Mycobacterium tuberculosis prosthetic joint infections a case series and literature review

Fabrice Uhel (1, 2) , Gregory Corvaisier (3) , Yves Poinsignon (3) , Catherine Chirouze (4) , Guillaume Béraud (5) , Olivier Grossi (6) , Nicolas Varache (7) , Cédric Arvieux (1) , Rozenn Le Berre (8) , Pierre Tattevin (1, 2)

1 CIC - Centre d'Investigation Clinique [Rennes]
2 MICMAC - Microenvironment, Cell Differentiation, Immunology and Cancer
3 CH Bretagne Atlantique
4 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
5 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
6 Nouvelles Cliniques Nantaises
7 Centre Hospitalier Le Mans (CH Le Mans)
8 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest

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.

Mots clés: debridement; arthroplasty; Prosthetic joint; antituberculosis drug; Mycobacterium tuberculosis

Domaines: Maladies infectieuses

Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Béraud, et al.. Mycobacterium tuberculosis prosthetic joint infections a case series and literature review. Journal of Infection, 2019, 78 (1), pp.27-34. ⟨10.1016/j.jinf.2018.08.008⟩. ⟨hal-01862286⟩