Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;51(3):743-747.
doi: 10.1007/s15010-022-01913-9. Epub 2022 Sep 8.

Clinically unsuspected orthopedic implants during S. aureus bacteremia do not require additional diagnostic work-up

Ilse J E Kouijzer  1 , L T D Speijker  2 , E H J G Aarntzen  3 , W H C Rijnen  4 , M P Somford  5 , I Maat  6 , M P A van Meer  7 , J Ten Oever  2 , E H Gisolf  8
Affiliations

Clinically unsuspected orthopedic implants during S. aureus bacteremia do not require additional diagnostic work-up

Ilse J E Kouijzer et al. Infection. 2023 Jun.

Abstract

Purpose: To assess the likelihood of occult infection in patients with clinically unsuspected orthopedic implants during Staphylococcus aureus bacteremia (SAB).

Methods: In a retrospective study in two Dutch hospitals, we included all patients with SAB between 2013 and 2020 with one or more orthopedic implants in whom [18F]FDG-PET/CT was performed. The primary outcome was the percentage of patients who had an orthopedic implant-related infection by S. aureus. We also compared clinical parameters in patients with clinically suspected and unsuspected implants.

Results: Fifty-five of 191 (29%) orthopedic implants in 118 SAB patients included had clinical signs of infection. Of all 136 unsuspected implants, 5 (3%, all arthroplasties), showed increased [18F]FDG uptake around the prosthesis on [18F]FDG-PET/CT. The clinical course of these patients without clinically overt infection or relapse of bacteremia during follow-up of a median of 48 months (range 0-48), however, argued against prosthetic joint infection.

Conclusion: Although orthopedic implants are evidently a risk factor for metastatic infection during SAB, the absence of clinical symptoms obviate the need of additional investigations or prolonged antibiotic treatment.

Keywords: Diagnostics; FDG-PET/CT; Orthopedic implants; Staphylococcus aureus bacteremia.

PubMed Disclaimer

Conflict of interest statement

IK, LS, EA, MS, IM, MvM, JtO, and EG declare they have no financial interests. WR has served as consultant for Stryker (faculty work in Exeter courses) and for Materialise (for education/surgical training).

References

    1. Honkanen M, Jamsen E, Karppelin M, Huttunen R, Eskelinen A, Syrjanen J. Periprosthetic joint infections as a consequence of bacteremia. Open Forum Infect Dis. 2019;6:ofz218. doi: 10.1093/ofid/ofz218. - DOI - PMC - PubMed
    1. Komnos GA, Manrique J, Goswami K, Tan TL, Restrepo C, Sherman MB, et al. Periprosthetic joint infection in patients who have multiple prostheses in place: what should be done with the silent prosthetic joints. J Bone Jt Surg Am. 2020;102:1160–1168. doi: 10.2106/JBJS.18.01500. - DOI - PubMed
    1. Berrevoets MAH, Kouijzer IJE, Aarntzen E, Janssen MJR, De Geus-Oei LF, Wertheim HFL, et al. (18)F-FDG PET/CT optimizes treatment in Staphylococcus aureus bacteremia and is associated with reduced mortality. J Nucl Med. 2017;58:1504–1510. doi: 10.2967/jnumed.117.191981. - DOI - PubMed
    1. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52:285–292. doi: 10.1093/cid/cir034. - DOI - PubMed
    1. Wouthuyzen-Bakker M, Sebillotte M, Arvieux C, Fernandez-Sampedro M, Senneville E, Barbero JM, et al. How to handle concomitant asymptomatic prosthetic joints during an episode of hematogenous periprosthetic joint infection, a multicenter analysis. Clin Infect Dis. 2021;73:e3820–e3824. doi: 10.1093/cid/ciaa1222. - DOI - PMC - PubMed

MeSH terms

Substances