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. 2017 Dec 28;17(1):802.
doi: 10.1186/s12879-017-2926-3.

Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection

Anupop Jitmuang  1 , Varah Yuenyongviwat  2 , Keerati Charoencholvanich  3 , Methee Chayakulkeeree  4
Affiliations

Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection

Anupop Jitmuang et al. BMC Infect Dis. .

Abstract

Background: Prosthetic joint infection (PJI) is a major complication of total hip and total knee arthroplasty (THA, TKA). Although mycobacteria are rarely the causative pathogens, it is important to recognize and treat them differently from non-mycobacterial infections. This study aimed to compare the clinical characteristics, associated factors and long-term outcomes of mycobacterial and non-mycobacterial PJI.

Methods: We conducted a retrospective case-control study of patients aged ≥18 years who were diagnosed with PJI of the hip or knee at Siriraj Hospital from January 2000 to December 2012. Patient characteristics, clinical data, treatments and outcomes were evaluated.

Results: A total of 178 patients were included, among whom 162 had non-mycobacterial PJI and 16 had mycobacterial PJI. Rapidly growing mycobacteria (RGM) (11) and M. tuberculosis (MTB) (5) were the causative pathogens of mycobacterial PJI. PJI duration and time until onset were significantly different between mycobacterial and non-mycobacterial PJI. Infection within 90 days of arthroplasty was significantly associated with RGM infection (OR 21.86; 95% CI 4.25-112.30; p < .001). Implant removal was associated with improved favorable outcomes at 6 months (OR 5.96; 95% CI 1.88-18.88; p < .01) and 12 months (OR 3.96; 95% CI 1.15-13.71; p = .03) after the infection.

Conclusions: RGM were the major pathogens of early onset PJI after THA and TKA. Both a high clinical index of suspicion and mycobacterial cultures are recommended when medically managing PJI with negative cultures or non-response to antibiotics. Removal of infected implants was associated with favorable outcomes.

Keywords: Hip arthroplasty; Knee arthroplasty; Mycobacteria; Prosthetic joint infection.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol for this study was approved by the Scientific Ethics Committee of the Siriraj Institutional Review Board (SIRB), Faculty of Medicine Siriraj Hospital, Mahidol University.

According to a retrospective design of the study, informed consent was waived and the authors had permission to access the data of patients in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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