Journal of Bone and Joint Infection最新文献

{"title":"Sex-specific analysis of clinical features and outcomes in staphylococcal periprosthetic joint infections managed with two-stage exchange arthroplasty.","authors":"Eibhlin Higgins, Don Bambino Geno Tai, Brian Lahr, Gina A Suh, Elie F Berbari, Kevin I Perry, Matthew P Abdel, Aaron J Tande","doi":"10.5194/jbji-8-125-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-125-2023","url":null,"abstract":"Abstract Background: Differences in susceptibility and response to infection between males and females are well established. Despite this, sex-specific analyses are under-reported in the medical literature, and there is a paucity of literature looking at differences between male and female patients with periprosthetic joint infection (PJI). Whether there are sex-specific differences in presentation, treatment tolerability, and outcomes in PJI has not been widely evaluated. Methods: We undertook a retrospective case-matched analysis of patients with staphylococcal PJI managed with two-stage exchange arthroplasty. To control for differences other than sex which may influence outcome or presentation, males and females were matched for age group, causative organism category (coagulase-negative staphylococci vs. Staphylococcus aureus), and joint involved (hip vs. knee). Results: We identified 156 patients in 78 pairs of males and females who were successfully matched. There were no significant baseline differences by sex, except for greater use of chronic immunosuppression among females (16.4 % vs. 4.1 %; p=0.012 ). We did not detect any statistically significant differences in outcomes between the two groups. Among the 156 matched patients, 16 recurrent infections occurred during a median follow-up time of 2.9 (IQR 1.5–5.3) years. The 3-year cumulative incidence of relapse was 16.1 % for females, compared with 8.8 % for males ( p=0.434 ). Conclusions: Success rates for PJI treated with two-stage exchange arthroplasty are high, consistent with previously reported literature. This retrospective case-matched study did not detect a significant difference in outcome between males and females with staphylococcal PJI who underwent two-stage exchange arthroplasty.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"125-131"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9398086","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":"Diagnosis of fracture-related infection in patients without clinical confirmatory criteria: an international retrospective cohort study.","authors":"Niels Vanvelk,&nbsp;Esther M M Van Lieshout,&nbsp;Jolien Onsea,&nbsp;Jonathan Sliepen,&nbsp;Geertje Govaert,&nbsp;Frank F A IJpma,&nbsp;Melissa Depypere,&nbsp;Jamie Ferguson,&nbsp;Martin McNally,&nbsp;William T Obremskey,&nbsp;Charalampos Zalavras,&nbsp;Michael H J Verhofstad,&nbsp;Willem-Jan Metsemakers","doi":"10.5194/jbji-8-133-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-133-2023","url":null,"abstract":"<p><p><b>Background</b>: fracture-related infection (FRI) remains a serious complication in orthopedic trauma. To standardize daily clinical practice, a consensus definition was established, based on confirmatory and suggestive criteria. In the presence of clinical confirmatory criteria, the diagnosis of an FRI is evident, and treatment can be started. However, if these criteria are absent, the decision to surgically collect deep tissue cultures can only be based on suggestive criteria. The primary study aim was to characterize the subpopulation of FRI patients presenting without clinical confirmatory criteria (fistula, sinus, wound breakdown, purulent wound drainage or presence of pus during surgery). The secondary aims were to describe the prevalence of the diagnostic criteria for FRI and present the microbiological characteristics, both for the entire FRI population. <b>Methods</b>: a multicenter, retrospective cohort study was performed, reporting the demographic, clinical and microbiological characteristics of 609 patients (with 613 fractures) who were treated for FRI based on the recommendations of a multidisciplinary team. Patients were divided in three groups, including the total population and two subgroups of patients presenting with or without clinical confirmatory criteria. <b>Results</b>: clinical and microbiological confirmatory criteria were present in 77 % and 87 % of the included fractures, respectively. Of patients, 23 % presented without clinical confirmatory criteria, and they mostly displayed one (31 %) or two (23 %) suggestive clinical criteria (redness, swelling, warmth, pain, fever, new-onset joint effusion, persisting/increasing/new-onset wound drainage). The prevalence of any suggestive clinical, radiological or laboratory criteria in this subgroup was 85 %, 55 % and 97 %, respectively. Most infections were monomicrobial (64 %) and caused by <i>Staphylococcus aureus</i>. <b>Conclusion</b>: clinical confirmatory criteria were absent in 23 % of the FRIs. In these cases, the decision to operatively collect deep tissue cultures was based on clinical, radiological and laboratory suggestive criteria. The combined use of these criteria should guide physicians in the management pathway of FRI. Further research is needed to provide guidelines on the decision to proceed with surgery when only these suggestive criteria are present.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"133-142"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9398084","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":"<i>Cutibacterium acnes</i> in spine tissue: characteristics and outcomes of non-hardware-associated vertebral osteomyelitis.","authors":"Matteo Passerini,&nbsp;Julian Maamari,&nbsp;Don Bambino Geno Tai,&nbsp;Robin Patel,&nbsp;Aaron J Tande,&nbsp;Zelalem Temesgen,&nbsp;Elie F Berbari","doi":"10.5194/jbji-8-143-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-143-2023","url":null,"abstract":"<p><p><i>Cutibacterium acnes</i> isolation from spine tissue can be challenging because the organism can represent a contaminant. There is a paucity of data regarding the role of <i>C. acnes</i> in non-hardware-associated vertebral osteomyelitis (VO). Herein we evaluate the clinical and microbiological characteristics, treatment, and outcome of patients with <i>C. acnes</i> VO. Data were retrospectively collected from adults with a positive spine culture for <i>C. acnes</i> at Mayo Clinic, Rochester (MN), from 2011 to 2021. Patients with spinal hardware and polymicrobial infections were excluded. Of the subjects, 16 showed radiological and clinical findings of VO: 87.5 % were male, the average age was 58 years (<math><mrow><mo>±</mo><mn>15</mn></mrow></math> SD), and back pain was the predominant symptom. Of the lesions, 89.5 % involved the thoracic spine. Of the subjects, 69 % had experienced an antecedent event at the site of VO. In five subjects, <i>C. acnes</i> was isolated after 7 d of anaerobic culture incubation. Thirteen subjects were treated with parenteral <math><mi>β</mi></math>-lactams, and three with oral antimicrobials, without any evidence of recurrence. Twenty-one subjects were not treated for VO, as <i>C. acnes</i> was considered a contaminant; at follow-up, none had evidence of progressive disease. <i>C. acnes</i> should be part of microbiological differential diagnosis in patients with suspected VO, especially in the context of a prior spinal procedure. Anaerobic spine cultures should undergo prolonged incubation to enable recovery of <i>C. acnes</i>. <i>C. acnes</i> VO may be managed with oral or parenteral antimicrobial therapy. Without clinical and radiological evidence of VO, a single positive culture of <i>C. acnes</i> from spine tissue frequently represents contaminants.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"143-149"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9480276","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":"Systemic rifampicin shows accretion to locally implanted hydroxyapatite particles in a rat abdominal muscle pouch model.","authors":"Sujeesh Sebastian,&nbsp;Jintian Huang,&nbsp;Yang Liu,&nbsp;Mattias Collin,&nbsp;Magnus Tägil,&nbsp;Deepak Bushan Raina,&nbsp;Lars Lidgren","doi":"10.5194/jbji-8-19-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-19-2023","url":null,"abstract":"<p><p><b>Introduction</b>: biomaterials combined with antibiotics are routinely used for the management of bone infections. After eluting high concentrations of antibiotics during the first week, sub-inhibitory concentrations of antibiotics may lead to late repopulation of recalcitrant bacteria. Recent studies have shown that systemically given antibiotics like tetracycline and rifampicin (RIF) could seek and bind to locally implanted hydroxyapatite (HA). The aim of this in vivo study was to test if systemically administered rifampicin could replenish HA-based biomaterials with or without prior antibiotic loading to protect the material from late bacterial repopulation. <b>Methods</b>: in vivo accretion of systemically administered RIF to three different types of HA-based materials was tested. In group 1, nano (n)- and micro (m)-sized HA particles were used, while group 2 consisted of a calcium sulfate <math><mo>/</mo></math> hydroxyapatite (CaS <math><mo>/</mo></math> HA) biomaterial without preloaded antibiotics gentamycin (GEN) or vancomycin (VAN), and in group 3, the CaS <math><mo>/</mo></math> HA material contained GEN (CaS <math><mo>/</mo></math> HA <math><mo>+</mo></math> GEN) or VAN (CaS <math><mo>/</mo></math> HA <math><mo>+</mo></math> VAN). The above materials were implanted in an abdominal muscle pouch model in rats, and at 7 d post-surgery, the animals were assigned to a control group (i.e., no systemic antibiotic) and a test group (i.e., animals receiving one single intraperitoneal injection of RIF each day (4 mg per rat) for 3 consecutive days). Twenty-four hours after the third injection, the animals were sacrificed and the implanted pellets were retrieved and tested against <i>Staphylococcus aureus</i> ATCC 25923 in an agar diffusion assay. After overnight incubation, the zone of inhibition (ZOI) around the pellets were measured. <b>Results</b>: in the control group, <math><mrow><mn>2</mn> <mo>/</mo> <mn>6</mn></mrow> </math> CaS <math><mo>/</mo></math> HA <math><mo>+</mo></math> GEN pellets had a ZOI, while all other harvested pellets had no ZOI. No pellets from animals in test group 1 had a ZOI. In test group 2, <math><mrow><mn>10</mn> <mo>/</mo> <mn>10</mn></mrow> </math> CaS <math><mo>/</mo></math> HA pellets showed a ZOI. In test group 3, <math><mrow><mn>5</mn> <mo>/</mo> <mn>6</mn></mrow> </math> CaS <math><mo>/</mo></math> HA <math><mo>+</mo></math> GEN and <math><mrow><mn>4</mn> <mo>/</mo> <mn>6</mn></mrow> </math> CaS <math><mo>/</mo></math> HA <math><mo>+</mo></math> VAN pellets showed a ZOI. <b>Conclusions</b>: in this proof-of-concept study, we have shown that a locally implanted biphasic CaS <math><mo>/</mo></math> HA carrier after 1 week can be loaded by systemic RIF administration and exert an antibacterial effect. Further in vivo infection models are necessary to validate our findings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 1","pages":"19-28"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850244/pdf/jbji-8-19.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10659342","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":"Murine models of orthopedic infection featuring <i>Staphylococcus</i> <i>aureus</i> biofilm.","authors":"Aiken Dao,&nbsp;Alexandra K O'Donohue,&nbsp;Emily R Vasiljevski,&nbsp;Justin D Bobyn,&nbsp;David G Little,&nbsp;Aaron Schindeler","doi":"10.5194/jbji-8-81-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-81-2023","url":null,"abstract":"<p><p><b>Introduction</b>: Osteomyelitis remains a major clinical challenge. Many published rodent fracture infection models are costly compared with murine models for rapid screening and proof-of-concept studies. We aimed to develop a dependable and cost-effective murine bone infection model that mimics bacterial bone infections associated with biofilm and metal implants. <b>Methods</b>: Tibial drilled hole (TDH) and needle insertion surgery (NIS) infection models were compared in C57BL/6 mice (female, <math><mrow><mi>N</mi> <mo>=</mo> <mn>150</mn></mrow> </math> ). Metal pins were inserted selectively into the medullary canal adjacent to the defect sites on the metaphysis. Free <i>Staphylococcus aureus</i> (ATCC 12600) or biofilm suspension (ATCC 25923) was locally inoculated. Animals were monitored for physiological or radiographic evidence of infection without prophylactic antibiotics for up to 14 d. At the end point, bone swabs, soft-tissue biopsies, and metal pins were taken for cultures. X-ray and micro-CT scans were performed along with histology analysis. <b>Results</b>: TDH and NIS both achieved a 100 % infection rate in tibiae when a metal implant was present with injection of free bacteria. In the absence of an implant, inoculation with a bacterial biofilm still induced a 40 %-50 % infection rate. In contrast, freely suspended bacteria and no implant consistently showed lower or negligible infection rates. Micro-CT analysis confirmed that biofilm infection caused local bone loss even without a metal implant as a nidus. Although a metal surface permissive for biofilm formation is impermeable to create progressive bone infections in animal models, the metal implant can be dismissed if a bacterial biofilm is used. <b>Conclusion</b>: These models have a high potential utility for modeling surgery-related osteomyelitis, with NIS being simpler to perform than TDH.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"81-89"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9391986","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":"The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review.","authors":"Thomas J A van Schaik, Lex D de Jong, Maurits P A van Meer, Jon H M Goosen, Matthijs P Somford","doi":"10.5194/jbji-7-259-2022","DOIUrl":"10.5194/jbji-7-259-2022","url":null,"abstract":"<p><p><b>Background</b>: this systematic review aims to evaluate the concordance between preoperative synovial fluid culture and intraoperative tissue cultures in patients with periprosthetic joint infection (PJI) undergoing total hip (THA) or knee arthroplasty (TKA) revision surgery. <b>Methods</b>: this review was conducted in accordance with the preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) statement. Cochrane, Embase, PubMed, and Web of Science databases were searched to identify studies involving patients who had THA or TKA revision surgery for PJI and for whom preoperative synovial fluid culture and intraoperative tissue cultures were performed. Studies were only included if the diagnosis of PJI was based on the EBJIS (the European Bone and Joint Infection Society) or MSIS (Musculoskeletal Infection Society) criteria. Risk of bias was assessed using an amended version of Joanna Briggs Institute's (JBI) critical appraisal checklist for case series. <b>Results</b>: seven studies were included in this review comprising 1677 patients. All studies had a retrospective study design and five studies explored patients undergoing revision surgery of THA or TKA. Concordance rates varied between 52 % and 79 %, but different authors defined and calculated concordance differently. Six studies were judged as having an unclear to high risk of bias and one study as having a low risk of bias. <b>Conclusions</b>: the included studies showed a wide range of concordance rates between preoperative synovial fluid culture and intraoperative tissue cultures and the majority of studies had a high risk of bias. Higher-quality studies are warranted to obtain a more accurate estimate of this concordance rate. We recommend continuing the use of a system such as the EBJIS definition or MSIS criteria when diagnosing PJI.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 6","pages":"259-267"},"PeriodicalIF":1.8,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9832305/pdf/jbji-7-259.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536112","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":"Utility of disc space aspirate cell counts and differentials in the diagnosis of native vertebral osteomyelitis.","authors":"Talha Riaz,&nbsp;Matthew Howard,&nbsp;Felix Diehn,&nbsp;Aaron Joseph Tande,&nbsp;Courtney Ross,&nbsp;Paul Huddleston,&nbsp;Elie Berbari","doi":"10.5194/jbji-7-213-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-213-2022","url":null,"abstract":"<p><p><b>Background</b>: Aspiration of intervertebral disc space is often done to confirm the diagnosis of native vertebral osteomyelitis. A study has not been done examining the utility of cell counts and differentials of the aspirated fluid in diagnosing native vertebral osteomyelitis (NVO). <b>Methods</b>: In this feasibility study, we prospectively enrolled patients with a suspected diagnosis of NVO referred to the Division of Neuroradiology for image-guided needle aspiration of the intervertebral disc. In this study, manual cell count was done on the aspirated fluid, followed by a differential cytospin technique and touch prep. We obtained demographic, lab, and microbiologic data and used the receiver operating curve (ROC) for statistical analysis. <b>Results</b>: Over 12 months, we performed 17 aspirates on 14 patients. The median age was 70.5 years (range: 45-77). The median manual cell count on the aspirated fluid was 52 cells  <math><mrow><mi>µ</mi> <msup><mi>L</mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </mrow> </math> (range: 0-6656), the median neutrophil percentage on the touch prep slide was 73 % (range: 5 %-100 %), and the median neutrophil percentage on the cytospin slide was 82 % (range: 0 %-100 %). Routine bacterial cultures were positive in five cases, and the 16S ribosomal RNA gene polymerase chain reaction was positive in two cases. The optimal cutoff for a cell count of 104 total nucleated cells offered a sensitivity and specificity of 86 %, and a neutrophil cutoff of 83 % was associated with a 71 % sensitivity and specificity. <b>Conclusion</b>: An image-guided aspirated specimen leukocyte differential of <math><mrow><mo>≥</mo> <mn>83</mn></mrow> </math>  % neutrophils or a leukocyte count of <math><mrow><mo>≥</mo> <mn>104</mn></mrow> </math>   <math><mrow><mi>µ</mi> <msup><mi>L</mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </mrow> </math> was a sensitive and specific test for diagnosing patients with suspected NVO. Additionally, more extensive studies are warranted to confirm the findings.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 5","pages":"213-219"},"PeriodicalIF":0.0,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9673032/pdf/jbji-7-213.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40479891","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":"Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study.","authors":"Sarah Browning, Laurens Manning, Sarah Metcalf, David L Paterson, James O Robinson, Benjamin Clark, Joshua S Davis","doi":"10.5194/jbji-7-203-2022","DOIUrl":"10.5194/jbji-7-203-2022","url":null,"abstract":"<p><p><b>Introduction</b>: Culture-negative (CN) prosthetic joint infections (PJIs) account for approximately 10 % of all PJIs and present significant challenges for clinicians. We aimed to explore the significance of CN PJIs within a large prospective cohort study, comparing their characteristics and outcomes with culture-positive (CP) cases. <b>Methods</b>: The Prosthetic joint Infection in Australia and New Zealand Observational (PIANO) study is a prospective, multicentre observational cohort study that was conducted at 27 hospitals between 2014 and 2017. We compared baseline characteristics and outcomes of all patients with CN PJI from the PIANO cohort with those of CP cases. We report on PJI diagnostic criteria in the CN cohort and apply internationally recognized PJI diagnostic guidelines to determine optimal CN PJI detection methods. <b>Results</b>: Of the 650 patients with 24-month outcome data available, 55 (8.5 %) were CN and 595 were CP. Compared with the CP cohort, CN patients were more likely to be female (32 (58.2 %) vs. 245 (41.2 %); <math><mi>p</mi></math>   <math><mo>=</mo></math>  0.016), involve the shoulder joint (5 (9.1 %) vs. 16 (2.7 %); <math><mi>p</mi></math>   <math><mo>=</mo></math>  0.026), and have a lower mean C-reactive protein (142 mg L <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> vs. 187 mg L <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> ; <math><mi>p</mi></math>   <math><mo>=</mo></math>  0.016). Overall, outcomes were superior in CN patients, with culture negativity an independent predictor of treatment success at 24 months (adjusted odds ratio, aOR, of 3.78 and 95 %CI of 1.65-8.67). Suboptimal diagnostic sampling was common in both cohorts, with CN PJI case detection enhanced using the Infectious Diseases Society of America PJI diagnostic guidelines. <b>Conclusions</b>: Current PJI diagnostic guidelines vary substantially in their ability to detect CN PJI, with comprehensive diagnostic sampling necessary to achieve diagnostic certainty. Definitive surgical management strategies should be determined by careful assessment of infection type, rather than by culture status alone.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 5","pages":"203-211"},"PeriodicalIF":1.8,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562689/pdf/jbji-7-203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40559823","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":"Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis.","authors":"Nour Bouji, Sijin Wen, Matthew J Dietz","doi":"10.5194/jbji-7-191-2022","DOIUrl":"10.5194/jbji-7-191-2022","url":null,"abstract":"<p><p><b>Introduction</b>: Long antibiotic courses, including intravenous (IV) and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. This meta-analysis examines the non-inferiority of short courses ( <math><mo><</mo></math>  4 weeks) of IV antibiotics compared to long courses in treating PJI. Critical review of IV treatment is necessary due to the clinical, physical, and financial burden associated with it and its continued prolonged use in the US without much evidence to support the practice. <b>Methods</b>: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), databases were searched using predefined medical subject headings (MeSH). <b>Results</b>: The nine included studies reported 521 total hip arthroplasties (THAs) and 530 total knee arthroplasties (TKAs). There was no significant difference in the overall success rate in short- vs. long-duration IV antibiotics for PJI treatment: odds ratio (OR) of 1.65, 95 % confidence interval (CI) of 0.78-3.46, and <math><mrow><mi>p</mi> <mo>=</mo> <mn>0</mn></mrow> </math> .18. However, due to the moderate to high heterogeneity ( <math> <mrow><msup><mi>I</mi> <mn>2</mn></msup> <mo>=</mo> <mn>68</mn></mrow> </math>  %, <math><mi>p</mi></math>   <math><mo><</mo></math>  0.01) amongst studies, an adjusted success rate was calculated after the exclusion of two studies. This showed a statistically significant difference between both groups (OR of 2.45, 95 % CI of 1.21-4.96, <math><mi>p</mi></math>   <math><mo><</mo></math>  0.001) favoring a short course of antibiotics and reflecting a more homogenous population ( <math> <mrow><msup><mi>I</mi> <mn>2</mn></msup> <mo>=</mo> <mn>51</mn></mrow> </math>  %, <math><mrow><mi>p</mi> <mo>=</mo> <mn>0</mn></mrow> </math> .06). <b>Conclusion</b>: This study highlights the limited data available for evaluating IV antibiotic duration in the setting of PJI. We found that a shorter duration of IV antibiotics was non-inferior to a longer duration, with an improved OR of 2.45 for treatment success, likely shortening inpatient stay as well as lessening side effects and antimicrobial resistance with a lower cost to patients and overall healthcare.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 5","pages":"191-202"},"PeriodicalIF":0.0,"publicationDate":"2022-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562697/pdf/jbji-7-191.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40559822","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":"Lysins - a new armamentarium for the treatment of bone and joint infections?","authors":"Parham Sendi,&nbsp;Tristan Ferry","doi":"10.5194/jbji-7-187-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-187-2022","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 5","pages":"187-189"},"PeriodicalIF":0.0,"publicationDate":"2022-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671247","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}