Abstracted/indexed

Accurate diagnosis of bone infections underlying bed sores is essential. Microscopic examination of bone samples is the preferred method for diagnosis, but alternative modalities are commonly used in everyday practice. We conducted a systematic review comparing results of microscopic examination with those of alternative modalities. Our study did not find any other method to be a reliable alternative for the diagnosis of bone infections underlying bed sores compared to microscopic examination.

Literature reporting on the effectiveness of DAIR (debridement, antibiotics and implant retention) procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI-related revision arthroplasty) is scarce. Infection control rates of a DAIR procedure after primary arthroplasty (n = 51) and after prior PJI-related revision arthroplasty (n = 16) were 69 % and 56 %, respectively. No statistically significant difference is found in infection control after 1 year.

Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation. We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.

Neisseria meningitidis is a rare cause of prosthetic joint infection (PJI) which we hypothesised could be safely managed with minimal surgical intervention and short-course antibiotics. In contrast to the existing three reported cases, all of which received a minimum of 12 weeks of antibiotics, we present three further cases of late acute haematogenous PJI due to Neisseria meningitidis, demonstrating successful treatment with 6 weeks or less of antimicrobial therapy and implant retention.

Bacterial biofilm infections of artificial knees are treated by mixing antibiotics into bone cement and calcium sulfate beads. We designed a knee size model to show that cement alone killed biofilms on orthopedic materials and prevented their spread close to the cement, but adding beads significantly killed biofilms further away. The model is useful in helping show how both the spread and the amount of antibiotic carrier can kill biofilms that might be in different places in the joint.

We present the first reported case of prosthetic joint infection caused by Trueperella pyogenes. This animal pathogen rarely causes human infection. Our patient was successfully treated with single-stage exchange and 12 weeks of rifampicin and moxifloxacin.

A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.

We compared the outcome of bioactive glass S53P4 as bone substitute versus autologous bone grafts for filling defects in patients with infected non-union. Our comparison of the outcomes revealed no significant differences between the groups with respect to recurrence of infection, bone healing, full weight bearing, or complications in general. Our results are promising. BAG seems to be an appropriate bone substitute. Further studies with larger numbers of patients are required.

This stepwise quality improvement project sought to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty. A new guideline removing routine urine testing from preoperative assessment was successfully implemented and there was a sustained reduction in the number of unnecessary preoperative urine cultures performed. This study is useful to other centres as an example of how implementation methodology can be used to challenge outdated clinical practice.

We report on a patient with septic arthritis of the knee with Pantoea agglomerans after a penetrating black locust thorn injury. Antibiotics alone or in combination with an arthroscopy may be insufficient for achieving source control. Accurate medical history and open debridement with a search for a thorn fragment are key to successful treatment. This publication includes a thorough literature review which analyses the outcome of all reported cases worldwide.

To evaluate bone and tissue concentrations following intraosseous vancomycin administration, eight pigs were injected with 500 mg vancomycin into the tibia followed by a 12 h sampling period. This provided high concentrations in the tibia bone nearby the injection site the entire period, though with a wide range of peak concentration. The systemic absorption was high and immediate, thus mirroring an intravenous administration. Low mean concentrations were found in adjacent tissue compartments.

This case highlights clinical and laboratory diagnostic challenges encountered with mycobacterial osteoarticular infections. Specifically, we focus on a rare complication of prosthetic joint infection following BCG therapy for non-muscle-invasive bladder cancer. We emphasize awareness of host risk factors to encourage consideration of mycobacteria in the relevant context.

Deep periprosthetic joint infection following knee replacement is a serious complication feared by surgeons. Our aim was to investigate if seasonality of deep infection incidence exists in a national registry of knee replacement patients. We extracted data from over 100 000 procedures, investigating if patients operated on during the summer had increased risk of re-operation due to infection. We found no signal of periodicity, meaning the summer season is not a risk factor for deep infection.

In order to monitor pin site infections, facilitate communication between team members, and assist treatment decision-making, we aimed to develop a registration tool. The present pilot study evaluates the feasibility of a prospective registration procedure for reporting, evaluating, and monitoring of pin site infections in 39 trauma, limb deformity, and bone infection patients with external ring fixation.

We report the treatment of bone infection in a patient with a rare disease which causes overgrowth of the limb. Careful assessment of the scans showed that the infection was in some new bone which had formed in the soft tissues after a minor injury to the leg and not in one of the major bones. This made treatment much easier with a successful outcome.

Antibiotics are frequently used in bone cement during joint replacements or treatment of bone and joint infections. Amikacin is rarely used in bone cement, particularly the liquid formulation. We describe a series of patients in which liquid amikacin was incorporated into bone cement. We did not observe the occurrence of adverse drug reactions definitively attributed to its use. All patients had favorable outcomes.