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Current Reviews in Musculoskeletal Medicine

Published in:

01-09-2018 | Prosthetic Joint Infection (S Nodzo and N Frisch, section editors)

Low-Virulence Organisms and Periprosthetic Joint Infection—Biofilm Considerations of These Organisms

Authors: K. Keely Boyle, Stuart Wood, T. David Tarity

Published in: Current Reviews in Musculoskeletal Medicine | Issue 3/2018

Abstract

Purpose of Review

The purpose of this manuscript is to provide a critical review of peer-reviewed literature over the last 5 years related to low virulent organisms associated with periprosthetic joint infection (PJI). We evaluated the most common organisms, the diagnostic challenges, and the novel tools available in the perioperative workup of PJI as well as the current understanding of how biofilm potentiates the indolent clinical presentation and explore a possible shift in the surgical management of these patients.

Recent Findings

Biofilm actively prevents macrophage phagocytosis by suppressing proinflammatory activity through the recruitment of myeloid-derived suppressor cells. Given the appropriate host and organism conditions, increased utilization of one-stage exchange arthroplasty in the surgical treatment of these low virulent infections may be on the rise.

Summary

Biomarkers and molecular techniques offer encouraging results to diagnose low virulent organisms and future research focused on the disruption of biofilm may ultimately give rise to improved treatment strategies.

Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51. https://doi.org/10.1007/s11999-009-0945-0.CrossRefPubMed

•• Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current epidemiology of revision Total knee arthroplasty in the United States. J Arthroplast. 2017;32(9):2663–8. https://doi.org/10.1016/j.arth.2017.03.066. Clinical, economic, and demongraphic data were collected and analyzed for 337,597 procedures. Infection was the most common etiology for revision TKA (20.4%), closely followed by mechanical loosening (20.3%). Medicare primary payor for freatest porportion of revisions (57.7%), with mean total charge for revision TKA $75.028.07. CrossRef

Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA, et al. Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplast. 2017;32(7):2088–92. https://doi.org/10.1016/j.arth.2017.02.046.CrossRef

Singh JA, Sperling JW, Schleck C, Harmsen WS, Cofield RH. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elb Surg. 2012;21(11):1534–41. https://doi.org/10.1016/j.jse.2012.01.006.CrossRef

Patton D, Kiewiet N, Brage M. Infected total ankle arthroplasty: risk factors and treatment options. Foot Ankle Int. 2015;36(6):626–34. https://doi.org/10.1177/1071100714568869.CrossRefPubMed

• Krukhaug Y, Hallan G, Dybvik E, Lie SA, Furnes ON. A survivorship study of 838 total elbow replacements: a report from the Norwegian Arthroplasty Register 1994–2016. J Shoulder Elb Surg. 2018;27(2):260–9. https://doi.org/10.1016/j.jse.2017.10.018. Most frequent reason for revision surgery was aseptic loosening, followed by defective polyethylene, infection and dislocation. CrossRef

Centers for Disease Control and Prevention. Cost of hospital discharges with common hospital operating room procedures in nonfederal community hospitals, by age and selected principle procedure: United States, selected years 2000–2012.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780–5. https://doi.org/10.2106/JBJS.F.00222.PubMedCrossRef

Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93(24):2249–54. https://doi.org/10.2106/JBJS.J.01994.CrossRefPubMed

10.

Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468(1):52–6. https://doi.org/10.1007/s11999-009-1013-5.CrossRefPubMed

11.

Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplast. 2012;27(8 Suppl):61–5 e1. https://doi.org/10.1016/j.arth.2012.02.022.CrossRef

12.

de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009;37(5):387–97. https://doi.org/10.1016/j.ajic.2008.12.010.CrossRefPubMed

13.

Al-Mulhim FA, Baragbah MA, Sadat-Ali M, Alomran AS, Azam MQ. Prevalence of surgical site infection in orthopedic surgery: a 5-year analysis. Int Surg. 2014;99(3):264–8. https://doi.org/10.9738/INTSURG-D-13-00251.1.CrossRefPubMedPubMedCentral

14.

Bozic KJ, Ries MD. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am. 2005;87(8):1746–51. https://doi.org/10.2106/JBJS.D.02937.PubMedCrossRef

15.

Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. 2013;95-B(11):1450–2. https://doi.org/10.1302/0301-620X.95B11.33135.CrossRefPubMed

16.

Berend KR, Lombardi AV Jr, Morris MJ, Bergeson AG, Adams JB, Sneller MA. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471(2):510–8. https://doi.org/10.1007/s11999-012-2595-x.CrossRefPubMed

17.

Sherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A, et al. The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection. Clin Orthop Relat Res. 2011;469(1):18–25. https://doi.org/10.1007/s11999-010-1434-1.CrossRefPubMed

18.

Fehring TK, Odum SM, Berend KR, Jiranek WA, Parvizi J, Bozic KJ, et al. Failure of irrigation and debridement for early postoperative periprosthetic infection. Clin Orthop Relat Res. 2013;471(1):250–7. https://doi.org/10.1007/s11999-012-2373-9.CrossRefPubMed

19.

•• Bryan AJ, Abdel MP, Sanders TL, Fitzgerald SF, Hanssen AD, Berry DJ. Irrigation and debridement with component retention for acute infection after hip arthroplasty: improved results with contemporary management. J Bone Joint Surg Am. 2017;99(23):2011–8. https://doi.org/10.2106/JBJS.16.01103. Treatment failure occurred in 17% (15 of 90 hips), with component removal secondary to recurrent infection in 10%. Systemic host grade A (McPherson) was predictive of treatment success. CrossRefPubMed

20.

•• Nodzo SR, Boyle KK, Nocon AA, Henry MW, Mayman DJ, Westrich GH. The influence of a failed irrigation and debridement on the outcomes of a subsequent 2-stage revision knee arthroplasty. J Arthroplast. 2017;32(8):2508–12. https://doi.org/10.1016/j.arth.2017.03.026. Retropective review of 132 patients who underwent a 2-stage exchange without prior I&D and 45 patients who had a failed I&D before a 2-stage exchange. Success rates between groups were similar (82.2 and 82.5% respectively). Use of greater than 2 g of vancomycin in the spacer construct decreased the odds of reoperation. CrossRef

21.

Grosso MJ, Sabesan VJ, Ho JC, Ricchetti ET, Iannotti JP. Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures. J Shoulder Elb Surg. 2012;21(6):754–8. https://doi.org/10.1016/j.jse.2011.08.052.CrossRef

22.

Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 2007;89(7):1605–18. https://doi.org/10.2106/JBJS.F.00901.PubMedCrossRef

23.

Nickinson RS, Board TN, Gambhir AK, Porter ML, Kay PR. The microbiology of the infected knee arthroplasty. Int Orthop. 2010;34(4):505–10. https://doi.org/10.1007/s00264-009-0797-y.CrossRefPubMed

24.

• Rothenberg AC, Wilson AE, Hayes JP, O'Malley MJ, Klatt BA. Sonication of arthroplasty implants improves accuracy of Periprosthetic joint infection cultures. Clin Orthop Relat Res. 2017;475(7):1827–36. https://doi.org/10.1007/s11999-017-5315-8. Routine use of implant sonicate cultures in arthroplasty revisions improves the diagnostic sensitivity for detecting the presence of bacteria in both clinical and occult infections. CONS was the most prevalent organims retreived. CrossRefPubMedPubMedCentral

25.

Shanmugasundaram S, Ricciardi BF, Briggs TW, Sussmann PS, Bostrom MP. Evaluation and management of periprosthetic joint infection—an international, multicenter study. HSS J. 2014;10(1):36–44. https://doi.org/10.1007/s11420-013-9366-4.CrossRefPubMed

26.

Gomez E, Cazanave C, Cunningham SA, Greenwood-Quaintance KE, Steckelberg JM, Uhl JR, et al. Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol. 2012;50(11):3501–8. https://doi.org/10.1128/JCM.00834-12.CrossRefPubMedPubMedCentral

27.

Bare J, MacDonald SJ, Bourne RB. Preoperative evaluations in revision total knee arthroplasty. Clin Orthop Relat Res. 2006;446:40–4. https://doi.org/10.1097/01.blo.0000218727.14097.d5.CrossRefPubMed

28.

• Stone GP, Clark RE, O’Brien KC, Vaccaro L, Simon P, Lorenzetti AJ, et al. Surgical management of periprosthetic shoulder infections. J Shoulder Elb Surg. 2017;26(7):1222–9. https://doi.org/10.1016/j.jse.2016.11.054. Patients with infection caused by Staphylococcus aureus or coagulase-negative Staphylococcus species may require additional operations to treat the infection. Although effective in some cases, component exchange presents an increased risk for reinfection. A 1-stage CRR procedure had similar reinfection rates as a 2-stage procedure in our patient population. CrossRef

29.

Mortazavi SM, Vegari D, Ho A, Zmistowski B, Parvizi J. Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res. 2011;469(11):3049–54. https://doi.org/10.1007/s11999-011-2030-8.CrossRefPubMedPubMedCentral

30.

Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg Am. 2014;96(5):430–6. https://doi.org/10.2106/JBJS.L.01793.CrossRefPubMed

31.

•• Tarabichi M, Shohat N, Goswami K, Alvand A, Silibovsky R, Belden K, et al. Diagnosis of periprosthetic joint infection: the potential of next-generation sequencing. J Bone Joint Surg Am. 2018;100(2):147–54. https://doi.org/10.2106/JBJS.17.00434. Next-generation sequecing may be a useful adjunct in identification of the causative organisms in culture-negative PJI. Some cases of monomicrobial PJI may have additional organisms that escape detection when culture is used. CrossRefPubMed

32.

Piper KE, Fernandez-Sampedro M, Steckelberg KE, Mandrekar JN, Karau MJ, Steckelberg JM, et al. C-reactive protein, erythrocyte sedimentation rate and orthopedic implant infection. PLoS One. 2010;5(2):e9358. https://doi.org/10.1371/journal.pone.0009358.CrossRefPubMedPubMedCentral

33.

Achermann Y, Goldstein EJ, Coenye T, Shirtliff ME. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clin Microbiol Rev. 2014;27(3):419–40. https://doi.org/10.1128/CMR.00092-13. CrossRefPubMedPubMedCentral

34.

• Perez-Prieto D, Portillo ME, Puig-Verdie L, Alier A, Martinez S, Sorli L, et al. C-reactive protein may misdiagnose prosthetic joint infections, particularly chronic and low-grade infections. Int Orthop. 2017;41(7):1315–9. https://doi.org/10.1007/s00264-017-3430-5. Per the American Association of Orthopaedic Surgeons (AAOS) guidelines or the Musculoskeletal Infection Society (MSIS), 23% of the patients in the present study with PJI would never have been identified. Blood inflammatory markers such as the CRP level and ESR may not be accurate as diagnostic tools in PJI, particularly to identify low-grade and chronic PJI. CrossRefPubMed

35.

• Sethi PM, Sabetta JR, Stuek SJ, Horine SV, Vadasdi KB, Greene RT, et al. Presence of Propionibacterium acnes in primary shoulder arthroscopy: results of aspiration and tissue cultures. J Shoulder Elb Surg. 2015;24(5):796–803. https://doi.org/10.1016/j.jse.2014.09.042. Samples were collected from 57 patients undergoing first-time shoulder arthroscopy; 56% had at least 1 positive culture; 21% (of all 371 culture specimens obtained) grew P. acnes. We suspect that it is a consequence of true positive cultures from imperfect skin preparation and dermal contamination. CrossRef

36.

• Figa R, Muneton D, Gomez L, Matamala A, Lung M, Cuchi E, et al. Periprosthetic joint infection by propionibacterium acnes: clinical differences between monomicrobial versus polymicrobial infection. Anaerobe. 2017;44:143–9. https://doi.org/10.1016/j.anaerobe.2017.03.008. There were no significant differences between monomicrobial and polymicrobial P. acnes PJI outcomes. ESR, CRP, and histologic study are established parameters for diagnosing PJI, which did not prove useful in P. acnes PJI. CrossRefPubMed

37.

Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, Dicarlo E, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elb Surg. 2010;19(2):303–7. https://doi.org/10.1016/j.jse.2009.07.065.CrossRef

38.

Butler-Wu SM, Burns EM, Pottinger PS, Magaret AS, Rakeman JL, Matsen FA 3rd, et al. Optimization of periprosthetic culture for diagnosis of Propionibacterium acnes prosthetic joint infection. J Clin Microbiol. 2011;49(7):2490–5. https://doi.org/10.1128/JCM.00450-11.CrossRefPubMedPubMedCentral

39.

•• Yoon HK, Cho SH, Lee DY, Kang BH, Lee SH, Moon DG, et al. A review of the literature on culture-negative periprosthetic joint infection: epidemiology, diagnosis and treatment. Knee Surg Relat Res. 2017;29(3):155–64. https://doi.org/10.5792/ksrr.16.034. The prevalence of CN PJI ranged from 0 to 42.1%. The major risk factors for CN PJI were prior antibiotic use and presence of postoperative wound drainage. Vancomycin and cephalosporins were the most commonly used antibiotics for CN PJI. Two-stage revision arthroplasty followed by 6 weeks of antibiotic therapy produced the most successful treatment outcomes. CrossRefPubMedPubMedCentral

40.

•• Lee YS, Koo KH, Kim HJ, Tian S, Kim TY, Maltenfort MG, et al. Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2017;99(24):2077–84. https://doi.org/10.2106/JBJS.17.00123. Synovial fluid leukocyte count, PMN%, CRP, α-defensin, LE, IL-6, and IL-8 all demonstrated high sensitivity for diagnosing PJI, with α-defensin being the best synovial marker. However, other synovial fluid tests that demonstrate good diagnostic performance can also be used in combination for the diagnosis of PJI. CrossRefPubMed

41.

Deirmengian C, Kardos K, Kilmartin P, Gulati S, Citrano P, Booth RE Jr. The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms. Clin Orthop Relat Res. 2015;473(7):2229–35. https://doi.org/10.1007/s11999-015-4152-x.CrossRefPubMedPubMedCentral

42.

Holinka J, Bauer L, Hirschl AM, Graninger W, Windhager R, Presterl E. Sonication cultures of explanted components as an add-on test to routinely conducted microbiological diagnostics improve pathogen detection. J Orthop Res. 2011;29(4):617–22. https://doi.org/10.1002/jor.21286.CrossRefPubMed

43.

Puig-Verdie L, Alentorn-Geli E, Gonzalez-Cuevas A, Sorli L, Salvado M, Alier A, et al. Implant sonication increases the diagnostic accuracy of infection in patients with delayed, but not early, orthopaedic implant failure. Bone Joint J. 2013;95-B(2):244–9. https://doi.org/10.1302/0301-620X.95B2.30486.CrossRefPubMed

44.

• Grosso MJ, Frangiamore SJ, Yakubek G, Bauer TW, Iannotti JP, Ricchetti ET. Performance of implant sonication culture for the diagnosis of periprosthetic shoulder infection. J Shoulder Elb Surg. 2018;27(2):211–6. https://doi.org/10.1016/j.jse.2017.08.008. Implant sonication fluid culture in revision shoulder arthroplasty showed no significant benefits over standard intraoperative cultures in diagnostic utility for periprosthetic joint infection. CrossRef

45.

Jacovides CL, Kreft R, Adeli B, Hozack B, Ehrlich GD, Parvizi J. Successful identification of pathogens by polymerase chain reaction (PCR)-based electron spray ionization time-of-flight mass spectrometry (ESI-TOF-MS) in culture-negative periprosthetic joint infection. J Bone Joint Surg Am. 2012;94(24):2247–54. https://doi.org/10.2106/JBJS.L.00210.CrossRefPubMed

46.

Melendez DP, Uhl JR, Greenwood-Quaintance KE, Hanssen AD, Sampath R, Patel R. Detection of prosthetic joint infection by use of PCR-electrospray ionization mass spectrometry applied to synovial fluid. J Clin Microbiol. 2014;52(6):2202–5. https://doi.org/10.1128/JCM.00570-14.CrossRefPubMedPubMedCentral

47.

•• Morgenstern C, Cabric S, Perka C, Trampuz A, Renz N. Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection. Diagn Microbiol Infect Dis. 2018;90(2):115–9. https://doi.org/10.1016/j.diagmicrobio.2017.10.016. While the overall performance of synovial fluid PCR was comparable to culture, PCR was superior for detection of low-virulent bacteria such as Cutibacterium spp. and coagulase-negative staphylococci. Synovial fluid culture required several days for growth, whereas multiplex PCR provided results within 5 h in an automated manner. CrossRefPubMed

48.

Marin M, Garcia-Lechuz JM, Alonso P, Villanueva M, Alcala L, Gimeno M, et al. Role of universal 16S rRNA gene PCR and sequencing in diagnosis of prosthetic joint infection. J Clin Microbiol. 2012;50(3):583–9. https://doi.org/10.1128/JCM.00170-11.CrossRefPubMedPubMedCentral

49.

Joyanes P, Pascual A, Martinez-Martinez L, Hevia A, Perea EJ. In vitro adherence of enterococcus faecalis and enterococcus faecium to urinary catheters. Eur J Clin Microbiol Infect Dis. 2000;19(2):124–7.CrossRefPubMed

50.

Veenstra GJ, Cremers FF, van Dijk H, Fleer A. Ultrastructural organization and regulation of a biomaterial adhesin of Staphylococcus epidermidis. J Bacteriol. 1996;178(2):537–41.CrossRefPubMedPubMedCentral

51.

Rogers KL, Fey PD, Rupp ME. Coagulase-negative staphylococcal infections. Infect Dis Clin N Am. 2009;23(1):73–98. https://doi.org/10.1016/j.idc.2008.10.001.CrossRef

52.

Arciola CR, Baldassarri L, Campoccia D, Creti R, Pirini V, Huebner J, et al. Strong biofilm production, antibiotic multi-resistance and high gelE expression in epidemic clones of enterococcus faecalis from orthopaedic implant infections. Biomaterials. 2008;29(5):580–6. https://doi.org/10.1016/j.biomaterials.2007.10.008.CrossRefPubMed

53.

El Helou OC, Berbari EF, Marculescu CE, El Atrouni WI, Razonable RR, Steckelberg JM, et al. Outcome of enterococcal prosthetic joint infection: is combination systemic therapy superior to monotherapy? Clin Infect Dis. 2008;47(7):903–9. https://doi.org/10.1086/591536.CrossRefPubMed

54.

Ramage G, Tunney MM, Patrick S, Gorman SP, Nixon JR. Formation of Propionibacterium acnes biofilms on orthopaedic biomaterials and their susceptibility to antimicrobials. Biomaterials. 2003;24(19):3221–7.CrossRefPubMed

55.

Mack D, Rohde H, Harris LG, Davies AP, Horstkotte MA, Knobloch JK. Biofilm formation in medical device-related infection. Int J Artif Organs. 2006;29(4):343–59.CrossRefPubMed

56.

Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302–45. https://doi.org/10.1128/CMR.00111-13. CrossRefPubMedPubMedCentral

57.

Li A, Gow N, Atkins BL, Taylor A, Peto T, McNally MA, et al. Metalware-associated orthopaedic infections caused by Staphylococcus lugdunensis: an emerging pathogen. J Inf Secur. 2017;75(4):368–70. https://doi.org/10.1016/j.jinf.2017.05.013.CrossRef

58.

•• Nodzo SR, Boyle KK, Bhimani S, Duquin TR, Miller AO, Westrich GH. Propionibacterium acnes host inflammatory response during periprosthetic infection is joint specific. HSS J. 2017;13(2):159–64. https://doi.org/10.1007/s11420-016-9528-2. The manner in which a patient with P. acnes PJI presents is joint specific. Inflammatory markers were significantly higher in the knee and hip groups compared to the shoulder groups, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism. CrossRefPubMed

59.

• Nodzo SR, Westrich GH, Henry MW, Miller AO. Clinical analysis of propionibacterium acnes infection after total knee arthroplasty. J Arthroplast. 2016;31(9):1986–9. https://doi.org/10.1016/j.arth.2016.02.025. P. acnes TKA infections are associated with more acute inflammatory symptoms than typically appreciated, and long hold anaerobic cultures up to 14 days are necessary to accurately identify this organism as the causative agent of TKA periprosthetic infection. CrossRef

60.

Piper KE, Jacobson MJ, Cofield RH, Sperling JW, Sanchez-Sotelo J, Osmon DR, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009;47(6):1878–84. https://doi.org/10.1128/JCM.01686-08.CrossRefPubMedPubMedCentral

61.

Sampedro MF, Piper KE, McDowell A, Patrick S, Mandrekar JN, Rouse MS, et al. Species of Propionibacterium and Propionibacterium acnes phylotypes associated with orthopedic implants. Diagn Microbiol Infect Dis. 2009;64(2):138–45. https://doi.org/10.1016/j.diagmicrobio.2009.01.024.CrossRefPubMed

62.

Nakatsuji T, Tang DC, Zhang L, Gallo RL, Huang CM. Propionibacterium acnes CAMP factor and host acid sphingomyelinase contribute to bacterial virulence: potential targets for inflammatory acne treatment. PLoS One. 2011;6(4):e14797. https://doi.org/10.1371/journal.pone.0014797.CrossRefPubMedPubMedCentral

63.

Gristina AG, Naylor P, Myrvik Q. Infections from biomaterials and implants: a race for the surface. Med Prog Technol. 1988;14(3–4):205–24.PubMed

64.

Nodzo SR, Hohman DW, Crane JK, Duquin TR. Hemolysis as a clinical marker for propionibacterium acnes orthopedic infection. Am J Orthop (Belle Mead NJ). 2014;43(5):E93–7.

65.

•• Wright TE, Boyle KK, Duquin TR, Crane JK. Propionibacterium acnes susceptibility and correlation with hemolytic phenotype. Infect Dis (Auckl). 2016;9:39–44. https://doi.org/10.4137/IDRT.S40539. P. acnes is very susceptible to the penicillins and the first-generation cephalosporins. Noted was an association between hemolytic phenotype on Brucella Blood Agar and clindamycin resistance. CrossRef

66.

Cobo J, Miguel LG, Euba G, Rodriguez D, Garcia-Lechuz JM, Riera M, et al. Early prosthetic joint infection: outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect. 2011;17(11):1632–7. https://doi.org/10.1111/j.1469-0691.2010.03333.x.CrossRefPubMed

67.

Hedke J, Skripitz R, Ellenrieder M, Frickmann H, Koller T, Podbielski A, et al. Low-grade infection after a total knee arthroplasty caused by Actinomyces naeslundii. J Med Microbiol. 2012;61(Pt 8):1162–4. https://doi.org/10.1099/jmm.0.030395-0. CrossRefPubMed

68.

Mashimo C, Kamitani H, Nambu T, Yamane K, Yamanaka T, Sugimori-Shinozuka C, et al. Identification of the genes involved in the biofilm-like structures on Actinomyces oris K20, a clinical isolate from an apical lesion. J Endod. 2013;39(1):44–8. https://doi.org/10.1016/j.joen.2012.08.009.CrossRefPubMed

69.

Otto M. Staphylococcal biofilms. Curr Top Microbiol Immunol. 2008;322:207–28.PubMedPubMedCentral

70.

Izano EA, Amarante MA, Kher WB, Kaplan JB. Differential roles of poly-N-acetylglucosamine surface polysaccharide and extracellular DNA in Staphylococcus aureus and Staphylococcus epidermidis biofilms. Appl Environ Microbiol. 2008;74(2):470–6. https://doi.org/10.1128/AEM.02073-07.CrossRefPubMed

71.

• Gries CM, Staphylococcal Biofilms KT. Immune polarization during prosthetic joint infection. J Am Acad Orthop Surg. 2017;25(Suppl 1):S20–S4. https://doi.org/10.5435/JAAOS-D-16-00636. With the rise in prosthetic hip and knee arthroplasty procedures, together with the recalcitrance of biofilm infections to antibiotic therapy, it is imperative to better understand the mechanism of crosstalk between biofilm-associated bacteria and host immune cells. This review describes the current understanding of how staphylococcal biofilms evade immune-mediated clearance to establish persistent infections. CrossRefPubMedPubMedCentral

72.

Heim CE, Vidlak D, Scherr TD, Kozel JA, Holzapfel M, Muirhead DE, et al. Myeloid-derived suppressor cells contribute to Staphylococcus aureus orthopedic biofilm infection. J Immunol. 2014;192(8):3778–92. https://doi.org/10.4049/jimmunol.1303408.CrossRefPubMedPubMedCentral

73.

Vuong C, Otto M. Staphylococcus epidermidis infections. Microbes Infect. 2002;4(4):481–9.CrossRefPubMed

74.

Hall-Stoodley L, Stoodley P. Evolving concepts in biofilm infections. Cell Microbiol. 2009;11(7):1034–43. https://doi.org/10.1111/j.1462-5822.2009.01323.x.CrossRefPubMed

75.

Dastgheyb S, Parvizi J, Shapiro IM, Hickok NJ, Otto M. Effect of biofilms on recalcitrance of staphylococcal joint infection to antibiotic treatment. J Infect Dis. 2015;211(4):641–50. https://doi.org/10.1093/infdis/jiu514.CrossRefPubMed

76.

Gehrke T, Kendoff D. Peri-prosthetic hip infections: in favour of one-stage. Hip Int. 2012;22(Suppl 8):S40–5. https://doi.org/10.5301/HIP.2012.9569. CrossRefPubMed

77.

Wolf CF, Gu NY, Doctor JN, Manner PA, Leopold SS. Comparison of one and two-stage revision of total hip arthroplasty complicated by infection: a Markov expected-utility decision analysis. J Bone Joint Surg Am. 2011;93(7):631–9. https://doi.org/10.2106/JBJS.I.01256.CrossRefPubMed

78.

Gulhane S, Vanhegan IS, Haddad FS. Single stage revision: regaining momentum. J Bone Joint Surg (Br). 2012;94(11 Suppl A):120–2. https://doi.org/10.1302/0301-620X.94B11.30746.CrossRef

79.

Ure KJ, Amstutz HC, Nasser S, Schmalzried TP. Direct-exchange arthroplasty for the treatment of infection after total hip replacement. An average ten-year follow-up. J Bone Joint Surg Am. 1998;80(7):961–8.CrossRefPubMed

80.

De Man FH, Sendi P, Zimmerli W, Maurer TB, Ochsner PE, Ilchmann T. Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm. Acta Orthop. 2011;82(1):27–34. https://doi.org/10.3109/17453674.2010.548025.CrossRefPubMedPubMedCentral

81.

•• Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical treatment of prosthetic joint infections of the hip and knee: changing paradigms? J Arthroplast. 2015;30(6):912–8. https://doi.org/10.1016/j.arth.2015.03.014. Indications and technique reviewed for management of PJI including the importance of waiting for bacterial identification, the decreasing role for irrigation and debridement (I&D) with retention of components, the increased utilization of single-stage revision, and conversely a decreasing role for two-stage exchange. Strategies for treating drug-resistant organisms and management of failed treatment will also be examined. CrossRef

82.

Lichstein P, Gehrke T, Lombardi A, Romano C, Stockley I, Babis G, et al. One-stage versus two-stage exchange. J Orthop Res. 2014;32(Suppl 1):S141–6. https://doi.org/10.1002/jor.22558.PubMedCrossRef

Title: Low-Virulence Organisms and Periprosthetic Joint Infection—Biofilm Considerations of These Organisms
Authors: K. Keely Boyle
Stuart Wood
T. David Tarity
Publication date: 01-09-2018
Publisher: Springer US
Published in: Current Reviews in Musculoskeletal Medicine / Issue 3/2018
Electronic ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-018-9503-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Low-Virulence Organisms and Periprosthetic Joint Infection—Biofilm Considerations of These Organisms

Abstract

Purpose of Review

Recent Findings

Summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

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