Concomitant Multiple Joint-Arthroplasty Infections: Report on 16 Cases

• Published in: The Journal of arthroplasty Vol. 31; no. 11; pp. 2564 - 2568
• Main Authors: Zeller, Valérie, MD, Dedome, Delphine, MD, Lhotellier, Luc, MD, Graff, Wilfrid, MD, Desplaces, Nicole, MD, Marmor, Simon, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Arthritis, Infectious - surgery; Arthroplasty - adverse effects; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Bacteremia - complications; Combined Modality Therapy; Female; France - epidemiology; Humans; Male; Middle Aged; multiple joint arthroplasty infections; Orthopedics; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Retrospective Studies; Sta aureus; Staphylococcal Infections - drug therapy; Staphylococcus aureus - isolation & purification; Staphylococcus epidermidis - isolation & purification; Streptococcal Infections - drug therapy; Streptococcus; suppressive antibiotic therapy; therapeutic strategy; therapeutic strategy; S. aureus; Streptococcus; Multiple joint-arthroplasty infections; suppressive antibiotic therapy; multiple joint arthroplasty infections; Sta aureus
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.02.012

Abstract Background Concomitant infections of several prostheses are very rare, serious events that pose particular medical and surgical therapeutic challenges. This study was undertaken to describe epidemiological, clinical and microbiological characteristics of concomitant multiple joint-arthroplasty infections, their treatments and outcomes. Methods Retrospective (January 2000 and January 2014), single-center, cohort study in a referral center for bone and joint infections. All the patients with at least two concomitant, microbiologically documented, prosthetic joint infections, i.e., during the same septic episode, were included. Results Sixteen patients were included. Median [range] age was 78 [46–93] years, sex ratio was 1, median [range] body mass index was 27 [21–42]. Multiple joint arthroplasties (bilateral hip in eight patients; bilateral knee in three; hip and knee in one; and two knees and a hip in one) were contaminated hematogenously in all patients, two after early post-operative infections. Eight Staphylococcus aureus , one Staphylococcus epidermidis , six Streptococcus and one Escherichia coli strains were isolated. A curative strategy was applied to 11 patients: three underwent bilateral synovectomies, six had successive one-stage exchange arthroplasties, and two were treated with other strategies. After 37 (range, 24–132) months of follow-up, reinfection occurred in one patient. The five other patients received prolonged suppressive antibiotic therapy. Conclusion These complex infections occur during staphylococcal or streptococcal bacteremia. Treatment strategies should be discussed by a multidisciplinary team on a case-by-case basis.