Journal of Bone and Joint Infection最新文献

{"title":"Postoperative antibiotic treatment does not lower re-revision rate in presumed aseptic hip and knee revision arthroplasties with unexpected positive intraoperative cultures - a matched cohort study.","authors":"Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J H Frank, Jochen G Hofstaetter","doi":"10.5194/jbji-10-51-2025","DOIUrl":"10.5194/jbji-10-51-2025","url":null,"abstract":"<p><p><b>Aims</b>: It remains unclear if postoperative antibiotic (AB) treatment is advantageous in presumed aseptic revision arthroplasties of the hip (rTHA) and knee (rTKA) with unexpected positive intraoperative cultures (UPIC). The aim of this study is to evaluate if there is a difference in the re-revision rate in patients with UPIC when treated with postoperative AB or when postoperative AB is withheld. <b>Methods</b>: In this retrospective matched cohort study we compared the re-revision rates in rTHA and rTKA with (AB group: 45 rTHA, 25 rTKA) and without (non-AB group: 45 rTHA, 25 rTKA) AB treatment in patients with UPIC. Baseline covariates for matching were the microorganism (likely or not likely to be a contaminant), patient demographics, joint, revision type, surgical site infection score, American Society of Anesthesiologists classification, serum C-reactive protein (CRP). <b>Results</b>: After a median follow-up of 4.1 (inter-quartile range, IQR: 2.9-5.5) years after rTHA and rTKA, the re-revision rate between the AB group and the non-AB group was 14.3 % versus 15.7 % (<i>P</i>=0.81). In the AB group, 4.3 % (3/70) of patients underwent revision due to septic complications compared to 5.7 % (4/70) in the non-AB group (<i>P</i>=0.69). None of the patients were diagnosed with a confirmed periprosthetic joint infection (PJI) according to the PJI diagnostic criteria of European Bone and Joint Infection Society (EBJIS). In 22/70 (31.4 %) of the patients in the AB group and in 15/70 (21.4 %) of the patients in the non-AB group, a diagnosis of \"infection likely\" was made according to the EBJIS criteria (<i>P</i>=0.18). All UPICs with low virulent microorganisms were considered to be contamination (coagulase-negative <i>Staphylococci</i>; <i>Corynebacterium</i>; anaerobic Gram-positive bacilli and cocci, e.g., <i>Finegoldia magna</i>, <i>Cutibacterium acnes</i>). <b>Conclusion</b>: Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPIC in presumed aseptic rTHA and rTKA. Patients diagnosed with pathogens classified as a likely contaminant can be safely ignored.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"51-59"},"PeriodicalIF":1.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670019","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":"Synovial glucose and serum-to-synovial-glucose ratio perform better than other biomarkers for the diagnosis of acute postoperative prosthetic knee infection.","authors":"Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, Juan Carlos Martínez-Pastor","doi":"10.5194/jbji-10-41-2025","DOIUrl":"10.5194/jbji-10-41-2025","url":null,"abstract":"<p><p><b>Introduction</b>: In native septic arthritis, synovial glucose is a well-established diagnostic marker. However, its diagnostic utility in periprosthetic joint infection (PJI) remains unexplored. Given the diagnostic challenges of acute postoperative PJI, we hypothesized that synovial glucose could serve as a valuable biomarker and aimed to evaluate its diagnostic accuracy. <b>Material and methods</b>:  This is a retrospective diagnostic study in acute postoperative PJI in total knee arthroplasty (TKA). We reviewed all TKA surgeries performed in the past 10 years and cross-checked those patients that consulted to our emergency room during the first 90 d after TKA surgery for knee-related symptoms. We calculated the serum-to-synovial-glucose ratio for each patient (serum-to-synovial-glucose ratio = [(serological glucose - synovial glucose) / serological glucose]), and we formed the receiver operating characteristic (ROC) curves for synovial glucose, serum-to-synovial-glucose ratio, serum C-reactive protein (CRP), synovial white blood cell (s-WBC) count, and polymorphonuclear cell percentage (PMN%); then we extracted the optimal cutoff values. <b>Results</b>: The optimal cutoffs for diagnosing acute postoperative PJI were < 44 mg dL^-1 for synovial glucose and > 0.69 for serum-to-synovial-glucose ratio. The area under the curve (AUC) values were 0.861 and 0.889, respectively. ROC curves for serum CRP, s-WBC count, and PMN% showed AUC values of 0.69, 0.714, and 0.66, respectively. The combined ROC curve analysis for serum CRP, s-WBC count, and PMN% showed an AUC of 0.722. When adding synovial glucose, the AUC was 0.859 and with serum-to-synovial-glucose ratio we achieved an AUC of 0.876. <b>Conclusion</b>: Synovial glucose and serum-to-synovial-glucose ratio demonstrated good diagnostic potential for acute postoperative PJI following TKA. These biomarkers exhibited superior accuracy compared to the combination of serum CRP, s-WBC count, and PMN%.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 2","pages":"41-49"},"PeriodicalIF":1.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670020","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":"Ten years of experience with elbow native joint arthritis: a multicenter retrospective cohort study.","authors":"Pansachee Damronglerd, Ryan Bijan Khodadadi, Said El Zein, Jack William McHugh, Omar M Abu Saleh, Mark Edward Morrey, Aaron Joseph Tande, Gina Ann Suh","doi":"10.5194/jbji-10-25-2025","DOIUrl":"10.5194/jbji-10-25-2025","url":null,"abstract":"<p><p><b>Background</b>: Elbow native joint septic arthritis (NJSA) is a rare condition, constituting 6 %-9 % of all native septic arthritis cases. It is associated with elevated mortality and morbidity. This study aims to clarify the characteristics, management, and outcomes of elbow NJSA. <b>Methods</b>: We retrospectively analyzed adults diagnosed with elbow NJSA who underwent surgical intervention at Mayo Clinic facilities from January 2012 to December 2021. Diagnosis relied on clinical presentation, synovial fluid white blood cell (WBC) count, and aspiration or operative cultures. <b>Results</b>: Among 557 patients with NJSA during the study time frame, 19 (3.4 %) were found to have elbow NJSA. The median age of these patients was 64 years. Joint aspirations were conducted in 16 cases (84.2 %). The median synovial fluid WBC count was 43 139 cells mm^-3. Crystals were observed in three patients (15.8 %). Synovial fluid and operative tissue samples revealed 12.5 % and 20 % positive Gram stains, mostly indicating Gram-positive cocci clusters. Open arthrotomy (72.2 %) was the predominant surgical approach, and three patients (16.7 %) required reoperation within 90 d. The median antimicrobial therapy duration was 30 d (interquartile range: 22-44 d). Non-tuberculosis mycobacterium (NTM) was detected in two patients, with a treatment duration of 274 and 374 d, respectively. Complications included joint contracture and joint resection. <b>Conclusions</b>: Elbow NJSA is an infrequent condition associated with significant complications, such as the necessity for reoperation. Although the synovial fluid WBC count, crystals, and Gram stain positivity were less helpful for diagnosis in this study, positive Gram stain and culture results from operative tissue specimens demonstrated greater effectiveness in diagnosing elbow NJSA.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 1","pages":"25-31"},"PeriodicalIF":1.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648568","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":"Effect of oral antibiotics after two-stage revision for periprosthetic joint infection on subsequent antibiotic resistance within a national cohort of United States veterans.","authors":"Judd Payne, Jesse D Sutton, Brenna E Blackburn, Snehal Bansod, Hannah Imlay, Emily S Spivak, Jakrapun Pupaibool, Jeremy M Gililland, Laura K Certain","doi":"10.5194/jbji-10-7-2025","DOIUrl":"10.5194/jbji-10-7-2025","url":null,"abstract":"<p><p><b>Background</b>: Prior studies have indicated that administration of prolonged courses of oral antibiotics after Stage 2 reimplantation surgery for periprosthetic joint infection (PJI) results in a lower rate of recurrent PJI. However, there is concern that this antibiotic usage results in an increased risk of antibiotic resistance in any subsequent PJI that does occur. <b>Methods</b>: We retrospectively reviewed patients who underwent Stage 2 reimplantation surgery for PJI within the national Veterans Affairs hospital system of the United States. We compared those who received at least 2 weeks of oral antibiotics after Stage 2 reimplantation to those who did not. The primary outcome was the proportion of organisms resistant to four classes of antibiotics (tetracyclines, fluoroquinolones, oral beta-lactams, and sulfonamides) in recurrent PJI. Secondary outcomes included recurrent PJI and death. <b>Results</b>: Of the 605 patients who underwent Stage 2 reimplantation for PJI, 154 patients received at least 14 d of antibiotics after surgery and 451 patients did not. Bacteria causing recurrent PJI in patients who received prolonged antibiotics were more likely to be resistant to tetracyclines and trimethoprim-sulfamethoxazole but not oral beta-lactams or fluoroquinolones. There was no difference in risk of recurrent PJI or death between the two groups. <b>Conclusions</b>: Prolonged oral antibiotic treatment after Stage 2 reimplantation increases the risk of antibiotic resistance to some antibiotics in subsequent PJI. We recommend further research to identify the best choice of antibiotic and duration after Stage 2 reimplantation, to maximize benefits while minimizing risks.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 1","pages":"7-14"},"PeriodicalIF":1.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573104","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":"Advancing cross-disciplinarity in bone and joint infection science using the COMBINE approach: an example from Denmark.","authors":"Louise Kruse Jensen, Thomas Bjarnsholt, Hans Gottlieb, Mats Bue","doi":"10.5194/jbji-10-1-2025","DOIUrl":"10.5194/jbji-10-1-2025","url":null,"abstract":"<p><p>In 2018, the Centrum fOr translational Medicine on Bone and joint INfEctions (COMBINE) was created to facilitate collaboration among Danish scientists and researchers dedicated to bone and joint infection research. The COMBINE approach was developed to ensure successful collaboration, and this publication aims to share this successful approach.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"10 1","pages":"1-5"},"PeriodicalIF":1.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573103","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":"A case report of fracture-related infection with <i>Metamycoplasma hominis</i> in an immunocompetent patient.","authors":"Karishma Gokani, Prabu Balasubramanian, Edward Matthews, Dunisha Samarasinghe","doi":"10.5194/jbji-9-271-2024","DOIUrl":"10.5194/jbji-9-271-2024","url":null,"abstract":"<p><p>We report a case of post-traumatic <i>Metamycoplasma hominis</i> fracture-related infection of the right femur in a young male with no identified immunodeficiency. Treatment required multiple washouts and femoral nail revision, combined with 10 weeks of treatment with doxycycline and clindamycin.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"9 6","pages":"271-275"},"PeriodicalIF":1.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382550","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":"Exploring the potential of naturally occurring antimicrobials for managing orthopedic-device-related infections.","authors":"Baixing Chen, T Fintan Moriarty, Hans Steenackers, Georges F Vles, Jolien Onsea, Thijs Vackier, Isabel Spriet, Rob Lavigne, R Geoff Richards, Willem-Jan Metsemakers","doi":"10.5194/jbji-9-249-2024","DOIUrl":"10.5194/jbji-9-249-2024","url":null,"abstract":"<p><p>Orthopedic-device-related infections (ODRIs) are challenging clinical complications that are often exacerbated by antibiotic resistance and biofilm formation. This review explores the efficacy of naturally occurring antimicrobials - including agents sourced from bacteria, fungi, viruses, animals, plants and minerals - against pathogens common in ODRIs. The limitations of traditional antibiotic agents are presented, and innovative naturally occurring antimicrobials, such as bacteriophage therapy and antimicrobial peptides, are evaluated with respect to their interaction with conventional antibiotics and antibiofilm efficacy. The integration of these natural agents into clinical practice could revolutionize ODRI treatment strategies, offering effective alternatives to conventional antibiotics and mitigating resistance development. However, the translation of these compounds from research into the clinic may require the substantial investment of intellectual and financial resources.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"9 5","pages":"249-260"},"PeriodicalIF":1.8,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621252","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":"A combined debridement, antibiotics, and implant retention (DAIR) procedure with flap coverage for acute soft tissue defects following total knee arthroplasty: a retrospective study.","authors":"Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, Juan Carlos Martínez-Pastor","doi":"10.5194/jbji-9-241-2024","DOIUrl":"10.5194/jbji-9-241-2024","url":null,"abstract":"<p><p>Acute soft tissue defects, such as persistent drainage, wound dehiscence, or necrosis, following total knee arthroplasty (TKA) can lead to the devastating complication of deep infection. Typically, when a medium-sized defect is present, a gastrocnemius flap is widely employed for soft tissue reconstruction due to its low morbidity and favourable functional outcomes. When facing this situation, we should consider associating the coverage treatment with a debridement, antibiotics, and implant retention (DAIR) surgery procedure, in order to treat a possible acute infection, even when the diagnosis of infection is not clear. We performed a retrospective study to compare TKA outcomes in patients with DAIR and flap procedures in the same surgical act against those who had received an isolated flap procedure for soft tissue reconstruction after an acute surgical wound defect. Patients had been identified from a prospectively collated TKA database. Between 2005 and 2021, 18 patients met our inclusion criteria, with a mean follow-up of approximately 8 years. A medial gastrocnemius flap procedure was performed for 15 patients (83 %). We compared the rates of infection clearance between the two groups. No differences in comorbidities or risk factors were observed between both groups. In the combination treatment group, 66.6 % of patients healed after treatment compared to 33.3 % in the isolated flap group. Although no significant statistical differences were found, the association of DAIR with the muscle flap procedure is highly recommended in the treatment of acute soft tissue defects after TKA. Further studies with larger sample sizes are necessary to extrapolate these findings to the general population.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"9 5","pages":"241-248"},"PeriodicalIF":1.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621168","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":"Predicting periprosthetic joint infection: external validation of preoperative prediction models.","authors":"Seung-Jae Yoon, Paul C Jutte, Alex Soriano, Ricardo Sousa, Wierd P Zijlstra, Marjan Wouthuyzen-Bakker","doi":"10.5194/jbji-9-231-2024","DOIUrl":"10.5194/jbji-9-231-2024","url":null,"abstract":"<p><p><b>Introduction</b>: Prediction models for periprosthetic joint infections (PJIs) are gaining interest due to their potential to improve clinical decision-making. However, their external validity across various settings remains uncertain. This study aimed to externally validate promising preoperative PJI prediction models in a recent multinational European cohort. <b>Methods</b>: Three preoperative PJI prediction models - by Tan et al. (2018), Del Toro et al. (2019), and Bülow et al. (2022) - that have previously demonstrated high levels of accuracy were selected for validation. A retrospective observational analysis of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at centers in the Netherlands, Portugal, and Spain between January 2020 and December 2021 was conducted. Patient characteristics were compared between our cohort and those used to develop the models. Performance was assessed through discrimination and calibration. <b>Results</b>: The study included 2684 patients, 60 of whom developed a PJI (2.2 %). Our cohort differed from the models' original cohorts with respect to demographic variables, procedural variables, and comorbidity prevalence. The overall accuracies of the models, measured with the <math><mi>c</mi></math>  statistic, were 0.72, 0.69, and 0.72 for the Tan, Del Toro, and Bülow models, respectively. Calibration was reasonable, but the PJI risk estimates were most accurate for predicted infection risks below 3 %-4 %. The Tan model overestimated PJI risk above 4 %, whereas the Del Toro model underestimated PJI risk above 3 %. <b>Conclusions</b>: The Tan, Del Toro, and Bülow PJI prediction models were externally validated in this multinational cohort, demonstrating potential for clinical application in identifying high-risk patients and enhancing preoperative counseling and prevention strategies.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"9 5","pages":"231-239"},"PeriodicalIF":1.8,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621255","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":"Glenohumeral joint septic arthritis and osteomyelitis caused by <i>Moraxella catarrhalis</i> after arthroscopic rotator cuff repair: case report and literature review.","authors":"Yong-Beom Kim, Jinjae Kim, Min Gon Song, Tae Hyong Kim, Tae-Yoon Choi, Gi-Won Seo","doi":"10.5194/jbji-9-225-2024","DOIUrl":"10.5194/jbji-9-225-2024","url":null,"abstract":"<p><p><i>Moraxella catarrhalis</i> commonly colonizes the upper respiratory tract of humans, but infection caused by <i>M. catarrhalis</i> after orthopedic surgery is rare. Here, we report the first case of septic arthritis of the shoulder caused by an <i>M. catarrhalis</i> infection and outline the diagnosis and treatment steps as well as differences compared with other cases.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"9 5","pages":"225-230"},"PeriodicalIF":1.8,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621253","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}