AimsGram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.MethodsA retrospective review was performed of all gram-negative spinal infections (n = 32; median age 71 years; interquartile range 60 to 78), excluding surgical site infections, at a single centre between 2015 to 2020 with two- to six-year follow-up. Information regarding organism identification, antibiotic regime, and treatment outcomes (including clinical, radiological, and biochemical) were collected from clinical notes.ResultsAll patients had comorbidities and/or non-spinal procedures within the previous year. Most infections affected lumbar segments (20/32), with Escherichia coli the commonest organism (17/32). Causative organisms were identified by blood culture (23/32), biopsy/aspiration (7/32), or intraoperative samples (2/32). There were 56 different antibiotic regimes, with oral (PO) ciprofloxacin being the most prevalent (13/56; 17.6%). Multilevel, contiguous infections were common (8/32; 25%), usually resulting in bone destruction and collapse. Epidural collections were seen in 13/32 (40.6%). In total, five patients required surgery, three for neurological deterioration. Overall, 24 patients improved or recovered with a mean halving of CRP at 8.5 days (SD 6). At the time of review (two to six years post-diagnosis), 16 patients (50%) were deceased.ConclusionThis is the largest published cohort of gram-negative spinal infections. In older patients with comorbidities and/or previous interventions in the last year, a high level of suspicion must be given to gram-negative infection with blood cultures and biopsy essential. Early organism identification permits targeted treatment and good initial clinical outcomes; however, mortality is 50% in this cohort at a mean of 4.2 years (2 to 6) after diagnosis.Cite this article: Bone Jt Open 2024;5(5):435–443.

Background: Revision total elbow arthroplasty (TEA) is a challenging procedure that is becoming increasingly common. In our unit, we regard it as essential to exclude infection as the underlying cause of TEA loosening. In all patients with arthroplasty loosening, we undertake a careful history and examination, perform radiographs, monitor inflammatory markers, and undertake a joint aspiration. If any investigation suggests infection as the etiology, then a 2-stage revision is undertaken. Open biopsies are not routinely performed. The aim was to ascertain from our outcomes whether it is safe to perform a single-stage revision for presumed aseptic loosening using these criteria. Methods: A retrospective review of a consecutive series of revision TEAs was performed in our unit over a 10-year period (2008-2018). Single-stage revisions performed for presumed aseptic loosening were identified. Case notes, radiographs, bloods, aspiration results, and microbiology of tissue samples taken at revision were reviewed. Results: A total of 123 revision elbow arthroplasty cases were performed in the study period. Sixty cases were revised for preoperatively proven infection, instability, or implant failure and were excluded from this study. In 63 cases, aseptic loosening was diagnosed based on history, clinical examination, blood markers, and aspiration. There were 21 dual-component and 42 single-component revisions. In the dual-component revision group, tissue samples taken at the time of revision were positive in only 1 case (5%). In the single-component revision group, positive culture samples were present in 3 cases (7%). chi(2) analysis showed no significant difference between single- and dual-component revisions (P = .76). No cases with positive culture samples from either group have required subsequent revision surgery. Conclusion: Given the results of this study, we conclude that is safe to perform single-stage revision arthroplasty for implant loosening based on history, examination, normal inflammatory markers, and negative aspiration results without the need for open biopsy. (C) 2020 All rights reserved.

The purpose of the study was to retrospectively assess the patients treated to date with the vac ulta system using a technique of antibiotic instillation.The vac ulta system is licensed for use with anti-septic instillation fluid but we have now treated a number of patients with antibiotic instillation under the guidance of the microbiology department. All patients being treated with the vac ulta system were included in the study. There were no exclusions. Pathology treated, infecting organism, antibiotic used and length of treatment were all recorded. Any antibiotic related complications were noted. Treatment was judged successful with resolution of presenting symptoms, normalization of inflammatory markers and three negative foam cultures.There were 21 patients included in the study. There were 13 male and 8 female patients. Length of treatment ranged from 1 week to 10 weeks with a mean of 4.2 weeks. Follow up ranged from 1 month to 42 months with a mean follow up of 17.9 monthsThe most common pathogen ...

No single test is 100% sensitive and specific for the diagnosis of prosthetic joint infection. Joint aspiration is currently the only preoperative investigation that can establish the identity of t...

Background: Recent studies have identified the diagnostic challenge of low-grade infections after shoulder arthroplasty surgery. Infections after nonarthroplasty procedures have not been reported. This study assessed patient-related risk factors, outcomes, and clinical presentation of low-grade infection after open and arthroscopic nonarthroplasty shoulder surgery.Methods: The cases of 35 patients presenting with suspected low-grade infection were reviewed. Biopsy specimens taken at revision surgery were cultured in the sterile environment of a class II laminar flow cabinet and incubated for a minimum of 14 days at a specialist orthopedic microbiology laboratory. Patient-related factors (age, occupation, injection), index surgery, and infection characteristics (onset of symptoms, duration to diagnosis, treatment) were analyzed.Results: Positive cultures were identified in 21 cases (60.0%), of which 15 were male patients (71%). Of all patients with low-grade infection, 47.6% were male patients between 16 and 35 years of age. Propionibacterium acnes and coagulase-negative staphylococcus were the most common organisms isolated (81.1% [n = 17] and 23.8% [n = 5], respectively). Of 14 negative culture cases, 9 were treated with early empirical antibiotics (64.3%); 7 patients reported symptomatic improvement (77.8%). Of 5 patients treated with late empirical antibiotics, 4 stated improvement. Patients presented with symptoms akin to resistant postoperative frozen shoulder (persistent pain and stiffness, unresponsive to usual treatments).Conclusion: Young male patients are at greatest risk for low-grade infections after arthroscopic and open nonarthroplasty shoulder surgery. P. acnes was the most prevalent organism. Patients presented with classic postoperative frozen shoulder symptoms, resistant to usual treatments. Interestingly, 78.6% of patients with negative cultures responded positively to empirical treatment. Crown Copyright (C) 2017 All rights reserved.

Purpose: The purpose of this study was to determine if demineralised bone matrix (DBM) enhanced with mesenchymal stem cells (MSCs) could improve healing when applied to a degenerative rotator cuff tear model.Methods: Eighteen female Wistar rats underwent unilateral detachment of the supraspinatus tendon.Three weeks later, tendon repair was carried out in animals randomized into three groups: Group 1 received augmentation of the repair with cortical allogenic DBM (n ¼ 6); Group 2 received augmentation with a commercially-available non-meshed, ultra-thick accellular human dermal matrix (n ¼ 6); and Group 3 underwent tendon-bone repair without a scaffold (n ¼ 6).All animals received one million MSCs.Specimens were retrieved at six weeks postoperatively for histological analysis and evaluation of bone mineral density.Results: All groups demonstrated closure of the tendon-bone gap with a fibrocartilaginous enthesis, but the degenerative process could not be reversed.Although there were no significant differences in the enthesis maturation and Modified Movin scores, repairs augmented with dermal matrix þ MSCs exhibited a disorganised enthesis, abnormal collagen fibre arrangement, and greater cellularity compared to other MSC groups.Only repairs augmented with DBM þ MSCs reached a bone mineral density not significantly lower than non-operated controls.Conclusions: This study demonstrated that when DBM and MSCs were applied to the healing enthesis in a chronic rotator cuff tear model, a fibrocartilaginous-based structure was produced, which significantly increased bone density compared to other groups.

Biofilms are a major aetiological factor in many infections. Bacteria growing within a biofilm are extremely resilient to standard antimicrobials; biofilm-associated infections are thus challenging to treat. Understanding how and why biofilms form can improve prevention and management of biofilm infections.

Journal of Orthopaedic ResearchVolume 32, Issue S1 p. S12-S15 EditorialFree Access Nations Represented First published: 24 January 2014 https://doi.org/10.1002/jor.22540AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume32, IssueS1January 2014Pages S12-S15 RelatedInformation

Infections involving bone and joint are a significant cause of morbidity and mortality. They can result in prolonged hospital stays, long courses of systemic antibiotics and frequently will require surgical intervention. In this review we will cover the commonest infections seen clinically. We have also chosen to divide the review into two sections: infections involving native tissue/joints and infections relating to prosthetic material. We have done this primarily because diagnostic and management pathways often vary according to whether there is prosthetic material present at the site of infection.

PJI is traditionally treated with intravenous (IV) antibiotics in order to obtain the minimum inhibitory concentration in the shortest time possible. Once this goal is met and there is clinical evidence of improvement, some IV antibiotic regimens can be switched to oral regimens. There is scarce literature reporting on the use of oral (combined or single) antibiotic therapy for the treatment of PJIs without an initial IV regimen [1–5]. Most of these studies were conducted in cases where the prosthesis was retained. There is one study in which no oral or prolonged IV regimen was used after debridement and the use of an antibiotic-impregnated cement spacers led to a 87% eradication rate [6]. No literature conclusively supports the use of only oral (combined or single) antibiotic therapy prior to reimplantation. The recently-published guidelines of the Infectious Diseases Society of America (IDSA) [7] suggest that pathogen-specific, highly bioavailable oral therapy (e.g. linezolid or fluoroquinolones) may be an alternative as initial therapy for some cases of PJI. Concerns against the routine use of appropriate oral agents in the treatment of PJI largely comprise questions of patient medication compliance and the long-term use of medication therapy with less intensive efficacy and toxicity monitoring.

An evaluation tool has been developed to allow bedside review of antibiotic use and infection management in acute medical and surgical patients, to assess whether patients with infections can be safely managed out of hospital with delivery of antibiotics (intravenous (IV) or oral) in the community. The tool also allows the potential bed day savings to be assessed from early discharge of antibiotic treated patients.

Infections involving bone and joint are a significant cause of morbidity and mortality. They can result in prolonged hospital stays, long courses of systemic antibiotics and frequently will require surgical intervention. In this review we will cover the commonest infections seen clinically. We have also chosen to divide the review into two sections; infections involving native tissue/joints and infections relating to prosthetic material. We have done this primarily because diagnostic and management pathways often vary according to whether there is prosthetic material present at the site of infection.