Journal of Bone and Joint Infection最新文献

{"title":"Short and oral antimicrobial therapy for diabetic foot infection: a narrative review of current knowledge.","authors":"Steven M Maurer,&nbsp;Zehra S Hepp,&nbsp;Shawna McCallin,&nbsp;Felix W A Waibel,&nbsp;Federico C Romero,&nbsp;Yılmaz Zorman,&nbsp;Benjamin A Lipsky,&nbsp;İlker Uçkay","doi":"10.5194/jbji-7-61-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-61-2022","url":null,"abstract":"<p><p>Diabetic foot infection is a frequent complication in long-standing diabetes mellitus. For antimicrobial therapy of this infection, both the optimal duration and the route of administration are often based more on expert opinion than on published evidence. We reviewed the scientific literature, specifically seeking prospective trials, and aimed at addressing two clinical issues: (1) shortening the currently recommended antibiotic duration and (2) using oral (rather than parenteral) therapy, especially after the patient has undergone debridement and revascularization. We also reviewed some older key articles that are critical to our understanding of the treatment of these infections, particularly with respect to diabetic foot osteomyelitis. Our conclusion is that the maximum duration of antibiotic therapy for osteomyelitis should be no more than to 4-6 weeks and might even be shorter in selected cases. In the future, in addition to conducting randomized trials and propagating national and international guidance, we should also explore innovative strategies, such as intraosseous antibiotic agents and bacteriophages.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 2","pages":"61-70"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8990364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10325284","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":"Usefulness of serum D-dimer and platelet count to mean platelet volume ratio to rule out chronic periprosthetic joint infection.","authors":"Ernesto Muñoz-Mahamud,&nbsp;Eduard Tornero,&nbsp;José A Estrada,&nbsp;Jenaro A Fernández-Valencia,&nbsp;Juan C Martínez-Pastor,&nbsp;Álex Soriano","doi":"10.5194/jbji-7-109-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-109-2022","url":null,"abstract":"<p><p><b>Background</b>: Diagnosing periprosthetic joint infection (PJI) is challenging and usually requires the evaluation of several biomarkers. Our main aim was to evaluate the usefulness of D-dimer levels as well as the platelet count (PC) to mean platelet volume (MPV) ratio serum as biomarkers to rule out chronic knee and hip infection. <b>Methods</b>: The study enrolled a prospective cohort of 93 patients undergoing hip or knee revision. D-dimer values, PC to MPV ratio, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were preoperatively determined and evaluated as a predictor of PJI. The definitive diagnosis of PJI was established according to the 2018 International Consensus Meeting criteria. <b>Results</b>: A total of 24 (25.8 %) cases were postoperatively diagnosed with PJI. The median D-dimer value was significantly higher ( <math><mi>p</mi></math>   <math><mo><</mo></math>  0.001) for patients with PJI (1950 ng mL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> ) than for patients with aseptic failure (700 ng mL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> ). The area under the receiver operating characteristic curves for D-dimer, CRP and ESR was 0.820, 0.793 and 0.791 respectively. D-dimer  <math><mo>≥</mo></math>  950 ng mL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> (91 % sensitivity, 64 % specificity), CRP  <math><mo>≥</mo></math>  1.95 mg dL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> (61 % sensitivity, 90 % specificity) and ESR  <math><mo>></mo></math>  20 (74 % sensitivity, 82 % specificity) were identified as the values with the best balance between sensitivity and specificity. The mean PC to MPV ratio was 37.0 for PJI patients and 29.8 for patients in the aseptic revision cohort ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0</mn></mrow> </math> .067). <b>Conclusions</b>: Serum D-dimer levels appear very unlikely to remain normal in the presence of chronic PJI. The 91 % sensitivity when considering 950 ng mL <math><msup><mi></mi> <mrow><mo>-</mo> <mn>1</mn></mrow> </msup> </math> as the threshold highlights D-dimer as the most accurate initial test to rule out chronic PJI. Conversely, the PC to MPV ratio may be of limited value for accurately diagnosing PJI.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 3","pages":"109-115"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10243870","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 unrelenting tide of osteoarticular infections in children: reflections from Uganda, eastern Africa.","authors":"Antonio Loro","doi":"10.5194/jbji-7-183-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-183-2022","url":null,"abstract":"<p><p>Forty years ago I made a radical professional choice: to dedicate a few years of practice to the African continent. Not surprisingly, a few years became many. This paper is dedicated to the children who are battling osteoarticular infections and to those who will be struggling with them in future.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 4","pages":"183-185"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9901513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10742570","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":"Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study.","authors":"Efthymia Giannitsioti,&nbsp;Mauro José Salles,&nbsp;Andreas Mavrogenis,&nbsp;Dolors Rodriguez-Pardo,&nbsp;Ibai Los-Arcos,&nbsp;Alba Ribera,&nbsp;Javier Ariza,&nbsp;María Dolores Del Toro,&nbsp;Sophie Nguyen,&nbsp;Eric Senneville,&nbsp;Eric Bonnet,&nbsp;Monica Chan,&nbsp;Maria Bruna Pasticci,&nbsp;Sabine Petersdorf,&nbsp;Natividad Benito,&nbsp;Nuala O' Connell,&nbsp;Antonio Blanco García,&nbsp;Gábor Skaliczki,&nbsp;Pierre Tattevin,&nbsp;Zeliha Kocak Tufan,&nbsp;Nikolaos Pantazis,&nbsp;Panayiotis D Megaloikonomos,&nbsp;Panayiotis Papagelopoulos,&nbsp;Alejandro Soriano,&nbsp;Antonios Papadopoulos,&nbsp;The Esgiai Collaborators Study Group","doi":"10.5194/jbji-7-279-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-279-2022","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Purpose&lt;/b&gt;: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. &lt;b&gt;Methods&lt;/b&gt;: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. &lt;b&gt;Results&lt;/b&gt;: Patients ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;57&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included &lt;i&gt;Escherichia coli&lt;/i&gt; ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;16&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ), &lt;i&gt;Pseudomonas aeruginosa&lt;/i&gt; ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;14&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ; XDR 50 %), &lt;i&gt;Klebsiella&lt;/i&gt; spp. ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;7&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ), &lt;i&gt;Enterobacter&lt;/i&gt; spp. ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;9&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ), &lt;i&gt;Acinetobacter&lt;/i&gt; spp. ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;5&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ), &lt;i&gt;Proteus mirabilis&lt;/i&gt; ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;3&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ), &lt;i&gt;Serratia marcescens&lt;/i&gt; ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;2&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ) and &lt;i&gt;Stenotrophomonas maltophilia&lt;/i&gt; ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;1&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ). The prevalence of ESBL (extended-spectrum &lt;math&gt;&lt;mi&gt;β&lt;/mi&gt;&lt;/math&gt; -lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;37&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ; 64.9 %) were treated with a combination including carbapenems ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;32&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ) and colistin ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;n&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;11&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) ( &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;p&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;0.008&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age &lt;math&gt;&lt;mrow&gt;&lt;mo&gt;&gt;&lt;/mo&gt; &lt;mn&gt;60&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt;  years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540-9.752; &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;p&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;0.004&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144-6.963; &lt;math&gt;&lt;mrow&gt;&lt;mi&gt;p&lt;/mi&gt; &lt;mo&gt;=&lt;/mo&gt; &lt;mn&gt;0.024&lt;/mn&gt;&lt;/mrow&gt; &lt;/math&gt; ). &lt;b&gt;Conclusions&lt;/b&gt;: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hamper","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 6","pages":"279-288"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9832304/pdf/jbji-7-279.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536117","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 scientific publication score - a new tool for summarizing evidence and data quality criteria of biomedical publications.","authors":"Dieter Bettin,&nbsp;Thomas Maurer,&nbsp;Ferdinand Schlatt,&nbsp;Simon Bettin","doi":"10.5194/jbji-7-269-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-269-2022","url":null,"abstract":"<p><p>The number of biomedical research articles increases by over 2.5 million publications each year, making it difficult to stay up to date. In this study, we introduce a standardized search and evaluation tool to combat this issue. Employing crowdsourcing, a large database of publications is gathered. Using a standardized data entry format, coined the \"scientific publication score\" (SPS), specific publication results can be easily aggregated, thereby allowing fast and accurate comparisons for clinical questions. The SPS combines two quality dimensions. The first captures the quality of evidence of the study using the evidence criteria defined by the Centre for Evidence-Based Medicine, Oxford, UK. The second is more fine-grained and considers the magnitude of statistical analyses on individual and specific results. From 2014 to 2019, experts of the European Bone and Joint Infection Society (EBJIS) were asked to enter data of relevant publications about prosthetic joint infection. Data and evidence levels of specific results were averaged, summarized and ranked. A total of 366 publications were divided into two groups: (I) risk factors (e.g., host-related factors, pre- and postoperative issues) with 243 publications and (II) diagnostic methods (e.g., laboratory tests, imaging methods) with 123 publications. After ranking, the highest score for risk factors of prosthetic joint infection were calculated by the SPS for anemia (mean <math><mrow><mn>3.50</mn> <mo>±</mo></mrow> </math>  SD 0.91), malignancy (mean <math><mrow><mn>3.17</mn> <mo>±</mo></mrow> </math>  SD 0.29) and previous alloarthroplasty (mean <math><mrow><mn>3.00</mn> <mo>±</mo></mrow> </math>  SD 0.35). A comparison of the full SPS ranking with the ranking determined at the 2018 International Consensus Meeting (ICM) on Musculoskeletal Infection resulted in a Spearman rank correlation coefficient of 0.48 and a <math><mi>p</mi></math>  value of 0.0382. The diagnostic methods ranked highest by the SPS were aspirate leucocyte count (mean <math><mrow><mn>3.15</mn> <mo>±</mo></mrow> </math>  SD 1.21), interleukin 6 (mean <math><mrow><mn>3.14</mn> <mo>±</mo></mrow> </math>  SD 1.07) and aspirate (neutrophils over 80 %) (mean <math><mrow><mn>3.12</mn> <mo>±</mo></mrow> </math>  SD 0.63). The comparison to the ICM ranking yielded a Spearman rank correlation coefficient of 0.91 and a <math><mi>p</mi></math>  value of 0.0015. Our pilot study evaluated a new tool for the quality assessment of specific results based on the quality of the source publication. The SPS is suitable for a ranking of specific results by evidence and data quality criteria important for systematic reviews.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 6","pages":"269-278"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9832303/pdf/jbji-7-269.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540957","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":"Early switch to oral antibiotic therapy for the treatment of patients with bacterial native vertebral osteomyelitis: a quaternary center experience, systematic review, and meta-analysis.","authors":"Matteo Passerini,&nbsp;Julian Maamari,&nbsp;Tarek Nayfeh,&nbsp;Leslie C Hassett,&nbsp;Aaron J Tande,&nbsp;Mohammad H Murad,&nbsp;Zelalem Temesgen,&nbsp;Elie F Berbari","doi":"10.5194/jbji-7-249-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-249-2022","url":null,"abstract":"<p><p>Recent data suggest that oral therapy can be effective for bone infections. We aim to assess the efficacy of an early switch to oral therapy ( <math><mrow><mo><</mo> <mn>2</mn></mrow> </math>  weeks) compared to a non-early switch in bacterial native vertebral osteomyelitis. We conducted a cohort study at Mayo Clinic, Rochester (MN), between 2019-2021 combined with a systematic review, which queried multiple databases. Data were analyzed using a random-effects model. The cohort study included 139 patients: two received an early switch. Of 3708 citations, 13 studies were included in the final analysis. Meta-analysis demonstrated no difference in treatment failure (odds ratio  <math><mo>=</mo></math>  1.073, 95 % confidence interval 0.370-3.116), but many studies presented high risk of bias. Current evidence is insufficient to conclude the proportion of patients with failure or relapse is different in the two groups. High-quality studies are warranted before early switch can be routinely recommended.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 6","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752704/pdf/jbji-7-249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766456","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 effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis - comparative analysis of custom-made versus commercially available nails.","authors":"Germán Garabano,&nbsp;Hernán Del Sel,&nbsp;Joaquin Anibal Rodriguez,&nbsp;Leonel Perez Alamino,&nbsp;Cesar Angel Pesciallo","doi":"10.5194/jbji-6-457-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-457-2021","url":null,"abstract":"<p><p><b>Background</b>: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. <b>Methods</b>: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement-nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. <b>Results</b>: Thirty patients were included. The affected bones were the femur ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>15</mn></mrow> </math> ) and the tibia ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>15</mn></mrow> </math> ). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement-bone debonding. Commercial nails were associated with shorter operating times ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0001</mn></mrow> </math> ). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. <b>Conclusions</b>: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement-bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"457-466"},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39818618","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":"Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis.","authors":"Jonathan Bourget-Murray,&nbsp;Rohit Bansal,&nbsp;Alexandra Soroceanu,&nbsp;Sophie Piroozfar,&nbsp;Pam Railton,&nbsp;Kelly Johnston,&nbsp;Andrew Johnson,&nbsp;James Powell","doi":"10.5194/jbji-6-443-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-443-2021","url":null,"abstract":"<p><p>The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset ( <math><mrow><mo>≤</mo> <mn>90</mn></mrow> </math>  d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann-Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.026</mn></mrow> </math> ). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI  <math><mo>></mo></math>  30 kg m <math><msup><mi></mi> <mrow><mo>-</mo> <mn>2</mn></mrow> </msup> </math> (odds ratio (OR) 3.42 [95 % CI 1.75-7.20]; <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ), chronic renal disease (OR, 3.52 [95 % CI 1.17-8.59]; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.011</mn></mrow> </math> ), and cardiac illness (OR, 2.47 [1.30-4.69]; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.005</mn></mrow> </math> ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.167</mn></mrow> </math> ) but was associated with an increased chance of 90 d readmission ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"443-450"},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39828003","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":"Immunological evaluation of patients with orthopedic infections: taking the Cierny-Mader classification to the next level.","authors":"Janet D Conway,&nbsp;Vache Hambardzumyan,&nbsp;Nirav G Patel,&nbsp;Shawn D Giacobbe,&nbsp;Martin G Gesheff","doi":"10.5194/jbji-6-433-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-433-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Cierny-Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the \"true\" host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. <b>Methods</b>: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny-Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. <b>Results</b>: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.002</mn></mrow> </math> ). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.03</mn></mrow> </math> ). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.0005</mn></mrow> </math> ). <b>Conclusions</b>: Adding immunologic evaluation to the Cierny-Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"433-441"},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39815915","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":"Methylene blue for the diagnosis of a sinus tract in periprosthetic knee joint infection.","authors":"Simon Martin Heinrich,&nbsp;Parham Sendi,&nbsp;Martin Clauss","doi":"10.5194/jbji-6-423-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-423-2021","url":null,"abstract":"<jats:p>\u0000 </jats:p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"423-424"},"PeriodicalIF":0.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644568","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}