Fabrice Uhel1, Gregory Corvaisier2, Yves Poinsignon2, Catherine Chirouze3, Guillaume Beraud4, Olivier Grossi5, Nicolas Varache6, Cédric Arvieux7, Rozenn Le Berre8, Pierre Tattevin9. 1. Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, U1236, F-35043 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France. 2. Médecine Interne, CH Bretagne Atlantique, F-56017 Vannes, France. 3. CNRS 6249, Université de Bourgogne-Franche-Comté, CHRU Besançon, F-25030 Besançon, France. 4. Maladies Infectieuses, CHU Poitiers, F-86021 Poitiers, France. 5. Médecine Interne - Infectiologie, Nouvelles Cliniques Nantaises, F-44277 Nantes, France. 6. Maladies Infectieuses et Tropicales, CH Le Mans, F-72037 Le Mans, France. 7. Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France. 8. Médecine Interne et Pneumologie, CHRU de la Cavale Blanche, F-29609 Brest, France. 9. Maladies Infectieuses et Réanimation Médicale, CHU Rennes, CHU Pontchaillou, 2 rue Henri Le Guilloux, F-35033 Rennes, France; Faculté de Médecine, Inserm, CIC-1414, Université Rennes 1, F-35043 Rennes, France. Electronic address: pierre.tattevin@chu-rennes.fr.
Abstract
OBJECTIVES: We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI). METHODS: Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords 'prosthetic joint', and 'tuberculosis'. RESULTS: During years 1997-2016, 13 patients (8 males, 5 females, median age 79 years [range, 60-86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4-20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6-32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS). CONCLUSIONS: M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.
OBJECTIVES: We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI). METHODS: Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords 'prosthetic joint', and 'tuberculosis'. RESULTS: During years 1997-2016, 13 patients (8 males, 5 females, median age 79 years [range, 60-86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4-20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6-32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS). CONCLUSIONS: M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.