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Introduction:Endocarditis is the infection of the endocardium, the inner lining of the heart and its valves. When the heart muscle is involved, the condition is termed myocarditis, while an infection of the outer lining is called pericarditis. Infective endocarditis (IE) primarily affects the endocardium, where pathogens adhere to the valves or lining, forming vegetation that can lead to severe complications. Infective endocarditis occurs when microorganisms, usually bacteria from other body...
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Endocarditis II: Clinical Features of Infective Endocarditis01:25

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Endocarditis can present various clinical features depending on the causative organism and the patient's underlying health conditions. Initially, the clinical features of infective endocarditis develop gradually, presenting with nonspecific symptoms that can be easily mistaken for other illnesses.General SymptomsEarly symptoms of infective endocarditis are fever, chills, weakness, malaise, fatigue, and weight loss. These symptoms reflect the systemic nature of the infection and the body's...
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Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes.

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Periprosthetic joint infection (PJI) caused by Enterococcus species has a high failure rate. Management is difficult, with combination antibiotic therapy showing a trend toward better outcomes in this study of enterococcal PJI.

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Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Surgical Infections

Background:

  • Periprosthetic joint infection (PJI) poses significant challenges in orthopedic surgery.
  • Enterococcus species are an increasingly recognized cause of PJI, yet definitive treatment strategies remain unclear.

Purpose of the Study:

  • To analyze the characteristics of enterococcal PJI.
  • To evaluate treatment outcomes for enterococcal PJI.
  • To define an effective treatment protocol for enterococcal PJI.

Main Methods:

  • Retrospective review of 87 patients with enterococcal PJI across three institutions (1999-2014).
  • Inclusion criteria: Musculoskeletal Infection Society criteria for PJI and positive intraoperative cultures for Enterococcus.
  • Kaplan-Meier survivorship analysis and Delphi consensus criteria for treatment failure assessment.

Main Results:

  • The overall incidence of enterococcal PJI was 4.2% with a treatment success rate of 51.7%.
  • Treatment success varied by procedure: 62.8% for 2-stage exchange, 39.4% for irrigation and debridement, and 45.5% for 1-stage exchange.
  • Combination antibiotic therapy showed a trend toward higher success rates compared to monotherapy, though not statistically significant.

Conclusions:

  • Enterococcal PJI is associated with a high rate of treatment failure and adverse outcomes.
  • Management of enterococcal PJI is challenging, requiring awareness of its poor prognosis.
  • While not statistically significant, combination antibiotic therapy may offer improved outcomes for enterococcal PJI.