RESUMO
CONCLUSION: Fracture-related infections (FRI) pose serious complications, requiring swift surgical intervention. Although C. perfringens infections in FRIs are rare and literature is scarce, this case highlights the successful management and good functional outcome, offering valuable insights for clinicians dealing with such infections.
Assuntos
Infecções por Clostridium , Clostridium perfringens , Humanos , Antibacterianos/uso terapêutico , Infecções por Clostridium/complicações , Clostridium perfringens/isolamento & purificação , Fraturas Ósseas/cirurgia , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico por imagemRESUMO
Prosthetic joint infections (PJIs) are commonly diagnosed via culture-based methods, which may miss hard-to-grow pathogens. This study contrasts amplicon metagenomic sequencing (16S AS) with traditional culture techniques for enhanced clinical decision-making. We analyzed sonicate fluid from 27 patients undergoing revision arthroplasty using both methods, emphasizing the distinction between contaminants and true positives. Our findings show moderate agreement between the two methods, with a Cohen's kappa of 0.490, varying across bacterial genera (Cohen's kappa -0.059 to 1). The sensitivity of 16S AS compared to culture was 81% (95% CI, 68% to 94%). Sequencing revealed greater microbial diversity, including anaerobic genera like Anaerococcus and Citrobacter. Interestingly, several culture-negative PJI samples showed diverse bacteria via 16S AS. Despite rigorous controls and algorithms to eliminate contaminants, confirming bacteria presence with 16S AS remains a challenge. This highlights the need for improved PJI diagnostic methods, while also pointing out the limitations of next-generation sequencing (NGS) as a clinical diagnostic tool.
Assuntos
Artrite Infecciosa , Infecções Relacionadas à Prótese , Humanos , Artrite Infecciosa/diagnóstico , Bactérias/genética , Próteses e Implantes , Artroplastia , Sequenciamento de Nucleotídeos em Larga Escala , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Sensibilidade e Especificidade , RNA Ribossômico 16S/genéticaRESUMO
A 68-year-old man was referred due to bilateral hip pain and gradual deterioration of walking. He had mold arthroplasties on both hips at the age of 7 years and has been functioning well for more than 5 decades. However, the original data on operative report and the prostheses were missing. The radiological examination revealed bilateral broken prosthetic material. Thus, stage bilateral revision total hip arthroplasty was performed. A detailed chemical analysis of retrieved mold arthroplasty implants proved that the acrylic material was noted to be the same composition with the difference in appearance likely being related to different thermal treatments originally applied to the implants. As presented in our clinical case, even obsolete implants may have good survivorship. According to the case presented, total hip arthroplasty could be considered an effective option with the desired functional outcome when conservative and joint-preserving measures are exhausted.