Factors Associated With an Intra-articular Infection After Anterior Cruciate Ligament Reconstruction: A Large Single-Institution Cohort Study.

Background: An intra-articular infection after anterior cruciate ligament (ACL) reconstruction (ACLR) is a rare complication but one with potentially devastating consequences. The rare nature of this complication raises difficulties in detecting risk factors associated with it and with worse outcomes after one has occurred.

Purpose: To (1) evaluate the association between an infection after ACLR and potential risk factors in a large single-center cohort of patients who had undergone ACLR and (2) assess the factors associated with ACL graft retention versus removal.

Sequencing of Circulating Microbial Cell-Free DNA Can Identify Pathogens in Periprosthetic Joint Infections.

Background: Over 1 million Americans undergo joint replacement each year, and approximately 1 in 75 will incur a periprosthetic joint infection. Effective treatment necessitates pathogen identification, yet standard-of-care cultures fail to detect organisms in 10% to 20% of cases and require invasive sampling. We hypothesized that cell-free DNA (cfDNA) fragments from microorganisms in a periprosthetic joint infection can be found in the bloodstream and utilized to accurately identify pathogens via next-generation sequencing.

Assessing the Role of Daptomycin as Antibiotic Therapy for Staphylococcal Prosthetic Joint Infection.

: The role of daptomycin, a potent, safe, convenient anti-staphylococcal antibiotic, in treatment of prosthetic joint infection (PJI) is unclear. We evaluated our experience with the largest cohort of patients with staphylococcal PJI managed with daptomycin. : A cohort of staphylococcal hip and knee PJI treated with daptomycin was identified by hospital records from 2009 to 2016.

Bacterial toxins in musculoskeletal infections.

Musculoskeletal infections (MSKIs) remain a major health burden in orthopaedics. Bacterial toxins are foundational to pathogenesis in MSKI, but poorly understood by the community of providers that care for patients with MSKI, inducing an international group of microbiologists, infectious diseases specialists, orthopaedic surgeons and biofilm scientists to review the literature in this field to identify key topics and compile the current knowledge on the role of toxins in MSKI, with the goal of illuminating potential impact on biofilm formation and dispersal as well as therapeutic strategies. The group concluded that further research is needed to maximize our understanding of the effect of toxins on MSKIs, including: (i) further research to identify the roles of bacterial toxins in MSKIs, (ii) establish the understanding of the importance of environmental and host factors and in vivo expression of toxins throughout the course of an infection, (iii) establish the principles of drug-ability of antitoxins as antimicrobial agents in MSKIs, (iv) have well-defined metrics of success for antitoxins as antiinfective drugs, (v) design a cocktail of antitoxins against specific pathogens to (a) inhibit biofilm formation and (b) inhibit toxin release.

Prophylactic Postoperative Antibiotics May Not Reduce Pin Site Infections After External Fixation.

Background: Pin infection continues to be a nuisance when using definitive external fixation. Prophylactic antibiotic treatment has been proposed in an effort to decrease pin complications.

Questions/purposes: We performed a prospective, randomized, single-blinded study to answer the following questions: (1) what was the effect of a 10-day course of oral prophylactic antibiotics administered immediately after external fixation surgery on the incidence of a subsequent pin infection, (2) what was the effect on the severity of a subsequent pin infection, and (3) what was the effect on the timing of a subsequent pin infection?

Methods: Patients were randomized into antibiotic treatment and control groups, and incidence, severity, and time of onset of pin infection were recorded.

Fungal Musculoskeletal Infections.

Fungi are rare but important causes of osteoarticular infections, and can be caused by a wide array of yeasts and molds. Symptoms are often subacute and mimic those of other more common causes of osteoarticular infection, which can lead to substantial delays in treatment. A high index of suspicion is required to establish the diagnosis.

Osteomyelitis and Bacteremia: Review of an Emerging Human Pathogen with an Expanding Spectrum of Disease.

Background: is an uncommon pathogen that may be misdiagnosed as viridans group streptococci. We review the literature of and report 2 clinical cases in which catalase-negative Gram-positive cocci resembling viridans group streptococci with elevated minimum inhibitory concentrations (MICs) to ceftriaxone were inconsistently identified phenotypically, with further molecular characterization and ultimate identification of .

Methods: Two clinical strains (from 2 obese women; 1 with a prosthetic hip infection and the other with bacteremia) were analyzed with standard identification methods, followed by matrix-assisted laser desorption ionization time-of-flight mass spectrometry, 16S recombinant ribonucleic acid (rRNA), and polymerase chain reaction (PCR).

Prosthetic joint infections secondary to rapidly growing mycobacteria: Two case reports and a review of the literature.

Rapidly growing mycobacteria (RGM) are a rare but treatable cause of prosthetic joint infections. This study reports on two patients comprising three prosthetic joint infections caused by RGM successfully treated at the institution. With removal of the infected prosthetic joint and judicious use of prolonged courses of antibiotics, patients with prosthetic joint infections secondary to RGM can both be cured and retain function of the affected joint.

Successful treatment of Candida osteoarticular infections with limited duration of antifungal therapy and orthopedic surgical intervention.

Background: Current guidelines for treatment of Candida osteoarticular infections (COAIs) recommend a prolonged course of antifungal therapy (AFT) of 6-12 months. Based upon strategies developed at the Hospital for Special Surgery (HSS), we hypothesized that the duration of antifungal therapy may be substantially reduced for management of COAI.

Methods: This was a retrospective chart review of cases of COAI treated at the HSS for the past 14 years.

Perioperative infection in the patient with rheumatic disease.

The risk of infection accompanies the benefits of surgery. Immunomodulatory chronic illnesses may increase the risk of surgical infections. Surgical patients with rheumatologic illness need close preoperative assessment regarding their infection risks (fixed and modifiable), which vary on the basis of the proposed procedure, specific rheumatologic illness, and underlying comorbidities.

Historical perspective on two-stage reimplantation for infection after total hip arthroplasty at Hospital for Special Surgery, New York City.

In this article, we report on our use of a 2-stage exchange in managing infected total hip arthroplasties (THAs) at the Hospital for Special Surgery in New York City. This protocol involves resection arthroplasty, 6 weeks of intravenous antibiotics to obtain a minimum "postpeak" serum bactericidal titer (SBT) of 1:8, and reimplantation. Over the past 20 years, we have conducted several studies showing the effectiveness of this treatment.

Postoperative infections of the lumbar spine: presentation and management.

Purpose: Postoperative surgical site infections (SSI) are a frequent complication following posterior lumbar spinal surgery. In this manuscript we review strategies for prevention, diagnosis and treatment of SSI.

Methods: The literature was reviewed using the Pubmed database.

Modern treatment of infected total knee arthroplasty with a 2-stage reimplantation protocol.

The purpose of this study was to determine if 2-stage reimplantation for the treatment of infected total knee arthroplasty (TKA) is still effective for treating contemporary pathogens, many of which are multidrug resistant (MDR). The medical records of all cases of infected TKAs from April 1998 to March 2006 were retrospectively reviewed for data on infecting organism and success of treatment. Of 72 patients (75 knees), with a minimum of 2 years of follow-up, who completed the protocol, the infection was eradicated in 90.

Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge.

Hypothesis: This study reviewed a series of patients diagnosed with Propionibacterium acnes infection after shoulder arthroplasty in order to describe its clinical presentation, the means of diagnosis, and provide options for treatment.

Materials And Methods: From 2002 to 2006, 11 patients diagnosed with P acnes infection after shoulder arthroplasty were retrospectively reviewed and analyzed for (1) clinical diagnosis; (2) laboratory data, including white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP); (3) fever; (4) number of days for laboratory growth of P acnes; (5) organism sensitivities; (6) antibiotic regimen and length of treatment; and (7) surgical management. Infection was diagnosed by 2 positive cultures.

Dental premedication protocols for patients with knee and hip protheses.

In 1997, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) published an advisory statement regarding antibiotic prophylaxis for patients with total joint replacements undergoing dental treatment. The first periodic update of these guidelines was published in 2003. Nevertheless, confusion exists among dentists and physicians as to the clinical indications for premedication in this patient population.

Flexor tenosynovitis caused by Mycobacterium scrofulaceum: case report.

Atypical hand infections with Mycobacterium species are uncommon, and Mycobacterium scrofulaceum infections are rare. We present a case of flexor tenosynovitis caused by M scrofulaceum in a 66-year-old man with hypertension and diabetes.

Dental premedication protocols for patients with knee and hip prostheses.

In 1997, the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) published an advisory statement regarding antibiotic prophylaxis for patients with total joint replacements undergoing dental treatment. The first periodic update of these guidelines was published in 2003. Nevertheless, confusion exists among dentists and physicians as to the clinical indications for premedication in this patient population.