Table of Contents
Credits
Host: Sara Dong
Guests: Sandra Nelson, Jodian Pinkney, Antonia Chen, Aaron Tande
Content is based on the CID article featured in this episode although with additional writing by Sara Dong
Cover Art: Sara Dong
Audio Editing: Bentley Brown
Produced by Sara Dong with support from the Infectious Diseases Society of America (IDSA)
Our Guests
Sandra Nelson, MD
Dr. Sandra Nelson is an Infectious Diseases physician at Massachusetts General Hospital (MGH) and an Assistant Professor at Harvard Medical School. She completed her medical school at Duke University School of Medicine, followed by residency training in Internal Medicine and Pediatrics at the University of Michigan Medical Center. She completed her fellowship training in Infectious Diseases at Johns Hopkins University before joining the faculty at MGH and Harvard Medical School in 2007.
At MGH Dr. Nelson is an Associate Clinical Director of the Division of Infectious Diseases. She oversees the Inpatient Infectious Diseases services and the Program in Outpatient Parenteral Antimicrobial Therapy (OPAT). She is a co-director of the highly acclaimed Harvard CME course on Infectious Diseases in Adults. Her academic interest is in the care of patients with musculoskeletal infections; at MGH she directs the Program in Musculoskeletal Infectious Diseases which is actively engaged in clinical care, educational efforts, and in research on treatment and prevention of musculoskeletal infection. She was a delegate to the 2013 and 2018 International Consensus Meetings on Periprosthetic Joint Infections, where she worked to create a new working definition of periprosthetic shoulder infections. She was on the panel for systematic review of management of post-operative surgical site infections of the American Academy of Orthopedic Surgeons (AAOS). She is a Past-President of the Musculoskeletal Infection Society (MSIS) and recently completed a five-year tenure on its Executive Board.
Jodian Pinkney, MD, MBBS
Dr. Jodi Pinkney is an Infectious Diseases (ID) physician at the Massachusetts General Hospital. She completed her medical training at the University of the West Indies in Jamaica, after which she served as the Clinical Coordinator for the Center for HIV/AIDS, Research and Education Services (an urban specialized clinic serving the third largest cohort of People Living with HIV in Jamaica). She subsequently completed her Internal Medicine residency at the University of South Carolina prior to joining the Mass General Brigham ID fellowship program in 2020. She is broadly interested in health equity and maternal health. She is also wholeheartedly dedicated to eliminating maternal deaths related to vaccine-preventable diseases. She is currently enrolled in the MPH-45 program in Health Policy with a concentration in Maternal and Child Health at the Harvard T.H. Chan School of Public Health and is a Fellow in the Commonwealth Fund Fellowship in Minority Health Policy.
Antonia Chen, MD
Dr. Antonia Chen is the Chief of Arthroplasty and Joint Reconstruction in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital (BWH) who specializes in hip and knee replacements. She is board certified in Orthopaedic Surgery, and her clinical practice is focused on taking care of patients with arthritic hips and knees, as well as avascular necrosis. In addition to primary hip and knee replacements and partial knee replacements, she also specializes in the care of complex patients who may require revision procedures or further treatment of their previous hip and knee replacements. She also takes care of patients who experience complications with their hips and knees, including infection, stiffness and fractures.
Dr. Chen graduated from Yale University in New Haven, CT with an undergraduate degree in Molecular, Cellular and Developmental Biology, after which she received her medical degree from Rutgers Medical School, where she graduated with Distinction in Research and was inducted into the Alpha Omega Alpha Medical Honor Society. Dr. Chen also received her MBA from Rutgers Business School during her medical training and is a member of the Beta Gamma Sigma Honor Society. Subsequently, she completed her residency training in Orthopaedic Surgery at the University of Pittsburgh, followed by her fellowship in hip and knee arthroplasty at the Rothman Institute in Philadelphia. She then joined the faculty at Rothman Institute and Sidney Kimmel Medical College / Thomas Jefferson University, where she was the Associate Director of Research and quickly rose to the rank of an Associate Professor of Orthopaedic Surgery at Sidney Kimmel Medical College. She also served as the Director of Medical Education Curriculum for Musculoskeletal Studies at the Sidney Kimmel Medical College and Thomas Jefferson University. Dr. Chen was then recruited to Brigham and Women’s Hospital in early 2018 to lead research efforts in the arthroplasty division and treat patients with hip and knee arthritis.
Dr. Chen is an actively practicing orthopaedic surgeon, as well as a dedicated researcher and clinician scientist. Her research involves studying clinical outcomes after total hip and knee replacements, including studies looking at “pre-habilitation” (activity prior to surgery to improve postoperative outcomes), activity after joint replacement, opioid use following hip and knee replacements, in addition to infection and joint stiffness. Dr. Chen also carries active collaborations with basic scientists investigating these complex scientific problems in laboratories across Harvard Medical School. For her research efforts, she has been awarded multiple grants and has been recognized with numerous national and international awards recognizing her practice changing work.
Nationally and internationally, Dr. Chen is a recognized and sought-after leader in her field. She recently served as the President of the Musculoskeletal Infection Society (MSIS) and is the Appropriate Use Criteria Leader for the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Quality and Value Committee. In the American Association of Hip and Knee Surgeons (AAHKS) organization, she is Vice-Chair of the Women in Arthroplasty Committee and is a member of the International Committee. She has been recognized for her scientific analysis as an Associate Editor for the Clinical Orthopaedics and Related Research (CORR) Journal and Associate Editor for the Annals of Joint (AOJ) Journal. Additionally, she sits on multiple editorial boards for orthopaedic journals, including the Journal of Bone & Joint Infection (JBJI); Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA); Bone & Joint 360; and Healthcare Transformation. Internationally, she is a board member of the European Knee Association (EKA) and leads the Research Committee.
Aaron Tande, MD
Dr. Aaron J. Tande is an Infectious Diseases Consultant and a Professor of Medicine at the Mayo Clinic in Rochester, Minnesota. After receiving his undergraduate degree from Macalester College and his medical degree from the University of Minnesota Medical School, he completed his internal medicine residency at Massachusetts General Hospital. He completed his infectious diseases fellowship training at the Mayo Clinic and joined the Mayo Clinic faculty upon graduation.
At Mayo Clinic, he is the Associate Division Chair for Outpatient Practice, the Chair of the Orthopedic Infectious Diseases Focus Group and Physician co-Chair of Antimicrobial Stewardship. Outside of Mayo Clinic, he serves as the Treasurer of the Musculoskeletal Infection Society and as an Associate Editor for the Journal of Bone and Joint Infection.
Culture
Antonia loves her Yorkie
Jodi Pinkney recommended the new Bob Marley movie
Aaron is a fan of Jason Isbell
Sandy shared her recent hobby of making her own kombucha
Consult Notes
Welcome to this Febrile StAR episode!
These StAR episodes feature discussions with authors from State-of-the-Art Review articles from the Clinical Infectious Diseases journal (CID).
This episode is based on: Nelson SB, Pinkney JA, Chen AF, Tande AJ. Periprosthetic Joint Infection: Current Clinical Challenges. Clin Infect Dis. 2023;77(7):e34-e45. doi:10.1093/cid/ciad360
Journal companion article – Executive summary link: https://academic.oup.com/cid/article/77/7/939/7289507
Infographics
Goal
Listeners will be able to understand the current approach to diagnosis and management of periprosthetic joint infections with a focus on frequent clinical challenges and collaborative multidisciplinary care
Learning Objectives
After listening to this episode, listeners will be able to:
- Compare and contrast the clinical presentation of acute vs chronic PJI
- Describe the typical surgical management options for PJI
- Discuss the available culture-based and molecular techniques to diagnose PJI
Disclosures
Febrile podcast reports no relevant financial disclosures
Potential conflicts of interest are noted in the CID article as well as reproduced below:
Sandra Nelson reports honorarium from the Infectious Diseases Board Review Course (George Washington University CME) paid to author; participation on Journal of Bone and Joint Infection’s Advisory Board; a role on the education committee for the Musculoskeletal Infection Society; and stock options from Sonoran Biosciences. A. J. T. reports royalties from UpToDate and an unpaid position with the Musculoskeletal Infection Society.
Antonia Chen reports grants or contracts from the Clinical Process Improvement Leadership Program, Foundation for Arthroplasty Research and Education, National Institutes of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases, Knee Society, Vela Foundation, Ruth Jackson Orthopaedic Society/Zimmer Biomet Clinical/Basic Science Research Grant, Orthopaedic Trauma Association, Agency for Healthcare Research and Quality and Patient Centered Outcomes Research Initiative Large Conference Grant Program, American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Quality and Patient Safety Action Fund, and Centers for Medicare and Medicaid Services; consulting fees from Adaptive Phage Therapeutics, Avanos, Best In Class MD, Convatec, Ethicon, Gerson Lehrman Group, Guidepoint, Heraeus, IrriMax, Peptilogics, Pfizer, Stryker, and Smith and Nephew; board or committee positions with AAOS, American Joint Replacement Registry, American Association of Hip and Knee Surgeons, and the European Knee Association; stock or stock options from Hyalex, IrriMax, Osteal Therapeutics, Sonoran, IlluminOss; a grant from Ruth Jackson Orthopaedic Society/Zimmer Biomet; royalties from Stryker, SLACK Incorporated, and UpToDate; and editorial board roles for the following publications: Journal of Bone and Joint Surgery; Journal of Arthroplasty; Clinical Orthopaedics and Related Research; Journal of Bone and Joint Infection; Knee Surgery, Sports Traumatology, Arthroscopy; Journal of Orthopaedic Research; and Anthroplasty Today.
All remaining authors: No reported conflicts of interest.
Citation
Nelson, S., Pinkney, J., Chen, A., Tande, A., Dong, S. “#100: StAR: Periprosthetic Joint Infections”. Febrile: A Cultured Podcast. https://player.captivate.fm/episode/3bca5798-3986-4359-b9ec-4369a8a83cd5