Lower Rates of Reoperation Following Partial or Complete Revision Arthroplasty Compared to Debridement, Antibiotics, and Implant Retention for Early Postoperative and Acute Hematogenous Periprosthetic Hip Infection.

BACKGROUND: This study aimed to: 1) compare treatment outcomes between debridement, antibiotics, and implant retention (DAIR) and partial or complete revision arthroplasty (RA) for early postoperative and acute hematogenous total hip arthroplasty periprosthetic joint infection (PJI) and 2) identify factors associated with treatment outcome. METHODS: The study consisted of a retrospective cohort of patients who underwent surgery for PJI between 2004 and 2021. There were 76 patients (74.5%) who underwent DAIR and 26 patients (25.5%) who underwent RA. Treatment success was defined as treatment eradication at a minimum of a 2-year follow up. Bivariate regression analysis was used to assess the effect of different factors on treatment outcomes. Kaplan-Meier survivorship was performed to compare survivorship between cohorts. RESULTS: At a mean follow-up of 8.2 years (range, 2.2 to 16.4), significantly more DAIR failed treatment (DAIR, 50 [65.8%]; 10 [38.5%]; P = .015). The 8-year Kaplan-Meier survivorship was 35.1% [95% confidence interval (CI), 24.3 to 45.9] for patients treated with DAIR and 61.5% [95% CI, 42.9 to 80.1] for those treated with RA (log rank = 0.039). Bivariate regression analysis showed performing a RA was associated with a higher likelihood of treatment success (odds ratio 4.499, 95% CI 1.600 to 12.647, P = .004), whereas a higher body mass index was associated with treatment failure (odds ratio 0.934, 95% CI 0.878 to 0.994, P = .032). CONCLUSIONS: To reduce the rate of recalcitrant infection following early postoperative or acute hematogenous total hip arthroplasty PJI, RA may be of benefit over DAIR. This is especially relevant in the early postoperative period, when components can be readily exchanged.

Robinsoniella peoriensis: An emerging pathogen and rare cause of wound infection in children.

BACKGROUND: Robinsoniella peoriensis is an anaerobic gram-positive bacilli first isolated from swine manure in 2003 but has since been associated with human infections. METHODS: We describe a pediatric case of R. peoriensis infection following a below-knee amputation for a limb injury and its treatment. Methods of identifying R. peoriensis and reported in vitro antimicrobial minimum inhibitory concentrations from the literature are reviewed. RESULTS: R. peoriensis is readily identifiable via 16S rRNA gene sequencing and Matrix-Assisted Laser Desorption Ionization-Time of Flight. There is variability in the antibiotic susceptibility profiles reported in the literature, but antibiotics with low in vitro minimum inhibitor concentrations against R. peoriensis include beta-lactam/beta-lactamase inhibitors, carbapenems, vancomycin, and metronidazole. CONCLUSION: This is the first reported case of R. peoriensis infection following a traumatic injury in Canada to our knowledge and highlights the importance of recognizing this organism and other anaerobes in settings where wounds are grossly contaminated with soil.

HISTORIQUE: Le Robinsoniella peoriensis est un bacille anaérobie à Gram positif d'abord isolé en 2003 dans le lisier de porc, mais qui a été associé à des infections humaines depuis. MÉTHODOLOGIE: Les auteurs décrivent un cas pédiatrique d'infection à R. peoriensis après une amputation au-dessous du genou à cause de la lésion d'un membre et de son traitement. Les chercheurs ont examiné les méthodes pour identifier le R. peoriensis et les concentrations minimales inhibitrices antimicrobiennes in vitro tirées des publications. RÉSULTATS: Le R. peoriensis est facile à identifier au moyen du séquençage du gène d'ARNr 16S et du spectromètre de masse à temps de vol pour la désorption-ionisation laser assistée par matrice. La description des profils de susceptibilité des antibiotiques est variable selon les publications, mais les antibiotiques aux concentrations minimales inhibitrices contre le R. peoriensis sont les bêta-lactamines et les inhibiteurs de bêta-lactamase, les carbapénems, la vancomycine et le métronidazole. CONCLUSION: À la connaissance des auteurs, il s'agit du premier cas déclaré d'infection à R. peoriensis après une lésion traumatique au Canada, ce qui fait ressortir l'importance de tenir compte de cet organisme et d'autres anaérobies lorsque les plaies sont grandement contaminées par de la terre.