Multiflora and Gram-Negative Microorganisms Predominate in Infections Affecting Pelvic Endoprostheses Following Tumor Resection
| Autor: | Jos A. M. Bramer, P. D. S. Dijkstra, P. T. J. Sanders, M. A. J. van de Sande, M.G.J. de Boer, R. J. P. van der Wal, M. P. A. Bus, Henk Scheper, Gerard R. Schaap |
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| Přispěvatelé: | Orthopedic Surgery and Sports Medicine, APH - Personalized Medicine, APH - Quality of Care, AMS - Musculoskeletal Health |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty Prosthesis-Related Infections Fistula medicine.medical_treatment Arthroplasty Replacement Hip Periprosthetic Bone Neoplasms 030218 nuclear medicine & medical imaging 03 medical and health sciences Young Adult 0302 clinical medicine Epidemiology Gram-Negative Bacteria medicine Humans Orthopedics and Sports Medicine Pelvic Bones Aged Retrospective Studies 030222 orthopedics business.industry Retrospective cohort study General Medicine Middle Aged medicine.disease Antimicrobial Arthroplasty Surgery Debridement Female Implant Hip Prosthesis business Gram-Negative Bacterial Infections Cohort study |
| Zdroj: | Journal of Bone and Joint Surgery, 101(9), 797-803 Journal of bone and joint surgery. American volume, 101(9), 797-803. Journal of Bone and Joint Surgery Inc. |
| ISSN: | 0021-9355 |
| Popis: | BACKGROUND: Periprosthetic infections after pelvic reconstruction are common, with reported rates ranging from 11% to 53%. Management of these infections is troublesome, as they commonly necessitate multiple surgical interventions and implant removal. The epidemiology and outcomes of these infections are largely unknown. The aim of this study was to analyze the causative microorganisms and the clinical outcome of treatment in a series of patients with pelvic endoprostheses affected by infection following tumor resection. METHODS: In this retrospective, multicenter cohort study, we identified all patients who developed an infection after endoprosthetic reconstruction in periacetabular tumor resection, between 2003 and 2017. The microorganisms that were isolated during the first debridement were recorded, as were the number of reoperations for ongoing infection, the antimicrobial treatment strategy, and the outcome of treatment. RESULTS: In a series of 70 patients who underwent pelvic endoprosthetic reconstruction, 18 (26%) developed an infection. The type of pelvic resection according to the Enneking-Dunham classification was type P2-3 in 14 (78%) of these patients and type P2 in 4 (22%). Median follow-up was 66 months. Fourteen (78%) of the 18 patients with infection had a polymicrobial infection. Enterobacteriaceae were identified on culture for 12 (67%). Of a total 42 times that a microorganism was isolated, the identified pathogen was gram-negative in 26 instances (62%). Microorganisms associated with intestinal flora were identified 32 times (76%). At the time of latest follow-up, 9 (50%) of the patients had the original implant in situ. Of these, 2 had a fistula and another 2 were receiving suppressive antibiotic therapy. In the remaining 9 (50%) of the patients, the original implant had been removed. At the time of final follow-up, 3 of these had a second implant in situ. The remaining 6 patients had undergone no secondary reconstruction. CONCLUSIONS: Infections that affect pelvic endoprostheses are predominantly polymicrobial and caused by gram-negative microorganisms, and may be associated with intestinal flora. This differs fundamentally from mono-bacterial gram-positive causes of conventional periprosthetic joint infections and may indicate a different pathogenesis. Our results suggest that prophylaxis and empiric treatment may need to be re-evaluated. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
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