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Hoellwarth J, Reif T, Henry M, Miller A, Kaidi A, Rozbruch S. Unexpected positive intraoperative cultures (UPIC) at index osseointegration do not lead to increased postoperative infectious events. J Bone Jt Infect 2022; 7:155-162. [PMID: 35937089 PMCID: PMC9350876 DOI: 10.5194/jbji-7-155-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The most common complication following transcutaneous
osseointegration for amputees is infection. Although an obvious source of
contamination is the permanent stoma, operative site contamination at the time
of implantation may be an additional source. This study investigates the impact
of unexpected positive intraoperative cultures (UPIC) on postoperative
infection. Methods: Charts were reviewed for 8 patients with UPIC
and 22 patients with negative intraoperative cultures (NIC) who had at least 1
year of post-osseointegration follow-up. All patients had 24 h of routine
postoperative antibiotic prophylaxis, with UPIC receiving additional antibiotics
guided by culture results. The main outcome measure was postoperative infection
intervention, which was graded as (0) none, (1) antibiotics unrelated to the
initial surgery, (2) operative debridement with implant retention, or (3)
implant removal. Results: The UPIC vs. NIC rate of infection
management was as follows: Grade 0, 6/8 = 75 % vs. 14/22 = 64 %, p= 0.682; Grade 1, 2/8 = 25 % vs. 8/22 = 36.4 % (Fisher's p= 0.682); Grade 2, 1/8 = 12.5 % vs. 0/22 = 0 % (Fisher's p= 0.267); Grade 3, 0/8 = 0 % vs. 1/22 = 4.5 % (Fisher's p= 1.000). No differences were statistically significant.
Conclusions: UPIC at index osseointegration, managed with
directed postoperative antibiotics, does not appear to increase the risk of
additional infection management. The therapeutic benefit of providing additional
directed antibiotics versus no additional antibiotics following UPIC is unknown
and did not appear to increase the risk of other adverse outcomes in our
cohort.
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Affiliation(s)
- Jason S. Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Hospital for
Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New
York, NY 10021, USA
| | - Taylor J. Reif
- Limb Lengthening and Complex Reconstruction Service, Hospital for
Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New
York, NY 10021, USA
| | - Michael W. Henry
- Infectious Disease Service, Hospital for Special Surgery, Weill
Cornell Medical College, 535 East 70th Street, New York, NY 10021,
USA
| | - Andy O. Miller
- Infectious Disease Service, Hospital for Special Surgery, Weill
Cornell Medical College, 535 East 70th Street, New York, NY 10021,
USA
| | - Austin C. Kaidi
- Limb Lengthening and Complex Reconstruction Service, Hospital for
Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New
York, NY 10021, USA
| | - S. Robert Rozbruch
- Limb Lengthening and Complex Reconstruction Service, Hospital for
Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New
York, NY 10021, USA
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Van Belkum A, Gros MF, Ferry T, Lustig S, Laurent F, Durand G, Jay C, Rochas O, Ginocchio CC. Novel strategies to diagnose prosthetic or native bone and joint infections. Expert Rev Anti Infect Ther 2021; 20:391-405. [PMID: 34384319 DOI: 10.1080/14787210.2021.1967745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed. AREAS COVERED We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available. EXPERT OPINION Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.
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Affiliation(s)
- Alex Van Belkum
- bioMérieux, Open Innovation and Partnerships, 3 Route De Port Michaud, La Balme Les Grottes, France
| | | | - Tristan Ferry
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre Interrégional De Référence Pour La Prise En Charge Des Infections Ostéo-articulaires Complexes (Crioac Lyon), Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | - Sebastien Lustig
- Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Service De Chirurgie Orthopédique, Hôpital De La Croix-Rousse, Lyon, France
| | - Frédéric Laurent
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | | | - Corinne Jay
- bioMérieux, BioFire Development Emea, Grenoble, France
| | - Olivier Rochas
- Corporate Business Development, bioMérieux, Marcy-l'Étoile, France
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