JBJI Journal of Bone and Joint Infection JBJI J. Bone Joint Infect. 2206-3552 Ivyspring Göttingen, Germany 10.7150/jbji.25887 Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series Medina Fernanda 1 Meyssonnier Vanina 1 2 Zeller Valérie 1 2 Heym Beate 1 3 Ziza Jean-Marc 1 2 Marmor Simon 1 4 Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France Internal Medicine Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France Microbiology Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France Orthopedic Surgery Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France 31 10 2018 3 5 241 244 Copyright: © 2018 Fernanda Medina et al. 2018 This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/ This article is available from https://jbji.copernicus.org/articles/3/241/2018/jbji-3-241-2018.html The full text article is available as a PDF file from https://jbji.copernicus.org/articles/3/241/2018/jbji-3-241-2018.pdf

<p class="p p-first" id="__p2"><strong>Introduction:</strong> Prosthetic joint infections (PJIs) can be acquired hematogenously from a distant site or device. Notably, 30%-40% of patients with PJIs have <em>Staphylococcus aureus</em> bacteremia. No case reports or series of PJIs acquired from totally implantable venous-access device (TIVAD) infection or colonization have been published. This study was undertaken to describe epidemiological, clinical, microbiological and radiological characteristics of such PJIs, their treatments and outcomes.</p><p id="__p3"><strong>Methods:</strong> This retrospective study included all patients, identified in a prospective French Bone-and-Joint Infections Referral Center cohort treated between 2004 and 2017, with PJI secondary to TIVAD infection, with the same microbiologically documented microorganism isolated from both.</p><p id="__p4"><strong>Results:</strong> We describe six consecutive hematogenous PJIs (4 women, 2 men; median age: 66.5 years) acquired from TIVAD primary infections. The main infection risk factors were malignancy (n=5) and prior septic arthritis (n=2). Four participants' TIVADs were implanted for chemotherapy, preceding the prosthesis for one patient. The median TIVAD-implantation-to-symptom-onset interval was 12 months. Microorganisms were <em>Staphylococcus epidermidis</em> (n=4), <em>Staphylococcus capitis</em> (n=1) and <em>Staphylococcus aureus</em> (n=1). All TIVADs were removed. Five participants received curative treatment, with a median of 12 weeks of antibiotics. After median follow-up of 42 months, none have relapsed.</p><p class="p p-last" id="__p5"><strong>Conclusions:</strong> When PJI occurs in a patient with a TIVAD, the latter must be tested as a potential source of the prosthesis infection. Conversely, PJIs must sought in all patients with bacteremia.</p>

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