Prosthetic joint infections due to Mycobacterium tuberculosis: A retrospective study - 02/03/19
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Highlights |
• | Tuberculous prosthetic joint infection is rare. The diagnosis is simple but requires culturing of osteoarticular samples on a medium specifically designed to detect mycobacteria. |
• | The prognosis is good in patients given appropriate anti-tuberculosis therapy, whose optimal duration remains to be defined. |
• | The surgical strategy should be discussed on a case-by-case basis. Surgery is not always required when the diagnosis is made based on samples taken during implantation of the prosthesis. |
Abstract |
Objective |
Tuberculous prosthetic joint infection (PJI) is uncommon and often diagnosed late. The objective here is to describe the management of tuberculous PJI at an osteoarticular infection referral center.
Methods |
A single-center retrospective study of patients managed between 1987 and 2016 was performed.
Results |
We identified 9 patients with a median age of 80 years. The hip was involved in all 9 patients. A known history of tuberculosis was noted in 2 patients and tuberculosis was present at other sites in 4 patients (lung, n = 3; urinary tract and scrotum, n = 1; and spine, n = 1). The diagnosis was established by routine intra-operative microbiological sampling, during (n = 4) or at a distance from (n = 5) hip arthroplasty. In the 8 patients with available follow-up data, mean antibiotic therapy duration was 16 months (range, 12–18 months). None of the 4 patients in whom the infection was diagnosed during arthroplasty required surgical revision because of the infection. Of the other 5 patients, 3 were managed by exchange arthroplasty and 1 by excision of the hip without subsequent prosthesis implantation; the remaining patient did not undergo revision surgery. The infection was eradicated in all 9 patients, after 15 months to 10 years.
Conclusion |
Tuberculous PJI is uncommon. The prognosis is good with prolonged antibiotic therapy, although the optimal duration remains unclear. The surgical strategy should be discussed on a case-by-case basis. The prosthesis can be retained if the tuberculous infection is an unexpected finding during arthroplasty.
Le texte complet de cet article est disponible en PDF.Keywords : Mycobacterium tuberculosis, Periprosthetic joint infection
Plan
Vol 86 - N° 2
P. 239-243 - mars 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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