Knee Infection* Strange Infection!!

[jeffreyclay]

Hi friends. As many of you know I had a revision on my right knee due to infection. That surgery was done on Nov 1. About 2 weeks later I discover some weeping near the incision and go to show the Dr..
I was rushed to the OR and the Dr. opened the knee and did a thorough flushing and debridment ( a scraping and brush cleansing). He closed and sent blood work for a culture. Lab results show that I have a Fungal infection of all things! The infectous disease Dr. has only seen 2 cases in his 20 years and the surgeon has never seen it in a joint.
The protocol for me is 8 weeks of daily anti-fungal infusion by IV. I'm being taught how to do this on my own. I was expecting an IV pole and pump to be delivered at my home, boy was I wrong!. Now they deliver a "pressurized baseball" to do the work. You are free to move about the house while it is running. When it's finished, you disconnect and throw it away. Here's a picture of what it looks like.

 

[Nanners]

Oh dear so sorry to hear you got an infection. Sending big healing hugs your way!

 

[bottomshollow]

Gosh, Jeffrey, so sorry that it's snowing on your parade. You have been through a lot since you first joined the forum. Hope this will take care of the problem so you can got on with your recovery and get to enjoy your new knee. Please take care of yourself and keep us posted. We care.

 

[KathyH]

Yikes, but let's hope that this contraption clears you up. You certainly deserve it after all you have been through.

 

[Titianlady]

Oh, my goodness!! I'm so glad that you went right to the Dr and got this taken care of!!
May I ask what part of the country you live in??

 

[Knitter4444]

Wow..thank goodness you were so astute and got to the doctor right away. I think the chance of infection scares all of us with replacements. Heal well!!

 

[Jamie]

Jeffrey, so sorry this has happened to you, but VERY glad to see the quick response from your medical team. I'm going to tag Josephine so that she can read about this latest development. That is kind of a weird contraption....it's new to me. It certainly looks like it could get the job done, though.

 

[Pumpkin]

Jeffery, you have been through so much and now this. Glad you got to the doctor fast enough, and they have you on the right medications. The pump looks interesting, at least you are not stuck to a pole. Hopefully you will soon be running faster and jumping higher in your PF Flyers!

 

[Brownie51]

Wow that's so interesting. So you had the revision due to infection. What cultured out at the time of surgery? So then you developed another infection...fungal. That IS strange! Where would you get that other than it being introduced during the surgery? Did you have any fungal infections else where on your body? Lordy these joint replacements are scary when they go wrong. So they didn't take out your implant, just cleaned out? Thanks for posting that photo. I've never seen that but it sure beats having to have the IV pole. Did they put in a central port? You poor thing! I hope you get well quick and that no further surgery is necessary! Good luck!

 

[Dhare63]

Wow Jeffrey, what a ride you have been on! I sure hope that this is the last bump in the road that you have to deal with!

All good wishes for better days ahead!

Dawn

 

[Bumpa]

Jeffrey, may I join the others and wish you well in the future. On the subject of knee infections this has just been published:
IDSA releases new guidelines for PJI treatment in joint arthroplasty patients

• December 7, 2012

The Infectious Diseases Society of America has released new guidelines to reduce mortality, disability and costs associated with periprosthetic joint infection following total knee and total hip arthroplasty.
“There are few things that improve quality of life as much as joint replacement, but 1% to 2% of the time the new joint can become infected, even when precautions are taken,” Douglas R. Osmon, MD, associate professor of infectious diseases at the Mayo Clinic in Rochester, Minn., stated in a press release. “There are many different ways to treat these infections to achieve the same outcome. The guidelines provide a framework to help multidisciplinary teams choose the best method of diagnosis and treatment for each patient.”
The guidelines recommend the following precautions while performing total joint arthroplasty:

• Persistent wound drainage in the skin over the joint replacement is a sign of periprosthetic joint infection (PJI). Sudden or ongoing pain after placing the implant is also a sign if the patient had no previous history of pain, or if there is a history of prior wound healing problems or infections.
• In patients with PJI, those patients with a well-fixed implant without an open skin wound could be a likely candidate for debridement by re-opening the incision and cleaning the wound if they had the surgery within the last 30 days.
• Patients with a more extensive infection extending to the bone and tissue might need their implant replaced, which can be done during the same surgery or during a later surgery.
• Amputation should be a last resort. Prior to amputation, if the infection allows it, the patient should be referred to a center with a PJI specialist.
• In almost all cases, a 4- to 6-week intravenous or highly bioavailable oral antiobiotic therapy is necessary to treat PJI.

Reference:
Osmon DR. Clin Infec Dis. 2012;doi: 10.1093/cid/cis803.

 

[Josephine]

Jeffrey, what's if called and how often do you have to use it?

 

[vicledsome]

Jeffrey, I had infection too. Although I had Staph. I had total revision. I had PICC line for 9 weeks. I am happy to say so far so good.
My IV was in bag and then 2 minute push. I've heard about the ball but had never seen one.
Wishing you the best! Keep us updated on your progress.

 

[jancat]

Good Luck, Jeffrey! Were you on lots of antibiotics before the revision? Perhaps that allowed the fungus to grow.
I had an infection with a washout and then another washout with spacer exchange. Then 6 weeks on PICC line IV antibiotics, then 10 weeks of oral abx. I had the quick push syringes after I was diagnosed as being allergic to the abx I was prescribed initially.
How does the baseball work? Do you pump it?

 

[jeffreyclay]

Thanks for all the "well wishes". So many questions to answer so I will just shout out what I learned. The fungus is call "Canadian Albacan" and is almost none existent in Virginia. The infectious disease Dr has seen 2 cases in 20 years. The surgeon has never seen a case in 20 years. The baseball contains it's own pressure and regulator. It's designed to move up to 100ml payload at a 175mll/hr rate. (90 minutes in my case) We are using Eraxis for the antifungal. I'm on my 2nd PICC line as they took the first one out after the 40 day anti-biotic routine. I'm going to be getting a wound vac next few days as the sutures have pulled through at one end of the incision. Surgeon says the flesh along this incision line has really been though it with 3 surgeries. The PT nurse likes to get his numbers with brute force. (I'm at -3 and 90. The Surgeon said 105 would be realistic for my revision) I bleed after his visits. His participation has been canceled until the flesh has grown together and I plan to discharge his company and go to an outpatient PT clinic of which I'm very satisfied from past association.

 

[Brownie51]

thanks Jeff. I think that's Candida albicans. We can't blame our Canadian friends for that one!
Glad you are not going back to your therapist. You have really been through it. Just try letting your leg hang and get flexion through gravity no pushing.
Good luck. I sure hope the baseball is killing your rare infection off! Hang in there!!!

 

[RestAssured]

:: Jeffery, oh my goodness! Dr. Maale has been seeing a man who picked up a fungal infection after his first replacement! It is hard to get rid of, and can cause big problems! I always venture around the waiting room, and he and his wife are such nice people, the patient and his wife! They came and talked to me again about 3 months ago. I recognize the antibotic pump ball! Isn't it great, you can stuff it in your pocket, and go on to do other things while it is pumping!

I will continue to keep you in my prayers!

 

[jeffreyclay]

:: Jeffery, oh my goodness! Dr. Maale has been seeing a man who picked up a fungal infection after his first replacement! It is hard to get rid of, and can cause big problems! I always venture around the waiting room, and he and his wife are such nice people, the patient and his wife! They came and talked to me again about 3 months ago. I recognize the antibotic pump ball! Isn't it great, you can stuff it in your pocket, and go on to do other things while it is pumping!

I will continue to keep you in my prayers!

Thanks for your good message. I'm sure a sprinkle of dachshund love was also in there! This is my girl Savannah who gives me hope each day!

 

[RestAssured]

How darling! My husband absolutely is nuts aboutPugs! I will have to show him the picture. By the way, the guy that got the fungus lived in AZ. The OS told him they would "just do a revision" and everything would be fine! He said after reading about it, he needed to find someone who had actually worked on people who knew what they were talking about! That is how he ended up at Dr. Maale's. he takes the hardest cases from all over the world. If you find that the washout and debridement didn't do the trick,you might contact him for a second opinion. He has been the reason that I am doing so well! He saw me when I was so sick from MRSA and now, I am MRSA free! I walk in and see really sick patients from all over, and I say to myself, I am truly blessed!

 

[RestAssured]

Jeffery, how are you doing? Is the medication clearing up the fungus? You have been through so much and I just wanted to let you know that I have been thinking about you!