Help with infection details please?
Per Ardua ad Astraeus
Thread Starter
Join Date: Mar 2000
Location: UK
Posts: 18,579
Likes: 0
Received 0 Likes
on
0 Posts
Help with infection details please?
If any of our 'readers' have any experience of patients with a Corynebacterium Group G infection, I would very much appreciate a PM. My wife has had this persistent infection for almost 2 years following hip revision surgery and the specialist today said he did not know of any other case histories with this infection.
I have trawled 'Google' but am out of my depth in the terminology. We are seeking that 'light at the end of the tunnel'.
I have trawled 'Google' but am out of my depth in the terminology. We are seeking that 'light at the end of the tunnel'.
Join Date: Mar 2006
Location: Queensland
Posts: 95
Likes: 0
Received 0 Likes
on
0 Posts
Not sure what Corynebacterium group G is, although I'm not really up on my baterial taxonomy. But in regards to Corynebacterium prosthetic joint infections - well........
effortless - diptheria is indeed caused by Corynebacterium diphtheriae, but this is not the bacterium which causes joint infections.
There is another strain (or species - remember, I'm no taxonomist!!!) called Corynebacterium jeikeium (C. jeikeium). This is often found on the skin of patients in hospital, although normally causes no problems. There was an article published in the Scandinavian Journal of Infectious Diseases in 2005 about C. jeikeium joint infections. They did a literature review and found only two reported cases of prosthetic hip joint infection in the literature. In both cases, the patients required removal of the prosthesis, treatment with intravenous vancomycin for 6 weeks (a really strong antibiotic), and in both patients it took a year to recover.
In this article, they report a case where they just replaced the cup (the pevic side or acetabular component) but left the stem (the femur side) in place. The patient needed life long treatment with oral antibiotics, but they report that the infection has not returned.
So, where does that leave us?
1. These infections are extremely rare
2. They are extremely difficult to treat
3. The only way to guarantee complete eradication of infection is to remove the components and administer antibiotics, and this might take up to a year
4. If the hip is to be retained, life long oral antibiotics will be required.
My suggestion - see an orthopaedic surgeon with experience in hip revision surgery and/or especially infected joint revision surgery. A consult from an infectious diseases specialist should also be sought. However, I suspect that you have probably done this.
I hope your wife is recovering. Keep me posted
effortless - diptheria is indeed caused by Corynebacterium diphtheriae, but this is not the bacterium which causes joint infections.
There is another strain (or species - remember, I'm no taxonomist!!!) called Corynebacterium jeikeium (C. jeikeium). This is often found on the skin of patients in hospital, although normally causes no problems. There was an article published in the Scandinavian Journal of Infectious Diseases in 2005 about C. jeikeium joint infections. They did a literature review and found only two reported cases of prosthetic hip joint infection in the literature. In both cases, the patients required removal of the prosthesis, treatment with intravenous vancomycin for 6 weeks (a really strong antibiotic), and in both patients it took a year to recover.
In this article, they report a case where they just replaced the cup (the pevic side or acetabular component) but left the stem (the femur side) in place. The patient needed life long treatment with oral antibiotics, but they report that the infection has not returned.
So, where does that leave us?
1. These infections are extremely rare
2. They are extremely difficult to treat
3. The only way to guarantee complete eradication of infection is to remove the components and administer antibiotics, and this might take up to a year
4. If the hip is to be retained, life long oral antibiotics will be required.
My suggestion - see an orthopaedic surgeon with experience in hip revision surgery and/or especially infected joint revision surgery. A consult from an infectious diseases specialist should also be sought. However, I suspect that you have probably done this.
I hope your wife is recovering. Keep me posted
Per Ardua ad Astraeus
Thread Starter
Join Date: Mar 2000
Location: UK
Posts: 18,579
Likes: 0
Received 0 Likes
on
0 Posts
BC - thank you for your time. Sadly, she acquired the infection following a revision due to a faulty Hylamer product.
We have indeed tried the suggestions and she probably does face unpleasant anti-biotics for life. The 'dismantle'/'pack and replace' option is known but one she can not face at the moment following the sad failure of the first hip joint. Maybe at the next revision if nothing comes up as 'fix'.
We have indeed tried the suggestions and she probably does face unpleasant anti-biotics for life. The 'dismantle'/'pack and replace' option is known but one she can not face at the moment following the sad failure of the first hip joint. Maybe at the next revision if nothing comes up as 'fix'.
Join Date: Dec 2004
Location: Under the clag EGKA
Posts: 1,026
Received 0 Likes
on
0 Posts
I knew that I had heard of it, still sorry to put up a decoy. I am not a doctor but a user of the system.Though I have a working knowledge of infection control.
The nature of the bacterium is less important than where it is. If the infection is in the bone itself then this is a problem and will need to be treated as above. As this is a revision then the matter will be more problematic. A second removal of a prosthesis is going to be difficult and if, as I suspect she is a little bit older, then this is a greater problem due to reduced bone density.
Whereas infection of this type with this bacterium may be rare, infection during hip replacement is not so much. My mate has spent five years in excruciating pain due to staph. auris in his hip replacement. He had to find his own surgeon in the end who removed the prosthesis, packed the cavity with antibiotics and left him without a hip for several months before doing a further revision. He was on oral antibiotics (Clyndemycin, absolute domestos) for months afterwards but he isn't sure if he is clear. He is however relatively young, fitish and constantly topping up his immunity by fixing other peoples bogs.
The antibiotics used in bone infections can carry their own risks. The flora of the intestines will be killed off and leave the patient at risk of infections like Clostridium Difficile. This is well named and is a problem in quite a few hospitals. I know about this from experience. If she does end up taking these things then some people swear by live yogourt and other flora ecourgement.
Check your pms.
The nature of the bacterium is less important than where it is. If the infection is in the bone itself then this is a problem and will need to be treated as above. As this is a revision then the matter will be more problematic. A second removal of a prosthesis is going to be difficult and if, as I suspect she is a little bit older, then this is a greater problem due to reduced bone density.
Whereas infection of this type with this bacterium may be rare, infection during hip replacement is not so much. My mate has spent five years in excruciating pain due to staph. auris in his hip replacement. He had to find his own surgeon in the end who removed the prosthesis, packed the cavity with antibiotics and left him without a hip for several months before doing a further revision. He was on oral antibiotics (Clyndemycin, absolute domestos) for months afterwards but he isn't sure if he is clear. He is however relatively young, fitish and constantly topping up his immunity by fixing other peoples bogs.
The antibiotics used in bone infections can carry their own risks. The flora of the intestines will be killed off and leave the patient at risk of infections like Clostridium Difficile. This is well named and is a problem in quite a few hospitals. I know about this from experience. If she does end up taking these things then some people swear by live yogourt and other flora ecourgement.
Check your pms.
Join Date: Mar 2006
Location: Queensland
Posts: 95
Likes: 0
Received 0 Likes
on
0 Posts
Hip replacement is probably the best and most effective operation in orthopaedic surgery. So it is devastating when things go wrong. I can understand your wife's reluctance to go through another operation. In time, though, I think she should have and excision +/- revision. Most prosthetic joint infections are cured by this. But it is big surgery, takes a long long time, and the recovery phase is prolonged. But there usually is light at the end of the tunnel.
What would I do? Make sure she keeps going back to see the orthopaedic surgeon semi-regularly. Certainly wouldn't pressure her in to anything. Ultimately only she can decide if she wnats/needs anything else done. But don't lose touch with the surgeon. Would see him every 6 to 12 months at least for a while for progress check and a chat. Good luck..........
What would I do? Make sure she keeps going back to see the orthopaedic surgeon semi-regularly. Certainly wouldn't pressure her in to anything. Ultimately only she can decide if she wnats/needs anything else done. But don't lose touch with the surgeon. Would see him every 6 to 12 months at least for a while for progress check and a chat. Good luck..........
