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Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection

Anupop Jitmuang1, Varah Yuenyongviwat2, Keerati Charoencholvanich3

  • 1Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.

BMC Infectious Diseases
|December 29, 2017
PubMed
Abstract

Insights

Mycobacterial prosthetic joint infections (PJI) present differently than non-mycobacterial PJI, with rapidly growing mycobacteria often causing early-onset infections. Early diagnosis and implant removal are crucial for favorable outcomes in PJI management.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Microbiology

Background:

  • Prosthetic joint infection (PJI) is a significant complication following total hip (THA) and total knee arthroplasty (TKA).
  • While uncommon, mycobacterial infections require distinct diagnostic and treatment approaches compared to non-mycobacterial PJIs.

Purpose of the Study:

  • To compare the clinical characteristics, risk factors, and long-term outcomes of mycobacterial versus non-mycobacterial PJI.
  • To identify specific pathogens and their association with PJI onset and outcomes.

Main Methods:

  • Retrospective case-control study of 178 patients (hip or knee PJI) from 2000-2012.
  • Evaluation of patient demographics, clinical data, treatments, and outcomes.
  • Comparison between 16 mycobacterial PJI cases and 162 non-mycobacterial PJI cases.

Main Results:

  • Rapidly growing mycobacteria (RGM) and Mycobacterium tuberculosis (MTB) were identified as causative agents in mycobacterial PJI.
  • Early PJI (within 90 days) was strongly associated with RGM infection (OR 21.86).
  • Implant removal correlated with improved outcomes at 6 and 12 months post-infection.

Conclusions:

  • RGM are key pathogens in early-onset PJI after THA and TKA.
  • A high clinical suspicion and mycobacterial cultures are vital for diagnosing PJI, especially with negative conventional cultures or antibiotic non-response.
  • Surgical removal of infected implants is associated with favorable PJI outcomes.
Keywords:
Hip arthroplastyKnee arthroplastyMycobacteriaProsthetic joint infection

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