Journal of Bone and Joint Infection最新文献

{"title":"Musculoskeletal manifestations of lower-extremity coccidioidomycosis: a case series","authors":"William Estes, L. D. Latt, Jacob Robishaw-Denton, Matthew L. Repp, Yash Suri, Tyson S. Chadaz, Christina Boulton, Talha Riaz","doi":"10.5194/jbji-9-197-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-197-2024","url":null,"abstract":"Abstract. Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Musculoskeletal manifestations are uncommon and seen in disseminated disease. While the involvement of the axial skeleton has been well described, the literature is limited on diseases involving the lower extremity. Methods: We identified three patients, at two regional academic medical centers in southern Arizona, who demonstrated different manifestations of osteoarticular coccidioidomycosis involving the lower extremity. Results: Case 1 is a 41-year-old male, with a history of HIV/AIDS and vertebral coccidioidomycosis, who presented with abscesses in the left hemipelvis and left proximal femoral osteomyelitis. He was treated with staged surgical debridement, including the use of amphotericin B impregnated beads. He remains on indefinite oral posaconazole suppression. Case 2 is a 46-year-old female, who presented with suspected right knee osteoarthritis. An MRI revealed septic arthritis and osteomyelitis. Necrotic bone was debrided, and synovial fluid cultures were positive for Coccidioides. She underwent a resection of the native knee joint with the insertion of an amphotericin B and voriconazole impregnated spacer. She continues oral itraconazole and awaits a total knee arthroplasty. Case 3 is a 76-year-old male, who presented with a draining right heel ulcer. Radiographs revealed bony destruction consistent with Charcot arthropathy. Irrigation and debridement revealed the gelatinous destruction of the talus and calcaneus, and cultures confirmed Coccidioides infection. A polymethyl methacrylate voriconazole spacer was placed. He subsequently underwent arthrodesis and remains on lifelong fluconazole. Conclusion: Lower-extremity osteoarticular coccidioidomycosis has various debilitating presentations that frequently mimic non-infectious etiologies. Treatment warrants surgical debridement, and prolonged antifungal therapy should be considered.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141804462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of rifampicin-resistant staphylococci on the skin and nose of rifampicin-treated patients with an orthopaedic-device-related infection","authors":"Alexandra Wallimann, Yvonne Achermann, Ciara Ferris, Mario Morgenstern, Martin Clauss, Vincent Stadelmann, Hannes A Rüdiger, L. O’Mahony, T. F. Moriarty","doi":"10.5194/jbji-9-191-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-191-2024","url":null,"abstract":"Abstract. Rifampicin is a key antibiotic in the treatment of staphylococcal biofilm infections. In this pilot study, we found that patients who received rifampicin for treatment of an orthopaedic-device-related infection (ODRI) were colonized with rifampicin-resistant staphylococci during treatment and this persisted for up to 2 months after cessation of treatment.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141807838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the agreement between principles and practice of antibiotic stewardship in the management of diabetic foot infection: an in-hospital quality control study.","authors":"Noémie Reinert, Katinka Wetzel, Fabian Franzeck, Mario Morgenstern, Markus Aschwanden, Thomas Wolff, Martin Clauss, Parham Sendi","doi":"10.5194/jbji-9-183-2024","DOIUrl":"10.5194/jbji-9-183-2024","url":null,"abstract":"<p><p><b>Introduction</b>: Standardization of diagnostic and treatment concepts in diabetes-related foot infection (DFI) is challenging. In 2019, specific recommendations regarding diagnostic principles and antibiotic therapy (ABT) for DFI, including the one for osteomyelitis (DFO), were introduced in our institution. In this study, we assessed the adherence to these in-house guidelines 2 years after their implementation. <b>Methods</b>: Adult patients with DFI with and without DFO who underwent surgical intervention between 2019 and 2021 were included. Patients' charts were retrospectively reviewed. Accordance to recommendations regarding biopsy sampling, labeling, requesting microbiological and histopathological examinations, and treatment duration were assessed. <b>Results</b>: A total of 80 patients with 117 hospital episodes and 163 surgical interventions were included; 84.6 % required an amputation. Patients with HbA1c levels of <math><mrow><mo><</mo> <mn>6.5</mn></mrow> </math>  % more often required a revision during the same hospitalization than those with HbA1c levels of <math><mrow><mo>≥</mo> <mn>6.5</mn></mrow> </math>  % (29.4 % vs. 12.1 %, respectively, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.023</mn></mrow> </math> ). Specimens were obtained in 71.8 % of operations and sent for histological examination in 63.2 %. The mean duration of ABT was 9 (interquartile range (IQR) 5-15) d in macroscopically surgically cured episodes and 40.5 (IQR 15-42) d in cases with resection margins in non-healthy bone ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0001</mn></mrow> </math> ). Treatment duration results were similar when using histological results: 13 (IQR 8-42) d for healthy bone vs. 29 (IQR 13-42) d for resection margins consistent with osteomyelitis ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.026</mn></mrow> </math> ). <b>Conclusion</b>: The adherence to recommendations in terms of biopsy sampling was good, moderate for histopathological analysis and poor for labeling the anatomic location. Adherence to recommendations for ABT duration was good, but further shortening of treatment duration for surgically cured cases is necessary.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It is time for a unified definition of native vertebral osteomyelitis: a framework proposal.","authors":"Francesco Petri, Omar Mahmoud, Said El Zein, Ahmad Nassr, Brett A Freedman, Jared T Verdoorn, Aaron J Tande, Elie F Berbari","doi":"10.5194/jbji-9-173-2024","DOIUrl":"10.5194/jbji-9-173-2024","url":null,"abstract":"<p><p>In recent years, there has been a notable increase in research output on native vertebral osteomyelitis (NVO), coinciding with a rise in its incidence. However, clinical outcomes remain poor, due to frequent relapse and long-term sequelae. Additionally, the lack of a standardized definition and the use of various synonyms to describe this condition further complicate the clinical understanding and management of NVO. We propose a new framework to integrate the primary diagnostic tools at our disposal. These collectively fall into three main domains: clinical, radiological, and direct evidence. Moreover, they and can be divided into seven main categories: (a) clinical features, (b) inflammatory biomarkers, (c) imaging techniques, microbiologic evidence from (d) blood cultures and (e) invasive techniques, (f) histopathology, and (g) empirical evidence of improvement following the initiation of antimicrobial therapy. We provide a review on the evolution of these techniques, explaining why no single method is intrinsically sufficient to formulate an NVO diagnosis. Therefore, we argue for a consensus-driven, multi-domain approach to establish a comprehensive and universally accepted definition of NVO to enhance research comparability, reproducibility, and epidemiological tracking. Ongoing research effort is needed to refine these criteria further, emphasizing collaboration among experts through a Delphi method to achieve a standardized definition. This effort aims to streamline research, expedite accurate diagnoses, optimize diagnostic tools, and guide patient care effectively.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11262020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ureaplasma urealyticum osteomyelitis of the greater trochanter in a patient with multiple sclerosis using ocrelizumab – a case report","authors":"Fred Ruythooren, S. Ghijselings, M. Depypere, W. Metsemakers, L. Henckaerts, Nathalie Noppe, G. Vles","doi":"10.5194/jbji-9-167-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-167-2024","url":null,"abstract":"Abstract. Ocrelizumab – a monoclonal anti-CD20 antibody used in treatment of multiple sclerosis (MS) – marks significant progress in treating autoimmune diseases but raises susceptibility to opportunistic infections due to hypogammaglobulinemia. A young MS patient developed osteomyelitis from persistent Ureaplasma urealyticum urethritis, which was diagnosed with specialized polymerase chain reaction and resolved with targeted antibiotics. A multidisciplinary approach is crucial for managing such infections.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141347604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthopedic infectious diseases: a survey on the composition and perceived value of an emerging subspecialty clinical service","authors":"Nicolas W Cortes-Penfield, D. B. G. Tai, Angela L Hewlett","doi":"10.5194/jbji-9-161-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-161-2024","url":null,"abstract":"Abstract. We surveyed US orthopedic infectious disease (Ortho ID) specialists and surgeons (n=54 clinicians from at least 17 institutions). Three-quarters had a dedicated clinic or inpatient service; orthopedic device-related infections were most commonly seen. All respondents highly valued Ortho ID teams for improving multidisciplinary communication, trust, access to care, and outcomes.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141350440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosing and treatment duration of suppressive antimicrobial therapy in orthopedic implant infections: a cohort study","authors":"Jaap L. J. Hanssen, R. V. D. van der Wal, H. M. van der Linden, J. van Prehn, H. Scheper, Mark G.J. de Boer","doi":"10.5194/jbji-9-149-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-149-2024","url":null,"abstract":"Abstract. Introduction: Limited data inform about the optimal dosing and duration of suppressive antimicrobial therapy (SAT) for orthopedic implant infection (OII). We aimed to compare the effectiveness of low-dosage with standard-dosage SAT and evaluate the safety of stopping SAT. Methods: All patients with OII treated with SAT from 2011 to 2022 were retrospectively included. Data were extracted from electronic patient files. Low-dosage SAT was defined as antimicrobial therapy dosed lower than the standard dosage recommended for OII. The association of dosing strategy and other factors with failure-free survival were assessed by Kaplan–Meier and Cox proportional hazard models. Results: One-hundred-and-eight patients were included. The median follow-up time after SAT initiation was 21 months (interquartile range (IQR) 10–42 months). SAT was successful in 74 patients (69 %). Low-dosage SAT (n=82) was not associated with failure in univariate (hazard ratio (HR) 1.23, 95 % confidence interval (CI) 0.53–2.83) and multivariate analyses (HR 1.24, 95 % CI 0.54–2.90). In 25 patients (23 %), SAT was stopped after a median treatment duration of 26 months. In this group, one patient (4 %) developed a relapse. Conclusions: In this study, low-dosage SAT was as effective as standard dosage SAT. Moreover, stopping SAT after 2 to 3 years may be justified in patients with a good clinical course. These findings warrant further research on optimal dosing and duration of SAT and on the durability of in vivo biofilms.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No differences in outcomes with stopping or continuing antibiotic suppression in periprosthetic joint infections","authors":"Daisuke Furukawa, Megan Dunning, Sa Shen, Amy Chang, Jenny Aronson, Derek F. Amanatullah, Gina A Suh, S. Kappagoda","doi":"10.5194/jbji-9-143-2024","DOIUrl":"https://doi.org/10.5194/jbji-9-143-2024","url":null,"abstract":"Abstract. The data on long-term antibiotic use following debridement, antibiotics, and implant retention (DAIR) for treatment of periprosthetic joint infections are limited. In this single-center retrospective study, we show that patients with eventual cessation of antibiotic suppression after DAIR had similar outcomes to those who remained on chronic antibiotic suppression.\u0000","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140981841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences in periprosthetic joint infection research.","authors":"Domenico De Mauro, Cesare Meschini, Giovanni Balato, Tiziana Ascione, Enrico Festa, Davide Bizzoca, Biagio Moretti, Giulio Maccauro, Raffaele Vitiello","doi":"10.5194/jbji-9-137-2024","DOIUrl":"10.5194/jbji-9-137-2024","url":null,"abstract":"<p><p><b>Introduction</b>: Periprosthetic joint infections (PJIs) have emerged as a focal point in the realm of orthopedics, garnering widespread attention owing to the escalating incidence rates and the profound impact they impose on patients undergoing total joint arthroplasties (TJAs). Year after year, there has been a growing trend in the analysis of multiple risk factors, complication rates, and surgical treatments in the field. This study aims to illuminate the status of the sex-related differences in periprosthetic joint infections and advance research in this field. <b>Methods</b>: A systematic review was carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The final reference list comprised longitudinal studies (both retrospective and prospective) and randomized controlled trials. A sex-based analysis was conducted to assess differences between males and females. <b>Results</b>: A total of 312 studies were initially identified through online database searches and reference investigations. Nine studies were subsequently included in the review. Eight out of nine studies examined the risk of developing PJI after total joint replacement. Notably, only half of these studies demonstrated a statistically significant value, with a <math><mi>p</mi></math>  value  <math><mrow><mi><</mi> <mn>0.05</mn></mrow> </math> , indicating a higher risk of infectious complications in males compared to females. <b>Conclusion</b>: According to the current literature, there appears to be a propensity for males to develop periprosthetic joint infection after total joint arthroplasty at a higher rate than the female population. Enhancing sex-related analysis in this field is imperative for gathering more robust evidence and insights.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing the definition of treatment success alters treatment outcomes in periprosthetic joint infection: a systematic review and meta-analysis.","authors":"Eytan M Debbi, Tyler Khilnani, Ioannis Gkiatas, Yu-Fen Chiu, Andy O Miller, Michael W Henry, Alberto V Carli","doi":"10.5194/jbji-9-127-2024","DOIUrl":"10.5194/jbji-9-127-2024","url":null,"abstract":"<p><p><b>Background</b>: Variability in the definition of treatment success poses difficulty when assessing the reported efficacy of treatments for hip and knee periprosthetic joint infection (PJI). To address this problem, we determined how definitions of PJI treatment success have changed over time and how this has affected published rates of success after one-stage and two-stage treatments for hip and knee PJI. <b>Methods</b>: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify one-stage and two-stage revision hip and knee PJI publications in major databases (2006-2021). Definition of treatment success, based on Musculoskeletal Infection Society tier criteria, was identified for each study. Publication year, number of patients, minimum follow-up, and study quality were also recorded. The association of success definitions and treatment success rate was measured using multi-variable meta-regression. <b>Results</b>: Study quality remained unchanged in the 245 publications included. Over time, no antibiotics (tier 1) and no further surgery (tier 3) (40.7 % and 54.5 %, respectively) became the two dominant criteria. After controlling for type of surgery, study quality, study design, follow-up, and year of publication, studies with less strict success definitions (tier 3) reported slightly higher odds ratios of 1.05 [1.01, 1.10] ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.009</mn></mrow> </math> ) in terms of treatment success rates compared to tier 1. <b>Conclusions</b>: PJI researchers have gravitated towards tier-1 and tier-3 definitions of treatment success. While studies with stricter definitions had lower PJI treatment success, the clinical significance of this is unclear. Study quality, reflected in the methodological index for non-randomized studies (MINORS) score, did not improve. We advocate for improving PJI study quality, including clarification of the definition of treatment success.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11184615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}