Chapter 27 : Prosthetic Device Infections

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Prosthetic devices are frequently used in the management of patients with underlying immune deficiencies. Examples of prosthetic devices include a variety of joints, ventricular-assist devices, intravenous (IV) catheters, reservoirs for drug delivery, and postcancer reconstructive implants. The spectrum of underlying immunocompromised conditions spans the gamut of innate and acquired deficiencies of antibodies and complement, iatrogenic cellular-immune suppression to maintain transplanted stem cells and solid organs, neutropenia complicating chemotherapy, and biologic manipulation of interleukins and tumor-necrosis factor in numerous disease states. Dysfunction can occur in any and all arms of the immune system with sometimes predictable, but often surprising, infecting organisms and presentations. Prosthetic devices are especially prone to infection, given that skin provides a platform for bacterial colonization and immune evasion after violation of the skin by insertion of the device. Prosthetic-device infections can pose many clinical challenges, in particular the diagnosis and treatment of associated infections.

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015
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Image of Figure 1
Figure 1

Small-colony variants. SCV grows approximately 10X better on chocolate agar than on blood agar, incubated in ambient air at 35°C overnight. SCV grows approximately 10X better on blood agar than on MacConkey agar incubated in ambient air at 35°C overnight.

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015
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Image of Figure 2
Figure 2

Management of the infected total-joint replacement. One-stage exchange criteria: applies to hip prosthesis only, susceptible to antibiotics with good penetration, adequate soft-tissue coverage, adequate residual bone requires no bone grafting, use antibiotic-impregnated bone cement for reimplantation. Two-stage exchange criteria: nonhip prosthesis OR poor soft-tissue coverage OR prior infected prosthetic joint OR difficult-to-treat organism. Modified with permission from reference ( ).

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015
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Figure 3

Acridine orange. Smear stained with acridine-orange fluorescent dye. Microscopic observation at 1,000X reveals cocci in clusters, bacilli, and budding yeast. Photo courtesy of Jeffrey W. Prichard, D.O., Geisinger Health System.

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015
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Download as Powerpoint
Image of Figure 4
Figure 4

Prosthetic-joint culture comparison. sonicate fluid with (>100 CFU/10 ml) and (20–50 CFU/10 ml), periprosthetic tissue #1 with moderate and few , periprosthetic tissue #2 with moderate and few , synovial-fluid culture growing only, no .

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015
Permissions and Reprints Request Permissions
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Table 1

Guidelines for prosthetic-joint infection (PJI) diagnosis

Citation: Martinez R, Bowen T, Foltzer M. 2016. Prosthetic Device Infections, p 711-733. In Hayden R, Wolk D, Carroll K, Tang Y (ed),

Diagnostic Microbiology of the Immunocompromised Host, Second Edition

. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.DMIH2-0004-2015

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