Abstracted/indexed

Tenosynovitis due to Histoplasma capsulatum in an immunocompromised host warrants special attention. Following surgical debridement, the patient initially improved on antifungal therapy, but as immunosuppression was decreased, she presented with a flare, requiring further debridement. With negative fungal cultures and declining antigenemia, it was felt that her interim worsening was as a consequence of immune reconstitution inflammatory syndrome (IRIS).

This study shows that hip fractures that are complicated with infection are associated with higher mortality and worse outcomes. Delay in fracture management increases the risk of infection. Hip fractures should be treated with urgency not only to reduce mortality but also to reduce the risk of infection after the operation.

Costs related to off-label expensive antibiotics used to treat bone and joint infections (BJIs) in a referral centre in France were analysed in this cohort study. Despite the large increase in the number of patients treated with these antibiotics, the overall costs remained stable (approximately EUR 1 million) and were helped by the appearance of generic molecules at lower prices. Production of generic antibiotics at low cost is essential to limit the financial burden of the management of BJIs.

Infection after total hip (THA) or total knee (TKA) arthroplasty can be treated by a so-called DAIR procedure within 4 weeks after surgery. However, could a DAIR be successful up to 3 months? In the Dutch Arthroplasty Register we found a re-revision rate of 8% within 4 weeks after THA and 9% re-revisions between 4 and 12 weeks. After TKA we found 9% re-revisions within 4 weeks and 17% failures after 4–12 weeks. We show no difference for DAIRs performed within 4 weeks or between 4 and 12 weeks.

The aim of this study is to summarize and improve knowledge regarding fracture-related infection caused by Candida (CFRI) through a systematic review on the topic, accompanied by a case report. Candida infections in fractures are rare but difficult-to-treat events. The existing fracture-related infection treatment algorithm combined with long-term systemic antifungal therapy has an anecdotal value and needs more extensive studies to be validated.

Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.

When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.

In total hip arthroplasty, infection remains one of the most devastating postoperative complications. It can be difficult to treat and eradicate. Currently there are several validated methods of combating infection but complications both during and after the process can derail the patient's recovery. We seek to determine complications that occur during the infection eradication process and the stage they occur in to bring awareness to possible reasons for failure of the revision.

Osteomyelitis is an infection of bone and is often treated with surgical debridement. This results in a bone defect which requires the use of a void filler. This study evaluated the use of a gentamicin-impregnated ceramic void filler (CERAMENT G) and compared it to the same void filler without antibiotic (CERAMENT) and no void filler in a rat model of osteomyelitis. CERAMENT G was found to decrease the rate of persistent infection and grow more new bone than CERAMENT or an empty defect.

This case series highlights our treatment strategy for pubic symphysis osteomyelitis of aggressive local debridement with local antibiotic therapy. Additionally, debridement of the pubic symphysis without subsequent internal fixation did not result in pelvic instability, as determined by pelvic radiographs and ability to fully weight bear postoperatively.

Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.

We report on a clinical case of rapid progressive destruction of the femoral head after joint injection in rheumatoid arthritis.

Periprosthetic joint infection (PJI) is one of the most challenging complications following total joint arthroplasty. PJI infections are primarily caused by antibiotic-tolerant biofilms on the surface of the implant. Bacterial toxin antitoxin systems are believed to play a critical role in biofilm antibiotic tolerance and resistance. The objective of this study was to identify the role of the S. aureus toxin YoeB in biofilm formation, antibiotic susceptibility, and virulence.

We report an intriguing and challenging case of severe skin necrosis, in the setting of a periprosthetic knee infection, after the beginning of low-molecular-weight heparin. Our multidisciplinary approach and the results can be useful for other orthopaedic surgeons that may face a similar case.