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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint
Laurens Manning1,2, Sarah Metcalf3, Benjamin Clark1
1Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia.
Background:
Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. Most observational studies of PJI are retrospective or single-center, and reported management approaches and outcomes vary widely. We hypothesized that there would be substantial heterogeneity in PJI management and that most PJIs would present as late acute infections occurring as a consequence of bloodstream infections.
Methods:
The Prosthetic joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective study at 27 hospitals. From July 2014 through December 2017, we enrolled all adults with a newly diagnosed PJI of a large joint. We collected data on demographics, microbiology, and surgical and antibiotic management over the first 3 months postpresentation.
Results:
We enrolled 783 patients (427 knee, 323 hip, 25 shoulder, 6 elbow, and 2 ankle). The mode of presentation was late acute (>30 days postimplantation and <7 days of symptoms; 351, 45%), followed by early (≤30 days postimplantation; 196, 25%) and chronic (>30 days postimplantation with ≥30 days of symptoms; 148, 19%). Debridement, antibiotics, irrigation, and implant retention constituted the commonest initial management approach (565, 72%), but debridement was moderate or less in 142 (25%) and the polyethylene liner was not exchanged in 104 (23%).
Conclusions:
In contrast to most studies, late acute infection was the most common mode of presentation, likely reflecting hematogenous seeding. Management was heterogeneous, reflecting the poor evidence base and the need for randomized controlled trials.
Insights
Late acute periprosthetic joint infection (PJI) is common, often arising from bloodstream infections. Management of PJI is highly variable, highlighting the need for evidence-based guidelines and further research.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Clinical Epidemiology
Background:
- Periprosthetic joint infection (PJI) is a significant complication following joint replacement surgery.
- Existing studies on PJI are often retrospective or single-center, leading to varied management strategies and outcomes.
- Heterogeneity in PJI management and presentation modes was hypothesized.
Purpose of the Study:
- To investigate the presentation modes and management strategies for periprosthetic joint infection (PJI).
- To assess the heterogeneity in PJI management across multiple centers.
- To identify the most common presentation of PJI.
Main Methods:
- The Prosthetic Joint Infection in Australia and New Zealand, Observational (PIANO) study is a prospective, multi-center study.
- Data were collected from 783 adult patients diagnosed with a new PJI of a large joint between July 2014 and December 2017.
- Information gathered included demographics, microbiology, and initial surgical and antibiotic management within 3 months of presentation.
Main Results:
- Late acute infection (>30 days postimplantation, <7 days symptoms) was the most common presentation (45%), followed by early (25%) and chronic (19%) infections.
- Debridement, antibiotics, irrigation, and implant retention was the most frequent initial management (72%).
- However, moderate or less debridement occurred in 25% of cases, and polyethylene liner exchange was omitted in 23%.
Conclusions:
- Late acute PJI, potentially from hematogenous seeding, is the predominant presentation, contrary to prior assumptions.
- Significant heterogeneity exists in PJI management approaches.
- The findings underscore the need for robust evidence, including randomized controlled trials, to guide PJI treatment.
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