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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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Santoso A, Phatama KY, Rhatomy S, Budhiparama NC. Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review. World J Orthop 2022; 13:503-514. [PMID: 35633748 PMCID: PMC9125004 DOI: 10.5312/wjo.v13.i5.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/07/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.
AIM To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.
METHODS A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.
RESULTS Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.
CONCLUSION At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.
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Affiliation(s)
- Asep Santoso
- Department of Orthopaedic and Traumatology, Universitas Sebelas Maret, Surakarta and Prof. Dr. R. Soeharso Orthopaedic Hospital, Sukoharjo 57162, Indonesia
| | - Krisna Yuarno Phatama
- Department of Orthopaedic and Traumatology, Universitas Brawijaya, Saiful Anwar General Hospital, Malang 65112, Indonesia
| | - Sholahuddin Rhatomy
- Department of Orthopaedic and Traumatology, Universitas Gadjah Mada, Yogyakarta and Dr. Soeradji Tirtonegoro General Hospital, Klaten 57424, Indonesia
| | - Nicolaas Cyrillus Budhiparama
- Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation at Medistra Hospital, Jakarta 12950, Indonesia
- Faculty of Medicine, Universitas Airlangga, Jawa Timur 60132, Indonesia
- Department of Orthopaedics, Leiden University Medical Center, Leiden 2333, Netherlands
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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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