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

BMC Infectious Diseases

Research Article

Varah Yuenyongviwat¹  Keerati Charoencholvanich²  Methee Chayakulkeeree³  Anupop Jitmuang³ 

[1] Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand;Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand;

关键词: Hip arthroplasty;    Knee arthroplasty;    Mycobacteria;    Prosthetic joint infection;   

DOI  :  10.1186/s12879-017-2926-3

 received in 2017-09-16, accepted in 2017-12-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundProsthetic joint infection (PJI) is a major complication of total hip and total knee arthroplasty (THA, TKA). Although mycobacteria are rarely the causative pathogens, it is important to recognize and treat them differently from non-mycobacterial infections. This study aimed to compare the clinical characteristics, associated factors and long-term outcomes of mycobacterial and non-mycobacterial PJI.MethodsWe conducted a retrospective case-control study of patients aged ≥18 years who were diagnosed with PJI of the hip or knee at Siriraj Hospital from January 2000 to December 2012. Patient characteristics, clinical data, treatments and outcomes were evaluated.ResultsA total of 178 patients were included, among whom 162 had non-mycobacterial PJI and 16 had mycobacterial PJI. Rapidly growing mycobacteria (RGM) (11) and M. tuberculosis (MTB) (5) were the causative pathogens of mycobacterial PJI. PJI duration and time until onset were significantly different between mycobacterial and non-mycobacterial PJI. Infection within 90 days of arthroplasty was significantly associated with RGM infection (OR 21.86; 95% CI 4.25–112.30; p < .001). Implant removal was associated with improved favorable outcomes at 6 months (OR 5.96; 95% CI 1.88–18.88; p < .01) and 12 months (OR 3.96; 95% CI 1.15–13.71; p = .03) after the infection.ConclusionsRGM were the major pathogens of early onset PJI after THA and TKA. Both a high clinical index of suspicion and mycobacterial cultures are recommended when medically managing PJI with negative cultures or non-response to antibiotics. Removal of infected implants was associated with favorable outcomes.

【 授权许可】

CC BY   
© The Author(s). 2017