title: Concomitant Multiple Joint Arthroplasty Infections: Report on 16 Cases.
abstract: Concomitant infections of several prostheses are very rare, serious events that pose particular medical and surgical therapeutic challenges. This study was undertaken to describe epidemiologic, clinical, and microbiological characteristics of concomitant multiple joint arthroplasty infections, their treatments, and outcomes.
  
  
  
  Retrospective (January 2000 and January 2014), single-center, cohort study in a referral center for bone and joint infections. All patients with at least 2 concomitant, microbiologically documented, prosthetic joint infections, that is, during the same septic episode, were included.
  
  
  
  Sixteen patients were included. Median (range) age was 78 years (46-93 years), gender ratio was 1, and median (range) body mass index was 27 (21-42). Multiple joint arthroplasties (bilateral hip in 8 patients; bilateral knee in 3 patients; hip and knee in 1 patient; and 2 knees and 1 hip in 1 patient) were contaminated hematogenously in all patients, 2 after early postoperative infections. Eight Staphylococcus aureus, 1 Staphylococcus epidermidis, 6 Streptococcus, and 1 Escherichia coli strains were isolated. A curative strategy was applied to 11 patients: 3 underwent bilateral synovectomies, 6 had successive 1-stage exchange arthroplasties, and 2 were treated with other strategies. After 37 months (range, 24-132 months) of follow-up, reinfection occurred in 1 patient. The 5 other patients received prolonged suppressive antibiotic therapy.
  
  
  
  These complex infections occur during staphylococcal or streptococcal bacteremia. Treatment strategies should be discussed by a multidisciplinary team on a case-by-case basis.
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Service de Médecine Interne et Rhumatologie, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Valérie
authors: V
authors: Zeller
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Delphine
authors: D
authors: Dedome
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Luc
authors: L
authors: Lhotellier
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Wilfrid
authors: W
authors: Graff
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Nicole
authors: N
authors: Desplaces
authors: Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France; Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
authors: Simon
authors: S
authors: Marmor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000601:surgery; D001178:Arthroplasty / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D016470:Bacteremia / Q000150:complications; D003131:Combined Modality Therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Sta aureus; Streptococcus; multiple joint arthroplasty infections; suppressive antibiotic therapy; therapeutic strategy