scholarly journals Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review

2017 ◽  
Vol 2 (3) ◽  
pp. 127-135 ◽  
Author(s):  
Joshua M. Lawrenz ◽  
Nathan W. Mesko ◽  
Carlos A. Higuera ◽  
Robert M. Molloy ◽  
Claus Simpfendorfer ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
Clinical History ◽  
Iliopsoas Muscle ◽  
Oral Antibiotic ◽  
Treatment Protocols ◽  
Prosthetic Joint ◽  
Hip Infection ◽  
Iliacus Muscle

Abstract. Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges.In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months.This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.

Fusobacterium nucleatum prosthetic hip infection: Case report and review of the literature of unusual anaerobic prosthetic joint infection

Anaerobe ◽  
2018 ◽  
Vol 54 ◽  
pp. 75-82 ◽  
Author(s):  
J.C. Rodríguez Duque ◽  
P. Galindo Rubín ◽  
B. González Humara ◽  
A.A. Quesada Sanz ◽  
M.B. Busta Vallina ◽  
...  
Keyword(s):  
Case Report ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Fusobacterium Nucleatum ◽  
Review Of The Literature ◽  
Prosthetic Joint ◽  
Hip Infection

scholarly journals 239. Sex Differences in Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Christine M Mironenko ◽  
Milan Kapadia ◽  
Laura Donlin ◽  
Mark Figgie ◽  
Alberto V Carli ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
Univariate Analysis ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Exact Test ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Student’S T

Abstract Background Male sex has been demonstrated to be a non-modifiable risk factor for prosthetic joint infection (PJI) incidence in multiple studies. Given the known anatomical, genetic, and immunological differences between sexes, we compared the clinical characteristics of PJI among men and women. Methods A retrospective cohort of total hip and knee arthroplasty PJIs from 2009 to 2019 were identified using a single institution PJI database. Included cases met the 2013 MSIS criteria. Microbiology, acuity (defined by implant age and symptom days), and surgical outcomes were collected. Success was defined as no further PJI surgery at two years. Continuous variables were tested with either Student’s t test or Mann-Whitney U test. Categorical variables were tested with either Chi-squared test or Fisher’s exact test. Results We identified 1052 PJI patients, of whom 463 (44.0%) were women. In univariate analysis of the total cohort, women were younger (68.1 ± 11.2 vs 66.1 ± 11.8 years, p=0.01), had higher BMI (30.8 ± 7.78 vs 29.8 ± 6.0, p=0.04), and had a higher culture-negative rate (14.5% vs 9.0%, p < 0.01) than men, but no difference was noted in Charlson Comorbidity Index (Table 1). Among hip PJIs, women were likelier than men to present with acute PJI (15.9% vs 8.7%, p=0.03). There were no differences in debridement, antibiotics, and implant retention (DAIR) utilization (48.2% vs 44.1%, p=0.067), and overall treatment success (72.1% vs 71.6%, p=0.9), nor in any subanalysis of acute, hip, or knee PJIs. Conclusion Although females may present differently when diagnosed with PJI, overall outcomes and outcomes with respect to acuity and type of septic revision did not clearly differ in this single-center cohort. Further research in larger cohorts, including additional biomarkers and socioeconomic variables, may further elucidate relationships between sex and PJI characteristics including culture-negativity and symptom acuity. Disclosures All Authors: No reported disclosures

scholarly journals Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection

2020 ◽  
Vol 5 (2) ◽  
pp. 82-88
Author(s):  
Alberto V. Carli ◽  
Andy O. Miller ◽  
Milan Kapadia ◽  
Yu-fen Chiu ◽  
Geoffrey H. Westrich ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Treatment Success ◽  
International Consensus ◽  
Musculoskeletal Infection ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Comorbidity Index ◽  
Two Stages

Abstract. Background: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin.Methods: A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016. All cases met Musculoskeletal Infection Society International Consensus criteria for PJI. The primary endpoint was 2 year prosthesis retention. Univariate analyses and regression statistics were calculated.Results: 341 patients with staphylococcal PJI were analyzed. 154 two-stages (77%) and 74 DAIR procedures (52%) met criteria for treatment success at 2 years. 77 patients were treated with daptomycin, of which 34 two-stages (68%) and 15 DAIRs (56%) achieved treatment success. Pairwise and regression analysis found no association between treatment success and daptomycin use. Organism (DAIR only) and Charlson Comorbidity Index scores (DAIR and two-stage) were significantly associated with treatment outcome. Six daptomycin patients (7.8%) had adverse side effects.Discussion: Daptomycin fared no better or worse than comparable antibiotics in a retrospective cohort of staphylococcal hip and knee PJI patients, regardless of surgical strategy.Conclusion: The convenient dosing, safety, and potency of daptomycin make it an attractive antibiotic for staphylococcal PJI. However, these advantages must be weighed against higher costs and rare, but serious side effects.

scholarly journals Clinical Outcome of Antibiotic Suppressive Therapy in Patients with a Prosthetic Joint Infection after Hip Replacement

2019 ◽  
Vol 4 (6) ◽  
pp. 268-276 ◽  
Author(s):  
Borg Leijtens ◽  
Laura Weerwag ◽  
Berend Willem Schreurs ◽  
Bart-Jan Kullberg ◽  
Wim Rijnen
Keyword(s):  
Clinical Outcome ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Suppressive Therapy ◽  
Oral Antibiotic ◽  
Oral Antibiotic Therapy ◽  
Prosthetic Joint ◽  
Increased Risk

Abstract. Introduction: In Specific cases, curative treatment of a prosthetic joint infection (PJI) cannot be accomplished due to the increased risk of major complications after prosthetic joint revision surgery. In these patients, antibiotic suppressive therapy (AST) is often used to control the infection.Aim: To describe the clinical outcome of patients with a PJI after hip replacement treated with AST.Methods: Patients in which AST for PJI was started between 2006 and 2013, were retrospectively included. Follow-up was continued until October 2018. AST has been defined as treatment with oral antibiotic therapy intended to suppress PJI. Treatment was considered successful in patients without reoperation for PJI or death related to PJI during follow-up.Results: Twenty-three patients were included. The most commonly used antibiotics were doxycycline (n=14) and cotrimoxazole (n=6). The mean duration of AST was 38 months (1-151 months). AST was considered successful in 13 patients (56.5%) after a median follow-up of 33 months. AST was least successful in PJI caused by S. aureus with 80% failures versus 33% in PJI caused by other microorganisms and in patients who had an antibiotic-free period before the start of AST with 83% failures. Two patients ended AST due to side effects.Conclusion: AST can be an alternative treatment in selected patients with a PJI after hip replacement. However, there is a persisting and considerable amount of failures, particularly in PJI caused by S. aureus and in patient with an antibiotic-free period before the start of AST.

scholarly journals Successful Treatment of Staphylococcus aureus Prosthetic Joint Infection with Bacteriophage Therapy

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1182
Author(s):  
Claudia Ramirez-Sanchez ◽  
Francis Gonzales ◽  
Maureen Buckley ◽  
Biswajit Biswas ◽  
Matthew Henry ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Multidrug Resistant ◽  
Successful Outcome ◽  
Prolonged Treatment ◽  
Lytic Phage ◽  
Bacteriophage Therapy ◽  
Prosthetic Joint ◽  
Knee Joint Infection

Successful joint replacement is a life-enhancing procedure with significant growth in the past decade. Prosthetic joint infection occurs rarely; it is a biofilm-based infection that is poorly responsive to antibiotic alone. Recent interest in bacteriophage therapy has made it possible to treat some biofilm-based infections, as well as those caused by multidrug-resistant pathogens, successfully when conventional antibiotic therapy has failed. Here, we describe the case of a 61-year-old woman who was successfully treated after a second cycle of bacteriophage therapy administered at the time of a two-stage exchange procedure for a persistent methicillin-sensitive Staphylococcus aureus (MSSA) prosthetic knee-joint infection. We highlight the safety and efficacy of both intravenous and intra-articular infusions of bacteriophage therapy, a successful outcome with a single lytic phage, and the development of serum neutralization with prolonged treatment.

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