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.
Publication
Journal of Infection
Notes
Summary:
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Objective: The objective of the study was to characterize the diagnosis, management, and outcomes of Mycobacterium tuberculosis prosthetic joint infections.
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Methods: The study includes cases of M. tuberculosis PJI documented in seven French referral medical centers from 1997 to 2016. Data were collected from medical records using a standardized questionnaire. Additionally, a literature review was conducted using specific keywords.
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Results:
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13 patients with documented M. tuberculosis PJI were included.
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Patients had a median age of 79 years and an almost equal gender distribution.
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The most common sites of PJI were the hip and knee joints.
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The median time from joint arthroplasty to the diagnosis of M. tuberculosis PJI was 9 years.
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Diagnosis was typically obtained through joint aspirates or synovial tissue, with positive PCR results in all tested cases.
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Antituberculosis treatment was administered for a median duration of 14 months.
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Surgical interventions included debridement, resection arthroplasty, and revision arthroplasty.
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PJI was successfully controlled in 12 out of 13 patients.
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A literature review identified 70 additional cases of M. tuberculosis PJI, with favorable outcomes with various management strategies.
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Discussion: The study suggests that M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical intervention. The need for surgery and the timing of surgery may be different from conventional prosthetic joint infections.
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Conclusion: The findings of the study challenge traditional paradigms for managing prosthetic joint infections and highlight the potential success of prolonged antituberculosis treatment as a primary treatment option for M. tuberculosis PJI, particularly in elderly patients with comorbidities.
Limitations include the retrospective nature of the research and potential publication bias in the literature review.
Strengths include that it provides valuable insights into the management of a rare type of prosthetic joint infection caused by Mycobacterium tuberculosis.
Citation
1.
Uhel F, Corvaisier G, Poinsignon Y, et al. Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review. Journal of Infection. 2019;78(1):27-34.