No need to search for the source of haematogenous  arthroplasty infections

C Bouvet; D Tchernin; M Seirafi

doi:10.4414/smw.2011.13306

Original article

Vol. 141 No. 4950 (2011)

No need to search for the source of haematogenous arthroplasty infections

C Bouvet
D Tchernin
M Seirafi

DOI: https://doi.org/10.4414/smw.2011.13306
Cite this as:: Swiss Med Wkly. 2011;141:w13306
Published: 05.12.2011

Summary

QUESTIONS UNDER STUDY/PRINCIPLES:Prosthetic joint infections (PJI) may be a potential sentinel event for an unknown neoplastic or infectious source in elderly patients. However, the value and cost-effectiveness of investigations to determine the origin of these infections is unknown.

METHODS:Retrospective study at Geneva University Hospitals, evaluating associated medical examinations performed in search of the origin of all presumed surgical site and haematogenous arthroplasty infections.

RESULTS:A total of 182 PJI were found in 182 patients (median age 75 years). Seventy PJI (38%) were classified as probably haematogenous, occurring more than 2 years post-implantation, with 27 (15%) due to Gram-negative pathogens. Overall, the origin of PJI was found solely by admission history in 28 cases (15%). Among the remaining 154 cases, no remote origin could be detected despite 17 echocardiograms, 17 other sonograms, 49 chest x-rays, 23 computed tomograms, 107 urinary cultures, 11 endoscopies, 9 scintigraphies and 31 medical specialist consultations. The average cost of these exams was 675 Swiss francs (845 US$) per PJI. At long-term follow-up six patients were found to have developed a neoplasm, of which only one (hepatocellular carcinoma after PJI due to Streptococcus bovis) could eventually be attributed to prior infection.

CONCLUSIONS:From an epidemiologic point of view, patient history is the best way to predict the origin of PJI. Blind additional radiographic or endoscopic exams are costly, inconclusive and do not contribute to the management of these cases.

References

Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther. 2010;8:657–70.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic joint infections. N Eng J Med. 2004;351:1645–54.
Apsingi S, Kulkarni A, Gould KF, McCaskie AW. Late Streptococcus bovis infection of knee arthroplasty and its association with carcinoma of the colon: a case report. Knee Surg Sports Traumatol Arthrosc. 2007;15:761–2.
Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, et al. Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect. 2009;58:205–12.
Swan J, Dowsey M, Babazadeh S, Mandaleson A, Choong PF. Significance of sentinel infective events in haematogenous prosthetic knee infections. ANZ J Surg. 2011;81:40–5.
Burnell CD, Turgeon TR, Hedden DR, Bohm ER. Paraneoplastic Clostridium septicum Infection of a Total Knee Arthroplasty. J Arthroplasty. 2011;26:9–11.
Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, et al. Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect. 2009;59:337–45.
Bernard L, Legout L, Zürcher-Pfund L, Stern R, Rohner P, Peter R, et al. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. J Infect. 2010;61:125–32.
Teterycz D, Ferry T, Lew D, Stern R, Assal M, Hoffmeyer P, et al. Outcome of orthopedic implant infections due to different staphylococci. Int J Infect Dis. 2010;14:913–8.
Abraham J, Mansour C, Veledar E, Khan B, Lerakis S. Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S. aureus and methicillin-resistant S. aureus bacteremia. Am Heart J. 2004;147:536–9.
Ringberg H, Thoren A, Lilja B. Metastatic complications of Staphylococcus aureus septicemia. To seek is to find. Infection. 2000;28:132–6.
Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:1954–61.
Burchert A, Schmassmann A. Evaluation of various screening and surveillance methods in colorectal carcinoma. Schweiz Med Wochenschr. 1998;128:999–1011.

How to Cite

1.

Bouvet C, Tchernin D, Seirafi M. No need to search for the source of haematogenous arthroplasty infections. Swiss Med Wkly [Internet]. 2011 Dec. 5 [cited 2024 Apr. 20];141(4950):w13306. Available from: https://smw.ch/index.php/smw/article/view/1399

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

[1] Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther. 2010;8:657–70.

[2] Zimmerli W, Trampuz A, Ochsner PE. Prosthetic joint infections. N Eng J Med. 2004;351:1645–54.

[3] Apsingi S, Kulkarni A, Gould KF, McCaskie AW. Late Streptococcus bovis infection of knee arthroplasty and its association with carcinoma of the colon: a case report. Knee Surg Sports Traumatol Arthrosc. 2007;15:761–2.

[4] Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, et al. Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect. 2009;58:205–12.

[5] Swan J, Dowsey M, Babazadeh S, Mandaleson A, Choong PF. Significance of sentinel infective events in haematogenous prosthetic knee infections. ANZ J Surg. 2011;81:40–5.

[6] Burnell CD, Turgeon TR, Hedden DR, Bohm ER. Paraneoplastic Clostridium septicum Infection of a Total Knee Arthroplasty. J Arthroplasty. 2011;26:9–11.

[7] Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, et al. Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect. 2009;59:337–45.

[8] Bernard L, Legout L, Zürcher-Pfund L, Stern R, Rohner P, Peter R, et al. Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. J Infect. 2010;61:125–32.

[9] Teterycz D, Ferry T, Lew D, Stern R, Assal M, Hoffmeyer P, et al. Outcome of orthopedic implant infections due to different staphylococci. Int J Infect Dis. 2010;14:913–8.

[10] Abraham J, Mansour C, Veledar E, Khan B, Lerakis S. Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S. aureus and methicillin-resistant S. aureus bacteremia. Am Heart J. 2004;147:536–9.

[11] Ringberg H, Thoren A, Lilja B. Metastatic complications of Staphylococcus aureus septicemia. To seek is to find. Infection. 2000;28:132–6.

[12] Frazier AL, Colditz GA, Fuchs CS, Kuntz KM. Cost-effectiveness of screening for colorectal cancer in the general population. JAMA. 2000;284:1954–61.

[13] Burchert A, Schmassmann A. Evaluation of various screening and surveillance methods in colorectal carcinoma. Schweiz Med Wochenschr. 1998;128:999–1011.