title: Special issues involving periprosthetic infection in immunodeficiency patients.
abstract: Chronic systemic illnesses such as diabetes mellitus, chronic kidney disease (CKD), liver cirrhosis, neoplasia, etc. have been clearly associated with high rates of SWI. However, the exact mechanisms underlying these observations are still under investigation. Chronic kidney disease (CKD) is a growing problem in our society. Many of these patients will require an arthroplasty and it appears that the prosthetic infection risk for these types of patients is much higher than in the normal population. The risk of complications due to infection seems to be lower in patients with kidney transplants than in patients undergoing haemodialysis. Both prophylaxis and treatment of infection in patients with CKD should be carried out with a strict monitoring of potentially nephrotoxic antibiotics. The literature on the prognosis and risk of infection in patients with haematopoietic stem cell transplant is scarce and occasionally contradictory. The optimal time for the surgery should be determined by taking into account the immunological state of the patient and should be avoided, as much as possible, during the first year after the HSCT. Child's classification system is the most widely used method of stratifying the surgical risk for patients with cirrhosis; the infection appeared to be associated in a statistically significant way with advanced age and a Child B pre-operative classification. The prevention of prosthetic joint infections in HIV-infected patients should not be significantly different from the prevention for any other patient. Those patients that receive adequate antiretroviral treatment and periodic laboratory control show infection rates and periprosthetic complications that are similar to those for patients not affected by HIV. Therefore, the patient's level of immunodeficiency is the most important prognostic factor for prosthetic infection. The particular immunological condition of these patients can lead to infections due to particular microorganisms that immunocompetent patients do not have to deal with. Of all possibilities, because of their frequency and difficulty to treat, infections caused by methicillin-resistant S. aureus and fungus are highlighted.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Tornero
authors.forename: Josep
authors.initials: J
authors.lastname: Riba
authors.forename: Sebastian
authors.initials: S
authors.lastname: Garcia-Ramiro
keywords: HIV; Prosthetic joint infection; elderly.; kidney; liver
references.citation: Med Mycol. 2011 Apr;49(3):253-62
references.pmid: 21039308
references.citation: Chir Organi Mov. 1995 Apr-Jun;80(2):139-45
references.pmid: 7587515
references.citation: N Engl J Med. 1996 May 9;334(19):1209-15
references.pmid: 8606715
references.citation: J Rheumatol. 1983 Jun;10(3):494-5
references.pmid: 6684169
references.citation: Am J Gastroenterol. 1999 Aug;94(8):2193-7
references.pmid: 10445549
references.citation: Dig Liver Dis. 2001 Jan-Feb;33(1):41-8
references.pmid: 11303974
references.citation: Hepatology. 1999 Jun;29(6):1617-23
references.pmid: 10347099
references.citation: J Arthroplasty. 2004 Feb;19(2):248-52
references.pmid: 14973873
references.citation: Mayo Clin Proc. 1999 Jun;74(6):593-9
references.pmid: 10377935
references.citation: J Bone Joint Surg Br. 2005 Sep;87(9):1178-81
references.pmid: 16129738
references.citation: Clin Microbiol Infect. 2011 Mar;17(3):439-44
references.pmid: 20412187
references.citation: N Engl J Med. 2000 Jan 20;342(3):161-7
references.pmid: 10639541
references.citation: Surgery. 1997 Oct;122(4):730-5; discussion 735-6
references.pmid: 9347849
references.citation: Ital J Gastroenterol Hepatol. 1999 Oct;31(7):616-25
references.pmid: 10604106
references.citation: Presse Med. 2003 Apr 5;32(13 Pt 1):595-8
references.pmid: 12714913
references.citation: J Arthroplasty. 1997 Oct;12(7):825-9
references.pmid: 9355014
references.citation: Histopathology. 1998 Nov;33(5):479-84
references.pmid: 9839174
references.citation: Haemophilia. 2005 May;11(3):233-9
references.pmid: 15876268
references.citation: Antimicrob Agents Chemother. 2010 Oct;54(10):4474-5
references.pmid: 20660685
references.citation: Clin Orthop Relat Res. 1976 Nov-Dec;(121):20-32
references.pmid: 991504
references.citation: Semin Liver Dis. 2002 Feb;22(1):83-96
references.pmid: 11928081
references.citation: Clin Infect Dis. 2002 Aug 15;35(4):353-8
references.pmid: 12145715
references.citation: J Infect. 2001 Apr;42(3):208-9
references.pmid: 11545555
references.citation: Hepatology. 1994 Mar;19(3):628-34
references.pmid: 8119687
references.citation: Arch Surg. 1986 Mar;121(3):275-7
references.pmid: 3947226
references.citation: Rev Infect Dis. 1989 Jan-Feb;11(1):89-96
references.pmid: 2916098
references.citation: Hip Int. 2008 Jan-Mar;18(1):51-7
references.pmid: 18645975
references.citation: J Arthroplasty. 2003 Apr;18(3):259-64
references.pmid: 12728415
references.citation: J Bone Joint Surg Br. 2003 Jul;85(5):734-5
references.pmid: 12892201
references.citation: N Engl J Med. 2010 Jan 7;362(1):9-17
references.pmid: 20054045
references.citation: J Bone Joint Surg Br. 2005 Jun;87(6):844-50
references.pmid: 15911671
references.citation: Med Clin (Barc). 2006 Nov 18;127(19):738-40
references.pmid: 17198651
references.citation: J Arthroplasty. 1995 Apr;10(2):191-5
references.pmid: 7798100
references.citation: Infect Control Hosp Epidemiol. 2000 May;21(5):319-23
references.pmid: 10823564
references.citation: Hepatology. 1995 Jul;22(1):367-9
references.pmid: 7601431
references.citation: Clin Orthop Relat Res. 1979 Jun;(141):17-27
references.pmid: 477100
references.citation: J Bone Joint Surg Br. 1996 Nov;78(6):878-83
references.pmid: 8951000
references.citation: Int J Med Sci. 2009 Sep 04;6(5):247-52
references.pmid: 19834590
references.citation: Drugs. 1997;54 Suppl 6:39-52
references.pmid: 9474480
references.citation: Am J Surg. 1975 Nov;130(5):579-84
references.pmid: 1106243
references.citation: J Bone Joint Surg Am. 2009 Nov;91 Suppl 6:142-9
references.pmid: 19884422
references.citation: J Infect Dis. 2000 Aug;182(2):526-33
references.pmid: 10915084
references.citation: Major Probl Clin Surg. 1964;1:1-85
references.pmid: 4950264
references.citation: Rev Esp Quimioter. 2011 Mar;24(1):37-41
references.pmid: 21412668
references.citation: Arch Orthop Trauma Surg. 2004 Mar;124(2):82-5
references.pmid: 14740232
references.citation: Clin Infect Dis. 2003;37 Suppl 2:S91-5
references.pmid: 12942380
references.citation: Clin Orthop Relat Res. 1990 Aug;(257):107-28
references.pmid: 2199114
references.citation: Anesthesiology. 1996 Mar;84(3):732-47
references.pmid: 8659805
references.citation: Semin Nephrol. 2002 Nov;22(6):494-506
references.pmid: 12430094
references.citation: Clin Orthop Relat Res. 1993 May;(290):216-24
references.pmid: 8472452
references.citation: Public Health Rep. 1993 Mar-Apr;108(2):192-7
references.pmid: 8464975
references.citation: Am J Med. 1985 Jan;78(1):82-6
references.pmid: 3966493
references.citation: Eur J Clin Microbiol Infect Dis. 2006 Jan;25(1):35-8
references.pmid: 16424973
references.citation: J Bone Joint Surg Br. 1989 May;71(3):456-9
references.pmid: 2656719
references.citation: Hum Biol. 2000 Oct;72(5):801-20
references.pmid: 11126726
references.citation: HIV Med. 2012 Nov;13(10):623-9
references.pmid: 22500743
references.citation: J Antimicrob Chemother. 2010 Feb;65(2):271-4
references.pmid: 19996142
references.citation: J Arthroplasty. 2005 Oct;20(7):870-3
references.pmid: 16230237
references.citation: Clin Infect Dis. 2000 Dec;31(6):1488-92
references.pmid: 11096017
references.citation: Clin Orthop Relat Res. 1998 Dec;(357):127-34
references.pmid: 9917709
references.citation: Clin Orthop Relat Res. 2007 Aug;461:175-9
references.pmid: 17806151
references.citation: J Nephrol. 2003 Jan-Feb;16(1):34-9
references.pmid: 12649533
references.citation: Enferm Infecc Microbiol Clin. 2010 Mar;28(3):150-5
references.pmid: 19683365
references.citation: Anesthesiology. 1999 Jan;90(1):42-53
references.pmid: 9915311
references.citation: Infect Control Hosp Epidemiol. 2001 Oct;22(10):607-12
references.pmid: 11776345
references.citation: N Engl J Med. 2002 Jun 13;346(24):1871-7
references.pmid: 12063371
references.citation: J Infect. 2001 Jan;42(1):74-6
references.pmid: 11243760
references.citation: Clin Infect Dis. 2002 Apr 1;34(7):930-8
references.pmid: 11880958
references.citation: J Arthroplasty. 2001 Jun;16(4):529-32
references.pmid: 11402423
references.citation: Mod Rheumatol. 2007;17(5):380-4
references.pmid: 17929129
references.citation: J Bone Joint Surg Am. 1969 Jun;51(4):737-55
references.pmid: 5783851
references.citation: J Bone Joint Surg Am. 2004 Feb;86(2):335-41
references.pmid: 14960679
references.citation: J Bone Joint Surg Am. 1982 Sep;64(7):1063-7
references.pmid: 7118973
references.citation: J Arthroplasty. 1998 Jun;13(4):479-82
references.pmid: 9645532
references.citation: J Bone Joint Surg Am. 1984 Jan;66(1):142-3
references.pmid: 6690437