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Sambri A, Maso A, Storni E, Megaloikonomos PD, Igoumenou VG, Errani C, Mavrogenis AF, Bianchi G. Sonication Improves the Diagnosis of Megaprosthetic Infections. Orthopedics 2019; 42:28-32. [PMID: 30321444 DOI: 10.3928/01477447-20181010-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023]
Abstract
Limited data are available for the diagnosis of patients with tumors with infected endoprosthetic reconstructions. The purpose of this study was to evaluate whether sonication is effective for the diagnosis of infection and to compare it with tissue cultures. The files of 58 patients who underwent revision surgery for suspected infected endoprosthetic reconstructions were reviewed. Cultures were performed on 5 tissue samples obtained from each patient and on fluid obtained by sonication of the megaprosthesis. The sensitivity, specificity, and negative and positive predictive values of tissue and sonication fluid cultures were evaluated. Overall, tissue and sonication fluid cultures confirmed an infection in 42 of the 58 patients. In 36 of the 42 infected endoprosthetic reconstructions, tissue and sonication fluid cultures identified the same bacterial isolate. In 5 cases, a bacterial isolate was identified only in sonication fluid cultures, and in 1 case, a bacterial isolate was identified only in tissue cultures. The sensitivity and negative predictive value of sonication fluid cultures were statistically significantly better than those of tissue cultures, while the specificity and positive predictive value were not different between the 2 culture types. Compared with tissue cultures for the diagnosis of infected megaprostheses in patients with tumors, sonication fluid cultures are associated with a better sensitivity and negative predictive value and a similar specificity and positive predictive value. Therefore, sonication should be considered a useful adjunct for the optimal diagnosis and management of these patients. [Orthopedics. 2019; 42(1):28-32.].
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Bozhkova SA, Kasimova AR, Tikhilov RM, Polyakova EM, Rukina AN, Shabanova VV, Liventsov VN. Adverse Trends in the Etiology of Orthopedic Infection: Results of 6-Year Monitoring of the Structure and Resistance of Leading Pathogens. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2018. [DOI: 10.21823/2311-2905-2018-24-4-20-31] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Osteomyelitis remains one of the most intractable diseases. The nature of the pathogen and its resistance to antibiotics significantly affect the outcome and cost of treatment.The aim of the study: to analyze the dynamics of the spectrum and antibiotic resistance of the leading pathogens of orthopedic infection for the period 2012– 2017.Material and methods. The structure of pathogens isolated from the focus of infection from 2774 patients with periprosthetic infection and chronic osteomyelitis was retrospectively analyzed. Antibiotic resistance of the leading pathogens that occupied more than 4% in the species structure was studied. Comparative analysis of changes in the spectrum of pathogens and antibiotic resistance was carried out for the periods 2012-2013, 2014–2015 and 2016-2017. Epidemiological analysis was performed in the program „microbiological monitoring system” Microbe-2. Statistical processing of the obtained data was carried out using the Z-criterion.Results.From 2774 patients with orthopedic infection have been isolated 4359 strains, in the structure of which about 73.5% were occupied by S. aureus, S. epidermidis, E. faecalis, E. faecium, P. aeruginosa, Acinetobacter sp. representatives of the family Enterobacteriacea. In 27% of the cases, microorganisms of other species were identified. Microbial associations were identified in 19.4% of cases. In the structure of the leading Gram(+) pathogens, a significant decrease in the incidence of S. aureus was detected, while the share of S. epidermidis increased significantly. Among the leading Gram(-) microorganisms, a significant increase in the proportion of representatives of the fam. Enterobacteriacea was found, against the background of a decrease in the share of Acinetobacter sp. and P. aeruginosa. The level of resistance of MSSA to the studied antibiotics ranged from 0.1 to 8.8%, for MSSE the spread was from 1.9 to 16.7%. Negative dynamics of growth of resistance of non-fermenting bacteria is established. The strains of Acinetobacter sp. demonstrated greater resistance to tested antibiotics in comparison with P. aeruginosa.Conclusion.An increase in the role of S. epidermidis and K. pneumoniae in the etiology of orthopedic infection was established. The revealed increase in the resistance of microbial pathogens to most tested and used antibiotics should be taken into account in the appointment of empirical antibiotic therapy. The extremely high frequency of resistance of gram-negative bacteria to cephalosporins and fluoroquinolones excludes the possibility of their empirical use, which requires the management of carbapenems in the starting treatment regimens. High resistance to fluoroquinolones limits the ability of oral antibiotic therapy in patients with periprosthetic infection.
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Affiliation(s)
- S. A. Bozhkova
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - A. R. Kasimova
- Vreden Russian Research Institute of Traumatology and Orthopedics; Vreden Russian Research Institute of Traumatology and Orthopedics
| | - R. M. Tikhilov
- Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University
| | - E. M. Polyakova
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - A. N. Rukina
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - V. V. Shabanova
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - V. N. Liventsov
- Vreden Russian Research Institute of Traumatology and Orthopedics
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Sebastian S, Malhotra R, Dhawan B. Prosthetic Joint Infection: A Major Threat to Successful Total Joint Arthroplasty. Indian J Med Microbiol 2018; 36:475-487. [DOI: 10.4103/ijmm.ijmm_19_11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Triffault-Fillit C, Valour F, Guillo R, Tod M, Goutelle S, Lustig S, Fessy MH, Chidiac C, Ferry T. Prospective Cohort Study of the Tolerability of Prosthetic Joint Infection Empirical Antimicrobial Therapy. Antimicrob Agents Chemother 2018; 62:e00163-18. [PMID: 30038037 PMCID: PMC6153819 DOI: 10.1128/aac.00163-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/05/2018] [Indexed: 12/20/2022] Open
Abstract
The empirical use of vancomycin in combination with a broad-spectrum beta-lactam is currently recommended after the initial surgery of prosthetic joint infection (PJI). However, the tolerability of such high-dose intravenous regimens is poorly known. Adult patients receiving an empirical antimicrobial therapy (EAT) for a PJI were enrolled in a prospective cohort study (2011 to 2016). EAT-related adverse events (AE) were described according to the common terminology criteria for AE (CTCAE), and their determinants were assessed by logistic regression and Kaplan-Meier curve analysis. The EAT of the 333 included patients (median age, 69.8 years; interquartile range [IQR], 59.3 to 79.1 years) mostly relies on vancomycin (n = 229, 68.8%), piperacillin-tazobactam (n = 131, 39.3%), and/or third-generation cephalosporins (n = 50, 15%). Forty-two patients (12.6%) experienced an EAT-related AE. Ten (20.4%) AE were severe (CTCAE grade ≥ 3). The use of vancomycin (odds ratio [OR], 6.9; 95% confidence interval [95%CI], 2.1 to 22.9), piperacillin-tazobactam (OR, 3.7; 95%CI, 1.8 to 7.2), or the combination of both (OR, 4.1; 95%CI, 2.1 to 8.2) were the only AE predictors. Acute kidney injury (AKI) was the most common AE (n = 25; 51.0% of AE) and was also associated with the use of the vancomycin and piperacillin-tazobactam combination (OR, 6.7; 95%CI, 2.6 to 17.3). A vancomycin plasma overexposure was noted in nine (37.5%) of the vancomycin-related AKIs only. Other vancomycin-based therapies were significantly less at risk for AE and AKI. The EAT of PJI is associated with an important rate of AE, linked with the use of the vancomycin and the piperacillin-tazobactam combination. These results corroborate recent findings suggesting a synergic toxicity of these drugs in comparison to vancomycin-cefepime, which remains to be evaluated in PJI. (This study has been registered at ClinicalTrials.gov under identifier NCT03010293.).
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Affiliation(s)
- Claire Triffault-Fillit
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Ronan Guillo
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Michel Tod
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Pharmaceutique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- ISPB, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sylvain Goutelle
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service de Pharmaceutique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- ISPB, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Lustig
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- ISPB, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Michel-Henry Fessy
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- ISPB, UMR CNRS 5558, Laboratoire de Biométrie et Biologie Évolutive, Faculté de Pharmacie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service de Chirurgie Orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Christian Chidiac
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Lyon, France
| | - Tristan Ferry
- Centre de Référence Interrégional pour la Prise en Charge des Infections Ostéo-articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- INSERM U1111, Centre International de Recherche en Infectiologie, Université Claude Bernard Lyon 1, Lyon, France
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Triffault-Fillit C, Ferry T, Laurent F, Pradat P, Dupieux C, Conrad A, Becker A, Lustig S, Fessy MH, Chidiac C, Valour F. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect 2018; 25:353-358. [PMID: 29803842 DOI: 10.1016/j.cmi.2018.04.035] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/17/2018] [Accepted: 04/30/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (<3 months), delayed (3-12 months) and late (>12 months)-as well as mechanism of acquisition. RESULTS Initial microbiologic documentation (n = 511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S. aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n = 182), Enterobacteriaceae (n = 7; 3.8%) were less represented than in the first year after implantation (n = 56; 17.2%; p <0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n = 40; 21.9%; including 32 (80.0%) C. acnes) was higher in late PJI (p <0.001). Consequently, a broad-spectrum β-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p <0.001). CONCLUSIONS Considering the minority amount of GNB in late postoperative PJI, the empirical use of a broad-spectrum β-lactam should be reconsidered, especially when a two-stage exchange is planned.
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Affiliation(s)
- C Triffault-Fillit
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France.
| | - T Ferry
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - F Laurent
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de microbiologie, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - P Pradat
- INSERM U1052, Center for Clinical Research, Croix-Rousse Hospital, Lyon, France
| | - C Dupieux
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de microbiologie, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - A Conrad
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - A Becker
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - S Lustig
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - M H Fessy
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - C Chidiac
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - F Valour
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
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Bortolin M, Romanò CL, Bidossi A, Vecchi ED, Mattina R, Drago L. BAG-S53P4 as bone graft extender and antimicrobial activity against gentamicin- and vancomycin-resistant bacteria. Future Microbiol 2018. [PMID: 29521127 DOI: 10.2217/fmb-2016-0171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate the suitability of bioactive glass (BAG)-S53P4 as a bone-graft extender for large bony defect filling in bone and joint infection. MATERIALS & METHODS Antimicrobial activity of BAG-S53P4 against clinically relevant strains isolated from bone and joint infections was evaluated by means of time-kill curves in presence of bone graft. Furthermore, the susceptibility to BAG of strains resistant to vancomycin and gentamicin was assessed. RESULTS Though attenuated, BAG maintains a good in vitro antimicrobial activity in presence of human body fluids and tissues contained in bone graft, with the exception of Enterococcus faecalis. CONCLUSION BAG-S53P4 is a suitable bone substitute that can be used as an extender with autologous bone graft to promote better fusion and healing.
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Affiliation(s)
- Monica Bortolin
- Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Carlo L Romanò
- Department of Reconstructive Surgery of Osteo-articular Infections CRIO Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Alessandro Bidossi
- Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Roberto Mattina
- Department of Biomedical, Surgical & Odontoiatric Sciences, University of Milan, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.,Laboratory of Clinical Microbiology, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Managing an Acute and Chronic Periprosthetic Infection. Case Rep Orthop 2017; 2017:6732318. [PMID: 29348954 PMCID: PMC5733624 DOI: 10.1155/2017/6732318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/27/2017] [Indexed: 11/17/2022] Open
Abstract
A case report of a 65-year-old female with a history of right total hip arthroplasty (THA) in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5) and Proteus mirabilis (2/5). Three weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. The indication and management of periprosthetic infections are discussed.
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