Advertisement

Osteoarticular infections: a specific program for older patients?

  • Ilker UçkayEmail author
  • Dominique Holy
  • Michael Betz
  • Regina Sauer
  • Tanja Huber
  • Jan Burkhard
Review
  • 30 Downloads

Abstract

Background

With the increasing number of elderly patients, arthroplasties, fractures and diabetic foot infections, the worldwide number of osteoarticular infections (OAI) among the elderly is concomitantly expected to rise.

Aims

We explore existing scientific knowledge about OAI in the frail elderly population.

Methods

We performed a literature search linking OAIs to geriatric patients and comparing elderly patients (> 65 years) with average adults (range 18–65 years).

Results

In this literature, financial aspects, comparison of diverse therapies on quality of life, reimbursement policies, or specific guidelines or nursing recommendations are missing. Age itself was not an independent factor related to particular pathogens, prevention of OAI, nursing care, and outcomes of OAI. However, geriatric patients were significantly more exposed to adverse events of therapy. They had more co-morbidities and more conservative surgery for OAI.

Conclusion

Available literature regarding OAI management among elderly patients is sparse. In recent evaluations, age itself does not seem an independent factor related to particular epidemiology, pathogens, prevention, nursing care, rehabilitation and therapeutic outcomes of OAI. Future clinical research will concern more conservative surgical indications, but certainly reduce inappropriate antibiotic use.

Keywords

Osteoarticular infections Elderly Therapy Epidemiology Prevention 

Notes

Author contributions

All six authors contributed to the drafting and writing of this review.

Compliance with ethical standards

Conflict of interest

This work had no financial funding or sponsorship, and we have no conflict of interest.

Statement of human and animal rights

This article does not contain any human participation or animal studies.

Informed consent

For this type of study formal consent is not required.

References

  1. 1.
    Al-Mayahi M, Betz M, Muller DA et al (2013) Remission rate of implant-related infections following revision surgery after fractures. Int Orthop 37:2253–2258CrossRefGoogle Scholar
  2. 2.
    Uçkay I, Aragon-Sanchez J, Lew D et al (2015) Diabetic foot infections: what have we learned in the last 30 years? Int J Infect Dis 40:81–91CrossRefGoogle Scholar
  3. 3.
    Murillo O, Grau I, Lora-Tamayo J et al (2015) The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect 21:254–262CrossRefGoogle Scholar
  4. 4.
    Post V, Wahl P, Uçkay I et al (2014) Phenotypic and genotypic characterisation of Staphylococcus aureus causing musculoskeletal infections. Int J Med Microbiol 304:565–576CrossRefGoogle Scholar
  5. 5.
    Tumminello A, Dominguez D, Lebowitz D et al (2017) Staphylococcus aureus versus streptococci in orthopaedic infections. Infect Dis (Lond) 49:716–718CrossRefGoogle Scholar
  6. 6.
    Lebowitz D, Müller CA, Balague N (2015) Staphylococcus aureus versus Streptococcus pyogenes in hand infection. Infect Dis (Lond) 47:747–748CrossRefGoogle Scholar
  7. 7.
    Uçkay I, Pires D, Agostinho A et al (2017) Enterococci in orthopaedic infections: who is at risk getting infected? J Infect 75:309–314CrossRefGoogle Scholar
  8. 8.
    Charles PG, Uçkay I, Kressmann B et al (2015) The role of anaerobes in diabetic foot infections. Anaerobe 34:8–13CrossRefGoogle Scholar
  9. 9.
    Lebowitz D, Kressmann B, Gjoni S et al (2017) Clinical features of anaerobic orthopaedic infections. Infect Dis (Lond) 49:137–140CrossRefGoogle Scholar
  10. 10.
    Uçkay I, Dinh A, Vauthey L et al (2010) Spondylodiscitis due to Propionibacterium acnes: report of twenty-nine cases and a review of the literature. Clin Microbiol Infect 16:353–358CrossRefGoogle Scholar
  11. 11.
    Coppens EPD, Al-Mayahi M, Cunningham G et al (2016) Characteristics of Propionibacterium acnes infections in orthopaedic surgery 11 year study in a referral center, 2004–2014. Austin J Infect Dis 3:1021–1026Google Scholar
  12. 12.
    Jamei O, Gjoni S, Zenelaj B et al (2017) Which orthopaedic patients are infected with gram-negative non-fermenting rods? J Bone Jt Infect 2:73–76CrossRefGoogle Scholar
  13. 13.
    Uçkay I, Harbarth S, Ferry T et al (2011) Methicillin resistance in orthopaedic coagulase-negative staphylococcal infections. J Hosp Infect 79:248–253CrossRefGoogle Scholar
  14. 14.
    Mohamad M, Uçkay I, Hannouche D et al (2018) Particularities of Staphylococcus lugdunensis in orthopaedic infections. Infect Dis (Lond) 50:223–225CrossRefGoogle Scholar
  15. 15.
    Müller CT, Uçkay I, Erba P et al (2015) Septic tenosynovitis of the hand: factors predicting need for subsequent debridement. Plast Reconstr Surg 136:338–343CrossRefGoogle Scholar
  16. 16.
    Gariani K, Lebowitz D, von Dach E et al (2019) Remission in diabetic foot infections: duration of antibiotic therapy and other possible associated factors. Diabetes Obes Metab 21:244–251CrossRefGoogle Scholar
  17. 17.
    Teterycz D, Ferry T, Lew D et al (2010) Outcome of orthopedic implant infections due to different staphylococci. Int J Infect Dis 14:913–918CrossRefGoogle Scholar
  18. 18.
    Jugun K, Richard JC, Lipsky BA et al (2016) Factors associated with treatment failure of infected pressure sores. Ann Surg 264:399–403CrossRefGoogle Scholar
  19. 19.
    Sahli H, Cherif I, Tekaya R et al (2014) Osteoarticular infections in elderly patients: a study of 44 cases. EULAR, Zürich (Scientific Abstract)Google Scholar
  20. 20.
    Cuérel C, Abrassart S, Billières J et al (2017) Clinical and epidemiological differences between implant-associated and implant-free orthopaedic infections. Eur J Orthop Surg Traumatol 27:229–231CrossRefGoogle Scholar
  21. 21.
    Ruppen C, Notter J, Strahm C et al (2018) Osteoarticular and skin and soft-tissue infections caused by Streptococcus agalactiae in elderly patients are frequently associated with bacteremia. Diagn Microbiol Infect Dis 90:55–57CrossRefGoogle Scholar
  22. 22.
    Uçkay I, Lübbeke A, Emonet S et al (2009) Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 59:337–345CrossRefGoogle Scholar
  23. 23.
    Bouvet C, Tchernin D, Seirafi M et al (2011) No need to search for the source of haematogenous arthroplasty infections. Swiss Med Wkly 141:13306Google Scholar
  24. 24.
    Vu DL, Uçkay I, Gonzalez A et al (2016) Factors related to outcome of early and delayed prosthetic joint infections. J Infect 72:255–257CrossRefGoogle Scholar
  25. 25.
    Uçkay I, Harbarth S, Peter R et al (2010) Preventing surgical site infections. Expert Rev Anti Infect Ther 8:657–670CrossRefGoogle Scholar
  26. 26.
    Sax H, Uçkay I, Balmelli C et al (2011) Overall burden of healthcare-associated infections among surgical patients. Results of a national study. Ann Surg 253:365–370CrossRefGoogle Scholar
  27. 27.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243CrossRefGoogle Scholar
  28. 28.
    Al-Mayahi M, Cian A, Kressmann B et al (2016) Associations of diabetes mellitus with orthopaedic infections. Infect Dis (Lond) 48:70–73CrossRefGoogle Scholar
  29. 29.
    Uçkay I, Lübbeke A, Harbarth S et al (2012) Low risk despite high endemicity of methicillin-resistant Staphylococcus aureus infections following elective total joint arthroplasty: a 12-year experience. Ann Med 44:360–368CrossRefGoogle Scholar
  30. 30.
    Davat M, Wuarin L, Stafylakis D et al (2018) Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay? Antimicrob Resist Infect Control 7:131–138CrossRefGoogle Scholar
  31. 31.
    Guanziroli N, Hannouche D, Uçkay I (2019) Is malnutrition associated with orthopaedic infections? A single-centre pilot evaluation. J Hosp Infect 101:229–230CrossRefGoogle Scholar
  32. 32.
    Signori V, Romano CL, De Vecchi E et al (2015) May osteoarticular infections be influenced by vitamin D status? An observational study on selected patients. BMC Musculoskelet Disord 16:183CrossRefGoogle Scholar
  33. 33.
    Uçkay I, Jugun K, Gamulin A et al (2012) Chronic osteomyelitis. Curr Infect Dis Rep 14:566–575CrossRefGoogle Scholar
  34. 34.
    Valour F, Karsenty J, Bouaziz A et al (2014) Antimicrobial-related severe adverse events during treatment of bone and joint infection due to methicillin-susceptible Staphylococcus aureus. Antimicrob Agents Chemother 58:746–755CrossRefGoogle Scholar
  35. 35.
    Schindler M, Bernard L, Belaieff W et al (2013) Epidemiology of adverse events and Clostridium difficile-associated diarrhea during long-term antibiotic therapy for osteoarticular infections. J Infect 67:433–438CrossRefGoogle Scholar
  36. 36.
    Lavergne A, Vigneau C, Polard E et al (2018) Acute kidney injury during treatment with high-dose cloxacillin: a report of 23 cases and literature review. Int J Antimicrob Agents 52:344–349CrossRefGoogle Scholar
  37. 37.
    Hirsiger S, IIgaz I, Uçkay I (2017) New antibiotics in the therapy of osteomyelitis. Mediterr J Infect Microb Antimicrob 6:15–23Google Scholar
  38. 38.
    Jugun K, Vaudaux P, Garbino J et al (2013) The safety and efficacy of high-dose daptomycin combined with rifampin for the treatment of Gram-positive osteoarticular infections. Int Orthop 37:1375–1380CrossRefGoogle Scholar
  39. 39.
    Deabate L, Pagani L, Uçkay I (2014) Modern antibiotic treatment of chronic long bone infections in adults-theory, evidence and practice. Mediterr J Infect Microbes Antimicrob 3:9Google Scholar
  40. 40.
    Tascini C, Tagliaferri E, Di Paolo A et al (2009) Three-times weekly teicoplanin as outpatient treatment of chronic osteoarticular infections. J Chemother 21:421–425CrossRefGoogle Scholar
  41. 41.
    Goutelle S, Valour F, Gagnieu MC et al (2018) Population pharmacokinetics and probability of target attainment of ertapenem administered by subcutaneous or intravenous route in patients with bone and joint infection. J Antimicrob Chemother 73:987–994CrossRefGoogle Scholar
  42. 42.
    Uhart M, Leroy B, Michaud A et al (2013) Inter-individual and intra-individual pharmacokinetic variability during teicoplanin therapy in geriatric patients. Med Mal Infect 43:295–298CrossRefGoogle Scholar
  43. 43.
    Huwyler T, Lenggenhager L, Abbas M et al (2017) Cefepime plasma concentrations and clinical toxicity: a retrospective cohort study. Clin Microbiol Infect 23:454–459CrossRefGoogle Scholar
  44. 44.
    Li HK, Rombach I, Zambellas R et al (2019) Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 380:425–436CrossRefGoogle Scholar
  45. 45.
    Cordero-Ampuero J, Esteban J, Garcia-Cimbrelo E (2009) Oral antibiotics are effective for highly resistant hip arthroplasty infections. Clin Orthop Relat Res 467:2335–2342CrossRefGoogle Scholar
  46. 46.
    Kim BN, Kim ES, Oh MD (2014) Oral antibiotic treatment of staphylococcal bone and joint infections in adults. J Antimicrob Chemother 69:309–322CrossRefGoogle Scholar
  47. 47.
    Uçkay I, Garzoni C, Ferry T et al (2010) Postoperative serum pro-calcitonin and C-reactive protein levels in patients with orthopedic infections. Swiss Med Wkly 140:13124Google Scholar
  48. 48.
    Czekaj J, Dinh A, Moldovan A et al (2011) Efficacy of a combined oral clindamycin-rifampicin regimen for therapy of staphylococcal osteoarticular infections. Scand J Infect Dis 43:962–967CrossRefGoogle Scholar
  49. 49.
    Betz M, Landelle C, Lipsky BA et al (2015) Letter to the editor concerning the review of Prof. Sheldon L. Kaplan, “Recent lessons for the management of bone and joint infections”–bacteriostatic or bactericidal agents in osteoarticular infections? J Infect 71:144–146CrossRefGoogle Scholar
  50. 50.
    Schindler M, Gamulin A, Belaieff W et al (2013) No need for broad-spectrum empirical antibiotic coverage after surgical drainage of orthopaedic implant infections. Int Orthop 37:2025–2030CrossRefGoogle Scholar
  51. 51.
    Lebowitz D, Gariani K, Kressmann B et al (2017) Are antibiotic-resistant pathogens more common in subsequent episodes of diabetic foot infection? Int J Infect Dis 59:61–64CrossRefGoogle Scholar
  52. 52.
    Gonzalez A, Suvà D, Dunkel N et al (2014) Are there clinical variables determining antibiotic prophylaxis-susceptible versus resistant infection in open fractures? Int Orthop 38:2323–2327CrossRefGoogle Scholar
  53. 53.
    Osmon DR, Berbari EF, Berendt AR et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:1–25CrossRefGoogle Scholar
  54. 54.
    Chaussade H, Uçkay I, Vuagnat A et al (2017) Antibiotic therapy duration for prosthetic joint infections treated by debridement and implant retention (DAIR): similar long-term remission for 6 weeks as compared to 12 weeks. Int J Infect Dis 63:37–42CrossRefGoogle Scholar
  55. 55.
    Puhto AP, Puhto T, Syrjala H (2012) Short-course antibiotics for prosthetic joint infections treated with prosthesis retention. Clin Microbiol Infect 18:1143–1148CrossRefGoogle Scholar
  56. 56.
    Billières J, Uçkay I, Faundez A et al (2016) Variables associated with remission in spinal surgical site infections. J Spine Surg 2:128–134CrossRefGoogle Scholar
  57. 57.
    Bernard L, Dinh A, Ghout I et al (2015) Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 385:875–882CrossRefGoogle Scholar
  58. 58.
    Rod-Fleury T, Dunkel N, Assal M et al (2011) Duration of post-surgical antibiotic therapy for adult chronic osteomyelitis: a single-centre experience. Int Orthop 35:1725–1731CrossRefGoogle Scholar
  59. 59.
    Uçkay I, Tovmirzaeva L, Garbino J et al (2013) Short parenteral antibiotic treatment for adult septic arthritis after successful drainage. Int J Infect Dis 17:199–205CrossRefGoogle Scholar
  60. 60.
    Bernard L, Legout L, Zürcher-Pfund L et al (2010) Six weeks of antibiotic treatment is sufficient following surgery for septic arthroplasty. J Infect 61:125–132CrossRefGoogle Scholar
  61. 61.
    Farhad R, Roger PM, Albert C et al (2010) Six weeks antibiotic therapy for all bone infections: results of a cohort study. Eur J Clin Microbiol Infect Dis 29:217–222CrossRefGoogle Scholar
  62. 62.
    Gehrke T, Parvizi J (2013) Proceedings of the international consensus meeting on periprosthetic joint infection. https://www.efort.org/wp-content/uploads/2013/10/philadelphia_consensus.pdf Accessed 12 Mar 2019
  63. 63.
    Uçkay I, Bouchuiguir-Wafa K, Ninet B et al (2010) Posttraumatic ankle arthritis due to a novel Nocardia species. Infection 38:407–412CrossRefGoogle Scholar
  64. 64.
    Gariani K, Lebowitz D, Kressmann B et al (2019) Oral amoxicillin/clavulanate for treating diabetic foot infections. Diabetes Obes Metab.  https://doi.org/10.1111/dom.13651 Google Scholar
  65. 65.
    Prendki V, Ferry T, Sergent P et al (2017) Prolonged suppressive antibiotic therapy for prosthetic joint infection in the elderly: a national multicentre cohort study. Eur J Clin Microbiol Infect Dis 36:1577–1585CrossRefGoogle Scholar
  66. 66.
    Al-Mayahi M, Cian A, Lipsky BA et al (2015) Administration of antibiotic agents before intraoperative sampling in orthopedic infections alters culture results. J Infect 71:518–525CrossRefGoogle Scholar
  67. 67.
    Uçkay I, Agostinho A, Belaieff W et al (2011) Noninfectious wound complications in clean surgery: epidemiology, risk factors, and association with antibiotic use. World J Surg 35:973–980CrossRefGoogle Scholar
  68. 68.
    Uçkay I, Agostinho A, Stern R et al (2011) Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery. Int Orthop 35:1257–1260CrossRefGoogle Scholar
  69. 69.
    Reber A, Moldovan A, Dunkel N et al (2012) Should the methicillin-resistant Staphylococcus aureus carriage status be used as a guide to treatment for skin and soft tissue infections? J Infect 64:513–519CrossRefGoogle Scholar
  70. 70.
    Agostinho A, Renzi G, Haustein T et al (2013) Epidemiology and acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a septic orthopedic ward. SpringerPlus 2:91CrossRefGoogle Scholar
  71. 71.
    Uçkay I, Teterycz D, Ferry T et al (2009) Poor utility of MRSA screening to predict staphylococcal species in orthopaedic implant infections. J Hosp Infect 73:89–91CrossRefGoogle Scholar
  72. 72.
    Bouvet C, Lübbeke A, Bandi C et al (2014) Is there any benefit in pre-operative urinary analysis before elective total joint replacement? Bone Jt J 96:390–394CrossRefGoogle Scholar
  73. 73.
    Uçkay I, Pittet D, Bernard L et al (2008) Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. J Bone Jt Surg Br 90:833–838CrossRefGoogle Scholar
  74. 74.
    Uçkay I, Kressmann B, Di Tommaso S et al (2018) A randomized controlled trial of the safety and efficacy of a topical gentamicin-collagen sponge in diabetic patients with a mild foot ulcer infection. SAGE Open Med 6:2050312118773950CrossRefGoogle Scholar
  75. 75.
    Hirsiger S, Betz M, Stafylakis D et al (2019) The benefice of mobile parts’ exchange in the management of infected total joint arthroplasties with prosthesis retention (DAIR procedure). J Clin Med 9:8Google Scholar
  76. 76.
    Boas PJ, Ruiz T (2004) Occurrence of hospital infection among interned elderly in a university hospital. Rev Saude Publica 38:372–378CrossRefGoogle Scholar
  77. 77.
    Oberoi L, Neki NS, Kaur R et al (2012) Changing trends of nosocomial infections in geriatric patients in a tertiary care hospital. JIMSA 25:233–234Google Scholar
  78. 78.
    Uçkay I, Sax H, Harbarth S et al (2008) Multi-resistant infections in repatriated patients after natural disasters: lessons learned from the 2004 tsunami for hospital infection control. J Hosp Infect 68:1–8CrossRefGoogle Scholar
  79. 79.
    Balagué N, Uçkay I, Vostrel P et al (2015) Non-tuberculous mycobacterial infections of the hand. Chir Main 34:18–23CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.InfectiologyBalgrist University HospitalZurichSwitzerland
  2. 2.Infection ControlBalgrist University HospitalZurichSwitzerland
  3. 3.Internal MedicineBalgrist University HospitalZurichSwitzerland
  4. 4.Orthopaedic SurgeryBalgrist University HospitalZurichSwitzerland
  5. 5.Nursing CareBalgrist University HospitalZurichSwitzerland
  6. 6.PharmacyBalgrist University HospitalZurichSwitzerland

Personalised recommendations