Bone and Joint Infections Bone and Joint Infections From Microbiology to Diagnostics and Treatment Editor Werner Zimmerli This edition first published 2015 © 2015 by John Wiley & Sons, Inc. Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. All rights reserved. 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Cover image: Courtesy Werner Zimmerli Cover design by Soephian Zainal Set in 10/11.5pt Times New Roman by SPi Publishers Services, Pondicherry, India 1 2015 This book is dedicated to my wife Annelies, and my children, Simone, Joëlle, and Laurent, who sometimes queued behind the kind of patients described in this book. Contents Contributors xiii Foreword xvii Acknowledgments xix Chapter 1 Introduction 1 Werner Zimmerli Chapter 2 Microbiology of Bone and Joint Infections 5 Seong Yeol Ryu and Robin Patel Microorganisms in Osteomyelitis 5 Microorganisms in Implant-Associated Bone and Joint Infection 7 Microorganisms in Native Joint Arthritis 10 Diagnostic Approach in Osteomyelitis 11 Diagnostic Approach in Foreign Body–Associated Infection 12 Diagnostic Approach in Native Joint Infection 15 Novel Diagnostic Procedures 17 Acknowledgment 17 References 17 Chapter 3 Pharmacokinetics and Pharmacodynamics of Antibiotics in Bone 21 Cornelia B. Landersdorfer, Jürgen B. Bulitta, and Fritz Sörgel Pharmacokinetics 21 Bone Sample Preparation and Analysis 22 Pharmacokinetic Sampling and Data Analysis 23 Penetration of Antibiotics into Bone 24 Pharmacodynamics and Monte Carlo Simulations 31 Conclusions 34 Key Points 34 References 35 vii viii Contents Chapter 4 Preclinical Models of Infection in Bone and Joint Surgery 39 Lorenzo Calabro, R. Geoff Richards, and T. Fintan Moriarty Introduction 39 Influence of Species in Preclinical Models of Bone and Joint Infection 40 Overview of Animal Models 42 Direct Inoculation with Minimal Trauma 42 Animal Osteomyelitis Models Incorporating Trauma 46 Hematogenous Models 47 Future Directions 48 Conclusion 49 Key Points 49 References 49 Chapter 5 Native Joint Arthritis in Children 55 Pablo Yagupsky Introduction 55 Epidemiology 55 Microbiology 56 Pathogenesis 61 Clinical Presentation 62 Laboratory Investigation 63 Imaging Studies 66 Differential Diagnosis 66 Treatment 67 Prognosis 71 Key Points 72 References 72 Chapter 6 Native Joint Arthritis 77 Ilker Uçkay, Mohamed Al-Mayahi, Domizio Suvà, Daniel Lew, and Pierre Vaudaux Introduction 77 Pathogenesis, Epidemiology, and Microbiology 77 Diagnosis 79 Treatment 81 Outcome of Native Joint Septic Arthritis 87 Key Points 88 Acknowledgments 88 References 88 Chapter 7 Septic Arthritis of Axial Joints 93 Werner Zimmerli Septic Arthritis of the Sternoclavicular Joint 93 Key Points 98 Septic Arthritis of the Symphysis Pubis 98 Key Points 103 Septic Arthritis of the Sacroiliac Joint 103 Key Points 107 References 107 Contents ix Chapter 8 Periprosthetic Joint Infection: General Aspects 113 Werner Zimmerli Introduction 113 Definition 114 Classification 115 Pathogenesis 115 Diagnostic Algorithm 118 Laboratory Investigation 119 Therapeutic Management 121 Prophylaxis 122 Errors in the Management of PJI 123 Key Points 124 References 124 Chapter 9 Periprosthetic Joint Infection after Total Hip and Knee Arthroplasty 131 Werner Zimmerli and Martin Clauss Introduction 131 Risk Factors 131 Microbiology 132 Clinical Features 133 Laboratory Investigation 133 Imaging Procedures 134 Management 135 Instructive Cases 142 References 146 Chapter 10 Periprosthetic Joint Infection after Shoulder Arthroplasty 151 Parham Sendi, Beat K. Moor, and Matthias A. Zumstein Introduction 151 Risk Factors 151 Microbiology 153 Pathogenesis 154 Clinical Features 154 Laboratory Investigation 155 Imaging Procedures 157 Management 158 Instructive Cases 162 References 163 Chapter 11 Periprosthetic Joint Infection after Elbow Arthroplasty 167 Yvonne Achermann and Michael C. Glanzmann Introduction 167 Microbiology 168 Clinical Features 168 Diagnostic Procedures 169 Instructive Cases 176 References 179 x Contents Chapter 12 Periprosthetic Joint Infection after Ankle Arthroplasty 183 Parham Sendi, Bernhard Kessler, and Markus Knupp Introduction 183 History of Total Ankle Arthroplasty 184 Risk Factors 185 Microbiology 186 Management 189 Instructive Cases 192 References 194 Chapter 13 Osteomyelitis: Classification 197 Werner Zimmerli Classification According to Pathogenesis 197 Classification According to the Duration of Infection 199 Classification According to the Localization 200 Classification According to the Presence of an Implant 200 Classification According to Anatomy and Comorbidity 200 References 201 Chapter 14 Osteomyelitis in Children 205 Priya Sukhtankar, Saul N. Faust, and Nicholas M.P. Clarke Introduction 205 Epidemiology 205 Pathophysiology 206 Clinical Presentation, Diagnosis, and Microbiology 207 Treatment 214 Complications 217 Key Points 217 References 217 Chapter 15 Acute Osteomyelitis in Adults 221 Werner Zimmerli Introduction 221 Pathogenesis 221 Epidemiology 223 Microbiology 224 Risk Factors 225 Clinical Features 227 Laboratory Investigation 229 Imaging Procedures 231 Clinical and Imaging Differential Diagnosis 232 Treatment 233 Key Points 236 References 236 Chapter 16 Subacute Osteomyelitis: Tuberculous and Brucellar Vertebral Osteomyelitis 241 Juan D. Colmenero and Pilar Morata Introduction 241 Epidemiology 241 Contents xi Clinical Features 242 Laboratory Investigation 244 Imaging Procedures 247 Antimicrobial and Surgical Therapy 250 Key Points 252 References 252 Chapter 17 Chronic Osteomyelitis in Adults 257 Silvin Lito, Antoine Lomessy, Pierre Vaudaux, and Ilker Uçkay Introduction 257 Epidemiology and Pathogenesis 259 Diagnosis 260 Treatment 262 Future Perspectives 268 Key Points 268 Acknowledgments 269 References 269 Chapter 18 Diabetic Foot Osteomyelitis 273 Eric Senneville and Sophie Nguyen Introduction 273 Classification 273 Microbiology 276 Risk Factors 278 Clinical Features 279 Inflammatory Parameters 279 Imaging Procedures 280 Management 281 Prevention 284 References 284 Chapter 19 Osteomyelitis of the Jaws 289 Werner Zimmerli Introduction 289 Classification 289 Microbiology 291 Risk Factors 292 Clinical Features 292 Laboratory Investigation 294 Imaging Procedures 296 Management 297 Key Points 299 References 299 Chapter 20 Implant-Associated Osteomyelitis of Long Bones 303 Martin McNally and Parham Sendi Introduction 303 Classification and Risk Factors 304 Microbiology 306 xii Contents Clinical Features 306 Laboratory Investigation 307 Imaging Procedures 309 Management 309 Instructive Cases 317 References 320 Chapter 21 Implant-Associated Vertebral Osteomyelitis 325 Todd J. Kowalski Introduction 325 Epidemiology, Risk Factors, and Preventive Measures 326 Microbiology 327 Clinical Features 331 Diagnostic Procedures 332 Management 333 Instructive Cases 339 References 341 Chapter 22 Postoperative Sternal Osteomyelitis 347 Parham Sendi, Örjan Friberg, Mihai A. Constantinescu, and Lars Englberger Introduction 347 Risk Factors 348 Microbiology 351 Clinical Features 352 Laboratory Investigation 354 Imaging Procedures 355 Management 356 Instructive Cases 360 References 362 Index