Journal of Bone and Joint Infection最新文献

{"title":"First evaluation of a commercial multiplex PCR panel for rapid detection of pathogens associated with acute joint infections.","authors":"Jorrit Willem Adriaan Schoenmakers,&nbsp;Rosanne de Boer,&nbsp;Lilli Gard,&nbsp;Greetje Anna Kampinga,&nbsp;Marleen van Oosten,&nbsp;Jan Maarten van Dijl,&nbsp;Paulus Christiaan Jutte,&nbsp;Marjan Wouthuyzen-Bakker","doi":"10.5194/jbji-8-45-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-45-2023","url":null,"abstract":"<p><p><b>Background</b>: prompt recognition and identification of the causative microorganism in acute septic arthritis of native and prosthetic joints is vital to increase the chances of successful treatment. The aim of this study was to independently assess the diagnostic accuracy of the multiplex BIOFIRE^® Joint Infection (JI) Panel (investigational use only) in synovial fluid for rapid diagnosis. <b>Methods</b>: synovial fluid samples were collected at the University Medical Center Groningen from patients who had a clinical suspicion of a native septic arthritis, early acute (post-operative, within 3 months after arthroplasty) periprosthetic joint infection (PJI) or late acute (hematogenous, <math><mrow><mo>≥</mo> <mn>3</mn></mrow> </math> months after arthroplasty) PJI. JI Panel results were compared to infection according to Musculoskeletal Infection Society criteria and culture-based methods as reference standard. <b>Results</b>: a total of 45 samples were analysed. The BIOFIRE JI Panel showed a high specificity (100 %, 95 % confidence interval (CI): 78-100) in all patient categories. Sensitivity was 83 % (95 % CI: 44-97) for patients with a clinical suspicion of native septic arthritis ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>12</mn></mrow> </math> ), 73 % (95 % CI: 48-89) for patients with a clinical suspicion of a late acute PJI ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>14</mn></mrow> </math> ), and 30 % (95 % CI: 11-60) for patients with a clinical suspicion of an early acute PJI ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>19</mn></mrow> </math> ). <b>Conclusion</b>: the results of this study indicate a clear clinical benefit of the BIOFIRE JI Panel in patients with a suspected native septic arthritis and late acute (hematogenous) PJI, but a low clinical benefit in patients with an early acute (post-operative) PJI due to the absence of certain relevant microorganisms, such as <i>Staphylococcus epidermidis</i>, from the panel.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 1","pages":"45-50"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10681667","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":"Guideline for management of septic arthritis in native joints (SANJO).","authors":"Christen Ravn,&nbsp;Jeroen Neyt,&nbsp;Natividad Benito,&nbsp;Miguel Araújo Abreu,&nbsp;Yvonne Achermann,&nbsp;Svetlana Bozhkova,&nbsp;Liselotte Coorevits,&nbsp;Matteo Carlo Ferrari,&nbsp;Karianne Wiger Gammelsrud,&nbsp;Ulf-Joachim Gerlach,&nbsp;Efthymia Giannitsioti,&nbsp;Martin Gottliebsen,&nbsp;Nis Pedersen Jørgensen,&nbsp;Tomislav Madjarevic,&nbsp;Leonard Marais,&nbsp;Aditya Menon,&nbsp;Dirk Jan Moojen,&nbsp;Markus Pääkkönen,&nbsp;Marko Pokorn,&nbsp;Daniel Pérez-Prieto,&nbsp;Nora Renz,&nbsp;Jesús Saavedra-Lozano,&nbsp;Marta Sabater-Martos,&nbsp;Parham Sendi,&nbsp;Staffan Tevell,&nbsp;Charles Vogely,&nbsp;Alex Soriano,&nbsp;The Sanjo Guideline Group","doi":"10.5194/jbji-8-29-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-29-2023","url":null,"abstract":"<p><p>This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 1","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689689","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":"Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition.","authors":"Sara Elisa Diniz,&nbsp;Ana Ribau,&nbsp;André Vinha,&nbsp;José Carlos Oliveira,&nbsp;Miguel Araújo Abreu,&nbsp;Ricardo Sousa","doi":"10.5194/jbji-8-109-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-109-2023","url":null,"abstract":"<p><p><b>Introduction</b>: diagnosis of periprosthetic joint infection (PJI) is challenging, as no single test has absolute accuracy. The purpose of this study was to assess the utility of different simple synovial biomarkers in the diagnosis of PJI as defined by the European Bone and Joint Infection Society (EBJIS). <b>Methods</b>: we retrospectively identified all patients undergoing revision hip or knee arthroplasty from 2013 to 2019 on our prospectively maintained database. Only patients with minimum required infection diagnostic workup were included in the study. Patients with comorbidities that may influence the accuracy of synovial biomarkers were excluded. Receiver operator characteristic (ROC) curves were utilised to assess the diagnostic utility of synovial fluid white blood cell (WBC) count, polymorphonuclear leukocyte percentage (PMN %), C-reactive protein (CRP), adenosine deaminase (ADA), and alpha-2-microglobulin (A2M). <b>Results</b>: in total, 102 patients met the inclusion criteria. Of these, 58 were classified as infection unlikely, 8 as infection likely, and 36 as infection confirmed. Synovial WBC count (area under the curve (AUC) 0.94) demonstrated the best utility for the diagnosis of PJI, followed by PMN % (AUC 0.91), synovial CRP (AUC 0.90), ADA (AUC 0.82), and A2M (AUC 0.76). We found added value in the combined interpretation of different biomarkers. We calculated high sensitivity and negative predictive value if at least two of them are negative and high specificity and positive predictive value if at least two are elevated. <b>Conclusion</b>: current results show that synovial fluid investigation is a useful tool for the diagnosis of PJI, and the combined interpretation of simple and inexpensive biomarkers demonstrated improved diagnostic accuracy.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"109-118"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10077577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9626429","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":"Outcomes in patients with clinically suspected pedal osteomyelitis based on bone marrow signal pattern on MRI.","authors":"Christin A Tiegs-Heiden,&nbsp;Tanner C Anderson,&nbsp;Mark S Collins,&nbsp;Matthew P Johnson,&nbsp;Douglas R Osmon,&nbsp;Doris E Wenger","doi":"10.5194/jbji-8-99-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-99-2023","url":null,"abstract":"<p><p><b>Objective</b>: confluent T1 hypointense marrow signal is widely accepted to represent osteomyelitis on MRI. Some authors have suggested that non-confluent bone marrow signal abnormality should be considered early osteomyelitis. The purpose of this study was to address this issue by comparing the rate of osteomyelitis and amputation based on T1 marrow signal characteristics. <b>Materials and methods</b>: a total of 112 patients who underwent MRI of the foot for the evaluation of possible osteomyelitis were included. Patients were assigned to confluent T1 hypointense, reticulated T1 hypointense, and normal bone marrow signal groups. <b>Results</b>: patients with confluent T1 hypointense signal on MRI had significantly higher rates of osteomyelitis and amputation at 2 and 14 months post-MRI than the reticulated T1 hypointense group ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). Six patients had normal T1 signal, 16.7 % of whom had osteomyelitis and underwent amputation by 2 months post-MRI. Of 61 patients with reticulated T1 hypointense signal, 19.7 % had a diagnosis of osteomyelitis at 2 months post-MRI and 30.8 % had a diagnosis of osteomyelitis at 14 months post-MRI; moreover, 14.8 % and 31.5 % underwent amputation by 2 and 14 months post-MRI, respectively. Of 45 patients with confluent T1 hypointense signal, 73.3 % of patients had osteomyelitis at 2 months post-MRI and 82.5 % had osteomyelitis at 14 months post-MRI. In this group, 66.7 % underwent amputation by 2 months post-MRI and 77.8 % underwent amputation by 14 months post-MRI. <b>Conclusions</b>: over half of the patients with suspected pedal osteomyelitis who had reticulated or normal T1 bone marrow signal on MRI healed with conservative measures. Therefore, we recommend terminology such as \"osteitis\", \"reactive osteitis\", or \"nonspecific reactive change\" to describe bone marrow edema-like signal and reticulated hazy T1 hypointense signal without associated confluent T1 hypointensity. Moreover, we recommend that the MRI diagnosis of osteomyelitis is reserved for confluent T1 hypointense bone signal in the area of concern.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"99-107"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10134750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9398085","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":"Pyogenic spinal infections warrant a total spine MRI.","authors":"Cristian Balcescu,&nbsp;Khalid Odeh,&nbsp;Alexander Rosinski,&nbsp;Brandon Nudelman,&nbsp;Adam Schlauch,&nbsp;Ishan Shah,&nbsp;Victor Ungurean,&nbsp;Priya Prasad,&nbsp;Jeremi Leasure,&nbsp;Flora Stepansky,&nbsp;Amit Piple,&nbsp;Dimitriy Kondrashov","doi":"10.5194/jbji-8-1-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-1-2023","url":null,"abstract":"<p><p><b>Study design</b>: retrospective case series. <b>Objective</b>: the presenting clinical symptoms of spinal infections are often nonspecific and a delay in diagnosis can lead to adverse patient outcomes. The morbidity and mortality of patients with multifocal spinal infections is significantly higher compared to unifocal infections. The purpose of the current study was to analyse the risk factors for multifocal spinal infections. <b>Methods</b>: we conducted a retrospective review of all pyogenic non-tuberculous spinal infections treated surgically at a single tertiary care medical center from 2006-2020. The medical records, imaging studies, and laboratory data of 43 patients during this time period were reviewed and analysed after receiving Institutional Review Board approval. Univariate and multivariate analyses were performed to identify factors associated with a multifocal spinal infection. <b>Results</b>: 15 patients (35 %) had multifocal infections. In univariate analysis, there was a significant association with chronic kidney disease ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.040</mn></mrow> </math> ), gender ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.003</mn></mrow> </math> ), a white blood cell count ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.011</mn></mrow> </math> ), and cervical ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ) or thoracic ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0</mn></mrow> </math> .001) involvement. In multivariate analysis, both cervical and thoracic involvement remained statistically significant ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.001</mn></mrow> </math> and <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> , respectively). <b>Conclusions</b>: patients with infections in the thoracic or cervical region are more likely to have a multifocal infection. Multifocal pyogenic spinal infections remain a common entity and a total spine MRI should be performed to aid in prompt diagnosis.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850241/pdf/jbji-8-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9134269","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":"Evaluating the utility of inflammatory markers in the diagnosis of soft tissue abscesses of the forearm and hand.","authors":"Sarah R Blumenthal,&nbsp;Adnan N Cheema,&nbsp;Steven E Zhang,&nbsp;Benjamin L Gray,&nbsp;Nikolas H Kazmers","doi":"10.5194/jbji-8-119-2023","DOIUrl":"https://doi.org/10.5194/jbji-8-119-2023","url":null,"abstract":"<p><p>Upper extremity abscesses frequently present to the acute care setting with inconclusive physical examination and imaging findings. We sought to investigate the diagnostic accuracy of inflammatory markers including white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). A retrospective cohort study was performed to identify subjects <math><mrow><mo>≥</mo> <mn>18</mn></mrow> </math>  years treated with surgical debridement of upper extremity abscesses at our institution between January 2012 and December 2015. In this study, 188 patients were screened, and 72 met the inclusion criteria. A confirmed abscess as defined by culture positivity was present in 67 (93.1 %) cases. The sensitivity of WBC, ESR, or CRP individually was 0.45, 0.71, and 0.81. The specificity of WBC, ESR, or CRP individually was 0.80, 0.80, and 0.40. In combination all three markers when positive had a sensitivity of 0.26 and specificity of 1.0. These values were similar among patients with diabetes and those with obesity. With the highest sensitivity and lowest specificity, CRP exhibited the most utility as a screening test (level IV).</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"8 2","pages":"119-123"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10077572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9626427","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":"Sex-specific analysis of clinical features and outcomes in staphylococcal periprosthetic joint infections managed with two-stage exchange arthroplasty.","authors":"Eibhlin Higgins,&nbsp;Don Bambino Geno Tai,&nbsp;Brian Lahr,&nbsp;Gina A Suh,&nbsp;Elie F Berbari,&nbsp;Kevin I Perry,&nbsp;Matthew P Abdel,&nbsp;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}