Articles | Volume 6, issue 8
https://doi.org/10.5194/jbji-6-367-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-6-367-2021
© Author(s) 2021. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Review
| 
07 Oct 2021
Review |
| 07 Oct 2021
| 07 Oct 2021
Diagnosis of orthopaedic-implant-associated infections caused by slow-growing Gram-positive anaerobic bacteria – a clinical perspective
Diana Salomi Ponraj
Department of Clinical Medicine, Aarhus University, Aarhus, 8000,
Denmark
Thomas Falstie-Jensen
Department of Orthopaedic Surgery, Aarhus University Hospital,
Aarhus, 8200, Denmark
Nis Pedersen Jørgensen
Department of Infectious Diseases, Aarhus University Hospital,
Aarhus, 8200, Denmark
Christen Ravn
Department of Orthopaedic Surgery, Lillebaelt Hospital, Kolding,
6000, Denmark
Holger Brüggemann
Department of Biomedicine, Aarhus University, Aarhus, 8000, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, 8000,
Denmark
Department of Orthopaedic Surgery, Horsens Regional Hospital,
Horsens, 8700, Denmark
Related authors
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Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Related subject area
Subject: Microbiology of bone and joint infections | Topic: All topics
Multi-centre evaluation of Gram stain in the diagnosis of septic arthritis
Yield of routine mycobacterial culture of osteoarticular specimens in a tertiary orthopaedic hospital in England, 2017–2022
Musculoskeletal infections associated with Nocardia species: a case series
Musculoskeletal manifestations of lower-extremity coccidioidomycosis: a case series
Potential value of a rapid syndromic multiplex PCR for the diagnosis of native and prosthetic joint infections: a real-world evidence study
Optimized decision algorithm for the microbiological diagnosis of osteoarticular infections in adults using synovial fluid samples: a prospective study in two French hospitals including 423 samples of synovial fluid
Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study
Prosthetic joint infections caused by Mycobacterium avium complex: a series of five cases
Charlotte Smith, Robert J. Maloney, Deborah Wearmouth, Hemant Sharma, Kordo Saeed, Nusreen Ahmad-Saeed, Rachel Annett, Lucinda Barrett, Sara E. Boyd, Peter Davies, Harriet Hughes, Gwennan Jones, Laura Leach, Maureen Lynch, Deepa Nayar, Martin Marsh, Shanine Mitchell, Lynn Moffat, Luke S. P. Moore, Michael E. Murphy, Shaan Ashk O'Shea, Teresa Peach, Christina Petridou, Niamh Reidy, Ben Talbot, Catherine Aldridge, and Gavin Barlow
J. Bone Joint Infect., 10, 61–71, https://doi.org/10.5194/jbji-10-61-2025, https://doi.org/10.5194/jbji-10-61-2025, 2025
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Urgent analysis of joint fluid is a common test in patients with possible septic arthritis (bacterial infection of a joint). One aspect of this test, called the Gram stain, is considered important clinically, but previous single hospital studies have suggested it will miss a considerable number of infections. This large multi-hospital UK study assessed this test and found that it will miss 73 % of infections, questioning its value. More research on rapid tests using new technologies is required.
Tom A. Yates, Olivier Vahesan, Simon Warren, and Antonia Scobie
J. Bone Joint Infect., 9, 217–223, https://doi.org/10.5194/jbji-9-217-2024, https://doi.org/10.5194/jbji-9-217-2024, 2024
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Our orthopaedic hospital attempts to culture tuberculosis (TB) bacteria from all bone and joint samples sent to the microbiology laboratory. We looked at 6162 TB cultures performed between 2017 and 2022. Bacteria that cause TB, or similar bacteria, were found in 1 in every 229 patients. Tests were more likely to be positive in people being investigated for cancer (sarcoma) and in samples from the spine, whereas they were much less likely to be positive in samples taken from replacement joints.
Ryan B. Khodadadi, Jack W. McHugh, Supavit Chesdachai, Nancy L. Wengenack, Wendelyn Bosch, Maria Teresa Seville, Douglas R. Osmon, Elena Beam, and Zachary A. Yetmar
J. Bone Joint Infect., 9, 207–212, https://doi.org/10.5194/jbji-9-207-2024, https://doi.org/10.5194/jbji-9-207-2024, 2024
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In a multicenter retrospective study of musculoskeletal Nocardia infections (2011–2022), nine cases were identified. Disseminated disease occurred in 33 %, all in solid organ transplant recipients. Surgical intervention was common (89 %), with varied treatment duration (21–467 d). The 1-year mortality was 22%; all fatal cases involved disseminated disease. Localized infection generally had favorable outcomes compared to disseminated disease and requires a collaborative approach for management.
William Estes, L. Daniel Latt, Jacob Robishaw-Denton, Matthew L. Repp, Yash Suri, Tyson Chadaz, Christina Boulton, and Talha Riaz
J. Bone Joint Infect., 9, 197–205, https://doi.org/10.5194/jbji-9-197-2024, https://doi.org/10.5194/jbji-9-197-2024, 2024
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Musculoskeletal coccidioidomycosis can present in a variety of ways and often mimics non-infectious disease processes, making timely diagnosis challenging. Missed diagnosis can lead to devastating consequences, including joint destruction. Treatment often involves surgical debridement and prolonged antifungal therapy. Physicians in endemic areas should have a low threshold for obtaining Coccidioides-specific labs when patients present with unexplained musculoskeletal complaints.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
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This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Céline Dupieux, Ghislaine Descours, Paul Verhoeven, Florence Grattard, Yvonne Benito, François Vandenesch, Céline Cazorla, Tristan Ferry, Sébastien Lustig, Bertrand Boyer, Sandrine Boisset, Anne Carricajo, Frédéric Laurent, and PIRLA investigator group
J. Bone Joint Infect., 9, 37–48, https://doi.org/10.5194/jbji-9-37-2024, https://doi.org/10.5194/jbji-9-37-2024, 2024
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We define an algorithm to optimize bone and joint infection diagnosis in adults on synovial fluid samples. This prospective multi-center study included a large number of synovial fluids and compared the performance of classical culture on different media, inoculation of synovial fluid in blood culture bottles, and broad-range and specific PCR. We proposed an algorithm associating culture onto three solid media and into blood culture bottles and 16S, Staphylococcus, and Streptococcus PCR.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
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Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Katharine Dobos, Gina A. Suh, Aaron J. Tande, and Shanthi Kappagoda
J. Bone Joint Infect., 7, 137–141, https://doi.org/10.5194/jbji-7-137-2022, https://doi.org/10.5194/jbji-7-137-2022, 2022
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This paper describes five cases of prosthetic joint infection (PJI) caused by Mycobacterium avium complex (MAC). Infections occurred in both immune competent and immunosuppressed patients. Interestingly, using the Musculoskeletal Infection Society diagnostic criteria for PJI may miss some cases of MAC PJI. Treatment courses and outcomes are described.
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Short summary
Implant-associated infections (IAIs) in orthopaedic surgery are associated with high morbidity and mortality. Slow-growing anaerobic bacteria are increasingly being recognized as potential causative agents in such infections, but their diagnosis is difficult. The purpose of this review is to summarize the current knowledge of IAIs with these bacteria. In particular, the review gives an overview of the current methodology in the diagnosis of such infections, to serve as a guide for clinicians.
Implant-associated infections (IAIs) in orthopaedic surgery are associated with high morbidity...
