Kimura O, Mozella A, Cobra H, Maciel Saraiva AC, Carvalho de Almendra Freitas EH, Cury Fernandes MB, Matheus Guimarães JA, Defino H, Leal AC. Neutrophil Extracellular Trap-related Biomarkers Are Increased in the Synovial Fluid of Patients With Periprosthetic Joint Infections. Clin Orthop Relat Res 2024; 482:727-733. [PMID: 37882792 PMCID: PMC10937003 DOI: 10.1097/corr.0000000000002891] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The diagnosis of periprosthetic joint infection (PJI) is a major challenge in clinical practice. The role of neutrophils in fighting infection has been increasingly understood, and one mechanism of action of these cells is neutrophil extracellular traps. However, little is known about this process in PJI. QUESTIONS/PURPOSES (1) Are the biomarkers of neutrophil extracellular trap formation (citrullinated histone H3 [H3Cit], cell-free DNA [cf-DNA], and myeloperoxidase [MPO]) increased in the synovial fluid of patients with PJI? (2) What is the diagnostic accuracy of biomarkers of neutrophil extracellular trap formation for PJI? METHODS Between May 2020 and March 2021, 43 patients who underwent revision THA or TKA were enrolled in this study. Eleven patients were excluded and 32 patients were categorized into the PJI group (n = 16) or non-PJI group (n = 16) according to the 2018 Second International Consensus Meeting on Musculoskeletal Infection criteria. There were 15 men and 17 women in this study, with a median (range) age of 70 years (60 to 80 years). Twenty-seven patients had TKA and five had THA. We measured cf-DNA, MPO, and H3Cit in synovial fluid. The sensitivity, specificity, and receiver operating characteristic curve were calculated for each biomarker using the Musculoskeletal Infection Society criteria as the gold standard for diagnosis and considering a clinical surveillance of 2 years for patients in the non-PJI group. RESULTS Patients with PJI had higher levels of synovial fluid cf-DNA (median [range] 130 ng/µL [18 to 179] versus 2 ng/µL [0 to 6]; p < 0.001), MPO (1436 ng/µL [55 to 3996] versus 0 ng/µL [0 to 393]; p < 0.001), and H3Cit (2115 ng/µL [5 to 2885] versus 3 ng/µL [0 to 87]; p < 0.001) than those in the non-PJI group. In receiver operating characteristic curve analyses, we observed near-perfect performance for all biomarkers evaluated, with an area under the curve of 1 (95% CI 0.9 to 1), 0.98 (95% CI 0.9 to 1), and 0.94 (95% CI 0.8 to 0.99) for cf-DNA, MPO, and H3Cit, respectively. The sensitivity for detecting PJI using synovial fluid was 100% for cf-DNA, 94% for MPO, and 88% for H3Cit. The specificity was 100% for cf-DNA and MPO, and 88% for H3Cit. CONCLUSION Our results show that neutrophils in the periprosthetic microenvironment release neutrophil extracellular traps as part of the bactericidal arsenal to fight infection. These results allow a better understanding of the cellular and molecular processes that occur in this microenvironment, enabling the design of more assertive strategies for identifying new biomarkers and improving the available ones. Novel studies are needed to define whether and how neutrophil extracellular trap-related biomarkers can be useful for diagnosing PJI. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Osamu de Sandes Kimura
- Center for Surgery of Hip, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - Alan Mozella
- Center for Surgery of Knee, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - Hugo Cobra
- Center for Surgery of Knee, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | | | | | | | | | - Helton Defino
- Department of Orthopaedics and Anaesthesiology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Leal
- Teaching and Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
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14
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Fuentes-Nava AG, Fierro-Arias L, Zenteno JC, Apam-Garduño D. Clinical and genetic analysis of the first Mexican patient with a diagnosis of pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA) syndrome. Clin Exp Dermatol 2024; 49:441-443. [PMID: 37942851 DOI: 10.1093/ced/llad384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
Our report discusses the first Mexican patient with a clinical and molecular diagnosis of pyogenic sterile arthritis, pyoderma gangrenosum and acne syndrome. In addition, a literature review of the clinical and molecular spectrum of the disease is included.
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Affiliation(s)
| | - Leonel Fierro-Arias
- Dermatology Service, Hospital General de Mexico, Mexico City, Mexico
- The American British Cowdray (ABC) Medical Center, Mexico City, Mexico
| | - Juan Carlos Zenteno
- Research Unit, Institute of Ophthalmology 'Conde de Valenciana', Mexico City, Mexico
- Department of Biochemistry, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - David Apam-Garduño
- Genetics Service, Hospital General de México, Mexico City, Mexico
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
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15
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Chen CL, Chao TK, Yeh FC, Wu CL, Wang CH. Chronic infective arthritis with osteomyelitis of the ankle due to Pseudomonas aeruginosa infection in a middle-age woman: A rare causative pathogen requiring vigilance. Medicine (Baltimore) 2024; 103:e37344. [PMID: 38457596 PMCID: PMC10919506 DOI: 10.1097/md.0000000000037344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024] Open
Abstract
RATIONALE Pseudomonas aeruginosa-induced septic arthritis is a relatively uncommon phenomenon. It has been documented in children with traumatic wounds, young adults with a history of intravenous drug use, and elderly patients with recent urinary tract infections or surgical procedures. PATIENT CONCERNS Fifty-nine year-old female had no reported risk factors. The patient sought medical attention due to a 6-month history of persistent pain and swelling in her right ankle. DIAGNOSES Magnetic resonance imaging and a 3-phase bone scan revealed findings suggestive of infectious arthritis with concurrent osteomyelitis. Histopathological examination of the synovium suggested chronic synovitis, and synovial tissue culture confirmed the presence of P aeruginosa. INTERVENTION Arthroscopic synovectomy and debridement, followed by 6 weeks of targeted antibiotic therapy for P aeruginosa. OUTCOMES Following treatment, the patient experienced successful recovery with no symptom recurrence, although she retained a mild limitation in the range of motion of her ankle. LESSONS To our knowledge, this is the first reported case of chronic arthritis and osteomyelitis caused by P aeruginosa in a patient without conventional risk factors. This serves as a crucial reminder for clinicians to consider rare causative organisms in patients with chronic arthritis. Targeted therapy is imperative for preventing further irreversible bone damage and long-term morbidity.
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Affiliation(s)
- Chien-Liang Chen
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tai-Kuang Chao
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Chiang Yeh
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hsun Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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16
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Tan J, Wu L, Zhan L, Sheng M, Tang Z, Xu J, Ma H. Optimal selection of specimens for metagenomic next-generation sequencing in diagnosing periprosthetic joint infections. Front Cell Infect Microbiol 2024; 14:1356804. [PMID: 38500507 PMCID: PMC10945027 DOI: 10.3389/fcimb.2024.1356804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Objective This study aimed to assess the diagnostic value of metagenomic next-generation sequencing (mNGS) across synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues among patients with periprosthetic joint infection (PJI), intending to optimize specimen selection for mNGS in these patients. Methods This prospective study involved 61 patients undergoing revision arthroplasty between September 2021 and September 2022 at the First Affiliated Hospital of Zhengzhou University. Among them, 43 cases were diagnosed as PJI, and 18 as aseptic loosening (AL) based on the American Musculoskeletal Infection Society (MSIS) criteria. Preoperative or intraoperative synovial fluid, periprosthetic tissues, and prosthetic sonicate fluid were collected, each divided into two portions for mNGS and culture. Comparative analyses were conducted between the microbiological results and diagnostic efficacy derived from mNGS and culture tests. Furthermore, the variability in mNGS diagnostic efficacy for PJI across different specimen types was assessed. Results The sensitivity and specificity of mNGS diagnosis was 93% and 94.4% for all types of PJI specimens; the sensitivity and specificity of culture diagnosis was 72.1% and 100%, respectively. The diagnostic sensitivity of mNGS was significantly higher than that of culture (X2 = 6.541, P=0.011), with no statistically significant difference in specificity (X2 = 1.029, P=0.310). The sensitivity of the synovial fluid was 83.7% and the specificity was 94.4%; the sensitivity of the prosthetic sonicate fluid was 90.7% and the specificity was 94.4%; and the sensitivity of the periprosthetic tissue was 81.4% and the specificity was 100%. Notably, the mNGS of prosthetic sonicate fluid displayed a superior pathogen detection rate compared to other specimen types. Conclusion mNGS can function as a precise diagnostic tool for identifying pathogens in PJI patients using three types of specimens. Due to its superior ability in pathogen identification, prosthetic sonicate fluid can replace synovial fluid and periprosthetic tissue as the optimal sample choice for mNGS.
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Affiliation(s)
- Jun Tan
- Department of Mini-invasive Spinal Surgery, The Third People’s Hospital of Henan Province, Zhengzhou, Henan, China
| | - Lingxiao Wu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lijuan Zhan
- Department of Neurology, People’s Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Minkui Sheng
- Department of Mini-invasive Spinal Surgery, The Third People’s Hospital of Henan Province, Zhengzhou, Henan, China
| | - Zhongxin Tang
- Department of Mini-invasive Spinal Surgery, The Third People’s Hospital of Henan Province, Zhengzhou, Henan, China
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianzhong Xu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haijun Ma
- Department of Mini-invasive Spinal Surgery, The Third People’s Hospital of Henan Province, Zhengzhou, Henan, China
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17
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Pugsley RA, Gadju G, Young K, Rose C, Haugan N, Vasiliu O. Evaluation of Surveillance System Changes to Improve Detection of Disseminated Gonococcal Infections in Virginia, 2018 to 2021. Sex Transm Dis 2024; 51:171-177. [PMID: 38133574 PMCID: PMC10948019 DOI: 10.1097/olq.0000000000001914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Disseminated gonococcal infection (DGI), a complication of untreated gonorrhea, is rarely reported through routine surveillance. We sought to improve local surveillance system capacity to estimate and monitor the incidence of DGI in Virginia. METHODS We modified surveillance protocols to identify possible DGI cases using information extracted from gonorrhea case reports and performed provider follow-up using standardized case report forms to confirm DGI diagnosis and collect clinical information. Suspect cases included those with a laboratory report indicating sterile site of specimen collection (e.g., blood, synovial fluid) and/or intravenous (IV) treatment. We performed descriptive analyses to summarize the characteristics of suspect and confirmed DGIs and estimated incidence. RESULTS After piloting protocols in 2018 to 2019, we identified 405 suspect DGI cases from 29,294 gonorrhea cases reported in 2020 to 2021 (1.4%). We initiated investigations for 298 (73.6%) of the suspect cases, received provider responses for 105 (25.9%), and confirmed 19 DGI cases (4.7%). Positive laboratory reports from nonmucosal sites were the most reliable predictor of confirmed DGI status, but most were not confirmed as DGI even when provider follow-up was successful. The confirmed and estimated incidence of DGI were 0.06% and 0.22%, respectively. Sixteen (84%) of the confirmed cases were older than 25 years, 3 (16%) were HIV positive, and approximately half were male and non-Hispanic Black. Most (15 [74%]) were hospitalized, and common manifestations included septic arthritis and bacteremia. CONCLUSIONS We improved surveillance for DGI in Virginia while incurring minor programmatic costs. Additional efforts to improve the completeness and quality of surveillance data for DGI are needed.
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Affiliation(s)
| | - Gracia Gadju
- STD Prevention and Surveillance, Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, Richmond, VA
| | - Kaylah Young
- STD Prevention and Surveillance, Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, Richmond, VA
| | - Cameron Rose
- STD Prevention and Surveillance, Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, Richmond, VA
| | - Nan Haugan
- STD Prevention and Surveillance, Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, Richmond, VA
| | - Oana Vasiliu
- STD Prevention and Surveillance, Division of Disease Prevention, Office of Epidemiology, Virginia Department of Health, Richmond, VA
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18
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Compton T, Ferguson NA, Certain L, Nixon D. Extrapulmonary, Chronic Septic Arthritis From Mycobacterium tuberculosis in the Ankle and Subtalar Joints. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00011. [PMID: 38466986 PMCID: PMC10927327 DOI: 10.5435/jaaosglobal-d-23-00273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
In the United States, rates of Mycobacterium tuberculosis infection have been declining for decades. Osteoarticular tuberculosis of the ankle is rarely observed. We present the case of a 65-year-old man who immigrated to the United States from India 24 years before the onset of symptoms. The patient initially reported atraumatic swelling and pain of the left ankle and foot and was treated for venous insufficiency. Later, the patient was referred to a nonsurgical orthopaedic clinic for additional workup and was found to have elevated inflammatory markers. MRI showed septic arthritis and osteomyelitis of the talus, distal tibia, and calcaneus. Joint aspiration revealed elevated white blood cell counts with predominately PMNs. The patient was then referred to an orthopaedic foot and ankle surgeon and underwent extensive irrigation and débridement. The patient was discharged on empiric antibiotics. Culture results from the original joint aspirate returned 14 days after surgery as positive for acid-fast bacillus, later identified as M tuberculosis by sequencing. Empiric antibiotics were discontinued, and the patient was started on appropriate antituberculotic therapy. This case report illustrates the challenge in the diagnosis of skeletal tuberculosis and the importance of including this condition on the differential for patients with atypical foot and ankle presentations.
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Affiliation(s)
- Tyson Compton
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Nicholas Andrew Ferguson
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Laura Certain
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
| | - Devon Nixon
- From the Department of Orthopedics, University of Utah, Salt Lake City, UT (Mr. Compton, Dr. Certain, Dr. Nixon); Department of Anatomic Pathology, University of Utah, Salt Lake City, UT (Dr. Ferguson); Department of Medicine, Division of Infectious Diseases, University of Utah, Salt Lake City, UT (Dr. Certain)
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19
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Theil C, Moellenbeck B, Schwarze J, Puetzler J, Klingebiel S, Bockholt S, Gosheger G. Can the Current Thresholds for Synovial Cell Count and Neutrophil Percentage to Diagnose Prosthetic Joint Infection be Applied to Metal-on-Metal Rotating Hinge Total Knee Arthroplasty? J Arthroplasty 2024; 39:801-805. [PMID: 37648100 DOI: 10.1016/j.arth.2023.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Synovial leukocyte count analysis is an important tool in the diagnosis of PJI. However, results can be poor if metallosis is present. The issue of metallosis was established for some rotating hinge knee arthroplasty designs. METHODS This was a retrospective single-center analysis that included 108 patients who had a single-design metal-on-metal rotating hinge knee arthroplasty who underwent revision surgery and had prior synovial fluid analysis performed. The diagnostic accuracy of leukocyte count and the percentage of polymorphonuclear neutrophiles (% PMN) were investigated. RESULTS Patients who had a PJI had a higher median leukocyte count and % PMN compared to aseptic revisions (7,905/μL (interquartile range (IQR) 2,419 to 37,400) and 85% (IQR 70.3 to 93.8) versus 450 (IQR 167 to 1,215) and 46% (IQR 28.5 to 67.4%), P < .001). The respective areas under the curves were 0.916 (95% confidence interval 0.862 to 0.970) for leukocyte count and 0.821 (95% confidence interval 0.739 to 0.902) for % PMN. We calculated an optimal cut-off value of 1,200 leukocytes/μL (Sensitivity 94.5%/specificity 75.5%) and 63% PMN (Sensitivity 85.5%/specificity 73.6%) to define PJI. Established thresholds were less sensitive, but more specific. The "infection likely" scenario of the European Bone and Joint Infection Society (EBJIS) definition was closest to the calculated thresholds. CONCLUSION Currently used thresholds for leukocyte cell count and %PMN to define PJI were less sensitive and specific in the diagnosis of PJI in metal-on-metal RHK knees. Surgeons must consider lower cut-off values when evaluating such implants for PJI.
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Affiliation(s)
- Christoph Theil
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Schwarze
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Jan Puetzler
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Sebastian Klingebiel
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Sebastian Bockholt
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
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20
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Salimi M, Karam JA, Willman M, Willman J, Lucke-Wold B, Khanzadeh S, Mirghaderi P, Parvizi J. Neutrophil to Lymphocyte Ratio and Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:831-838. [PMID: 37633509 DOI: 10.1016/j.arth.2023.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) has shown promising results as a diagnostic tool for periprosthetic joint infection (PJI) after total joint arthroplasty. We conducted a systematic review and meta-analysis to determine the utility of NLR in the diagnosis of PJI. METHODS We searched PubMed, Scopus, and Web of Science from inception up to 2022 and evaluated the quality of the included literature. RESULTS Based on the 12 eligible studies, NLR levels were significantly higher in patients who had PJI compared to those who had aseptic loosening (standard mean difference (SMD) = 1.05, 95% Confidence Interval (CI) = 0.71 to 1.40, P < .001). In the subgroup analysis according to type of PJI, NLR levels were significantly higher in patients who had either acute (SMD = 1.04, 95% CI = 0.05 to 2.03, P < .001) or chronic PJI (SMD = 1.08, 95% CI = 0.55 to 1.61, P < .001), compared to those who had aseptic loosening. According to type of arthroplasty, NLR levels were significantly higher in patients who had either total knee arthroplasty (SMD = 1.81, 95% CI = 1.48 to 2.13, P < .001) or total hip arthroplasty (SMD = 1.76, 95% CI = 1.54 to 1.98, P < .001) compared to aseptic loosening. The pooled sensitivity of the 12 studies was 0.73 (95% CI, 0.65 to 0.79), and the pooled specificity was 0.75 (95% CI, 0.71 to 0.78). The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of NLR were 2.94 (95% CI = 2.44 to 3.54), 0.35 (95% CI = 0.27 to 0.46), and 8.26 (95% CI = 5.42 to 12.58), respectively. CONCLUSION In summary, this meta-analysis indicates that NLR is a reliable marker in the diagnosis of PJI.
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Affiliation(s)
- Maryam Salimi
- Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Joseph Albert Karam
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | | | | | | | - Shokoufeh Khanzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Peyman Mirghaderi
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Parvizi
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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21
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Puzzitiello RN, Agarwalla A, Masood R, Bragg J, Hanna J, Pagani NR, Salzler MJ. Arthroscopic Treatment Is a Safe and Effective Alternative to Open Treatment for Acute Septic Arthritis of the Native Knee: A Systematic Review. Arthroscopy 2024; 40:972-980. [PMID: 37437787 DOI: 10.1016/j.arthro.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To compare complication rates, reoperation rates, and subjective outcomes after arthroscopic and open irrigation and debridement for treatment of native knee septic arthritis. METHODS Following The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the Embase, Cochrane, and PubMed databases was performed. Comparative studies reporting clinical outcomes after arthroscopic versus open treatment for septic arthritis of the native knee in human adults were included. Excluded were case series with <10 patients, inclusion of patients <18 years old, studies on non-native joints, abstract-only publications, and studies without stratification of the involved joint. Two reviewers in duplicate independently performed search and data extraction. The quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies instrument. The mean score among the included studies was 18.2 (range 16-23). RESULTS Eleven studies were included, comprising 2,343 knees treated arthroscopically, and 1,595 treated with arthrotomy. Studies reported no differences in erythrocyte sedimentation rate, C-reactive protein, peripheral white blood cells, or symptom chronicity between groups. Nine studies (81.8%) attempted to control for potentially confounding variables in their analyses, and 4 studies (36.4%) reported significant differences in patient characteristics. Reoperation rates ranged from 0% to 50% for arthroscopy and 6% to 71% for arthrotomy. Complication rates ranged from 0% to 39.4% arthroscopically and 0% to 49% for arthrotomy. Superior patient-reported outcomes were achieved after arthroscopy in 2 studies that analyzed subjective outcomes. CONCLUSIONS Arthroscopic management of native knee septic arthritis is a safe and effective alternative to open treatment and is associated with comparable complication rates, reoperation rates, hospitalization lengths, readmission rates, and superior patient-reported outcomes compared with open irrigation and debridement. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Raisa Masood
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Jack Bragg
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - John Hanna
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A..
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22
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Wang Y, Xu Y. Coexistence of Gouty and Septic Arthritis. J Clin Rheumatol 2024; 30:e67. [PMID: 37916975 DOI: 10.1097/rhu.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Waters M, Avery EG, German GJ, Krajden S, Chen Y. Melioidosis with septic arthritis in a returning traveller. CMAJ 2024; 196:E129-E132. [PMID: 38316453 PMCID: PMC10843435 DOI: 10.1503/cmaj.230902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Affiliation(s)
- Mara Waters
- Departments of Medicine (Waters), and Department of Laboratory Medicine & Pathobiology (Avery, German, Krajden, Chen), University of Toronto; Division of Infectious Diseases (German, Krajden, Chen), St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ont.
| | - Ellen G Avery
- Departments of Medicine (Waters), and Department of Laboratory Medicine & Pathobiology (Avery, German, Krajden, Chen), University of Toronto; Division of Infectious Diseases (German, Krajden, Chen), St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ont
| | - Greg J German
- Departments of Medicine (Waters), and Department of Laboratory Medicine & Pathobiology (Avery, German, Krajden, Chen), University of Toronto; Division of Infectious Diseases (German, Krajden, Chen), St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ont
| | - Sigmund Krajden
- Departments of Medicine (Waters), and Department of Laboratory Medicine & Pathobiology (Avery, German, Krajden, Chen), University of Toronto; Division of Infectious Diseases (German, Krajden, Chen), St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ont
| | - Yan Chen
- Departments of Medicine (Waters), and Department of Laboratory Medicine & Pathobiology (Avery, German, Krajden, Chen), University of Toronto; Division of Infectious Diseases (German, Krajden, Chen), St. Joseph's Health Centre, Unity Health Toronto, Toronto, Ont
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24
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Walinga AB, Janssen SJ, Kievit AJ, de Borgie CAJM, Kerkhoffs GMMJ. Consensus on the definition and criteria for failure of surgical treatment in bacterial arthritis of a native joint: An international Delphi study. Knee Surg Sports Traumatol Arthrosc 2024; 32:235-242. [PMID: 38226727 DOI: 10.1002/ksa.12027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE The literature presents a wide range of success rates for a single surgical intervention of bacterial-septic-arthritis, and there is a lack of clear criteria for identifying treatment failure and making decisions about reintervention. This Delphi study aims to establish a consensus among an international panel of experts regarding the definition of treatment failure and the criteria for reintervention in case of bacterial arthritis. METHODS The conducting and reporting Delphi studies (CREDES) criteria were used. Data from a systematic review was provided as the basis for the study. A list of 100 potential experts were identified. The study was designed and conducted as follows: (I) identification and invitation of an expert panel, (II) informing the participating expert panel on the research question and subject, and (III) conducting two or three Delphi rounds to reach consensus on explicit research items. Potential criteria were rated on a five-point Likert scale. RESULTS Sixty orthopaedic experts from nine countries participated in this Delphi study, with 55 completing all three rounds. The mean experience as an orthopaedic surgeon was 15 years (SD ± 9). Strong (96%) consensus was reached on the definition of treatment failure: the persistence of physical signs of arthritis (e.g., pain and swelling) and/or systemic inflammation (e.g., fever and no improvement in CRP) despite surgical and antibiotic treatment. Furthermore, consensus (>80%) was reached on six criteria influencing the decision for reintervention; pain (81%), sepsis (98%), fever (88%), serum CRP (93%), blood culture (82%), and synovial fluid culture (84%). CONCLUSION The definition of treatment failure for bacterial arthritis after a single surgical intervention was established through a three-round Delphi study. Additionally, consensus was reached on six criteria that are helpful for determining the need for reintervention. This definition and these criteria may help in the development of clinical guidelines, and will empower physicians to make more precise and consistent decisions regarding reintervention for patients, ultimately aiming to reduce over- and undertreatment and improve patient outcomes. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Alex B Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Stein J Janssen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Arthur J Kievit
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
| | - Corianne A J M de Borgie
- Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Sport, Amsterdam, The Netherlands
- Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health & Safety in Sports (ACHSS), IOC Research Center, Amsterdam, The Netherlands
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25
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Beeson AM, Baker M, Dell B, Schnitzler H, Oltean HN, Woodall T, Riedo F, Schwartz A, Petersen J, Hinckley AF, Marx GE. Francisella tularensis Bone and Joint Infections: United States, 2004-2023. Clin Infect Dis 2024; 78:S67-S70. [PMID: 38294110 DOI: 10.1093/cid/ciad688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Tularemia is caused by the highly infectious bacterium Francisella tularensis, which is recognized as a Tier 1 bioterrorism agent. Tularemia has a range of recognized clinical manifestations, but fewer than 20 bone or joint infections from 6 countries have been reported in the literature to date. This series includes 13 cases of F. tularensis septic arthritis or osteomyelitis in the United States during 2004-2023 and describes exposures, clinical presentation, diagnosis, and outcomes for this rare but severe form of tularemia. Clinicians should consider F. tularensis in patients with compatible exposures or a history of joint replacement or immunosuppression.
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Affiliation(s)
- Amy M Beeson
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Molly Baker
- Missouri Department of Health and Senior Services, Jefferson City, Missouri, USA
| | - BreeAnna Dell
- Public Health-Seattle and King County, Seattle, Washington, USA
| | | | - Hanna N Oltean
- Washington State Department of Health, Shoreline, Washington, USA
| | - Tracy Woodall
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | | | - Amy Schwartz
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Jeannine Petersen
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Alison F Hinckley
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
| | - Grace E Marx
- Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado, USA
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Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, Copley LA, Arrieta AC, Fowler SL, Harrison C, Eppes SC, Creech CB, Stadler LP, Shah SS, Mazur LJ, Carrillo-Marquez MA, Allen CH, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics. J Pediatric Infect Dis Soc 2024; 13:1-59. [PMID: 37941444 DOI: 10.1093/jpids/piad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee Health Sciences Center College of Medicine Chattanooga, Chattanooga, Tennessee
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, School of Medicine, and Rady Children's Hospital, San Diego, California
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Antonio C Arrieta
- Division of Infectious Diseases, Children's Hospital of Orange County and University of California, Irvine, California
| | - Sandra L Fowler
- Division of Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas
| | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada
- University of Montreal Research Center, Montreal, Quebec, Canada
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27
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Drummond K, Holmes NE. Invasive pneumococcal disease serotype 23B1 causing multifocal septic arthritis, myositis and retroperitoneal abscess. BMJ Case Rep 2024; 17:e257318. [PMID: 38233006 PMCID: PMC10806890 DOI: 10.1136/bcr-2023-257318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
We describe a case of a previously healthy unvaccinated man in his 70s who developed penicillin-susceptible bacteraemic invasive pneumococcal disease due to non-vaccine serotype 23B with the unusual manifestations of multifocal myositis, intramuscular abscesses, polyarticular septic arthritis and synovitis. Blood cultures drawn prior to antibiotic therapy and culture of iliopsoas collection were helpful in making the diagnosis. At follow-up, he had persistent hip pain attributed to avascular necrosis of the head of femur, a possible late complication of his pyomyositis.
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Affiliation(s)
- Kate Drummond
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Natasha E Holmes
- Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
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28
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Saishoji Y, Mori K, Izumi Y. Sternoclavicular Septic Arthritis Caused by Parvimonas micra and Fusobacterium nucleatum Infection with Intra-articular Corticosteroid Administration. Intern Med 2024; 63:341-344. [PMID: 37197959 PMCID: PMC10864072 DOI: 10.2169/internalmedicine.1563-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/26/2023] [Indexed: 05/19/2023] Open
Abstract
Sternoclavicular septic arthritis is a rare form of septic arthritis that can lead to fatal complications, such as abscess formation and mediastinitis, in the absence of prompt diagnosis and appropriate treatment. A man in his 40s presented with pain in the right sternoclavicular joint area, and after a joint injection of steroids was administered, he was diagnosed with septic sternoclavicular arthritis caused by Parvimonas micra and Fusobacterium nucleatum. Gram staining of a specimen obtained from the abscess formation area led to early suspicion of anaerobic infection, and appropriate antibiotics were administered.
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Affiliation(s)
- Yusuke Saishoji
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
| | - Keisuke Mori
- Department of Orthopaedic Surgery, National Hospital Organization Nagasaki Medical Center, Japan
| | - Yasumori Izumi
- Department of General Internal Medicine, National Hospital Organization Nagasaki Medical Center, Japan
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29
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Li M, Shao Z, Zhu H, Zhang Y. The diagnosis and treatment of septic hip with osteonecrosis of the femoral head. J Orthop Surg Res 2024; 19:46. [PMID: 38195515 PMCID: PMC10775663 DOI: 10.1186/s13018-023-04518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
This article aims to provide clinical doctors with references for the diagnosis and treatment of osteonecrosis of the femoral head (ONFH) accompanied with septic hip by summarizing and analyzing clinical data and postoperative follow-up information of patients treated with two-stage arthroplasty. We retrospectively analyzed ten patients who underwent two-stage arthroplasty in our hospital due to ONFH accompanied with septic hip. The diagnosis of septic hip includes erythrocyte sedimentation rate (ESR) > 30 mm/h, C-reactive protein (CRP) > 10 mg/L, pus-like synovial fluid, positive microbiological culture, and the findings of septic arthritis on magnetic resonance imaging (MRI) scan. Patient's information was evaluated based on the review of medical records, including gender, age, symptoms, risk factor of ONFH and septic arthritis, blood test, radiograph, MRI scan, microbiological culture, treatment, follow-up period and outcome. A total of ten patients were diagnosed with ONFH accompanied with septic hip. The average follow-up period was 43.5 months. None of the patients experienced failure during the follow-up period. The risk factor of ONFH was alcohol-related (60%), steroid-related (20%) and idiopathic (20%). Nine patients (90%) have no risk factor of septic arthritis and one patient (10%) has nephrotic syndrome. All patients did not experience any fever symptoms before surgery, but all showed worsening symptoms of pain. There were three patients (30%) with abnormal WBC count > 10 × 109/L. All patients had elevated ESR and/or CPR. Nine patients (90%) had positive MRI findings, and seven patients (70%) had positive microbiological culture. When patients with ONFH experience worsening hip joint pain accompanied by unexplained elevated CRP and/or ESR, it should be suspected whether ONFH is accompanied with septic hip. In these cases, MRI scans should be performed to exclude septic hip. Patients with ONFH accompanied with septic hip showed satisfactory results after two-stage arthroplasty.
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Affiliation(s)
- MingYang Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - ZhenShuai Shao
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - HaoXiang Zhu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - YongTao Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Sharoff L, Bowditch M, Morgan-Jones R. Management of septic arthritis and prosthetic joint infection. Br J Hosp Med (Lond) 2024; 85:1-9. [PMID: 38300684 DOI: 10.12968/hmed.2023.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Management of joint infection is an evolving topic. This article reviews the literature on the management of native and prosthetic joint infection and suggests some areas of improvement in short- and long-term management which could lead to better patient outcomes. Surgical management is the mainstay of treatment for native or prosthetic knee infection and aspiration should only be used for diagnostic purposes. A multidisciplinary team approach and compliance with national guidelines, alongside referral networks and pooling of expertise, should be mandatory to improve patient outcomes.
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Affiliation(s)
- Lokesh Sharoff
- Department of Trauma and Orthopaedics, East Suffolk and North Essex NHS Foundation Trust, UK
| | - Mark Bowditch
- Department of Trauma and Orthopaedics, East Suffolk and North Essex NHS Foundation Trust, UK
| | - Rhidian Morgan-Jones
- Department of Trauma and Orthopaedics, East Suffolk and North Essex NHS Foundation Trust, UK
- Department of Orthopaedics, Schoen Clinic, London, UK
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31
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Røgind SS, Hetland ML. Delayed identification of disseminated infection in a patient with rheumatoid arthritis and septic arthritis: a case report. Scand J Rheumatol 2024; 53:72-73. [PMID: 38153362 DOI: 10.1080/03009742.2023.2266909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/02/2023] [Indexed: 12/29/2023]
Affiliation(s)
- S S Røgind
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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32
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Schattner A, Dubin I, Uliel L, Finn T. Staphylococcus aureus bacteraemia presenting as sternoclavicular arthritis. QJM 2023; 116:1013-1015. [PMID: 37669140 DOI: 10.1093/qjmed/hcad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Indexed: 09/07/2023] Open
Affiliation(s)
- A Schattner
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Israel
- The Faculty of Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - I Dubin
- Department of Medicine, Laniado University Hospital, Sanz Medical Center, Netanya, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - L Uliel
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Imaging, Laniado University Hospital, Sanz Medical Center, Netanya, Israel
| | - T Finn
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Infectious Diseases, Laniado University Hospital, Sanz Medical Center, Netanya, Israel
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33
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Santos P, Gouveia C, Ovídio J, Ribeiro C. Elbow septic arthritis in an infant: an unusual presentation of invasive pneumococcal disease. BMJ Case Rep 2023; 16:e256888. [PMID: 38086576 PMCID: PMC10728931 DOI: 10.1136/bcr-2023-256888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Acute septic arthritis is a rare, potentially severe infection that requires immediate treatment to avoid long-term morbidity. Most common aetiological agents are commonly used for empirical treatment, but the choice of antibiotics may be influenced by other factors, such as the patient's age and the epidemiological context.We report an infant with elbow arthritis, whose treatment was changed after Streptococcus pneumoniae serotype 9N was isolated in the blood and synovial fluid. The child underwent arthrocentesis and received intravenous ampicillin followed by oral amoxicillin, with a favourable response and no sequelae at 1-year follow-up.We report an uncommon manifestation of invasive pneumococcal disease in a young immunised healthy infant caused by a non-vaccine serotype. The presence of S. pneumoniae should be considered in joint infections, especially in infants and those with a history of respiratory symptoms.
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Affiliation(s)
- Paula Santos
- Pediatrics, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
| | - Catarina Gouveia
- Pediatrics, Centro Hospitalar de Lisboa Central, Hospital Dona Estefania, Lisboa, Portugal
| | - Joana Ovídio
- Pediatric Orthopedics, Centro Hospitalar de Lisboa Central, Hospital Dona Estefania, Lisboa, Portugal
| | - Catarina Ribeiro
- Pediatrics, Centro Hospitalar do Médio Tejo, Hospital Rainha Santa Isabel, Torres Novas, Portugal
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34
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Vale JS, Castelo FS, Barros BS, Ribau AC, Carvalho AD, Sousa RJG. Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection-A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions. J Arthroplasty 2023; 38:2731-2738.e3. [PMID: 37321521 DOI: 10.1016/j.arth.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Different synovial fluid biomarkers have emerged to improve periprosthetic joint infection (PJI) diagnosis. The goals of this paper were (i) to assess their diagnostic accuracy and (ii) to evaluate their performance according to different PJI definitions. METHODS A systematic review and meta-analysis was performed using studies that reported diagnostic accuracy of synovial fluid biomarkers using validated PJI definitions published from 2010 to March 2022. A database search was performed through PubMed, Ovid MEDLINE, Central, and Embase. The search identified 43 different biomarkers with four being the more commonly studied, with 75 papers overall: alpha-defensin; leukocyte esterase; synovial fluid C-reactive protein; and calprotectin. RESULTS Overall accuracy was higher for calprotectin, followed by alpha-defensin, leukocyte esterase, and synovial fluid C-reactive protein with sensitivities of 78 to 92% and specificities of 90 to 95%. Their diagnostic performance was different according to which definition was adopted as the reference. Specificity was consistently high across definitions for all four biomarkers. Sensitivity varied the most with lower values for the more sensitive European Bone and Joint Infection Society or Infectious Diseases Society of America definitions with higher values for the Musculoskeletal Infection Society definition. The International Consensus Meeting 2018 definition showed intermediate values. CONCLUSION All evaluated biomarkers had good specificity and sensitivity, making their use acceptable in the diagnosis of PJI. Biomarkers perform differently according to the selected PJI definitions.
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Affiliation(s)
- João S Vale
- Department of Orthopedics, Centro Hospitalar Universitário Santo António, Porto, Portugal
| | - Filipe S Castelo
- Department of Orthopedics, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Bianca S Barros
- Department of Orthopedics, Centro Hospitalar Universitário Santo António, Porto, Portugal
| | - Ana C Ribau
- Department of Orthopedics, Centro Hospitalar Universitário Santo António, Porto, Portugal
| | - André D Carvalho
- Department of Orthopedics, Centro Hospitalar Universitário Santo António, Porto, Portugal
| | - Ricardo J G Sousa
- Department of Orthopedics, Centro Hospitalar Universitário Santo António, Porto, Portugal; Porto Bone and Joint Infection Group (GRIP), Centro Hospitalar Universitário Santo António, CUF - Hospitais e Clínicas, Lisbon, Portugal
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35
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Kendall IS, McGinn C, Sands AJ. Sore knee - why and when to call a cardiologist. Arch Dis Child Educ Pract Ed 2023; 108:450-455. [PMID: 37290895 DOI: 10.1136/archdischild-2023-325651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
A young girl received a diagnosis of septic arthritis of the knee unresponsive to standard medical and surgical treatment. We report the patient's clinical journey with clinical commentary throughout, underlying the importance of differential diagnosis that may open several scenarios and a different final diagnosis accordingly. Finally, we will discuss the treatment and management of the patient's final diagnosis.
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Affiliation(s)
- Ian Scott Kendall
- Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Claire McGinn
- Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Andrew J Sands
- Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, UK
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36
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Bois AJ, Gabig AM, Griffin LP, Rockwood CA, Brady CI, Dutta AK. The evaluation, classification, and management of septic arthritis of the shoulder: the comprehensive shoulder sepsis system. J Shoulder Elbow Surg 2023; 32:2453-2466. [PMID: 37331502 DOI: 10.1016/j.jse.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Septic arthritis of the shoulder is distinctly challenging to diagnose and treat. Guidelines for appropriate workup and management are limited and do not account for the variations in clinical presentation. The purpose of this study was to present a comprehensive and anatomically based classification system and treatment algorithm for septic arthritis of the native shoulder joint. METHODS A multicenter, retrospective analysis of all patients treated surgically for septic arthritis of the native shoulder joint was performed at 2 tertiary care academic institutions. Preoperative magnetic resonance imaging and operative reports were used to classify patients as having 1 of 3 infection subtypes: type I, confined to the glenohumeral joint; type II, extra-articular extension; or type III, concomitant osteomyelitis. On the basis of these clinical groupings of patients, the comorbidities, types of surgical management, and outcomes were analyzed. RESULTS Sixty-five shoulders in 64 patients met the inclusion criteria for the study. Of these infected shoulders, 9.2% had type I infections, 47.7% had type II, and 43.1% had type III. Age and the time between symptom onset and diagnosis were the only significant risk factors for the development of a more severe infection. Fifty-seven percent of shoulder aspirates revealed cell counts below the standard surgical cutoff of 50,000 cells/mL. On average, each patient required 2.2 surgical débridements to eradicate the infection. Infections recurred in 8 shoulders (12.3%). Body mass index was the only risk factor for recurrence of infection. Of the 64 patients, 1 (1.6%) died acutely of sepsis and multiorgan system failure. CONCLUSION We propose a comprehensive system for the classification and management of spontaneous shoulder sepsis based on stage and anatomy. Preoperative magnetic resonance imaging can help determine the severity of disease and aid in surgical decision making. A systematic approach to septic arthritis of the shoulder as a unique entity from septic arthritis of other large peripheral joints may lead to more timely diagnosis and treatment and improve the overall prognosis.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Andrew M Gabig
- Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Charles A Rockwood
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christina I Brady
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anil K Dutta
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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37
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Esteban J, Salar-Vidal L, Schmitt BH, Waggoner A, Laurent F, Abad L, Bauer TW, Mazariegos I, Balada-Llasat JM, Horn J, Wolk DM, Jefferis A, Hermans M, Verhoofstad I, Butler-Wu SM, Umali-Wilcox M, Murphy C, Cabrera B, Craft D, von Bredow B, Leber A, Everhart K, Dien Bard J, Flores II, Daly J, Barr R, Holmberg K, Graue C, Kensinger B. Multicenter evaluation of the BIOFIRE Joint Infection Panel for the detection of bacteria, yeast, and AMR genes in synovial fluid samples. J Clin Microbiol 2023; 61:e0035723. [PMID: 37877730 PMCID: PMC10662359 DOI: 10.1128/jcm.00357-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
The bioMérieux BIOFIRE Joint Infection (JI) Panel is a multiplex in vitro diagnostic test for the simultaneous and rapid (~1 h) detection of 39 potential pathogens and antimicrobial resistance (AMR) genes directly from synovial fluid (SF) samples. Thirty-one species or groups of microorganisms are included in the kit, as well as several AMR genes. This study, performed to evaluate the BIOFIRE JI Panel for regulatory clearance, provides data from a multicenter evaluation of 1,544 prospectively collected residual SF samples with performance compared to standard-of-care (SOC) culture for organisms or polymerase chain reaction (PCR) and sequencing for AMR genes. The BIOFIRE JI Panel demonstrated a sensitivity of 90.9% or greater for all but six organisms and a positive percent agreement (PPA) of 100% for all AMR genes. The BIOFIRE JI Panel demonstrated a specificity of 98.5% or greater for detection of all organisms and a negative percent agreement (NPA) of 95.7% or greater for all AMR genes. The BIOFIRE JI Panel provides an improvement over SOC culture, with a substantially shorter time to result for both organisms and AMR genes with excellent sensitivity/PPA and specificity/NPA, and is anticipated to provide timely and actionable diagnostic information for joint infections in a variety of clinical scenarios.
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Affiliation(s)
- Jaime Esteban
- IIS-Fundacion Jimenez Diaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Llanos Salar-Vidal
- IIS-Fundacion Jimenez Diaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Bryan H. Schmitt
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy Waggoner
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | | | - Jared Horn
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | | | | | | | - Caitlin Murphy
- University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
| | - Barbara Cabrera
- University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
| | - David Craft
- The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Amy Leber
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | | | | | | | - Judy Daly
- Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Rebecca Barr
- Primary Children’s Hospital, Salt Lake City, Utah, USA
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38
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Salar-Vidal L, Chaves C, Dianzo-Delgado IT, Favier P, Giner-Almaraz S, Gómez-Gómez MJ, Martín-Gutiérrez G, Pereira I, Rodríguez-Fernández A, Ruiz-Garbajosa P, Salas-Venero C, Esteban J. Multicenter evaluation of BioFire JI panel related to improved microbiological diagnostics on acute osteoarticular infections. Int J Med Microbiol 2023; 313:151588. [PMID: 37925748 DOI: 10.1016/j.ijmm.2023.151588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023] Open
Abstract
Microbiological diagnosis of osteoarticular infections (OI) is crucial for a successful treatment. A prospective multicenter study including 262 synovial fluids with suspicion of acute OI was performed between July 2021 and October of 2022. BioFire Joint Infection Panel multiplex-PCR test was performed and results were compared with conventional cultures of synovial fluid specimens. In total, 136 microorganisms were detected, and fourteen samples were positive for more than one microorganism. In monomicrobial infections (n = 87) agreement with culture was 69%. In 26 samples, the multiplex PCR yield an additional positive result when culture result was negative. It helped in the detection of fastidious microorganisms as K. kingae and N. gonorrhoeae. This multiplex PCR has proven to be a useful technique that can be used for patients with high suspicion of acute OI in a rapid and automated manner.
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Affiliation(s)
- Llanos Salar-Vidal
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Catarina Chaves
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Ileana T Dianzo-Delgado
- Department of Clinical Microbiology, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | | | - María José Gómez-Gómez
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Seville, Spain
| | - Guillermo Martín-Gutiérrez
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Seville, Spain; Department of Health Sciences, Loyola Andalucía University, Seville, Spain
| | - Isabel Pereira
- Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | | | - Patricia Ruiz-Garbajosa
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Clinical Microbiology, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | | | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain; CIBERINFEC-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Zhou P, Li S, Zhao M, Shao H, Zhang P. Clinical efficacy of arthroscopy combined with irrigation and drainage in the treatment of brucellosis of the hip. Int Orthop 2023; 47:2751-2756. [PMID: 37561152 DOI: 10.1007/s00264-023-05926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE To evaluate the short-term clinical efficacy of hip arthroscopy combined with catheter irrigation and drainage in the treatment of brucellosis of the hip. METHODS From 2015 to 2020, 11 patients with a diagnosis of brucellosis-induced unilateral hip joint arthritis were treated with arthroscopic debridement and lesion synovectomy. Catheterization was performed during the operation, and normal saline lavage was continued after the operation. A regimen of doxycycline plus rifampicin, plus a third-generation cephalosporin in cases of refractory infections, were used for three months. RESULTS The rate of positive synovial bacterial culture during the operation was 91% (10/11). Postoperative pathological examination of 11 patients showed purulent arthritis; this result combined with the disease history led to the diagnosis of all patients with brucellosis of the hip. All patients were followed up for more than 24 months. From three months after surgery to the last follow-up, both ESR and CPR were within the normal range, but the VAS score decreased significantly (P < 0.05), and the mHHS and HOS-ADL scores increased significantly (P < 0.01). Compared with that on preoperative imaging, the measurement of the hip joint space on imaging at the last follow-up showed no significant change (P > 0.01). CONCLUSION Arthroscopic treatment of brucellosis in the hip joint not only preserves the joint fluid and lesion tissue for a clear diagnosis but also allows thorough removal of the infected and injured tissue during surgery. Hip arthroscopy combined with postoperative tube irrigation and drainage is an effective method for the diagnosis and treatment of brucellosis in the hip joint.
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Affiliation(s)
- Peng Zhou
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - ShenSong Li
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - MaoSheng Zhao
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - HongBin Shao
- Department of Sports Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, Gansu, China
| | - Peng Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Grünwald L, Schmidutz F, Döttger P, Erne F, Schreiner AJ, Hemmann P. Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study. Int Orthop 2023; 47:2663-2668. [PMID: 37582980 PMCID: PMC10602937 DOI: 10.1007/s00264-023-05914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker of leukocyte esterase (LE) promises some advantages: feasibility, availability, and fast result reporting. The aim of this study was the evaluation of the predictive quality and correlation between both diagnostic tools in the diagnosis of PJI. METHODS A prospective study was conducted between April 2018 and August 2022. All patients with suspicion of PJI on hip and knee joint were included and underwent a routine and standardized joint punction. For laboratory diagnostics of AD, the synovial liquid was analyzed by ELISA. The sample was additionally applied to a LE test strip (Combur 10 Test, Roche Diagnostics, Mannheim, Germany). RESULTS A total of 249 patients were examined (mean age 67.12 ± 11.89; gender distribution man/woman 139 (55.8%)/110(44.2%), hip/knee 71(28.5%)/178 (71.5%). According to EBJIS criteria, PJI was diagnosed in 54 (21.7%) patients. AD showed excellent results with an AUC of 0.930 (sensitivity/specificity 0.870/0.990). LE yielded very good results with an AUC of 0.820 (sensitivity/specificity 0.722/0.918). Both parameters showed a strong positive correlation. CONCLUSION LE is a rapidly available alternative in PJI diagnostics. The simultaneous determination of both markers may enhance diagnostic reliability. A routine usage may shorten the time from diagnosis to treatment of PJI.
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Affiliation(s)
- Leonard Grünwald
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Florian Schmidutz
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany
- Orthozentrum Rosenheim, Äußere Münchener Str. 94, 83026, Rosenheim, Germany
| | - Philipp Döttger
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
| | - Felix Erne
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany.
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany.
| | - Anna Janine Schreiner
- Siegfried Weller Institute for Trauma Research, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Tuebingen, 72076, Germany
| | - Philipp Hemmann
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany
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Walinga AB, Stornebrink T, Emanuel KS, Kievit AJ, Janssen SJ, Kerkhoffs GMMJ. Failure rates in surgical treatment in adults with bacterial arthritis of a native joint: a systematic review of 8,586 native joints. Arch Orthop Trauma Surg 2023; 143:6547-6559. [PMID: 37395855 PMCID: PMC10541340 DOI: 10.1007/s00402-023-04958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Most adult cases of bacterial-septic-arthritis of a native joint are effectively managed with a single surgical debridement, but some cases may require more than one debridement to control the infection. Consequently, this study assessed the failure rate of a single surgical debridement in adults with bacterial arthritis of a native joint. Additionally, risk factors for failure were assessed. MATERIALS AND METHODS The review protocol was registered on PROSPERO (CRD42021243460) before data collection and conducted in line with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. Multiple libraries were systematically searched to identify articles including patients reporting on the incidence of failure (i.e. persistence of infection requiring reoperation) of the treatment of bacterial arthritis. The quality of individual evidence were assessed using the Quality in Prognosis Studies (QUIPS) tool. Failure rates were extracted from included studies and pooled. Risk factors for failure were extracted and grouped. Moreover, we evaluated which risk factors were significantly associated with failure. RESULTS Thirty studies (8,586 native joints) were included in the final analysis. The overall pooled failure rate was 26% (95% CI 20 to 32%). The failure rate of arthroscopy and arthrotomy was 26% (95% CI 19 to 34%) and 24% (95% CI 17 to 33%), respectively. Seventy-nine potential risk factors were extracted and grouped. Moderate evidence was found for one risk factor (synovial white blood cell count), and limited evidence was found for five risk factors (i.e. sepsis, large joint infection, the volume of irrigation, blood urea nitrogen-test, and blood urea nitrogen/creatinine ratio). CONCLUSION A single surgical debridement fails to control bacterial arthritis of a native joint in approximately a quarter of all adult cases. Limited to moderate evidence exists that risk factors associated with failure are: synovial white blood cell count, sepsis, large joint infection, and the volume of irrigation. These factors should urge physicians to be especially receptive to signs of an adverse clinical course.
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Affiliation(s)
- Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Arthur J. Kievit
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Stein J. Janssen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
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Lorrot M, Gillet Y, Basmaci R, Bréhin C, Dommergues MA, Favier M, Jeziorski E, Panetta L, Pinquier D, Ouziel A, Grimprel E, Cohen R. Antibiotic therapy for osteoarticular infections in 2023: Proposals from the Pediatric Infectious Pathology Group (GPIP). Infect Dis Now 2023; 53:104789. [PMID: 37741341 DOI: 10.1016/j.idnow.2023.104789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
Most osteoarticular infections (OAI) occur via the hematogenous route, affect children under 5 years of age old, and include osteomyelitis, septic arthritis, osteoarthritis and spondylodiscitis. Early diagnosis and prompt treatment are needed to avoid complications. Children with suspected OAI should be hospitalized at the start of therapy. Surgical drainage is indicated in patients with septic arthritis or periosteal abscess. Staphylococcus aureus is implicated in OAI in children at all ages; Kingella kingae is a very common causative pathogen in children from 6 months to 4 years old. The French Pediatric Infectious Disease Group recommends empirical antibiotic therapy with appropriate coverage against methicillin-sensitive S. aureus (MSSA) with high doses (150 mg/kg/d) of intravenous cefazolin. In most children presenting uncomplicated OAI with favorable outcome (disappearance of fever and pain), short intravenous antibiotic therapy during 3 days can be followed by oral therapy. In the absence of bacteriological identification, oral relay is carried out with the amoxicillin/clavulanate combination (80 mg/kg/d of amoxicillin) or cefalexin (150 mg/kg/d). If the bacterial species is identified, antibiotic therapy will be adapted to antibiotic susceptibility. The minimum total duration of antibiotic therapy should be 14 days for septic arthritis, 3 weeks for osteomyelitis and 4-6 weeks for OAI of the pelvis, spondylodiscitis and more severe OAI, and those evolving slowly under treatment or with an underlying medical condition (neonate, infant under 3 months of old, immunocompromised patients). Treatment of spondylodiscitis and severe OAI requires systematic orthopedic advice.
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Affiliation(s)
- Mathie Lorrot
- General Pediatrics Department, Centre de Référence des Infections Ostéoarticulaires complexes (CRIOAc Pitié-Trousseau), France; Sorbonne Université, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France
| | - Yves Gillet
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Faculty of Medicine Lyon Est - Claude Bernard University Lyon 1, France; Pediatric Emergency and Intensive Care Service, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, France
| | - Romain Basmaci
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service de Pédiatrie-urgences, Hôpital Louis-Mourier, Colombes, France; Université Paris Cité et Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
| | - Camille Bréhin
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Pédiatrie Générale, CHU Toulouse, France
| | - Marie-Aliette Dommergues
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service de pédiatrie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Marion Favier
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service urgences post-urgences pédiatriques, CHU Bordeaux, Bordeaux, France
| | - Eric Jeziorski
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Service urgences post-urgences pédiatriques, PCCEI, CeRéMAIA, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Luc Panetta
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Faculty of Medicine Lyon Est - Claude Bernard University Lyon 1, France; Pediatric Emergency and Intensive Care Service, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, France
| | - Didier Pinquier
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Department of Neonatal and Pediatric Intensive Care Medicine, Normadie University, UNIROUEN, INSERM U1245, CHU Rouen, 7600 Rouen, France
| | - Antoine Ouziel
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Faculty of Medicine Lyon Est - Claude Bernard University Lyon 1, France; Pediatric Emergency and Intensive Care Service, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, France
| | - Emmanuel Grimprel
- General Pediatrics Department, Centre de Référence des Infections Ostéoarticulaires complexes (CRIOAc Pitié-Trousseau), France; Sorbonne Université, France; Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France
| | - Robert Cohen
- Pediatric Infectious Pathology Group of the French Pediatric Society, Créteil, France; Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Centre Hospitalier Intercommunal de Créteil, France; ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Créteil des Fossés, France.
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Tay ST, Merican AM, Abdul Jabar K, Velayuthan RD, Ayob KA, Lee JL, Chong J, Karunakaran R. Falsarthrobacter nasiphocae periprosthetic joint infection. Int J Infect Dis 2023; 136:77-80. [PMID: 37660726 DOI: 10.1016/j.ijid.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023] Open
Abstract
We report the isolation of a rare Gram-positive coccobacillary bacterium from synovial fluids of a patient with periprosthetic joint infection on three occasions over an 8-month period. As routine microbiological methods were not able to identify the isolate definitely, sequence analyses of the bacterial 16S ribosomal RNA gene and whole genome were performed. Analysis of the bacterial 16S ribosomal RNA gene showed the highest similarity (98.1%) with that of Falsarthrobacter (previously known as Arthrobacter) nasiphocae, which was first isolated from the nasal cavities of common seals (Phoca vitulina). The genome size of the strain (designated as UM1) is 2.4 Mb. With a high G+C content (70.4 mol%), strain UM1 is phylogenetically most closely related to F. nasiphocae based on whole genome analysis. Strain UM1 was susceptible to vancomycin, linezolid, trimethoprim-sulfamethoxazole, doxycycline, and intermediate to penicillin and ciprofloxacin. Ceftriaxone resistance was noted. The patient who was also on hemodialysis for his end stage kidney disease died approximately 3 weeks following implant removal and fusion with an external fixator. This study describes the first isolation of F. nasiphocae from human clinical samples. The use of emerging technologies has supported more definitive etiological diagnosis associated with rarely encountered organisms in periprosthetic joint infection.
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Affiliation(s)
- Sun Tee Tay
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Azhar Mahmood Merican
- Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Kartini Abdul Jabar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rukumani Devi Velayuthan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Khairul Anwar Ayob
- Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jiang Lin Lee
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Jennifer Chong
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rina Karunakaran
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Xu Y, Ma X, Guo H, Tang H, Liu J, Wang C, Wang C. Diagnostic Value of Synovial Fluid Biomarkers for Periprosthetic Joint Infection: A Prospective, Double-blind Trial. Med Sci Monit 2023; 29:e940842. [PMID: 37814443 PMCID: PMC10578642 DOI: 10.12659/msm.940842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/21/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND This prospective, double-blind study investigated the clinical diagnostic value of synovial fluid S100 calcium-binding protein A8 (S100A8) and S100 calcium-binding protein A9 (S100A9) in periprosthetic joint infection (PJI) and investigated the subtypes of a-defensin that have diagnostic value for PJI. MATERIAL AND METHODS Synovial fluid samples were collected from 82 patients with suspected PJI after total joint arthroplasty. Patients were divided into a PJI group (n=39) and non-PJI group (n=43). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to determine S100A8, S100A9, alpha-defensin, and internal reference standards in synovial fluid. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficiency of S100A8, S100A9, and alpha-defensin for PJI, as well as the diagnostic value in combination with common biomarkers of infection. RESULTS S100A8, 3 variants of S100A9, and 3 alpha-defensins (human neutrophil peptides [HNP]1-3) in synovial fluid were significantly higher in the PJI group than in the non-PJI group (P<0.001). The sensitivity, specificity, and the area under ROC curve (AUC) for diagnosing PJI were 97.4%, 86.0%, and 0.964 (95% CI: 0.929-0.998), respectively, for synovial fluid S100A8; 87.2%, 88.4% and 0.902 (95% CI: 0.823-0.980), respectively, for S100A9; and 89.7%, 83.7%, and 0.933 (95% CI: 0.884-0.982), respectively, for HNP1-3. The diagnostic efficiency was improved when combined with synovial fluid white blood cell count and percentage of polymorphonuclear neutrophils. CONCLUSIONS Synovial fluid S100A8, S100A9, and HNP1-3 have satisfactory diagnostic efficiency for the diagnosis of PJI, which will help clinicians to accurately diagnose PJI.
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Affiliation(s)
- Ying Xu
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
- School of Laboratory Medicine, Weifang Medical College, Weifang, Shandong, PR China
- NMPA Key Laboratory for Quality Evaluation of In Vitro Diagnostics, Beijing, PR China
| | - Xueting Ma
- Intelligence Biosystems (Qingdao), Co., Ltd., Beijing, PR China
| | - Haoran Guo
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
- NMPA Key Laboratory for Quality Evaluation of In Vitro Diagnostics, Beijing, PR China
- Medical School of Chinese PLA General Hospital, Beijing, PR China
| | - Hairong Tang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Jiayu Liu
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
| | - Chengbin Wang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
- School of Laboratory Medicine, Weifang Medical College, Weifang, Shandong, PR China
- NMPA Key Laboratory for Quality Evaluation of In Vitro Diagnostics, Beijing, PR China
| | - Chi Wang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, PR China
- NMPA Key Laboratory for Quality Evaluation of In Vitro Diagnostics, Beijing, PR China
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Bichay MSM, Ward H, Abukar AA, Gadikoppula S. Acute monoarticular hip joint pseudogout masquerading as septic arthritis. BMJ Case Rep 2023; 16:e256189. [PMID: 37813553 PMCID: PMC10565276 DOI: 10.1136/bcr-2023-256189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Monoarticular pseudogout of the hip joint is rare and to the best of our knowledge only four other cases exist in the literature. We present a case of primary monoarticular pseudogout affecting the right hip in a patient in his 50s. The diagnosis was confirmed through ultrasound-guided synovial fluid aspiration and crystal analysis. The patient was treated conservatively with analgesia and after hip joint aspiration resulted in dramatic symptomatic resolution. Acute attack of pseudogout is a rare cause of acute hip pain. The clinical features may mimic hip joint septic arthritis and should be considered in the differential diagnosis of any presentation of acute joint pain. Diagnosis is important to avoid unnecessary medical and surgical intervention reducing hospital stay.
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Affiliation(s)
| | - Harry Ward
- Trauma and Orthopaedic Surgery, North Middlesex University Hospital, London, UK
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Grant LM, Seville MT, Graf EH, Vikram HR. Rhodococcus erythropolis septic arthritis. BMJ Case Rep 2023; 16:e256864. [PMID: 37802590 PMCID: PMC10565188 DOI: 10.1136/bcr-2023-256864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy. She was diagnosed with left native knee septic arthritis and underwent arthroscopic irrigation and debridement of the knee; cultures from synovial tissue grew Rhodococcus erythropolis. Rhodococcus spp are soil-dwelling and livestock-dwelling bacteria which occasionally cause disease in immunocompromised hosts. Infection in immunocompetent hosts is rare, and septic arthritis secondary to Rhodococcus erythropolis has not been reported previously.
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Affiliation(s)
- Leah M Grant
- Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Maria T Seville
- Division of Infectious Diseases, Mayo Clinic, Phoenix, Arizona, USA
| | - Erin H Graf
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
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Nelson SB, Pinkney JA, Chen AF, Tande AJ. Executive Summary: Periprosthetic Joint Infection-Current Clinical Challenges. Clin Infect Dis 2023; 77:939-940. [PMID: 37796054 PMCID: PMC11004925 DOI: 10.1093/cid/ciad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 10/06/2023] Open
Abstract
Over the last several decades, periprosthetic joint infection (PJI) has been increasing in incidence and is occurring in more complex patients. While there have been advances in both surgical and medical treatment strategies, there remain important gaps in our understanding. Here, we share our current approaches to the diagnosis and management of PJI, focusing on frequent clinical challenges and collaborative interdisciplinary care. The more detailed review including diagnosis, surgical considerations, and a detailed antimicrobial discussion is presented in the online version.
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Affiliation(s)
- Sandra B Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jodian A Pinkney
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Nelson SB, Pinkney JA, Chen AF, Tande AJ. Periprosthetic Joint Infection: Current Clinical Challenges. Clin Infect Dis 2023; 77:e34-e45. [PMID: 37434369 PMCID: PMC11004930 DOI: 10.1093/cid/ciad360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 07/13/2023] Open
Abstract
Over the last several decades, periprosthetic joint infection has been increasing in incidence and is occurring in more complex patients. While there have been advances in both surgical and medical treatment strategies, there remain important gaps in our understanding. Here, we share our current approaches to the diagnosis and management of periprosthetic joint infection, focusing on frequent clinical challenges and collaborative interdisciplinary care.
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Affiliation(s)
- Sandra B Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jodian A Pinkney
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Pérez-Prieto D, Totlis T, Madjarevic T, Becker R, Ravn C, Monllau JC, Renz N. ESSKA and EBJIS recommendations for the management of infections after anterior cruciate ligament reconstruction (ACL-R): prevention, surgical treatment and rehabilitation. Knee Surg Sports Traumatol Arthrosc 2023; 31:4204-4212. [PMID: 37243789 PMCID: PMC10471731 DOI: 10.1007/s00167-023-07463-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Infection after anterior cruciate ligament reconstruction (ACL-R) is a rare but severe complication. Despite an increase in articles published on this topic over the last decade, solid data to optimized diagnostic and therapeutic measures are scarce. For this reason, the European Bone and Joint Infection Society (EBJIS) and the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) collaborated in order to develop recommendations for the diagnosis and management of infections after ACL-R. The aim of the workgroup was to perform a review of the literature and provide practical guidance to healthcare professionals involved in the management of infections after ACL-R. METHODS An international workgroup was recruited to provide recommendations for predefined clinical dilemmas regarding the management of infections after ACL-R. MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for evidence to support the recommended answers to each dilemma. RESULTS The recommendations were divided into two articles. The first covers etiology, prevention, diagnosis and antimicrobial treatment of septic arthritis following ACL-R and is primarily aimed at infectious disease specialists. This article includes the second part of the recommendations and covers prevention of infections after ACL-R, surgical treatment of septic arthritis following ACL-R and subsequent postoperative rehabilitation. It is aimed not only at orthopedic surgeons, but at all healthcare professionals dealing with patients suffering from infections after ACL-R. CONCLUSION These recommendations guide clinicians in achieving timely and accurate diagnosis as well as providing optimal management, both of which are paramount to prevent loss of function and other devastating sequelae of infection in the knee joint. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Daniel Pérez-Prieto
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar, Barcelona, Spain
- IcatKNEE, Hospital Universitari Dexeus - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Trifon Totlis
- Thessaloniki Minimally Invasive Surgery (The-MIS) Orthopaedic Centre, St. Luke's Hospital, Thessaloniki, Greece.
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Tomislav Madjarevic
- University Hospital for Orthopaedic Surgery Lovran, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Roland Becker
- Centre of Orthopaedics and Traumatology, University of Brandenburg Theodor Fontane, Brandenburg, Germany
| | - Christen Ravn
- Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Juan C Monllau
- Department of Traumatology and Orthopaedic Surgery, Hospital del Mar, Barcelona, Spain
- IcatKNEE, Hospital Universitari Dexeus - Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nora Renz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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Abdelmalek A, Haines S, Tadros BJ, Evans JT, Judge A. Re-operation rates of arthroscopic management versus arthrotomy in treatment of septic arthritis of native shoulder joint in adults. A systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2023; 33:2717-2727. [PMID: 36869912 DOI: 10.1007/s00590-023-03495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
AIMS Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies. PATIENTS AND METHODS The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration's tool for assessing risk of bias (ROBINS-I) was used. RESULTS Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1-41 months. Mean duration of symptoms prior to presentation ranged from 8.3-23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data. CONCLUSION This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies.
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Affiliation(s)
- Amir Abdelmalek
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
| | - Samuel Haines
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Baha John Tadros
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Jonathan T Evans
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
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