Diagnosis of Periprosthetic Joint Infection

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Abstract

Next-generation sequencing is a well-established technique for sequencing of DNA and has recently gained attention in many fields of medicine. Our aim was to evaluate the accuracy of next-generation sequencing in identifying the causative organism(s) in patients with periprosthetic joint infection.

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The Microbiome of Aseptically Collected Human Breast Tissue in Benign and Malignant Disease

Tina Hieken, Jun Chen, Tanya Hoskin … (2016)

Globally breast cancer is the leading cause of cancer death among women. The breast consists of epithelium, stroma and a mucosal immune system that make up a complex microenvironment. Growing awareness of the role of microbes in the microenvironment recently has led to a series of findings important for human health. The microbiome has been implicated in cancer development and progression at a variety of body sites including stomach, colon, liver, lung, and skin. In this study, we assessed breast tissue microbial signatures in intraoperatively obtained samples using 16S rDNA hypervariable tag sequencing. Our results indicate a distinct breast tissue microbiome that is different from the microbiota of breast skin tissue, breast skin swabs, and buccal swabs. Furthermore, we identify distinct microbial communities in breast tissues from women with cancer as compared to women with benign breast disease. Malignancy correlated with enrichment in taxa of lower abundance including the genera Fusobacterium, Atopobium, Gluconacetobacter, Hydrogenophaga and Lactobacillus. This work confirms the existence of a distinct breast microbiome and differences between the breast tissue microbiome in benign and malignant disease. These data provide a foundation for future investigation on the role of the breast microbiome in breast carcinogenesis and breast cancer prevention.

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Periprosthetic joint infection increases the risk of one-year mortality.

Benjamin Zmistowski, Joseph A Karam, Joel Durinka … (2013)

Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.

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Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure.

Benjamin Zmistowski, Anthony Ho, David Vegari … (2011)

In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant. To identify (1) the rate of recurrent PJI after two-stage exchange and (2) the role of 15 presurgical and 11 operative factors in influencing the outcome of two-stage revision. From a prospective database we identified 117 patients who had undergone two-stage exchange arthroplasty for PJI of the knee from 1997 to 2007. Failure of two-stage revision was defined as any treated knee requiring further treatment for PJI. We identified 15 presurgical and 11 surgical factors that might be related to failure. Minimum followup was 2 years (average, 3.4 years; range, 2-9.4 years). Thirty-three of 117 reimplantations (28%) required reoperation for infection. Age, gender, body mass index, and comorbidity indices were similar in both groups. Multivariate analysis provided culture-negative (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.3-15.7), methicillin-resistant organisms (OR, 2.8; 95% CI, 0.8-10.3), and increased reimplantation operative time (OR, 1.01; 95% CI, 1.0-1.03) as predictors of failure. ESR and CRP values at the time of reimplantation and time from resection to reimplantation were not predictors. Our observations suggest the failure rate after two-stage reimplantation for infected TKA is relatively high. Culture-negative or methicillin-resistant PJI increases the risk of failure over four- and twofold, respectively. We identified no variables that would guide the surgeon in identifying acceptable circumstances in which to perform the second stage. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.