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Wang B, Wang Q, Li M, Yu J, Jiang F, Hu Y, Guo G, Chen X, Tang J, Han P, Shen H. Diagnostic Role of Metagenomic Next-Generation Sequencing in Tubercular Orthopedic Implant-Associated Infection. Infect Drug Resist 2024; 17:1951-1960. [PMID: 38774035 PMCID: PMC11107837 DOI: 10.2147/idr.s441940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/08/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The diagnosis of tubercular orthopedic implant-associated infection (TB-IAI) is challenging. This study evaluated the value of metagenomic next-generation sequencing (mNGS) for the diagnosis of TB-IAI and developed a standardized diagnostic procedure for TB-IAI. Methods The records of all patients with TB-IAI diagnosed and treated at our institution between December 2018 and September 2022 were retrospectively reviewed. Patient demographic characteristics, medical history, laboratory test, microbial culture, histopathology, and mNGS results, and time to diagnosis were recorded. The diagnostic efficiency of mNGS for TB-IAI was assessed by comparing the results and diagnostic time with that of other diagnostic modalities. Results Ten patients were included in the analysis, including eight with prosthetic joint infections and two with fracture-related infections. The mNGS positivity rate was 100% (10/10), which was higher than that of TB-antibody (11%, 1/9), real-time quantitative polymerase chain reaction (22%, 2/9), T-SPOT.TB (25%, 2/8), purified protein derivative (50%, 4/8), microbial culture (50%, 5/10), and histopathology (20%, 2/10). mNGS shortened the time to diagnosis of TB-IAI. A standardized diagnostic procedure for TB-IAI was developed based on the findings. Conclusion mNGS is useful for the diagnosis of TB-IAI. mNGS is recommended in cases where it is difficult to identify a pathogen using routine diagnostic tests. The standardized diagnostic procedure might improve TB-IAI diagnosis. Importance TB-IAI is a rare infection, which occurs after orthopedic surgery and hard to diagnose microbiologically. mNGS is a new detection technique not yet discussed in current literature as a means for TB-IAI diagnostics. Here we describe a cohort of patients with TB-IAI diagnosed by mNGS show high efficiency of mNGS for detection of this pathology and present a clinical algorithm supplementing conventional methods for TB-IAI assessment.
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Affiliation(s)
- Boyong Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Qiaojie Wang
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Mingzhang Li
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Jinlong Yu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Feng Jiang
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Yujie Hu
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Geyong Guo
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Xiaohua Chen
- Department of Infectious Diseases, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Jin Tang
- Clinical Laboratory, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Pei Han
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
| | - Hao Shen
- Department of Orthopedics, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People’s Republic of China
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Zhang X, Huang F. Letter to the Editor: Delayed-Onset Mycobacterium tuberculosis Infection After Total Knee Arthroplasty. Surg Infect (Larchmt) 2024. [PMID: 38683634 DOI: 10.1089/sur.2024.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Affiliation(s)
- Xin Zhang
- Department of Infectious Diseases, Department of Tuberculosis, Department of Infection and Immunization Laboratories, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Fuli Huang
- Department of Infectious Diseases, Department of Tuberculosis, Department of Infection and Immunization Laboratories, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
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3
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Auñon A, Salar-Vidal L, Mahillo-Fernandez I, Almeida F, Pereira P, Lora-Tamayo J, Ferry T, Souèges S, Dinh A, Escudero R, Menéndez Fernández-Miranda C, Rico A, Rossi N, Esteban J. Prosthetic Joint Infections Caused by Mycobacterium tuberculosis Complex-An ESGIAI-ESGMYC Multicenter, Retrospective Study and Literature Review. Microorganisms 2024; 12:849. [PMID: 38792679 PMCID: PMC11123809 DOI: 10.3390/microorganisms12050849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/08/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
PURPOSE While tuberculosis remains a significant global health concern, prosthetic joint infections (PJIs) caused by members of the Mycobacterium tuberculosis complex are exceptionally rare. Our objective is to perform a retrospective search of new cases of this disease and analyze all cases available in the literature of tuberculous PJIs, aiming to detect factors that may influence patient outcomes. METHODS The ESGIAI and ESGMYC study groups were used to collect information on non-published cases of tuberculous prosthetic joint infections (PJIs). Additionally, a literature review of all published cases of tuberculous PJIs was conducted. All identified cases in the retrospective study and in the literature review were merged and included in the statistical analysis, involving both univariate and multivariate analyses. RESULTS Fifteen previously unreported cases of tuberculous prosthetic joint infections (PJIs) from four countries were detailed. Among them, ten patients were female, with a median age of 76 years. The hip was affected in 13 cases. Seven patients experienced co-infection with another microorganism. Treatment approaches varied, with 13 patients undergoing implant removal, one treated with DAIR (debridement, antibiotics, and implant retention), and one case was treated with an unknown treatment method. All patients received antibiotic therapy and achieved a cure. The literature review that was conducted detected 155 published cases. Univariate analysis revealed a statistical significance for previous tuberculosis, joint, and no importance of surgery for cure. CONCLUSIONS Tuberculous prosthetic joint infection (PJI) is a rare condition, typically presenting as a localized chronic infection. Antibiotic treatment is essential for the management of these patients, but neither surgical treatment nor duration of treatment seems to have importance in the outcome.
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Affiliation(s)
- Alvaro Auñon
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - Llanos Salar-Vidal
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
| | | | | | | | - Jaime Lora-Tamayo
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital 12 de Octubre, 28041 Madrid, Spain
| | - Tristan Ferry
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- CHU-Hopital Croix Rousse, 69317 Lyon, France
| | | | - Aurélien Dinh
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Ambroise-Paré Hospital, 92104 Paris, France
| | - Rosa Escudero
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital Ramon y Cajal, 28034 Madrid, Spain
| | | | - Alicia Rico
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Nicolo Rossi
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
- UOC di Malattie Infettive, Ospedale Guglielmo da Saliceto, AUSL Piacenza, 29121 Piacenza, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Jaime Esteban
- IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, 28040 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI), Aeschenvorstadt 55, 4051 Basel, Switzerland
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4
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Nizar A, Misbah I, Purushothaman R, Rajabalaji V, Ashraf M, Balasubramanian N. A Systematic Review and Qualitative Analysis of Studies Performing Total Knee Arthroplasty (TKA) in Tuberculosis (TB) of the Knee. Cureus 2024; 16:e57964. [PMID: 38738119 PMCID: PMC11086042 DOI: 10.7759/cureus.57964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Tuberculosis (TB) is a widespread global disease that significantly impacts daily life. Skeletal TB comprises about 10-35% of all TB cases. Significant research on the spine and hip exists, but due to the rarity of cases, the management of TB is less explored. Furthermore, exercising the option of total knee arthroplasty (TKA) in TB knees is still in its initial stages. This systematic review aims to identify and comprehend the difficulties associated with diagnosing TB-affected knees, their treatment outcomes, and complications related to TKA. A systematic review of existing English literature retrieved from PubMed, Google Scholar, and Web of Science databases was performed using the PRISMA guidelines. A case series of arthroplasty performed on TB knees included a description of the diagnostic approach, clinical outcome, and complication rates. Moreover, studies involving case series with follow-up functional outcomes were included. The Coleman Methodology was used to assess the quality of the studies. A total of six studies (75 knees) were systematically reviewed in this study. The diagnosis of TB knee is multimodal, with MRI being a reliable tool. Administering anti-TB chemotherapy is essential during the perioperative period. Regarding recurrence, a two-stage TKA has a lower risk of recurrence. It is plausible to state that anti-TB chemotherapy needs to be initiated in the perioperative period to prevent the chances of recurrences. Two-stage TKA is reserved for patients who require soft tissue debridement despite adequate chemotherapy.
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Affiliation(s)
- Abin Nizar
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Iffath Misbah
- Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Raja Purushothaman
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Vasudevan Rajabalaji
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Munis Ashraf
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
| | - Navin Balasubramanian
- Department of Orthopedic Surgery, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, IND
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Redman RM, Maughan TD, Smith CB, Crossno PF, Granger DL. Development of multidrug-resistant Mycobacterium tuberculosis in the biofilm of a peritoneal-venous shunt. IDCases 2023; 32:e01801. [PMID: 37250376 PMCID: PMC10209681 DOI: 10.1016/j.idcr.2023.e01801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
A patient with ascites received a peritoneal-venous shunt for presumed cirrhosis, however surgical specimens grew Mycobacterium tuberculosis (MTb) sensitive to all anti-tuberculous drugs. Directly-Observed-Therapy (DOT) led to improvement followed by relapse with multidrug resistant MTb (MDRTB). We discuss pathways for selection of MDRTB within mycobacterial biofilm. This case illustrates the potential for development of MDRTB in patients with long-term indwelling catheters. We emphasize catheter removal and if not possible continuing follow-up for symptoms and signs of relapse.
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Affiliation(s)
- Romany M. Redman
- Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84145, USA
| | - Timothy D. Maughan
- Infectious Diseases Clinic, Providence Sacred Heart Hospital, 101 West 8th Avenue, Spokane, WA 99204, USA
| | - Charles B. Smith
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA
- Veterans Affairs Medical Center, 500 Foothill Drive, Salt Lake City, UT 84145, USA
| | - Peter F. Crossno
- Division of Pulmonary Medicine, Department of Medicine, Intermountain Healthcare, 5121 Cottonwood Street, Murray, UT 84107, USA
| | - Donald L. Granger
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, 30 North 1900 East, Salt Lake City, UT 84132, USA
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6
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Van Le T, Duong TB, Hien KQ, Ton QNQ, Huyn T, Binh TP, Tu DT, Tho PP, Binh LN, Hau HP, Hung TNK. Two-stage revision for treatment of tuberculous prosthetic hip infection: an outcome analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:645-651. [PMID: 35778623 DOI: 10.1007/s00590-022-03317-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/31/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Prosthetic joint infections (PJI) and especially tuberculosis (TB) PJI are rare diseases and hard to cure. The effectiveness of treatments for tuberculous PJI still remains a problem. The objective of this research was to indicate the success of two-stage revision replacement and also giving the associated criteria. METHODS From 2015 to 2020, five patients with tuberculous PJI were treated with two-stage revision at Cho Ray hospital, Vietnam. We collected the dataset which included demographic data, the interval from the time of joint replacement to reported infection, records of tuberculous PJI, administration of anti-TB medications (duration, months), history of operation(s), duration of follow-up, and specific type(s) of antibiotics loaded in bone cement. The approval for this study was made by the institutional review board from Cho Ray Hospital, Vietnam. We conducted a literature review based on the keywords "PJI" and "TB" on PubMed. RESULTS Five patients [median age 66 years (range 35-84)] had found tuberculous PJI. The median time from arthroplasty to diagnosis was 19 months (range 4-48). The diagnosis was confirmed by joint aspirates or synovial tissue. Positive PCR was also reported in all cases. The average duration of anti-tuberculosis polytherapy administration was 14.4 months. The operative techniques on five patients included debridement and using spacer loaded with 2 g streptomycin (and 2 g vancomycin if they got a coinfection) for 1 pack of bone cement, and revision arthroplasty. In most cases, the outcome of treatment using two-stage revision replacement was 80%. Overall, the auxiliary bacterial infections were recognized in three patients with tuberculous PJI and Staphylococcus aureus. Streptomycin and vancomycin were loaded in a cement spacer to increase the success rate, and tuberculous PJI was controlled for all patients. CONCLUSION Tuberculous PJI can be controlled with two-stage revision replacement with an antibiotic-loaded cement spacer that is molded intraoperatively with custom mold and prolonged anti-tuberculosis treatment in all cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tuan Van Le
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Tran Binh Duong
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Kha Quang Hien
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | | | - Tan Huyn
- Faculty of Pharmacy, Nguyen Tat Thanh University, Ho Chi Minh city, Vietnam
| | - Tran Phuoc Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Dao Thanh Tu
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Pham Phuoc Tho
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Le Nguyen Binh
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Huynh Phuoc Hau
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam
| | - Truong Nguyen Khanh Hung
- Department of Orthopedic Surgery, Cho Ray Hospital, 201B Nguyen Chi Thanh Street, Ward 12, District 5, Ho Chi Minh City, Vietnam.
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
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7
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Meert C, Poinot N, Haumont E, Tollet P. Mycobacterium tuberculosis infection of a reverse total shoulder arthroplasty: a case report. Acta Orthop Belg 2023; 89:152-155. [PMID: 37295000 DOI: 10.52628/89.1.10971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We describe the case of a 78-years-old male with dyspnea, inappetence and weight loss over a period of two weeks. The CT scan suggested disseminated tuberculosis and T5-T6 spondylodiscitis. During hospitalization, he developed a left shoulder pain where a reverse total shoulder arthroplasty was implanted 11 years ago. Open debridement and lavage with retention of the implant was performed first and intraveinous antibiotics were administered. 3 months after surgery the patient developed a painful sinus track at the incision site. Resection of the fistula tract, soft tissue debridement and removal of the implants were performed before restarting chemotherapy. As the incidence of reverse total shoulder arthroplasty continues to increase throughout the world, periprosthetic joint infection (PJI) will probably raise as well. Diagnosing and treatment of shoulder PJI with atypical germs remains a challenge and explantation seems to be the safer surgical option to avoid recurrent surgeries on patient with increasing comorbidities.
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8
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Tachi Y, Sato L, Ishikane M, Yamada G, Motohashi A, Ando H, Hayakawa K, Takasaki J, Katsuragawa Y, Ohmagari N. A case of prosthetic joint infection caused by Mycobacterium tuberculosis complicated secondary bacterial infection after knee joint replacement surgery. J Infect Chemother 2023; 29:367-370. [PMID: 36528274 DOI: 10.1016/j.jiac.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Mycobacterium tuberculosis (M. tuberculosis) is a rare cause of prosthetic joint infection (PJI). Previous studies have reported that many cases of PJI caused by M. tuberculosis have no medical history of active tuberculosis (TB) or other localization, which contributes to diagnostic difficulties. Furthermore, owing to the limited number of studies on treatment, appropriate treatment strategies, such as the duration of anti-tuberculosis (anti-TB) drugs and surgical indications, remain unclear. We report a case of PJI caused by M. tuberculosis and secondary pyogenic arthritis caused by Staphylococcus aureus and Streptococcus dysgalactiae in a 67-year-old man after knee joint replacement surgery in Japan, which was a moderately endemic country until 2020 and a low endemic country since 2021. Although he had no past medical history or close contact with TB, he was diagnosed with PJI caused by M. tuberculosis, following the culture of a synovectomy specimen. He underwent two-stage surgery and was treated with anti-TB drugs for a total of 12 months and recovered without recurrence. Based on our case and previous studies, there are three points of clinical significance for PJI caused by M. tuberculosis. First, about one year of anti-TB drugs with two staged joint revision resulted in a good course of treatment. Second, surgical treatment might be considered in cases complicated by secondary bacterial infection. Third, because the diagnosis of PJI caused by M. tuberculosis is difficult, TB should be considered in the differential diagnosis of routine bacterial culture-negative PJI, especially in endemic areas.
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Affiliation(s)
- Yurika Tachi
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Gen Yamada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ayano Motohashi
- Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Honami Ando
- Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Jin Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yozo Katsuragawa
- Department of Orthopedic Surgery, Center Hospital of the National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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9
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Bonnet I, Haddad E, Guglielmetti L, Bémer P, Bernard L, Bourgoin A, Brault R, Catho G, Caumes E, Escaut L, Fourniols E, Fréchet-Jachym M, Gaudart A, Guillot H, Lafon-Desmurs B, Lanoix JP, Lanotte P, Lemaignen A, Lemaire B, Lemaitre N, Michau C, Morand P, Mougari F, Marigot-Outtandy D, Patrat-Delon S, Perpoint T, Piau C, Pourcher V, Zarrouk V, Zeller V, Veziris N, Jauréguiberry S, Aubry A. Clinical Features and Outcome of Multidrug-Resistant Osteoarticular Tuberculosis: A 12-Year Case Series from France. Microorganisms 2022; 10:microorganisms10061215. [PMID: 35744731 PMCID: PMC9229793 DOI: 10.3390/microorganisms10061215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
The optimal treatment for osteoarticular infection due to multidrug-resistant tuberculosis strains (MDR-OATB) remains unclear. This study aims to evaluate the diagnosis, management and outcome of MDR-OATB in France. We present a case series of MDR-OATB patients reviewed at the French National Reference Center for Mycobacteria between 2007 and 2018. Medical history and clinical, microbiological, treatment and outcome data were collected. Twenty-three MDR-OATB cases were reported, representing 3% of all concurrent MDR-TB cases in France. Overall, 17 were male, and the median age was 32 years. Six patients were previously treated for TB, including four with first-line drugs. The most frequently affected site was the spine (n = 16). Bone and joint surgery were required in 12 patients. Twenty-one patients (91%) successfully completed the treatment with a regimen containing a mean of four drugs (range, 2-6) for a mean duration of 20 months (range, 13-27). Overall, high rates of treatment success were achieved following WHO MDR-TB treatment guidelines and individualized patient management recommendations by the French National TB Consilium. However, the optimal combination of drugs, duration of treatment and role of surgery in the management of MDR-OATB remains to be determined.
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Affiliation(s)
- Isabelle Bonnet
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Elie Haddad
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lorenzo Guglielmetti
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
| | - Pascale Bémer
- Department of Bacteriology, University Hospital, CHU Nantes, 44000 Nantes, France;
| | - Louis Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Anne Bourgoin
- Service de Virologie et Mycobactériologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Rachel Brault
- Service de Rhumatologie, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
| | - Gaud Catho
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Lélia Escaut
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
| | - Eric Fourniols
- Service de Chirurgie Orthopédique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne-Université, 75013 Paris, France;
| | - Mathilde Fréchet-Jachym
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Alice Gaudart
- Service de Bactériologie, Centre Hospitalier Universitaire de Nice, 06000 Nice, France;
| | - Hélène Guillot
- Service de Médecine Interne, Hôpital Robert Ballanger, 93600 Aulnay-sous-Bois, France;
| | - Barthélémy Lafon-Desmurs
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, France;
| | - Jean-Philippe Lanoix
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire d’Amiens-Picardie, 80054 Amiens, France;
| | - Philippe Lanotte
- Service de Bactériologie, Centre Hospitalier Universitaire de Tours, 37000 Tours, France;
| | - Adrien Lemaignen
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, 37000 Tours, France; (L.B.); (A.L.)
| | - Bénédicte Lemaire
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Nadine Lemaitre
- Service de Bactériologie, Centre Hospitalier Universitaire d’Amiens-Picardie, 59200 Tourcoing, France;
| | - Christophe Michau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Saint-Nazaire, 44606 Saint-Nazaire, France;
| | - Philippe Morand
- Service de Bactériologie, Hôpital Cochin, AP-HP, Centre-Université de Paris, 75014 Paris, France;
| | - Faiza Mougari
- Service de Bactériologie, Hôpital Lariboisière, AP-HP, Nord-Université de Paris, 75018 Paris, France;
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, 91640 Briis-sous-Forges, France; (M.F.-J.); (B.L.); (D.M.-O.)
| | - Solène Patrat-Delon
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Thomas Perpoint
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, 69002 Lyon, France; (G.C.); (T.P.)
| | - Caroline Piau
- Service de Bactériologie, Centre Hospitalier Universitaire de Rennes, 35033 Rennes, France;
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
| | - Virginie Zarrouk
- Service de Médecine Interne, Hôpital Beaujon, AP-HP, Nord-Université de Paris, 92110 Clichy, France;
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, 75020 Paris, France;
| | - Nicolas Veziris
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Service de Bactériologie, Hôpitaux Saint-Antoine, Tenon, Trousseau, Rothschild, AP-HP, 75012 Paris, France
| | - Stéphane Jauréguiberry
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP, INSERM 1136, Sorbonne-Université, 75013 Paris, France; (E.H.); (E.C.); (V.P.); (S.J.)
- Service de Maladies Infectieuses et Tropicales, Hôpital Bicêtre, AP-HP, Université Paris Saclay, 94270 Le Kremlin-Bicêtre, France;
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Alexandra Aubry
- Cimi-Paris, INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, Sorbonne Université, 75013 Paris, France; (I.B.); (L.G.); (N.V.)
- Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne-Université, 75013 Paris, France
- TB Consilium of the National Reference Center for Mycobacteria, 75013 Paris, France
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
- Correspondence:
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10
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Lo CKL, Chen L, Varma S, Wood GCA, Grant J, Wilson EW. Management of Mycobacterium tuberculosis Prosthetic Joint Infection: 2 Cases and Literature Review. Open Forum Infect Dis 2021; 8:ofab451. [PMID: 34631919 PMCID: PMC8496762 DOI: 10.1093/ofid/ofab451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/31/2021] [Indexed: 12/22/2022] Open
Abstract
Prosthetic joint infection caused by Mycobacterium tuberculosis (TBPJI) is uncommon but can be encountered in immunocompromised patients or those from tuberculosis-endemic regions. A lack of clinical suspicion and experience with TBPJI often leads to a delay in diagnosis. We report 2 cases of TBPJI in a Hungarian-Canadian and Iranian-Canadian immigrant, respectively. Both were treated with concurrent surgical and medical therapy. We also performed a literature review on TBPJI case reports, outlining their diagnosis and management.
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Affiliation(s)
- Carson K L Lo
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Lina Chen
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sonal Varma
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Gavin C A Wood
- Department of Surgery (Orthopedics), Queen’s University, Kingston, Ontario, Canada
| | - Jennifer Grant
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Evan W Wilson
- Division of Infectious Diseases, Queen’s University, Kingston, Ontario, Canada
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Guan Y, Zeng Z. Elbow arthroplasty complicated by Mycobacterium tuberculosis infection: A case report. Medicine (Baltimore) 2021; 100:e24376. [PMID: 33655913 PMCID: PMC7939209 DOI: 10.1097/md.0000000000024376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/29/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Total elbow arthroplasty (TEA) is an orthopedic procedure that is relatively infrequently performed, but its use has been increasing over time. Infection remains one of the most concerning complications after TEA, although Mycobacterium tuberculosis (TB) as a microbial etiology, is extremely rare. Here, we present a case of M. tuberculosis infection after TEA. PATIENT CONCERNS A 45-year-old woman underwent TEA for severe traumatic arthritis of the elbow following failure of conservative treatment. Four months after TEA, the patient experienced progressive elbow pain and swelling, without other external signs of infection such as a sensation of local heating and erythematous alterations. DIAGNOSIS Pulmonary computed tomography showed stable pulmonary TB in the right upper lobe. The T-SPOT, TB, and purified protein derivative test results were positive, and M. tuberculosis exhibited growth on cultures. The final diagnosis was periprosthetic infection of M. tuberculosis. INTERVENTIONS The patient was treated with debridement with submission of deep tissue cultures. According to these cultures and suggestions of a bacteriologist, anti-TB treatment was administered for 12 months. OUTCOMES The symptoms of the infection were controlled, and the prosthesis was retained. At the time of writing this case report, the elbow prosthesis had survived for more than 2 years, and no recurrent infection had been observed. CONCLUSION The diagnosis of TB infection after TEA is difficult to confirm due to its nonspecific signs and symptoms. Despite the extremely low incidence, failure to consider this possibility for diagnosis can lead to delayed treatment. Proper diagnosis allows for antitubercular therapy with retention of a prosthesis.
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Affiliation(s)
| | - Zhimin Zeng
- Department of Orthopaedic Surgery, Ningbo No. 6 Hospital, Ningbo, Zhejiang, China
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12
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Wang D, Sun X, Zhang C, Fang X, Huang Z, Zheng Q, Zhang W. Total Knee Arthroplasty in Patients with Unsuspected Tuberculosis of the Joint: A Report of Four Cases and a Systematic Review of the Literature. Orthop Surg 2020; 12:1900-1912. [PMID: 33145983 PMCID: PMC7767691 DOI: 10.1111/os.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To provide a case series and systematic review that explores the clinical manifestations, treatments, and methods for defining tuberculosis diagnoses in patients who have undergone total knee arthroplasty (TKA). METHODS Four patients (three women, one man; average age, 59.5 ± 8.89 years; range, 48-69 years) underwent TKA and were subsequently treated for previously unsuspected knee tuberculosis between January 2013 and December 2019. We also reviewed published cases of tuberculous periprosthetic joint infections (TBPJIs) following TKA through databases of MEDLINE/PubMed, the Cochrane Library, and EMBASE. We reviewed studies that were published between January 1980 and December 2019. RESULTS In our four cases, the preoperative diagnoses were osteoarthritis (n = 2), rheumatoid arthritis (one case), and Charcot's arthropathy (one case). The main clinical manifestations were knee swelling and pain, without fever, weakness, or weight loss. Comorbidities included multiple joints with rheumatoid arthritis or Charcot's arthropathy, diabetes mellitus, and uremia. One patient had a history of lumbar tuberculosis treated with debridement and intervertebral fusion. Preoperative elevated erythrocyte sedimentation rates (ESRs) were detected in all cases, and elevated C-reactive protein (CRP) levels were observed in three cases. The tuberculosis diagnoses were confirmed via histopathologic analysis (three cases) and second-generation sequencing (one case). Three patients received antituberculosis therapy for 1 year, without surgical intervention. Two-stage exchange arthroplasty was performed in one patient because of prosthesis loosening. Within an average follow-up period of 24.75 months, tuberculosis reactivation was not observed and overall functional improvement was demonstrated. Forty-four TBPJI cases were reported in the literature between January 1980 and December 2019. Most (59.09%) occurred within the first year after the index arthroplasty, and the diagnoses were confirmed by culturing Mycobacterium tuberculosis in 88.64% of cases. Favorable outcomes were achieved in 90.91% of the patients who did not undergo surgery, 71.43% of those treated with debridement, 93.33% undergoing revision arthroplasty, and in 90.91% of those undergoing resection and arthrodesis. CONCLUSIONS Clinical manifestations of knee tuberculosis and TBPJI are atypical. Thus, attention should be paid to finding the causes of increased ESRs and CRP levels, particularly in patients with weakened immune functioning, before performing TKA. Pathological examination is an effective method for diagnosing tuberculosis, although sending multiple specimens for pathological examination is necessary.
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Affiliation(s)
- Du Wang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xiao‐tang Sun
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Chao‐fan Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Xin‐yu Fang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Zi‐da Huang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
| | - Qing‐cong Zheng
- Department of Orthopaedics900th Hospital of Joint Logistics Support ForceFuzhouChina
| | - Wen‐ming Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Fujian Medical UniversityFuzhouChina
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13
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Ribeiro AF, Inacio Oliveira M, Jordão P, Tavares D, Varandas L, Gouveia C. Mycobacterium tuberculosis prosthesis joint infection. Pediatr Int 2020; 62:97-99. [PMID: 31916331 DOI: 10.1111/ped.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Andreia Fiúza Ribeiro
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Marisa Inacio Oliveira
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Pedro Jordão
- Pediatric Orthopedic Unit, Área da Mulher, Criança e Adolescente, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Delfin Tavares
- Pediatric Orthopedic Unit, Área da Mulher, Criança e Adolescente, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Luís Varandas
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Catarina Gouveia
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
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14
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Barry M, Akkielah L, Askar MA, Bin Nasser AS. Miliary tuberculosis with delayed-onset total knee arthroplasty Mycobacteria tuberculosis infection successfully treated with medical therapy alone: A case report and literature review. Knee 2019; 26:1152-1158. [PMID: 31427242 DOI: 10.1016/j.knee.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) affecting a prosthetic knee is an unusual and diagnostically challenging presentation of this disease. This study reported a case of an 80-year-old man with a left total knee arthroplasty (TKA) performed eight years before his presentation. He presented with left knee swelling and pain for one month. Knee X-rays showed a normal joint space with no loosening of his prosthesis. His chest X-ray showed miliary disease, and microbiological studies of his sputum and synovial fluid aspirate grew Mycobacteria tuberculosis complex. He was successfully medically treated with anti-tuberculous therapy alone for one year. His knee hardware was retained, and he did not require debridement, resection, or revision. It is believed that this is the first reported case of miliary TB with delayed-onset TKA prosthetic joint infection (PJI) in which the prosthesis was successfully retained. Thirty-eight published TB TKA PJI cases in medical literature were also reviewed.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Layan Akkielah
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Manar A Askar
- Division of Infectious Diseases, Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Bin Nasser
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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15
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Mycobacterium tuberculosis infection of reverse shoulder arthroplasty: a case report. J Shoulder Elbow Surg 2019; 28:e271-e274. [PMID: 31327396 DOI: 10.1016/j.jse.2019.04.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/25/2019] [Indexed: 02/01/2023]
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16
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Hannon M, Zachariah S, Etherington NB, Govind A, Weber D, Hess B. When an Infected Meniscus Portends a Perforated Viscus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Saeed K, McLaren AC, Schwarz EM, Antoci V, Arnold WV, Chen AF, Clauss M, Esteban J, Gant V, Hendershot E, Hickok N, Higuera CA, Coraça-Huber DC, Choe H, Jennings JA, Joshi M, Li WT, Noble PC, Phillips KS, Pottinger PS, Restrepo C, Rohde H, Schaer TP, Shen H, Smeltzer M, Stoodley P, Webb JCJ, Witsø E. 2018 international consensus meeting on musculoskeletal infection: Summary from the biofilm workgroup and consensus on biofilm related musculoskeletal infections. J Orthop Res 2019; 37:1007-1017. [PMID: 30667567 DOI: 10.1002/jor.24229] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/14/2019] [Indexed: 02/04/2023]
Abstract
Biofilm-associated implant-related bone and joint infections are clinically important due to the extensive morbidity, cost of care and socioeconomic burden that they cause. Research in the field of biofilms has expanded in the past two decades, however, there is still an immense knowledge gap related to many clinical challenges of these biofilm-associated infections. This subject was assigned to the Biofilm Workgroup during the second International Consensus Meeting on Musculoskeletal Infection held in Philadelphia USA (ICM 2018) (https://icmphilly.com). The main objective of the Biofilm Workgroup was to prepare a consensus document based on a review of the literature, prepared responses, discussion, and vote on thirteen biofilm related questions. The Workgroup commenced discussing and refining responses prepared before the meeting on day one using Delphi methodology, followed by a tally of responses using an anonymized voting system on the second day of ICM 2018. The Working group derived consensus on information about biofilms deemed relevant to clinical practice, pertaining to: (1) surface modifications to prevent/inhibit biofilm formation; (2) therapies to prevent and treat biofilm infections; (3) polymicrobial biofilms; (4) diagnostics to detect active and dormant biofilm in patients; (5) methods to establish minimal biofilm eradication concentration for biofilm bacteria; and (6) novel anti-infectives that are effective against biofilm bacteria. It was also noted that biomedical research funding agencies and the pharmaceutical industry should recognize these areas as priorities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kordo Saeed
- Department of Microbiology Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK and University of Southampton, School of Medicine, Southampton, UK
| | - Alex C McLaren
- Department of Orthopaedic Surgery, University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona
| | - Edward M Schwarz
- Department of Orthopaedics, University of Rochester, Rochester, New York
| | - Valentin Antoci
- Department of Orthopaedics, University Orthopedics Rhode Island, Providence, Rhode Island
| | - William V Arnold
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin Clauss
- Department for Orthopaedics and Trauma Surgery Kantonsspital Baselland, Liestal and University Hospital Basel Department for Orthopaedics and Trauma Surgery, Basel, CH
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2., 28040-Madrid, Spain
| | - Vanya Gant
- College Hospital, Hospital for Tropical Diseases, National Hospital for Neurology and Neurosurgery at University College London Hospitals, London, UK
| | - Edward Hendershot
- Department of Internal Medicine and Infectious Diseases at Duke University Hospital, Durham, North Carolina
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Department of Biochemistry & Molecular Biology Thomas Jefferson University, 1015 Walnut St., Philadelphia, 19107, Pennsylvania
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Débora C Coraça-Huber
- Research Laboratory for Implant Associated Infections (Biofilm Lab) - Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Hyonmin Choe
- Yokohama City University Orthopaedic Department, Fukuura-3-9, Kanazawa-ku, Yokohama, Japan
| | - Jessica A Jennings
- Department of Biomedical Engineering, The University of Memphis, 303B Engineering Technology Building, Memphis, Tennessee
| | - Manjari Joshi
- Department of Internal Medicine and Infectious Diseases at University of Mryland, School of Medicine, R Adams Cowley Shock Trauma Center Baltimore, Baltimore, Maryland
| | - William T Li
- Sydney Kimmel Medical College at Philadelphia University and Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Philip C Noble
- Institute of Orthopaedic Research and Education, Houston, Texas.,Baylor College of Medicine Department of Orthopaedic Surgery, Houston, Texas
| | - K Scott Phillips
- Division of Biology, Chemistry, and Materials Science, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Office of Medical Products and Tobacco, US Food and Drug Administration, Silver Spring, Maryland
| | - Paul S Pottinger
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Camilo Restrepo
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas P Schaer
- Department of Clinical Studies New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania
| | - Hao Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai, P. R. China
| | - Mark Smeltzer
- Department of Microbiology and Immunology, Department of Orthopaedic Surgery, Center for Microbial Pathogenesis and Host Inflammatory Responses, University of Arkansas for Medical Sciences 4301 W. Markham, Slot 511, Little Rock, 72205, Arkansas
| | - Paul Stoodley
- Department Microbial Infection and Immunity, College of Medicine, The Ohio State University, Columbus, Ohio.,Department Orthopaedics, College of Medicine, The Ohio State University, Columbus, Ohio.,Department National Centre for Advanced Tribology at Southampton (nCATS), Mechanical Engineering, University of Southampton, Southampton, UK
| | - Jason C J Webb
- Department of Orthopaedic Surgery, Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - Eivind Witsø
- Department of Orthopaedic Surgery at St. Olavs Hospital, Trondheim, Norway
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Meyssonnier V, Zeller V, Malbos S, Heym B, Lhotellier L, Desplaces N, Marmor S, Ziza JM. Prosthetic joint infections due to Mycobacterium tuberculosis: A retrospective study. Joint Bone Spine 2019; 86:239-243. [DOI: 10.1016/j.jbspin.2018.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 01/08/2023]
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19
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Boyle KK, Kuo FC, Horcajada JP, Hughes H, Cavagnaro L, Marculescu C, McLaren A, Nodzo SR, Riccio G, Sendi P, Silibovsky R, Stammers J, Tan TL, Wimmer M. General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S225-S237. [PMID: 30360976 DOI: 10.1016/j.arth.2018.09.074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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20
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Ascione T, Barrack R, Benito N, Blevins K, Brause B, Cornu O, Frommelt L, Gant V, Goswami K, Hu R, Klement MR, Komnos G, Malhotra R, Mirza Y, Munhoz Lima AL, Nelson C, Noor SS, O'Malley M, Oussedik S, Portillo ME, Prieto H, Saxena A, Sessa G. General Assembly, Diagnosis, Pathogen Isolation - Culture Matters: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S197-S206. [PMID: 30360977 DOI: 10.1016/j.arth.2018.09.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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21
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Aalirezaie A, Bauer TW, Fayaz H, Griffin W, Higuera CA, Krenn V, Krenn V, Molano M, Moojen DJ, Restrepo C, Shahi A, Shubnyakov I, Sporer S, Tanavalee A, Teloken M, Velázquez Moreno JD. Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S369-S379. [PMID: 30343965 DOI: 10.1016/j.arth.2018.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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22
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Sultan AA, Cantrell WA, Rose E, Surace P, Samuel LT, Chughtai M, Khlopas A, Newman JM, Moskal JT, Mont MA. Total knee arthroplasty in the face of a previous tuberculosis infection of the knee: what do we know in 2018? Expert Rev Med Devices 2018; 15:717-724. [DOI: 10.1080/17434440.2018.1520633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Assem A. Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Emily Rose
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter Surace
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linsen T. Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Jared M. Newman
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joseph T. Moskal
- Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, VA, USA
| | - Michael A. Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
- Department of Orthopedic Surgery, Lenox Hill Hospital, New York City, NY, USA
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23
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Uhel F, Corvaisier G, Poinsignon Y, Chirouze C, Beraud G, Grossi O, Varache N, Arvieux C, Berre RL, Tattevin P. Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review. J Infect 2018; 78:27-34. [PMID: 30138639 DOI: 10.1016/j.jinf.2018.08.008] [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] [Received: 05/05/2018] [Revised: 08/03/2018] [Accepted: 08/08/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI). METHODS Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords 'prosthetic joint', and 'tuberculosis'. RESULTS During years 1997-2016, 13 patients (8 males, 5 females, median age 79 years [range, 60-86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4-20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6-32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS). CONCLUSIONS M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.
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Affiliation(s)
- Fabrice Uhel
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, U1236, F-35043 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France
| | | | - Yves Poinsignon
- Médecine Interne, CH Bretagne Atlantique, F-56017 Vannes, France
| | - Catherine Chirouze
- CNRS 6249, Université de Bourgogne-Franche-Comté, CHRU Besançon, F-25030 Besançon, France
| | | | - Olivier Grossi
- Médecine Interne - Infectiologie, Nouvelles Cliniques Nantaises, F-44277 Nantes, France
| | - Nicolas Varache
- Maladies Infectieuses et Tropicales, CH Le Mans, F-72037 Le Mans, France
| | - Cédric Arvieux
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France
| | - Rozenn Le Berre
- Médecine Interne et Pneumologie, CHRU de la Cavale Blanche, F-29609 Brest, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France.
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