J Bone Jt Infect 2018; 3(5):241-244. doi:10.7150/jbji.25887
Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series
1. Bone-and-Joint Infections Referral Center, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
2. Internal Medicine Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
3. Microbiology Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
4. Orthopedic Surgery Department, Hôpital Croix Saint-Simon, 125, rue d'Avron 75020 Paris, France
Introduction: Prosthetic joint infections (PJIs) can be acquired hematogenously from a distant site or device. Notably, 30%-40% of patients with PJIs have Staphylococcus aureus bacteremia. No case reports or series of PJIs acquired from totally implantable venous-access device (TIVAD) infection or colonization have been published. This study was undertaken to describe epidemiological, clinical, microbiological and radiological characteristics of such PJIs, their treatments and outcomes.
Methods: This retrospective study included all patients, identified in a prospective French Bone-and-Joint Infections Referral Center cohort treated between 2004 and 2017, with PJI secondary to TIVAD infection, with the same microbiologically documented microorganism isolated from both.
Results: We describe six consecutive hematogenous PJIs (4 women, 2 men; median age: 66.5 years) acquired from TIVAD primary infections. The main infection risk factors were malignancy (n=5) and prior septic arthritis (n=2). Four participants' TIVADs were implanted for chemotherapy, preceding the prosthesis for one patient. The median TIVAD-implantation-to-symptom-onset interval was 12 months. Microorganisms were Staphylococcus epidermidis (n=4), Staphylococcus capitis (n=1) and Staphylococcus aureus (n=1). All TIVADs were removed. Five participants received curative treatment, with a median of 12 weeks of antibiotics. After median follow-up of 42 months, none have relapsed.
Conclusions: When PJI occurs in a patient with a TIVAD, the latter must be tested as a potential source of the prosthesis infection. Conversely, PJIs must sought in all patients with bacteremia.
Keywords: prosthetic joint infection, hematogenous dissemination, catheter infection.
Medina F, Meyssonnier V, Zeller V, Heym B, Ziza JM, Marmor S. Totally Implantable Venous-Access Device Infection Causing Hematogenous Prosthetic Joint Infection: A Retrospective Case Series. J Bone Jt Infect 2018; 3(5):241-244. doi:10.7150/jbji.25887. Available from http://www.jbji.net/v03p0241.htm