Next Article in Journal
Molecular Insights into miRNA-Driven Resistance to 5-Fluorouracil and Oxaliplatin Chemotherapy: miR-23b Modulates the Epithelial–Mesenchymal Transition of Colorectal Cancer Cells
Next Article in Special Issue
Extracellular Vesicle Isolation and Characterization from Periprosthetic Joint Synovial Fluid in Revision Total Joint Arthroplasty
Previous Article in Journal
Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999–2009
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 8
Issue 12
10.3390/jcm8122113
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

by
Luc Deroche
1,*,
Pascale Bémer
2,
Anne-Sophie Valentin
3,
Anne Jolivet-Gougeon
4,
Didier Tandé
5,
Geneviève Héry-Arnaud
5,
Carole Lemarié
6,
Marie Kempf
6,
Laurent Bret
7,
Christophe Burucoa
1,
Stéphane Corvec
2 and
Chloé Plouzeau
1
1
Bacteriology-Hospital Hygiene Department, University Hospital of Poitiers, Poitiers Universiy, F-86000 Poitiers, France
2
Bacteriology-Hospital Hygiene Department, University Hospital of Nantes, Nantes University, F-44000 Nantes, France
3
Bacteriology-Hospital Hygiene Department, University Hospital of Tours, Tours University, F-37000 Tours, France
4
Univ Rennes, INSERM, University Hospital of Rennes, NUMECAN Institute (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
5
Bacteriology-Hospital Hygiene Department, University Hospital of Brest, Brest University, F-29000 Brest, France
6
Bacteriology-Hospital Hygiene Department, University Hospital of Angers, Angers University, F-49000 Angers, France
7
Bacteriology-Hospital Hygiene Department, Hospital of Orléans, F-45000 Orléans, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(12), 2113; https://doi.org/10.3390/jcm8122113
Submission received: 18 October 2019 / Revised: 28 November 2019 / Accepted: 29 November 2019 / Published: 2 December 2019
(This article belongs to the Special Issue Advances in Prosthetic Joint Infection Care)
Browse Figure
Versions Notes

Abstract

:
Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

1. Introduction

The management of prosthetic joint infection (PJI) is a major challenge for physicians, as its consequences can be devastating for the patient. One of the key points in the treatment strategy is time of microbiological diagnosis. Pre-operative samples may be useful for identifying bacteria before surgery, but documentation may be incomplete, compared to peroperative samples [1]. An empirical antimicrobial treatment (EAT) with antibiotics is settled after surgery in order to cover the bacteria most frequently isolated from PJI. A combination containing a beta-lactam, such as piperacillin/tazobactam or a third-generation cephalosporin, is recommended, associated to an antibiotic that has been shown to be effective against Gram-positive bacteria, methicillin-resistant staphylococci in particular [2,3,4,5]. Vancomycin, daptomycin or linezolid are suitable options for this application [6,7,8]. Bacterial identification tools allow a faster diagnosis, but no recommendation provides guidelines on the duration of this EAT and the right time to re-evaluate it [2,3,9]. The probabilistic antibiotics often used are not harmless, and severe adverse effects can occur, such as nephrotoxicity when the vancomycin being used is associated with piperacillin/tazobactam [10,11]. The goal of the present study was to describe the growth time of bacteria involved in hip or knee PJI in order to find out when EAT can be safely re-evaluated, according to microbiological results.

2. Materials and Methods

2.1. Study Population

From December 2010 to March 2012, 204 consecutive patients from seven French medical centres with confirmed hip or knee PJI were enrolled in a multicenter, prospective, observational, cross-sectional study [12]. All patients had five surgical samples. The present study is a secondary analysis of these data, focusing on 183 patients with culture-positive PJI.

2.2. Definition of PJI

Early postoperative PJI was suspected for patients with pain, disunion, necrosis, or wound dehiscence within the first month following prosthesis implantation. Late chronic PJI was suspected in the presence of chronic pain, as well as a loosened prosthesis, occurring more than 1 month after the index surgery [13,14]. In accordance with the Infectious Diseases Society of America (IDSA) guidelines, PJI was diagnosed when at least one of the following criteria was positive: (i) clinical criterion with the presence of a sinus tract communicating with the prosthesis and/or purulence around the prosthesis, and/or (ii) bacteriological criterion for infection (as specified below).
In the present study, only microbiologically documented PJIs were analysed.

2.3. Laboratory Analysis

Each solid sample was crushed by stainless-steel beads, on a Retsch MM401 (Retsch Technology Gmbh, Haan, Germany), after the addition of 10 mL of sterile water. One paediatric blood culture and a thioglycolate liquid broth (Schaedler) were inoculated with 1 mL and incubated for 14 days. A blood agar plate and a PolyViteX chocolate agar plate were inoculated with 50 µL and incubated for 7 days under a CO2-enriched atmosphere. Another blood agar plate was inoculated and incubated for 7 days in an anaerobic atmosphere. Joint fluids were inoculated on the same media [12].
Time to positivity was defined as the time of growth of the first positive medium in at least one sample for pathogens such as Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacterales, or anaerobes (excluding Cutibacterium acnes), and the time of growth of the first positive medium in at least two samples for commensals such as coagulase-negative staphylococci (CoNS) or C. acnes. The sustained diagnosis day of polymicrobial infections was the time of growth of the last identified bacteria.

2.4. Statistical Analysis

Pearson Χ2 test or Fisher’s exact test were performed to compare qualitative variables, according to sample sizes. A mean comparison of time of growth was performed with an unpaired Student’s t test. A p-value < 0.05 was considered statistically significant.

2.5. Ethics

The study protocol (PHRCI API/N/041) was approved by the institutional review board and ethics committee. Informed consent was obtained from each patient before inclusion.

3. Results

Among the 183 confirmed PJIs analysed, 28 were polymicrobial. Patient characteristics are detailed in Table 1. No significant difference was observed between the clinical features of monomicrobial and polymicrobial infection groups.
Time to growth was analysed for each medium of the five samples of each patient, representing 4575 culture media. Detailed data of time to positivity for each bacterium is available in Table 2. All isolates of S. aureus, streptococci, enterococci and Pseudomonas aeruginosa were retrieved by culture in five days or less. Among other bacterial species, only six bacteria grew between D5 and D14: two C. acnes, one Enterobacter cloacae, one S. epidermidis, one Corynebacterium urealyticum and one Prevotella sp. Three out of six patients concerned by late culture (two at D7 and one at D14) had received antibiotics in the previous 15 days. One of the C. acnes infections diagnosed at D7 already had one positive sample at D4.
When considering each bacterial species separately, time of growth was similar in both monomicrobial and polymicrobial infections. Also, there was no difference in mean time to positivity between acute and chronic infections (mean of 1.545 and 1.586, respectively; p = 0.8871).
Table 3 represents the day of microbiological diagnosis, for each patient (every culture media from every sample of the same patient was included), including polymicrobial data. Microbiological diagnosis was given between D1 and D5 for 96.7% (177/183) of cases (monomicrobial: 97.4% (151/155); polymicrobial: 92.9% (26/28)). Definitive diagnosis was given earlier in monomicrobial than in polymicrobial infections (p = 0.0034).

4. Discussion

The present work is the first multicentre study focused on time to positivity of PJI samples. The main finding is that 96.7% of PJIs with positive culture were diagnosed between day 1 (D1) and D5, including polymicrobial infections, when cultures are optimized (beadmill processing, inoculation of blood culture).
There is strong evidence that when introduced after surgery, EAT is associated with a higher remission rate [15,16]. This empirical treatment should ensure wide coverage of the bacteria responsible for PJI. While current guidelines do not provide any advice on the duration of empirical treatment, they do recommend bacterial cultivation time up to 14 days [2,3]. Keeping the cultures two weeks is sufficient to recover almost all of the bacteria conventionally involved in PJI, including anaerobes [12,17]. The isolation of C. acnes remains a difficult topic in implant-associated infections, but it seems that in proven PJI due to this bacteria, cultures are positive in 5 to 7 days, whereas they are positive later in cases of plate contamination [18,19].
Infection can be documented before surgery, by aspiration of synovial fluid or collection of blood cultures. The specificity of pre-operative aspiration culture for infection diagnosis is very high, but its sensitivity remains moderate [1]. Moreover, the identified bacterial species may not reflect the exact microbiology of the infection [20]. As a result, it is unwise to narrow the spectrum of EAT to pre-operative samples.
In this study, the definitive bacterial diagnosis was given earlier for monomicrobial than for polymicrobial infections, but almost all infections were diagnosed between D1 and D5. Taking these results into account, when cultures are optimized (beadmill processing, inoculation of blood culture), EAT can be switched to an adapted treatment as soon as the fifth day of laboratory culture.
Our results may not be transposable to PJI infections other than hip and knee. As the proportion of skin commensals like C. acnes is higher in shoulder PJI, further studies are needed to describe the time of growth of bacteria found in other PJI locations [19,21].
Two other teams have suggested new approaches designed to adapt probabilistic treatment. Benito and colleagues focused on the influence of route of acquisition and time after surgery on the microbiology of PJI [22]. In their prospective study, Triffault-Fillit and colleagues described the microbiology of PJI depending on time to occurrence [23]. These two studies suggest that few or no Gram-negative bacilli are isolated from late PJI. We think these data are complementary to our results. In our study, no conclusion can be made on hematogenous acute infection, as the relevant clinical data were not available. However, as no difference was observed between acute or chronic infection, we think our results can be applied to every situation of hip or knee PJI, regardless of the EAT chosen. The 7-day threshold may seem safer, but only four bacteria grew between D5 and D7 (three monomicrobial infections, one polymicrobial). Among them, two out of four (50%) patients received antibiotics in the previous 15 days, and one C. acnes grew in one sample at D4. In the case of negative cultures, modification or discontinuation of EAT should be discussed, as described in the decision algorithm suggested in Figure 1.
This algorithm can be used in any centre already performing optimized bacterial culture for PJI diagnosis, as it enables faster bacterial growth and higher sensitivity and specificity [12,24,25]. When following this algorithm, four out of six infections diagnosed after D5 can be anticipated (three had antibiotics, one had a positive sample at D4), without taking into account other factors such as biological markers (not available in this study). When cultures are negative at D5, molecular testing (bacteria-specific PCR, 16S rRNA PCR) should be considered earlier, in the case of antibiotic intake, high clinical suspicion of PJI, presence of a minor criteria from the latest Musculoskeletal Infection Society (MSIS) definition or if histopathology is in favour [12,26,27]. These criteria include both serum (C-reactive protein (CRP), D-dimer and erythrocyte sedimentation rate) and synovial markers (white blood cells count, polymorphonuclear percentage, leucocyte esterase, alpha-defensin and CRP). The search for fastidious germs, such as moulds or mycobacteria, may be discussed, as it requires specific media [28]. Intracellular bacteria, like Mycoplasma, are rare causes of PJI, but should be considered and searched with a specific PCR [29]. This strategy may save time, as specific research can be considered earlier.
Oral antibiotics may be used when re-evaluating EAT, as the Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA) trial demonstrated that switching to an oral regiment within 7 days after surgery was noninferior to intravenous antibiotic treatment, with significant cost savings [30,31]. Lack of stable venous access is a common difficulty that justifies earlier adaptation of the EAT. In addition to the benefits of early oral antibiotic administration, a shorter EAT should reduce the number of adverse effects due to broad-spectrum antibiotics. The combination of piperacillin/tazobactam plus vancomycin is becoming more and more widely criticized due to the increased risk of kidney injury compared to other broad-spectrum beta-lactams associated with vancomycin [10,11,32,33]. However, a short course does not seem to be associated with an increased risk of adverse renal outcomes [34]. A shorter probabilistic treatment may also be beneficial in the case of linezolid use, as it limits the development of drug resistance and reduces side-effects, which are associated with the treatment duration [7,8,35,36,37,38].

5. Conclusions

Our results suggest that the EATs of hip or knee PJI can be adapted at the fifth day of an optimized culture (beadmill processing, inoculation of blood culture). This will reduce the duration of the EAT used in PJI.

Author Contributions

Conceptualization: P.B. and C.P.; methodology: P.B.; validation: L.D., P.B., A.-S.V., A.J.-G., D.T., G.H.-A., C.L., M.K., L.B., C.B., S.C., and C.P.; formal analysis: L.D.; investigation: P.B., A.-S.V., A.J.-G., D.T., G.H.-A., C.L., M.K., L.B., C.B., S.C., and C.P.; writing—original draft preparation: L.D.; writing—review and editing: L.D., P.B., A.-S.V., A.J.-G., D.T., G.H.-A., C.L., M.K., L.B., C.B., S.C., and C.P.; visualization: L.D.; supervision: P.B. and C.P.; project administration: P.B.

Funding

This work was supported by a grant from the French Ministry of Health (Programme Hospitalier de Recherche Clinique Interrégionale grant API/N/041) and a grant from the Centre de Référence des Infections Ostéo-articulaires du Grand Ouest (CRIOGO). Parts of the manuscript were presented at the 29th ECCMID in Amsterdam, 2019.

Acknowledgments

We wish to thank Jeffrey Arsham, an American medical translator, for having edited our original English-language manuscript. The CRIOGO Study Team members included the following: P. Bizot, P. Abgueguen, C. Lemarie, R. Chenouard, M. Kempf (CHU Angers); R. Gérard, E. Stindel, S. Ansart, D. Tande, G. Héry-Arnaud (CHU Brest); S. Touchais, C. Nich, D. Boutoille, N. Asseray, P. Bémer, S. Corvec, AG Leroy, L. Happi, C. Bourigault, (CHU Nantes); L.E. Gayet, F. Roblot, G. Le Moal, C. Plouzeau, L. Deroche, C. Burucoa, (CHU Poitiers); J.L. Polard, C. Arvieux, A. Jolivet-Gougeon, A. Méheut, (CHU Rennes); P. Rosset, J. Druon, L. Bernard, G. Gras, A.S. Valentin (CHU Tours).

Conflicts of Interest

The authors declare no conflict of interest

References

  1. Rodriguez-Merchan, E.C. Preoperative Aspiration Culture (PAC) for the Diagnosis of Infection in a Prosthetic Knee Joint. Arch. Bone Jt. Surg. 2018, 6, 342–345. [Google Scholar] [PubMed]
  2. Spilf, O. Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Med. Mal. Infect. 2010, 40, 185–211. [Google Scholar] [CrossRef] [PubMed]
  3. Osmon, D.R.; Berbari, E.F.; Berendt, A.R.; Lew, D.; Zimmerli, W.; Steckelberg, J.M.; Rao, N.; Hanssen, A.; Wilson, W.R. Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin. Infect. Dis. 2013, 56, e1–e25. [Google Scholar] [CrossRef] [PubMed]
  4. Esposito, S.; Leone, S.; Bassetti, M.; Borrè, S.; Leoncini, F.; Meani, E.; Venditti, M.; Mazzotta, F.; Bone Joint Infections Committee for the Italian Society of Infectious Tropical Diseases (SIMIT). Italian guidelines for the diagnosis and infectious disease management of osteomyelitis and prosthetic joint infections in adults. Infection 2009, 37, 478–496. [Google Scholar] [CrossRef]
  5. Ariza, J.; Cobo, J.; Baraia-Etxaburu, J.; Benito, N.; Bori, G.; Cabo, J.; Corona, P.; Esteban, J.; Horcajada, J.P.; Lora-Tamayo, J.; et al. Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm. Infecc. Microbiol. Clin. 2017, 35, 189–195. [Google Scholar] [CrossRef]
  6. Joseph, C.; Robineau, O.; Titecat, M.; Putman, S.; Blondiaux, N.; Loiez, C.; Valette, M.; Schmit, J.; Beltrand, E.; Dézeque, H.; et al. Daptomycin versus Vancomycin as Post-Operative Empirical Antibiotic Treatment for Prosthetic Joint Infections: A Case-Control Study. J. Bone Jt. Infect. 2019, 4, 72–75. [Google Scholar] [CrossRef]
  7. Takoudju, E.; Bemer, P.; Touchais, S.; Asseray, N.; Corvec, S.; Khatchatourian, L.; Serandour, N.; Boutoille, D.; Nantes Bone and Joint Infections Study Group. Bacteriological relevance of linezolid versus vancomycin in postoperative empirical treatment of osteoarticular infections: A retrospective single-center study. Int. J. Antimicrob. Agents 2018, 52, 663–666. [Google Scholar] [CrossRef]
  8. Deroche, L.; Plouzeau, C.; Bémer, P.; Tandé, D.; Valentin, A.S.; Jolivet-Gougeon, A.; Lemarié, C.; Bret, L.; Kempf, M.; Héry-Arnaud, G.; et al. Probabilistic chemotherapy in knee and hip replacement infection: The place of linezolid. Eur. J. Clin. Microbiol. Infect. Dis. 2019, 38, 1659–1663. [Google Scholar] [CrossRef]
  9. Aalirezaie, A.; Bauer, T.W.; Fayaz, H.; Griffin, W.; Higuera, C.A.; Krenn, V.; Krenn, V.; Molano, M.; Moojen, D.-J.; Restrepo, C.; et al. Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J. Arthroplast. 2019, 34, S369–S379. [Google Scholar] [CrossRef]
  10. Rutter, W.C.; Burgess, D.S. Incidence of Acute Kidney Injury among Patients Treated with Piperacillin-Tazobactam or Meropenem in Combination with Vancomycin. Antimicrob. Agents Chemother. 2018, 62. [Google Scholar] [CrossRef]
  11. Triffault-Fillit, C.; Valour, F.; Guillo, R.; Tod, M.; Goutelle, S.; Lustig, S.; Fessy, M.-H.; Chidiac, C.; Ferry, T.; Lyon BJI Study Group. Prospective Cohort Study of the Tolerability of Prosthetic Joint Infection Empirical Antimicrobial Therapy. Antimicrob. Agents Chemother. 2018, 62, e00163-18. [Google Scholar] [CrossRef] [PubMed]
  12. Bémer, P.; Plouzeau, C.; Tande, D.; Léger, J.; Giraudeau, B.; Valentin, A.S.; Jolivet-Gougeon, A.; Vincent, P.; Corvec, S.; Gibaud, S.; et al. Evaluation of 16S rRNA Gene PCR Sensitivity and Specificity for Diagnosis of Prosthetic Joint Infection: A Prospective Multicenter Cross-Sectional Study. J. Clin. Microbiol. 2014, 52, 3583–3589. [Google Scholar] [CrossRef] [PubMed]
  13. Tsukayama, D.T.; Estrada, R.; Gustilo, R.B. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J. Bone Jt. Surg. Am. 1996, 78, 512–523. [Google Scholar] [CrossRef] [PubMed]
  14. Tsukayama, D.T.; Goldberg, V.M.; Kyle, R. Diagnosis and management of infection after total knee arthroplasty. J. Bone Jt. Surg. Am. 2003, 85, S75–S80. [Google Scholar] [CrossRef] [PubMed]
  15. Senneville, E.; Joulie, D.; Legout, L.; Valette, M.; Dezèque, H.; Beltrand, E.; Roselé, B.; d’Escrivan, T.; Loïez, C.; Caillaux, M.; et al. Outcome and Predictors of Treatment Failure in Total Hip/Knee Prosthetic Joint Infections Due to Staphylococcus aureus. Clin. Infect. Dis. 2011, 53, 334–340. [Google Scholar] [CrossRef] [PubMed]
  16. Peel, T.N.; Cheng, A.C.; Choong, P.F.M.; Buising, K.L. Early onset prosthetic hip and knee joint infection: Treatment and outcomes in Victoria, Australia. J. Hosp. Infect. 2012, 82, 248–253. [Google Scholar] [CrossRef]
  17. Rieber, H.; Frontzek, A.; Jerosch, J.; Alefeld, M.; Strohecker, T.; Ulatowski, M.; Morawietz, T.; Hinsenkamp, S.; Bell, A.; Kücükköylü, D.; et al. Periprosthetic joint infection caused by anaerobes. Retrospective analysis reveals no need for prolonged cultivation time if sensitive supplemented growth media are used. Anaerobe 2018, 50, 12–18. [Google Scholar] [CrossRef]
  18. Renz, N.; Mudrovcic, S.; Perka, C.; Trampuz, A. Orthopedic implant-associated infections caused by Cutibacterium spp.—A remaining diagnostic challenge. PLoS ONE 2018, 13, e0202639. [Google Scholar] [CrossRef]
  19. Bossard, D.A.; Ledergerber, B.; Zingg, P.O.; Gerber, C.; Zinkernagel, A.S.; Zbinden, R.; Achermann, Y. Optimal Length of Cultivation Time for Isolation of Propionibacterium acnes in Suspected Bone and Joint Infections Is More than 7 Days. J. Clin. Microbiol. 2016, 54, 3043–3049. [Google Scholar] [CrossRef]
  20. Holleyman, R.J.; Deehan, D.J.; Charlett, A.; Gould, K.; Baker, P.N. Does pre-operative sampling predict intra-operative cultures and antibiotic sensitivities in knee replacements revised for infection? A study using the NJR dataset. Knee Surg. Sports Traumatol. Arthrosc. 2016, 24, 3056–3063. [Google Scholar] [CrossRef]
  21. Frangiamore, S.; Saleh, A.; Grosso, M.; Alolabi, B.; Bauer, T.; Iannotti, J.; Ricchetti, E. Early Versus Late Culture Growth of Propionibacterium acnes in Revision Shoulder Arthroplasty. J. Bone Jt. Surg. 2015, 97, 1149–1158. [Google Scholar] [CrossRef] [PubMed]
  22. Benito, N.; Mur, I.; Ribera, A.; Soriano, A.; Rodríguez-Pardo, D.; Sorlí, L.; Cobo, J.; Fernández-Sampedro, M.; del Toro, M.D.; Guío, L.; et al. The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms. J. Clin. Med. 2019, 8, 673. [Google Scholar] [CrossRef] [PubMed]
  23. Triffault-Fillit, C.; Ferry, T.; Laurent, F.; Pradat, P.; Dupieux, C.; Conrad, A.; Becker, A.; Lustig, S.; Fessy, M.H.; Chidiac, C.; et al. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: A prospective cohort study. Clin. Microbiol. Infect. 2019, 25, 353–358. [Google Scholar] [CrossRef] [PubMed]
  24. Trampuz, A.; Piper, K.E.; Jacobson, M.J.; Hanssen, A.D.; Unni, K.K.; Osmon, D.R.; Mandrekar, J.N.; Cockerill, F.R.; Steckelberg, J.M.; Greenleaf, J.F.; et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N. Engl. J. Med. 2007, 357, 654–663. [Google Scholar] [CrossRef]
  25. Peel, T.N.; Dylla, B.L.; Hughes, J.G.; Lynch, D.T.; Greenwood-Quaintance, K.E.; Cheng, A.C.; Mandrekar, J.N.; Patel, R. Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles. mBio 2016, 7, e01776-15. [Google Scholar] [CrossRef]
  26. Bémer, P.; Léger, J.; Milin, S.; Plouzeau, C.; Valentin, A.S.; Stock, N.; Jolivet-Gougeon, A.; Moreau, A.; Corvec, S.; Quintin-Roue, I.; et al. Histopathological Diagnosis of Prosthetic Joint Infection: Does a Threshold of 23 Neutrophils Do Better than Classification of the Periprosthetic Membrane in a Prospective Multicenter Study? J. Clin. Microbiol. 2018, 56, e00536-18. [Google Scholar] [CrossRef]
  27. Parvizi, J.; Tan, T.L.; Goswami, K.; Higuera, C.; Della Valle, C.; Chen, A.F.; Shohat, N. The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J. Arthroplast. 2018, 33, 1309–1314.e2. [Google Scholar] [CrossRef]
  28. Parvizi, J.; Erkocak, O.; Valle, C.D. Culture-Negative Periprosthetic Joint Infection. J. Bone Jt. Surg. 2014, 96, 430–436. [Google Scholar] [CrossRef]
  29. Rieber, H.; Frontzek, A.; Fischer, M. Periprosthetic joint infection associated with Mycoplasma hominis after transurethral instrumentation in an immunocompetent patient. Unusual or underestimated? A case report and review of the literature. Int. J. Infect. Dis. 2019, 82, 86–88. [Google Scholar] [CrossRef]
  30. Li, H.K.; Rombach, I.; Zambellas, R.; Walker, A.S.; McNally, M.A.; Atkins, B.L.; Lipsky, B.A.; Hughes, H.C.; Bose, D.; Kümin, M.; et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection. N. Engl. J. Med. 2019, 380, 425–436. [Google Scholar] [CrossRef]
  31. Marks, M.; Bell, L.C.K.; Jones, I.; Rampling, T.; Kranzer, K.; Morris-Jones, S.; Logan, S.; Pollara, G. Clinical and economic impact of implementing OVIVA criteria on patients with bone and joint infections in OPAT. Clin. Infect. Dis. 2019. [Google Scholar] [CrossRef] [PubMed]
  32. Navalkele, B.; Pogue, J.M.; Karino, S.; Nishan, B.; Salim, M.; Solanki, S.; Pervaiz, A.; Tashtoush, N.; Shaikh, H.; Koppula, S.; et al. Risk of Acute Kidney Injury in Patients on Concomitant Vancomycin and Piperacillin–Tazobactam Compared to Those on Vancomycin and Cefepime. Clin. Infect. Dis. 2017, 64, 116–123. [Google Scholar] [CrossRef] [PubMed]
  33. Luther, M.K.; Timbrook, T.T.; Caffrey, A.R.; Dosa, D.; Lodise, T.P.; LaPlante, K.L. Vancomycin Plus Piperacillin-Tazobactam and Acute Kidney Injury in Adults: A Systematic Review and Meta-Analysis. Crit. Care Med. 2018, 46, 12–20. [Google Scholar] [CrossRef] [PubMed]
  34. Schreier, D.J.; Kashani, K.B.; Sakhuja, A.; Mara, K.C.; Tootooni, M.S.; Personett, H.A.; Nelson, S.; Rule, A.D.; Steckelberg, J.M.; Tande, A.J.; et al. Incidence of acute kidney injury among critically ill patients with brief empiric use of anti-pseudomonal beta-lactams with vancomycin. Clin. Infect. Dis. 2018, 68, 1456–1462. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  35. Weßels, C.; Strommenger, B.; Klare, I.; Bender, J.; Messler, S.; Mattner, F.; Krakau, M.; Werner, G.; Layer, F. Emergence and control of linezolid-resistant Staphylococcus epidermidis in an ICU of a German hospital. J. Antimicrob. Chemother. 2018, 73, 1185–1193. [Google Scholar] [CrossRef] [PubMed]
  36. Dortet, L.; Glaser, P.; Kassis-Chikhani, N.; Girlich, D.; Ichai, P.; Boudon, M.; Samuel, D.; Creton, E.; Imanci, D.; Bonnin, R.; et al. Long-lasting successful dissemination of resistance to oxazolidinones in MDR Staphylococcus epidermidis clinical isolates in a tertiary care hospital in France. J. Antimicrob. Chemother. 2018, 73, 41–51. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  37. Beekmann, S.E.; Gilbert, D.N.; Polgreen, P.M. Toxicity of extended courses of linezolid: Results of an Infectious Diseases Society of America Emerging Infections Network survey. Diagn. Microbiol. Infect. Dis. 2008, 62, 407–410. [Google Scholar] [CrossRef]
  38. Boak, L.M.; Rayner, C.R.; Grayson, M.L.; Paterson, D.L.; Spelman, D.; Khumra, S.; Capitano, B.; Forrest, A.; Li, J.; Nation, R.L.; et al. Clinical Population Pharmacokinetics and Toxicodynamics of Linezolid. Antimicrob. Agents Chemother. 2014, 58, 2334–2343. [Google Scholar] [CrossRef] [Green Version]
Jcm 08 02113 g001 550
Figure 1. Algorithm proposal for the time of re-evaluation of empirical antimicrobial treatment and supplementary microbiological diagnosis of hip or knee prosthetic joint infection.
Figure 1. Algorithm proposal for the time of re-evaluation of empirical antimicrobial treatment and supplementary microbiological diagnosis of hip or knee prosthetic joint infection.
Jcm 08 02113 g001
Table
Table 1. Clinical features of the 183 cases of hip or knee prosthetic joint infection, according to the monomicrobial or polymicrobial type of infection.
Table 1. Clinical features of the 183 cases of hip or knee prosthetic joint infection, according to the monomicrobial or polymicrobial type of infection.
VariableMonomicrobial Infections (n = 155)Polymicrobial Infections (n = 28)All Infections
(n = 183)
Mean age (year +/- SD)71.4 ± 13.270.3 ± 11.671.5 ± 13.3
Male sex (no. [%])85 (54.8)12 (42.9)97 (53.0)
Location of arthroplasty (no. [%])
Knee53 (34.2)6 (21.4)59 (32.2)
Hip102 (65.8)22 (78.6)124 (67.8)
Presentation of infection (no. [%])
Acute infection (<1 month)33 (21.3)10 (35.7)43 (23.5)
Chronic infection (>1 month)122 (78.7)18 (64.3)140 (76.5)
Type of surgery (no. [%])
Debridement with retention48 (31.0)11 (39.3)59 (32.2)
One-stage technique43 (27.7)4 (14.3)47 (25.7)
Two-stage technique52 (33.5)9 (32.1)61 (33.3)
Permanent explantation of joint prosthesis5 (3.2)3 (10.7)8 (4.4)
Data not available7 (4.5)1 (3.6)8 (4.4)
Number of previous joint surgeries (no. [%])
183 (53.5)16 (57.1)99 (54.1)
249 (31.6)5 (17.9)54 (29.5)
≥316 (10.3)6 (21.4)22 (12.0)
Data not available7 (4.5)1 (3.6)8 (4.4)
Antibiotherapy in the 15 days before surgery
(no. [%]) a		44 (28.4)10 (35.7)54 (29.5)
β-lactams21 (47.7)5 (50.0)26 (48.1)
Pristinamycin3 (6.8)03 (5.6)
Clindamycin2 (4.5)02 (3.7)
Rifampin4 (9.1)04 (7.4)
Fluoroquinolones8 (18.2)1 (10.0)9 (16.7)
Cotrimoxazole5 (11.4)2 (20.0)7 (13.0)
Others13 (29.5)3 (30.0)16 (29.6)
a, some patients received two antibiotics; No significant difference in clinical features was observed between monomicrobial and polymicrobial infections; Percentages may not total 100 because of rounding.
Table
Table 2. Time of growth for each type of bacteria isolated in hip and knee PJI, according to the monomicrobial (M) or polymicrobial (P) type of infection.
Table 2. Time of growth for each type of bacteria isolated in hip and knee PJI, according to the monomicrobial (M) or polymicrobial (P) type of infection.
S. aureus
(n = 75)		CoNS *
(n = 58)		Streptococci
(n = 32)		Gram-Negative Bacilli (n = 32)Anaerobes
(n = 8)		C. acnes
(n = 7)		Others **
(n = 11)
Enterobacterales (n = 26)P. aeruginosa
(n = 6)
Mono- or Polymicrobial infectionMPMPMPMPMPMPMPMP
Day 15412381019101014221 43
Day 221633 1 2 14 2
Day 3 1 2
Day 4 1 1
Day 521 111
Day 7 1 1 11
Day 14 1 1
Jcm 08 02113 i001 Jcm 08 02113 i001 Jcm 08 02113 i001 Jcm 08 02113 i001
p-value0.21350.89460.23320.2176NCNCNCNC
*, CoNS: coagulase-negative staphylococci; **, Others: Corynebacterium sp. (n = 6), Listeria monocytogenes (n = 2), Bacillus cereus (n = 1), Actinomyces sp. (n = 1), Capnocytophaga canimorsus (n = 1); M: Monomicrobial infections; P: Polymicrobial infections; p-values were used to compare the mean time of growth in monomicrobial versus polymicrobial infections; NC: not calculated due to low n.
Table
Table 3. Cumulative number of infections diagnosed, according to the day of bacterial culture (monomicrobial or polymicrobial prosthetic joint infection).
Table 3. Cumulative number of infections diagnosed, according to the day of bacterial culture (monomicrobial or polymicrobial prosthetic joint infection).
Monomicrobial
(n = 155)		Polymicrobial
(n = 28)		Both
(n = 183)
n%n%n%
Day 113083.91657.114679.8
Day 214694.22175.016791.3
Day 314794.82278.616992.3
Day 414895.52382.117193.4
Day 515197.42692.917796.7
Day 715499.42796.418198.9
Day 14155100.028100.0183100.0

Share and Cite

MDPI and ACS Style

Deroche, L.; Bémer, P.; Valentin, A.-S.; Jolivet-Gougeon, A.; Tandé, D.; Héry-Arnaud, G.; Lemarié, C.; Kempf, M.; Bret, L.; Burucoa, C.; et al. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. J. Clin. Med. 2019, 8, 2113. https://doi.org/10.3390/jcm8122113

AMA Style

Deroche L, Bémer P, Valentin A-S, Jolivet-Gougeon A, Tandé D, Héry-Arnaud G, Lemarié C, Kempf M, Bret L, Burucoa C, et al. The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. Journal of Clinical Medicine. 2019; 8(12):2113. https://doi.org/10.3390/jcm8122113

Chicago/Turabian Style

Deroche, Luc, Pascale Bémer, Anne-Sophie Valentin, Anne Jolivet-Gougeon, Didier Tandé, Geneviève Héry-Arnaud, Carole Lemarié, Marie Kempf, Laurent Bret, Christophe Burucoa, and et al. 2019. "The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections" Journal of Clinical Medicine 8, no. 12: 2113. https://doi.org/10.3390/jcm8122113

APA Style

Deroche, L., Bémer, P., Valentin, A.-S., Jolivet-Gougeon, A., Tandé, D., Héry-Arnaud, G., Lemarié, C., Kempf, M., Bret, L., Burucoa, C., Corvec, S., & Plouzeau, C. (2019). The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections. Journal of Clinical Medicine, 8(12), 2113. https://doi.org/10.3390/jcm8122113

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop