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Kamihata S, Ando W, Nakahara I, Enami H, Takashima K, Uemura K, Hamada H, Sugano N. Optimizing vancomycin release from novel carbon fiber-reinforced polymer implants with small holes: periprosthetic joint infection treatment. J Artif Organs 2024; 27:269-276. [PMID: 37266841 DOI: 10.1007/s10047-023-01407-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty. A new drug-loaded carbon fiber-reinforced polymer (CFRP) prosthesis with a sustained drug-release mechanism is being developed for one-stage surgery. We aimed to examine the diffusion dynamics of vancomycin from vancomycin paste-loaded CFRP implants. The differences in the in vitro diffusion dynamics of vancomycin paste were investigated using the elution test by varying parameters. These included the mixing ratio of vancomycin and distilled water (1:0.8, 1:1.2, and 1:1.4) for vancomycin paste, and hole diameter (1 mm and 2 mm) on the container. The in vivo diffusion dynamics were investigated using a rabbit model with vancomycin-loaded CFRP implants placed subcutaneously. The in vitro experiments showed that the diffusion effect of vancomycin was highest in the parameters of vancomycin paste with distilled water mixed in a ratio of 1:1.4, and with a 2 mm hole diameter. The in vivo experiments revealed diffusion dynamics similar to those observed in the in vitro study. The drug diffusion effect tended to be high for vancomycin paste with a large water ratio, and a large diameter of holes. These results indicate that the drug diffusion dynamics from a CFRP implant with holes can be adjusted by varying the water ratio of the vancomycin paste, and the hole size on the CFRP implant.
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Affiliation(s)
- Satoshi Kamihata
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ichiro Nakahara
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Osaka, Japan
| | - Hideaki Enami
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Markel DC, Powell D, Wu B, Pawlitz P, Bou-Akl T, Chen L, Shi T, Ren W. Therapeutic Efficacy of an Erythromycin-Loaded Coaxial Nanofiber Coating in a Rat Model of S. aureus-Induced Periprosthetic Joint Infection. Int J Mol Sci 2024; 25:7926. [PMID: 39063169 PMCID: PMC11276967 DOI: 10.3390/ijms25147926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Implant surface nanofiber (NF) coatings represent an alternative way to prevent/treat periprosthetic joint infection (PJI) via local drug release. We developed and characterized a coaxial erythromycin (EM)-doped PLGA/PCL-PVA NF coating. The purpose of this study was to determine the efficacy of EM-NF coatings (EM0, no EM, EM100 (100 mg/mL), and EM1000 (1000 mg/mL) wt/wt) in a rat PJI model. A strong bond of the EM-NF coating to the surface of titanium (Ti) pins was confirmed by in vitro mechanical testing. Micro-computed tomography (mCT) analysis showed that both EM100 and EM1000 NF effectively reduced periprosthetic osteolysis compared to EM0 at 8 and 16 weeks after implantation. Histology showed that EM100 and EM1000 coatings effectively controlled infection and enhanced periprosthetic new bone formation. The bone implant contact (BIC) of EM100 (35.08%) was higher than negative controls and EM0 (3.43% and 0%, respectively). The bone area fraction occupancy (BAFO) of EM100 (0.63 mm2) was greater than controls and EM0 (0.390 mm2 and 0.0 mm2, respectively). The BAFO of EM100 was higher than that of EM1000 (0.3 mm2). These findings may provide a basis for a new implant surface fabrication strategy aimed at reducing the risks of defective osseointegration and PJI.
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Affiliation(s)
- David C. Markel
- The CORE Institute, 26750 Providence Pkwy #200, Novi, MI 48374, USA;
- Department of Biomedical Engineering, Wayne State University, 818 W. Hancock, Detroit, MI 48201, USA; (L.C.); (T.S.)
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
| | - Dexter Powell
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
| | - Bin Wu
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
| | - Paula Pawlitz
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
| | - Therese Bou-Akl
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
| | - Liang Chen
- Department of Biomedical Engineering, Wayne State University, 818 W. Hancock, Detroit, MI 48201, USA; (L.C.); (T.S.)
| | - Tong Shi
- Department of Biomedical Engineering, Wayne State University, 818 W. Hancock, Detroit, MI 48201, USA; (L.C.); (T.S.)
| | - Weiping Ren
- Section of Orthopaedic Surgery, Ascension Providence Hospital Orthopaedic Research Laboratory, 16001 West Nine Mile Road, Southfield, MI 48075, USA; (D.P.); (B.W.); (P.P.); (W.R.)
- John D. Dingell VA Medical Center, 4646 John R St., Detroit, MI 48201, USA
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Kobayashi S, Yasu T, Tagawa S, Ogura T, Kitaoka A, Matsubara M. CEFAZOLIN PROPHYLACTIC EFFICACY ON PROSTHETIC JOINT INFECTION AFTER PRIMARY HIP ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e248417. [PMID: 36506857 PMCID: PMC9721432 DOI: 10.1590/1413-785220223002e248417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/25/2021] [Indexed: 12/05/2022]
Abstract
Objective Perioperative deep prosthetic joint infection (PJI) is a serious postoperative complication of total hip arthroplasty (THA). We aimed to compare the efficacy of cefazolin administered within 24 and 48 h of primary THA for PJI prophylaxis. Methods In this retrospective study, 720 patients were divided into two groups depending on whether cefazolin was administered as a single injection of 2 g twice daily within 24 (24-h group) or 48 h of surgery and the following day (48-h group). Sex, age at surgery, body mass index, co-existing diseases, blood test data, and PJI risk factors were evaluated. Results The 24- and 48-h groups included 364 and 356 patients, respectively. Diabetes mellitus was the most common risk factor for PJI in both groups. The corresponding incidence of perioperative deep PJI following primary THA was 0.55% and 0.28% in the 24- and 48-h groups, respectively. There was no significant difference in patient background characteristics between the groups. Conclusions Cefazolin administration within 24 h of primary THA may be appropriate for perioperative deep PJI. Level of Evidence II; Retrospective study .
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Affiliation(s)
| | - Takeo Yasu
- Meiji Pharmaceutical University, Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Tokyo, Japan
| | - Seiji Tagawa
- Nissan Tamagawa Hospital, Department of Pharmacy, Tokyo, Japan
| | - Takashi Ogura
- Nissan Tamagawa Hospital, Department of Pharmacy, Tokyo, Japan
| | - Akira Kitaoka
- Nissan Tamagawa Hospital, Department of Pharmacy, Tokyo, Japan
| | - Masaaki Matsubara
- Nissan Tamagawa Hospital, Department of Orthopaedic Surgery, Tokyo, Japan
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Kuttner H, Pfister S, Moriarty TF, Meier C, Wahl P. Periprosthetic Joint Infection With Actinomyces radingae May Lead to the Identification of a Neglected Source of Intraoperative Contamination. Arthroplast Today 2022; 18:181-184. [PMID: 36405864 PMCID: PMC9672404 DOI: 10.1016/j.artd.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Periprosthetic joint infection remains a major complication in arthroplasty. We present the first description of a case of periprosthetic joint infection with Actinomyces radingae, microorganism that is mostly found on the skin of the upper body and might cause particular challenges as it is difficult to culture and specify. Furthermore, a thorough microbiologic workup may indicate the source of infection. In this case, it is possible that perspiration from the surgeon was the source of intraoperative contamination. Intraoperative contamination through perspiration may be important and should be avoided by all means.
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Affiliation(s)
- Hannes Kuttner
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Corresponding author. Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland.
| | - Stefan Pfister
- Laboratory of Microbiology, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
| | | | - Christoph Meier
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Asymptomatic Periprosthetic Joint Infection of the Hip with High-Virulence Pathogens: Report of Two Cases. Case Rep Infect Dis 2022; 2022:2699779. [PMID: 36249313 PMCID: PMC9553682 DOI: 10.1155/2022/2699779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/17/2022] [Accepted: 09/10/2022] [Indexed: 11/19/2022] Open
Abstract
Periprosthetic joint infection (PJI) may be a life-threatening condition, particularly when caused by pathogens with high virulence, capable of developing secondary bloodstream infection. We report two cases of chronic PJI of the hip, one with Staphylococcus aureus in a 27-year-old female with severe anorexia, the other one with Staphylococcus lugdunensis in a 74-year-old female suffering from morbid obesity. Both infections did not cause relevant symptoms over time despite the absence of suppressive antibiotic treatment. To our knowledge, there are no similar cases described in the literature. While it remains difficult to recommend postponing treatment in such cases, this option may be an alternative to suppressive antibiotic therapy.
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6
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Anagnostakos K, Becker SL, Sahan I. Antifungal-Loaded Acrylic Bone Cement in the Treatment of Periprosthetic Hip and Knee Joint Infections: A Review. Antibiotics (Basel) 2022; 11:antibiotics11070879. [PMID: 35884133 PMCID: PMC9311527 DOI: 10.3390/antibiotics11070879] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Little is known about the clinical use of antifungal-loaded acrylic bone cement in the treatment of periprosthetic hip and knee joint infections (PJIs). Hence, we performed a literature search using PubMed/MEDLINE from inception until December 2021. Search terms were “cement” in combination with 13 antifungal agents. A total of 10 published reports were identified, which described 11 patients and 12 joints in which antifungal-loaded cement was employed. All studies were case reports or case series, and no randomized controlled trials were identified. In 6 of 11 patients, predisposing comorbidities regarding the emergence of a fungal PJI were present. The majority of the studies reported on infections caused by Candida species. In six cases (seven joints), the cement was solely impregnated with an antifungal, but no antibiotic agent (amphotericin B, voriconazole, and fluconazole). In the other five joints, the cement was impregnated with both antibiotic(s) and antifungals. Great discrepancies were seen regarding the exact loading dose. Four studies investigated the local elution of antifungal agents in the early postoperative period and observed a local release of antifungals in vivo. We conclude that there is a paucity of data pertaining to the clinical use of antifungal-loaded bone cement, and no studies have assessed the clinical efficacy of such procedures. Future studies are urgently required to evaluate this use of antifungals in PJI.
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Affiliation(s)
- Konstantinos Anagnostakos
- Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, 66119 Saarbrücken, Germany;
- Correspondence:
| | - Sören L. Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, 66421 Homburg, Germany;
| | - Ismail Sahan
- Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, 66119 Saarbrücken, Germany;
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7
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Ren W, Yu X, Chen L, Shi T, Bou-Akl T, Markel DC. Osteoblastic differentiation and bactericidal activity are enhanced by erythromycin released from PCL/PLGA-PVA coaxial nanofibers. J Biomater Appl 2022; 37:712-723. [PMID: 35624088 DOI: 10.1177/08853282221105676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prosthesis with antibiotic-eluting nanofibrous (NF) coating represents coating alternative to prevent periprosthetic joint infection (PJI). In this study, four formulas of erythromycin (EM)-embedded both in core and sheath components of coaxial PCL/PLGA-PVA NF coatings were developed: EM 0 (no EM), EM 100 (100 μg/mL), EM500 (500 μg/mL) and EM1000 (1000 μg/mL). EM doping altered the physicochemical and structural properties of NFs to some extent, including the increase of NF porosity and surface wettability. A sustained EM release from EM-NFs for >4 weeks was observed. Eluents collected from EM-NFs showed strong zone of inhibition (ZOI) to Staphylococcus aureus growth and the sizes of ZOI positively related to the amount of EM released. EM-NFs were nontoxic to rat bone marrow stem cells (rBMSCs). Cell growth was significantly enhanced when comparing rBMSCs cultured on EM-NFs (EM0 and EM 100) to those cultured on NF-free control. Cell differentiation (ALP activity) was notably enhanced by EM100, compared to control and EM0. Eluents from EM-NFs on rBMSCs were also investigated. The presence of 10% EM-NF eluents inhibited the growth of rBMSCs, which was proportional to the amount of EM doped. The ALP activity was notably enhanced by eluents from EM-NFs with the highest activity in EM100 compared to control and EM0. Our data indicate that EM-doped PCL/PLGA-PVA coaxial NF coatings have a great potential to be applied as a new implant coating matrices. Further in vivo testing in animal models is currently planned that should represent the first step in predicting the clinical outcomes of EM-eluting NF coating approach.
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Affiliation(s)
- Weiping Ren
- Department of Orthopedic, 7432Ascension Providence Hospital, Southfield, MI, USA.,20036John D Dingle VA Medical Center, Detroit, MI, USA.,Biomedical Engineering, 2954Wayne State University, Detroit, MI, USA
| | - Xiaowei Yu
- Department of Orthopedics, 378725Shanghai 6th People's Hospital Jiaotong University, China
| | - Liang Chen
- Biomedical Engineering, 2954Wayne State University, Detroit, MI, USA
| | - Tong Shi
- Biomedical Engineering, 2954Wayne State University, Detroit, MI, USA
| | - Therese Bou-Akl
- Department of Orthopedic, 7432Ascension Providence Hospital, Southfield, MI, USA.,Biomedical Engineering, 2954Wayne State University, Detroit, MI, USA
| | - David C Markel
- Department of Orthopedic, 7432Ascension Providence Hospital, Southfield, MI, USA.,Biomedical Engineering, 2954Wayne State University, Detroit, MI, USA.,480289The Core Institute, Novi, MI, USA
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8
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Guardia A, Shi T, Bou-Akl T, Dietz P, Wu B, Ren W, Markel D. Properties of erythromycin-loaded polymeric dicalcium phosphate dehydrate bone graft substitute. J Orthop Res 2021; 39:2446-2454. [PMID: 33382124 DOI: 10.1002/jor.24979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 02/04/2023]
Abstract
A self-setting, injectable polymeric dicalcium phosphate dehydrate bone graft substitute that is mechanically strong and has excellent cohesion was developed. We assessed the performance of erythromycin-loaded polymeric dicalcium phosphate dehydrate cement. Its properties include drug release, growth inhibition against Staphylococcus aureus and biocompatibility with osteoblastic MC3T3 cells. The impact of erythromycin loading on cement injectability, setting time, and mechanical strength were also evaluated. A sustained, low burst release of erythromycin was observed. Eluents collected from erythromycin-loaded cement showed a considerable zone of inhibition for up to 28 days. Direct contact of erythromycin-loaded cement discs with agar plate showed a similarly sizable zone of inhibition for up to 22 days. Degraded ceramic residues had strong zones of inhibition as well. While the erythromycin-loaded cement was injectable, a notable delay of the setting time was observed (49.2 ± 6.8 min) as compared with control (drug-free cement, 12.2 ± 2.6 min). A slight increase in compressive strength (60.83 ± 6.28 MPa) was observed in erythromycin-loaded cement as compared with control (59.41 ± 6.48 MPa). Erythromycin-loaded cement was biocompatible although reduced cell growth was observed in the presence of the cement eluent. We propose that the bactericidal efficacy of erythromycin-loaded cement was caused by the combined effects of erythromycin released and exposed on the contact surface of degrading ceramics. Our data may elucidate the future application of polymeric dicalcium phosphate dehydrate bone graft substitute for the treatment of orthopedic infections and opportunities to use other antibiotics and applications considering its comparable handling and mechanical strength to poly (methyl methacrylate) cements.
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Affiliation(s)
- Angelica Guardia
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Tong Shi
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Therese Bou-Akl
- Department of Orthopedics, Providence Hospital, Southfield, Michigan, USA
| | - Paula Dietz
- Department of Orthopedics, Providence Hospital, Southfield, Michigan, USA
| | - Bin Wu
- Department of Orthopedics, Providence Hospital, Southfield, Michigan, USA
| | - Weiping Ren
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Orthopedics, Providence Hospital, Southfield, Michigan, USA
| | - David Markel
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Orthopedics, Providence Hospital, Southfield, Michigan, USA
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9
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Population pharmacokinetic model of cefazolin in total hip arthroplasty. Sci Rep 2021; 11:19763. [PMID: 34611213 PMCID: PMC8492877 DOI: 10.1038/s41598-021-99162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/13/2021] [Indexed: 02/02/2023] Open
Abstract
Cefazolin is an antibiotic recommended for infection prevention in total hip arthroplasty (THA). However, the dosing regimen necessary to achieve therapeutic concentrations in obese patients remains unclear. The aim of this study was to conduct a population analysis of cefazolin pharmacokinetics (PK) and assess whether cefazolin administration should be weight adapted in THA. Adult patients undergoing THA surgery received an injection of 2000 mg of cefazolin, doubled in the case of BMI > 35 kg/m2 and total body weight > 100 kg. A population PK study was conducted to quantify cefazolin exposure over time compared to the therapeutic concentration threshold. A total of 484 cefazolin measurements were acquired in 100 patients, of whom 29% were obese. A 2-compartment model best fitted the data, and creatinine clearance determined interpatient variability in elimination clearance. Our PK simulations using a 2000 mg cefazolin bolus showed that cefazolin concentrations remained above the threshold throughout surgery, regardless of weight or renal function. A 2000 mg cefazolin single injection without adaptation to weight or renal function and without intraoperative reinjection was efficient in maintaining therapeutic concentrations throughout surgery. The optimal target concentration and necessary duration of its maintenance remain unclear.
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10
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Anagnostakos K, Grzega C, Sahan I, Geipel U, Becker SL. Occurrence of Rare Pathogens at the Site of Periprosthetic Hip and Knee Joint Infections: A Retrospective, Single-Center Study. Antibiotics (Basel) 2021; 10:antibiotics10070882. [PMID: 34356802 PMCID: PMC8300814 DOI: 10.3390/antibiotics10070882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/31/2022] Open
Abstract
The frequency and clinical relevance of rare pathogens at the site of periprosthetic infections of the hip and knee joint and their antibiotic resistance profiles have not yet been assessed in-depth. We retrospectively analyzed all periprosthetic hip and knee joint infections that occurred between 2016 and 2020 in a single center in southwest Germany. Among 165 infections, 9.7% were caused by rare microorganisms such as Veilonella sp., Pasteurella sp., Pantoea sp., Citrobacter koseri, Serratia marcescens, Parvimonas micra, Clostridium difficile, Finegoldia magna, Morganella morganii, and yeasts. No resistance to piperacillin/tazobactam, carbapenemes, fluoroquinolones, or gentamicin was observed. Some bacteria displayed resistance to ampicillin, ampicillin/sulbactam, and cefuroxime. We present follow-up data of patients with infections due to rare pathogens and discuss the importance of close, interdisciplinary collaboration between orthopedic surgeons and clinical microbiologists to carefully select the most appropriate anti-infective treatment regimens for the increasing number of patients with such infections.
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Affiliation(s)
- Konstantinos Anagnostakos
- Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, 66119 Saarbrücken, Germany; (C.G.); (I.S.)
- Correspondence:
| | - Christoph Grzega
- Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, 66119 Saarbrücken, Germany; (C.G.); (I.S.)
| | - Ismail Sahan
- Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, 66119 Saarbrücken, Germany; (C.G.); (I.S.)
| | - Udo Geipel
- Bioscientia MVZ Saarbrücken GmbH, 66119 Saarbrücken, Germany;
| | - Sören L. Becker
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, 66421 Homburg/Saar, Germany;
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11
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Greenfield BJ, Wynn Jones H, Siney PD, Kay PR, Purbach B, Board TN. Is Preoperative Identification of the Infecting Organism Essential Before Single-Stage Revision Hip Arthroplasty for Periprosthetic Infection? J Arthroplasty 2021; 36:705-710. [PMID: 32919850 DOI: 10.1016/j.arth.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is commonly stated that identification of the infecting organism is a prerequisite to single-stage revision arthroplasty of the hip for deep infection. We have performed single-stage revision in a series of patients where the organism was not identified preoperatively. The aim of this study is to investigate whether the rate of infection eradication following single-stage revision was affected by preoperative knowledge of the infecting organism. METHODS We identified all patients who had undergone a single-stage revision for a deep infection at our hospital between 2006 and 2015. One hundred five patients were assigned into 2 groups based upon whether the infecting organism had been identified preoperatively (group A = 28) or not (group B = 77). RESULTS The reinfection rates were 3.6% in group A and 9.1% for group B (P = .679). Re-revision rates were 7.1% and 9.1%, respectively (P = 1.00). Overall, the implant survival rate at 6 years was 87.9% (95% confidence interval, 97.4-78.4). In group B, preoperative aspiration was performed in 36.4% (28/77) of cases. Staphylococci species were the predominant causative organisms, with gram-negative involvement in 19.0% (20/105) of cases. CONCLUSION The rate of infection eradication and overall survivorship with single-stage revision was similar in our series to that reported in the literature. While desirable, we did not find identification of the infecting organism before surgery influenced the outcome. Given the functional and economic benefits of single-stage revision, we suggest that failure to identify an organism is not an absolute contraindication to this approach.
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Affiliation(s)
- Benjamin J Greenfield
- School of Medical Sciences, Stopford Building, The University Of Manchester, Manchester
| | | | - Paul D Siney
- Centre For Hip Surgery, Wrightington Hospital, Appley Bridge
| | - Peter R Kay
- Centre For Hip Surgery, Wrightington Hospital, Appley Bridge
| | - Bodo Purbach
- Centre For Hip Surgery, Wrightington Hospital, Appley Bridge
| | - Tim N Board
- Centre For Hip Surgery, Wrightington Hospital, Appley Bridge
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12
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Arunshankar A, Chandy VJ, Elangovan D, Hariharan TD, Jude Prakash JA, George R, Oommen AT, Poonnoose PM. Microbiological profile of infections of the hip joint: An Indian perspective. Indian J Med Microbiol 2019; 37:509-513. [PMID: 32436872 DOI: 10.4103/ijmm.ijmm_20_31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Knowledge of the local microbiological epidemiology helps in formulating protocols for appropriate treatment of hip infections. The aim of this study was to profile the organisms cultured from infected hips. Methods The microbiological profile and sensitivity pattern of organisms in eighty infected hips were reviewed. Results Infection was secondary to arthroplasty in 35, fracture surgery in 34 and primary septic arthritis in 11. Twenty percent of the infections were polymicrobial, whereas the rest were monomicrobial. Fifty-five percent were Gram-positive, of which 45% were Staphylococcus species (36% methicillin-sensitive Staphylococcus aureus, 20% methicillin-resistant S. aureus, and 44% coagulase sensitive Staphylococcal species). All Staphylococcus species were sensitive to vancomycin, but 20% of Enterococcus species were resistant to vancomycin. One-third of the Enterococcus species and 2% of Staphylococcus species were resistant to teicoplanin. Escherichia coli (n = 10) and Pseudomonas sp. (n = 13) were the most common Gram-negative organism. Although 18% of the Gram-negative organisms were carbapenem resistant, all were sensitive to colistin. Conclusion Staphylococcus sp. was the most common pathogen found in hip infections. However, the high incidence of Gram-negative infection requires that prophylactic antibiotics cover these organisms as well. The high resistance to first-line antibiotics should be taken into consideration while making protocols. The knowledge of the microbial profile is especially important when considering arthroplasty for arthritis secondary to hip infections.
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Affiliation(s)
- A Arunshankar
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - V J Chandy
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Divyaa Elangovan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - T D Hariharan
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Rahul George
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anil T Oommen
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pradeep M Poonnoose
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India
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Garcia DR, Deckey D, Haglin JM, Emanuel T, Mayfield C, Eltorai AE, Spake CS, Jarrell JD, Born CT. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery. Surg Infect (Larchmt) 2019; 20:341-350. [DOI: 10.1089/sur.2018.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dioscaris R. Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Deckey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Toby Emanuel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cory Mayfield
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E.M. Eltorai
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carole Sl Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John D. Jarrell
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher T. Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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14
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Stravinskas M, Tarasevicius S, Laukaitis S, Nilsson M, Raina DB, Lidgren L. A ceramic bone substitute containing gentamicin gives good outcome in trochanteric hip fractures treated with dynamic hip screw and in revision of total hip arthroplasty: a case series. BMC Musculoskelet Disord 2018; 19:438. [PMID: 30522476 PMCID: PMC6284312 DOI: 10.1186/s12891-018-2360-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/22/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The primary objective was to investigate the clinical and radiological outcome in patients undergoing major hip surgery using a novel antibiotic containing bone substitute for local augmentation in trochanteric fracture fixation or revision of total hip arthroplasty (THA). METHODS We implanted a novel biphasic bone substitute CERAMENT™|G consisting of hydroxyapatite, calcium sulphate and gentamicin for bone regeneration and local antibiotic delivery in 20 patients treated surgically for trochanteric femoral fracture or uncemented hip revision. Preoperative, postoperative, 3 months and 1 year clinical and radiological assessment were performed including registration of any complications. In one trochanteric fracture patient, histological analyses were performed of bone biopsies taken at removal of hardware. RESULTS None of the trochanteric fractures or revision of THA showed any large migration. No local wound disturbances were seen and no infection was observed at one year follow-up. All trochanteric fractures healed at 3 months with a minimal sliding screw displacement on average 3 mm. Radiological analysis showed signs of bone remodeling and new bone formation in the substitute, illustrated also by histology in the biopsies taken from one trochanteric fracture at one year post-op. CONCLUSIONS Local CERAMENT™|G was shown to be safe in a limited prospective major hip surgery study. Remodeling of the bone graft substitute was observed in all patients. TRIAL REGISTRATION EU-CTR2018-004414-18 Retrospectively registered on November 20, 2018.
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MESH Headings
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/administration & dosage
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Bone Remodeling
- Bone Screws
- Bone Substitutes
- Calcium Sulfate
- Drug Combinations
- Durapatite
- Feasibility Studies
- Female
- Follow-Up Studies
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/methods
- Gentamicins/administration & dosage
- Hip/diagnostic imaging
- Hip/surgery
- Hip Fractures/diagnostic imaging
- Hip Fractures/surgery
- Humans
- Male
- Middle Aged
- Osteogenesis
- Postoperative Complications
- Prospective Studies
- Radiography
- Reoperation/adverse effects
- Reoperation/instrumentation
- Reoperation/methods
- Treatment Outcome
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Affiliation(s)
| | | | | | - Malin Nilsson
- Department of Orthopedics, Lund University Hospital, Lund, Sweden
| | | | - Lars Lidgren
- Department of Orthopedics, Lund University Hospital, Lund, Sweden
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15
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Lenguerrand E, Whitehouse MR, Beswick AD, Kunutsor SK, Burston B, Porter M, Blom AW. Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. THE LANCET. INFECTIOUS DISEASES 2018; 18:1004-1014. [PMID: 30056097 PMCID: PMC6105575 DOI: 10.1016/s1473-3099(18)30345-1] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/27/2018] [Accepted: 05/15/2018] [Indexed: 01/07/2023]
Abstract
Background The risk of prosthetic joint infection (PJI) is influenced by patient, surgical, and health-care factors. Existing evidence is based on short-term follow-up. It does not differentiate between factors associated with early onset caused by the primary intervention from those associated with later onset more likely to result from haematogenous spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to PJI after primary total hip replacement. Methods We did a prospective observational cohort study analysing 623 253 primary hip procedures performed between April 1, 2003, and Dec 31, 2013, in England and Wales and recorded the number of procedures revised because of PJI. We investigated the associations between risk factors and risk of revision for PJI across the overall follow-up period using Poisson multilevel models. We reinvestigated the associations by post-operative time periods (0–3 months, 3–6 months, 6–12 months, 12–24 months, >24 months) using piece-wise exponential multilevel models with period-specific effects. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data. Findings 2705 primary procedures were subsequently revised for an indication of PJI between 2003 and 2014, after a median (IQR) follow up of 4·6 years (2·6–7·0). Among the factors associated with an increased revision due to PJI there were male sex (1462 [1·2‰] of 1 237 170 male-years vs 1243 [0·7‰] of 1 849 691 female-years; rate ratio [RR] 1·7 [95% CI 1·6–1·8]), younger age (739 [1·1‰] of 688 000 person-years <60 years vs 242 [0·6‰] of 387 049 person-years ≥80 years; 0·7 [0·6–0·8]), elevated body-mass index (BMI; 941 [1·8‰] 517 278 person-years with a BMI ≥30 kg/m2vs 272 [0·9‰] of 297 686 person-years with a BMI <25 kg/m2; 1·9 [1·7–2·2]), diabetes (245 [1·4‰] 178 381 person-years with diabetes vs 2120 [1·0‰] of 2 209 507 person-years without diabetes; 1·4 [1·2–1·5]), dementia (5 [10·1‰] of 497 person-years with dementia at 3 months vs 311 [2·6‰] of 120 850 person-years without dementia; 3·8 [1·2–7·8]), previous septic arthritis (22 [7·2‰] of 3055 person-years with previous infection vs 2683 [0·9‰] of 3 083 806 person-years without previous infection; 6·7 [4·2–9·8]), fractured neck of femur (66 [1·5‰] of 43 378 person-years operated for a fractured neck of femur vs 2639 [0·9‰] of 3 043 483 person-years without a fractured neck of femur; 1·8 [1·4–2·3]); and use of the lateral surgical approach (1334 [1·0‰] of 1 399 287 person-years for lateral vs 1242 [0·8 ‰] of 1 565 913 person-years for posterior; 1·3 [1·2–1·4]). Use of ceramic rather than metal bearings was associated with a decreased risk of revision for PJI (94 [0·4‰] of 239 512 person-years with ceramic-on-ceramic bearings vs 602 [0·5‰] of 1 114 239 peron-years with metal-on-polyethylene bearings at ≥24 months; RR 0·6 [0·4–0·7]; and 82 [0·4‰] of 190 884 person-years with ceramic-on-polyethyene bearings vs metal-on-polyethylene bearings at ≥24 months; 0·7 [0·5–0·9]). Most of these factors had time-specific effects. The risk of revision for PJI was marginally or not influenced by the grade of the operating surgeon, the absence of a consultant surgeon during surgey, and the volume of procedures performed by hospital or surgeon. Interpretation Several modifiable and non-modifiable factors are associated with the risk of revision for PJI after primary hip replacement. Identification of modifiable factors, use of targeted interventions, and beneficial modulation of some of these factors could be effective in reducing the incidence of PJI. It is important for clinicians to consider non-modifiable factors and factors that exhibit time-specific effects on the risk of PJI to counsel patients appropriately preoperatively. Funding National Institute for Health Research.
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Affiliation(s)
- Erik Lenguerrand
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service (NHS) Foundation Trust, and University of Bristol, Bristol, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service (NHS) Foundation Trust, and University of Bristol, Bristol, UK
| | - Ben Burston
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Martyn Porter
- Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Lancashire, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service (NHS) Foundation Trust, and University of Bristol, Bristol, UK.
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16
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Microbial resistance related to antibiotic-loaded bone cement: a historical review. Knee Surg Sports Traumatol Arthrosc 2017; 25:3808-3817. [PMID: 27620468 DOI: 10.1007/s00167-016-4309-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The use of antibiotic-loaded bone cement (ALBC) has a range of indications for use in orthopaedics. It has the advantage of delivering high loads of antibiotics to a targeted site, thereby avoiding the side effects associated with systemic administration. However, there is concern that the use of ALBC may precipitate the development of antibiotic-resistant bacteria. METHODS This review focuses on (1) the published research using both animal and human models examining the association between ALBC and the induction of microbial resistance (2) the mechanisms by which antimicrobial resistance develop (3) the research pertaining to specific classes of antibiotics commonly used in orthopaedic practice (4) the recent developments in calcium sulphate beads, nanoparticles and chitosan, as alternative antimicrobial treatments for periprosthetic joint infections. CONCLUSION The literature for and against a link between ALBC and the development of microbiological resistance is reviewed and presented. It is concluded that further research is needed to develop a defined set of indications for the use of ALBC in the management of periprosthetic joint infection. In addition, further research into alternative antimicrobial therapies in this area should be encouraged.
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17
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Guo G, Wang J, You Y, Tan J, Shen H. Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review. Exp Ther Med 2017; 13:2599-2608. [PMID: 28587320 PMCID: PMC5450602 DOI: 10.3892/etm.2017.4300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 01/26/2017] [Indexed: 01/31/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating condition and Staphylococcus spp. are the predominant pathogens responsible, particularly coagulase-negative staphylococci (CoNS) and Staphylococcus aureus. The aim of the present systematic review was to evaluate the distribution characteristics of specific Staphylococcus spp. in different PJI phases, reveal the effect of pathogens' feature on their distribution and suggest recommendations for antibiotic treatment of Staphylococcal PJI. The present systematic review was performed using PubMed and EMBASE databases with the aim to identify existing literature that presented the spectrum of Staphylococcus spp. that occur in PJI. Once inclusion and exclusion criteria were applied, 20 cohort studies involving 3,344 cases in 3,199 patients were included. The predominant pathogen involved in PJI was indicated to be CoNS (31.2%), followed by S. aureus (28.8%). This trend was more apparent in hip replacement procedures. In addition, almost equal proportions of CoNS and S. aureus (28.6 and 30.0%, respectively) were indicated in the delayed phase. CoNS (36.6%) were the predominant identified organism in the early phase, whereas S. aureus (38.3%) occurred primarily in the late phase. In PJI caused by S. aureus, the number of cases of methicillin-sensitive Staphylococcus aureus (MSSA) was ~2.5-fold greater than that of methicillin-resistant Staphylococcus aureus (MRSA). MRSA occurred predominantly in the early phase, whereas MSSA was largely observed in the delayed and late phases. With regards to antibiotic treatment, the feature of various pathogens and the phases of PJI were the primary considerations. The present review provides useful information for clinical practice and scientific research of PJI.
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Affiliation(s)
- Geyong Guo
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jiaxing Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yanan You
- Department of Obstetrics, Fudan University Affiliated Obstetrics and Gynecology Hospital, Shanghai 200233, P.R. China
| | - Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Hao Shen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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18
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Frew NM, Cannon T, Nichol T, Smith TJ, Stockley I. Comparison of the elution properties of commercially available gentamicin and bone cement containing vancomycin with 'home-made' preparations. Bone Joint J 2017; 99-B:73-77. [PMID: 28053260 DOI: 10.1302/0301-620x.99b1.bjj-2016-0566.r1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 09/13/2016] [Indexed: 11/05/2022]
Abstract
AIMS Vancomycin is commonly added to acrylic bone cement during revision arthroplasty surgery. Proprietary cement preparations containing vancomycin are available, but are significantly more expensive. We investigated whether the elution of antibiotic from 'home-made' cement containing vancomycin was comparable with more expensive commercially available vancomycin impregnated cement. MATERIALS AND METHODS A total of 18 cement discs containing either proprietary CopalG+V; or 'home-made' CopalR+G with vancomycin added by hand, were made. Each disc contained the same amount of antibiotic (0.5 g gentamycin, 2 g vancomycin) and was immersed in ammonium acetate buffer in a sealed container. Fluid from each container was sampled at eight time points over a two-week period. The concentrations of gentamicin and vancomycin in the fluid were analysed using high performance liquid chromatography mass spectrometry. RESULTS The highest peak concentrations of antibiotic were observed from the 'home-made' cements containing vancomycin, added as in the operating theatre. The overall elution of antibiotic was, fivefold (vancomycin) and twofold (gentamicin) greater from the 'home-made' mix compared with the commercially mixed cement. The use of a vacuum during mixing had no significant effect on antibiotic elution in any of the samples. CONCLUSION These findings suggest that the addition of 2 g vancomycin powder to gentamicin-impregnated bone cement by hand significantly increases the elution of both antibiotics compared with commercially prepared cements containing vancomycin. We found no significant advantages of using expensive commercially produced vancomycin-impregnated cement and recommend the addition of vancomycin powder by hand in the operating theatre. Cite this article: Bone Joint J 2017;99-B:73-7.
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Affiliation(s)
- N M Frew
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
| | - T Cannon
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
| | - T Nichol
- Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB, UK
| | - T J Smith
- Sheffield Hallam University, City Campus, Howard Street, Sheffield, S1 1WB, UK
| | - I Stockley
- Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield, S5 7AU, UK
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19
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Langvatn H, Lutro O, Dale H, Schrama JC, Hallan G, Espehaug B, Sjursen H, Engesæter LB. Bacterial and Hematological Findings in Infected Total Hip Arthroplasties in Norway Assessment of 278 Revisions Due to Infection in the Norwegian Arthroplasty Register. Open Orthop J 2015; 9:445-9. [PMID: 26587060 PMCID: PMC4645952 DOI: 10.2174/1874325001509010445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
Our aim was to assess the bacterial findings in infected total hip arthroplasties (THAs) in Norway. We also wanted to investigate the relationship between causal bacteria and hematological findings. Revisions reported to the Norwegian Arthroplasty Register (NAR) due to infection after total hip arthroplasty during the period 1993 through September 2007 were identified. One single observer visited ten representative hospitals where clinical history, preoperative blood samples and the bacterial findings of intraoperative samples were collected. Bacterial growth in two or more samples was found in 278 revisions, and thus included. The following bacteria were identified: Coagulase-negative staphylococci (CoNS) (41%), Staphylococcus aureus (S. aureus) (19%), streptococci (11%), polymicrobial infections (10%), enterococci (9%), Gram-negative bacteria (6%) and others (4%). CoNS were the most common bacteria throughout the period but in the acute postoperative infections (< 3 weeks) S. aureus was the most frequent bacterial finding. We found no change in the distribution of the bacterial groups over time. S. aureus appears correlated with a higher C-reactive protein value (CRP) (mean 140 (95% Confidence interval (CI): 101-180)) than CoNS (mean 42 (CI: 31-53)). S. aureus also correlated with a higher erythrocyte sedimentation rate value (ESR) (mean 67 (CI: 55-79)) than CoNS (mean 47 (CI: 39-54)).
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Affiliation(s)
- Håkon Langvatn
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Olav Lutro
- Department of Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Håvard Dale
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway ; The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | | | - Geir Hallan
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Birgitte Espehaug
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Haakon Sjursen
- Department of Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars B Engesæter
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway ; The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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20
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Haas LM, Smith CM, Placek LM, Hall MM, Gong Y, Mellott NP, Wren AW. Investigating the effect of silver coating on the solubility, antibacterial properties, and cytocompatibility of glass microspheres. J Biomater Appl 2015; 30:450-62. [DOI: 10.1177/0885328215591902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Silver (Ag) coatings have been incorporated into many medical materials due to its ability to eradicate harmful microbes. In this study, glass microspheres (SiO2–Na2O–CaO–Al2O3) were synthesized and employed as substrates to investigate the effect Ag coating has on glass solubility and the subsequent biological effects. Initially, glasses were amorphous with a glass transition point (Tg) of 605℃ and microspheres were spherical with a mean particle diameter of 120 µm (±27). The Ag coating was determined to be crystalline in nature and its presence was confirmed using scanning electron microscopy and X-ray photoelectron spectroscopy. Ion release determined that Ag-coated ( Ag-S) microspheres increased the Na+ release rate but slightly reduced the Ca2+ and Si4+ release compared to an uncoated control ( UC-S). Additionally, the Ag-S reduced the pH to just above neutral (7.3–8.5) compared to the UC-S (7.7–9.1). Antibacterial testing determined significant reductions in planktonic Escherichia coli ( p = 0.000), Staphylococcus epidermidis ( p = 0.000) and Staphylococcus aureus ( p = 0.000) growth as a function of the presence of Ag and with respect to maturation (1, 7, and 30 days). Testing for toxicity levels using L929 Fibroblasts determined higher cell viability for the Ag-S at lower concentrations (5 µg/ml); in addition, no significant reduction in cell viability was observed with higher concentrations (15, 30 µg/ml).
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Affiliation(s)
- LM Haas
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - CM Smith
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - LM Placek
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - MM Hall
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - Y Gong
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - NP Mellott
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
| | - Anthony W Wren
- Inamori School of Engineering, Alfred University, Alfred, NY, USA
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21
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Ross AD, Boscainos PJ, Malhas A, Wigderowitz C. Peri-operative renal morbidity secondary to gentamicin and flucloxacillin chemoprophylaxis for hip and knee arthroplasty. Scott Med J 2014; 58:209-12. [PMID: 24215038 DOI: 10.1177/0036933013507850] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This retrospective cohort study uses serum creatinine levels to assess the effect of gentamicin and flucloxacillin on renal function in hip and knee arthroplasty patients. METHODS Serum creatinine levels were recorded pre-operatively and at two points post-operatively (sample 1 and sample 2) for all patients undergoing hip and knee arthroplasty. Either cefuroxime, or gentamicin and flucloxacillin were used for chemoprophylaxis. The Risk, Injury, Failure, Loss, End Stage classification was used to assess renal injury. RESULTS The differences in mean percentage change between the two groups were 5.86% (p = 0.077) and 11.34% (p = 0.030) at sample 1 and sample 2, respectively. Two patients (1.62%) receiving cefuroxime were exposed to renal risk or worse at some point. A total of nine patients (6.04%) receiving flucloxacillin and gentamicin were exposed to renal risk. Of these, three (2.01%) sustained renal injury and two (1.34%) sustained renal failure. The risk of being exposed to renal risk was 3.75 times greater for the gentamicin and flucloxacillin group. The risks of sustaining a significant deterioration of renal function were 1.9 and 17 times greater for the gentamicin and flucloxacillin group at the first and second post-operative samples, respectively. DISCUSSION Flucloxacillin and gentamicin significantly worsens renal function post-operatively compared with cefuroxime.
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Affiliation(s)
- A D Ross
- Specialty Registrar in Trauma and Orthopaedic Surgery, Wishaw General Hospital, UK
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22
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Hansen EN, Adeli B, Kenyon R, Parvizi J. Routine use of antibiotic laden bone cement for primary total knee arthroplasty: impact on infecting microbial patterns and resistance profiles. J Arthroplasty 2014; 29:1123-7. [PMID: 24418770 DOI: 10.1016/j.arth.2013.12.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/26/2013] [Accepted: 12/03/2013] [Indexed: 02/01/2023] Open
Abstract
Antibiotic-laden bone cement (ALBC) is used in primary arthroplasties throughout Europe. In North America, ALBC is only FDA approved for revision arthroplasty after periprosthetic joint infection (PJI). No article has evaluated whether infecting microbial profile and resistance has changed with the introduction of ALBC. We hypothesized that prophylactic use of ALBC in primary total knee arthroplasty (TKA) has not had a significant impact on infecting pathogens, and antibiotic resistance profiles. A retrospective cohort analysis was conducted of all PJI patients undergoing primary TKA and total hip arthroplasty (THA) between January 2000 and January 2009. No significant change in the patterns of infecting PJI pathogens, and no notable increase in percentage resistance was found among organisms grown from patients with PJI that had received prophylactic antibiotic-loaded cement in their primary joint arthroplasty. Early findings suggest that routine prophylactic use of ALBC has not led to changes in infecting pathogen profile, nor has led to the emergence of antimicrobial resistance at our institution.
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Affiliation(s)
- Erik N Hansen
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Bahar Adeli
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Robert Kenyon
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Javad Parvizi
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Hansen E, Belden K, Silibovsky R, Vogt M, Arnold WV, Bicanic G, Bini SA, Catani F, Chen J, Ghazavi MT, Godefroy KM, Holham P, Hosseinzadeh H, Kim KII, Kirketerp-Møller K, Lidgren L, Lin JH, Lonner JH, Moore CC, Papagelopoulos P, Poultsides L, Randall RL, Roslund B, Saleh K, Salmon JV, Schwarz EM, Stuyck J, Dahl AW, Yamada K. Perioperative antibiotics. J Arthroplasty 2014; 29:29-48. [PMID: 24355256 DOI: 10.1016/j.arth.2013.09.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Erik Hansen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine Belden
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randi Silibovsky
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Markus Vogt
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William V Arnold
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Goran Bicanic
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stefano A Bini
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Fabio Catani
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jiying Chen
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Mohammad T Ghazavi
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karine M Godefroy
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Paul Holham
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Hamid Hosseinzadeh
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kang I I Kim
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Lars Lidgren
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jian Hao Lin
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christopher C Moore
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Lazaros Poultsides
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Lor Randall
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brian Roslund
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Khalid Saleh
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julia V Salmon
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Edward M Schwarz
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jose Stuyck
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Annette W Dahl
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Koji Yamada
- Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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24
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Hansen E, Belden K, Silibovsky R, Vogt M, Arnold W, Bicanic G, Bini S, Catani F, Chen J, Ghazavi M, Godefroy KM, Holham P, Hosseinzadeh H, Kim KII, Kirketerp-Møller K, Lidgren L, Lin JH, Lonner JH, Moore CC, Papagelopoulos P, Poultsides L, Randall RL, Roslund B, Saleh K, Salmon JV, Schwarz E, Stuyck J, Dahl AW, Yamada K. Perioperative antibiotics. J Orthop Res 2014; 32 Suppl 1:S31-59. [PMID: 24464896 DOI: 10.1002/jor.22549] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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25
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Effect of erythromycin-doped calcium polyphosphate scaffold composite in a mouse pouch infection model. J Biomed Mater Res B Appl Biomater 2013; 102:1140-7. [DOI: 10.1002/jbm.b.33095] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 11/07/2022]
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26
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Zhang P, Qin L. Potential Use of Erythromycin to Prevent and Treat Prosthetic Failure. J Clin Pharmacol 2013; 50:858-60. [DOI: 10.1177/0091270009360535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Anderson AS, Miller AA, Donald RGK, Scully IL, Nanra JS, Cooper D, Jansen KU. Development of a multicomponent Staphylococcus aureus vaccine designed to counter multiple bacterial virulence factors. Hum Vaccin Immunother 2012; 8:1585-94. [PMID: 22922765 PMCID: PMC3601133 DOI: 10.4161/hv.21872] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus is a major cause of healthcare-associated infections and is responsible for a substantial burden of disease in hospitalized patients. Despite increasingly rigorous infection control guidelines, the prevalence and corresponding negative impact of S. aureus infections remain considerable. Difficulties in controlling S. aureus infections as well as the associated treatment costs are exacerbated by increasing rates of resistance to available antibiotics. Despite ongoing efforts over the past 20 years, no licensed S. aureus vaccine is currently available. However, learnings from past clinical failures of vaccine candidates and a better understanding of the immunopathology of S. aureus colonization and infection have aided in the design of new vaccine candidates based on multiple important bacterial pathogenesis mechanisms. This review outlines important considerations in designing a vaccine for the prevention of S. aureus disease in healthcare settings.
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28
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Sprowson A, Symes T, Khan SK, Oswald T, Reed MR. Changing antibiotic prophylaxis for primary joint arthroplasty affects postoperative complication rates and bacterial spectrum. Surgeon 2012; 11:20-4. [PMID: 22709532 DOI: 10.1016/j.surge.2012.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 02/24/2012] [Accepted: 02/26/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND The reduction of Clostridium difficile associated diarrhoea (CDAD) is a national priority. As part of the C. difficile improvement plan in our Trust, antibiotic prophylaxis for primary arthroplasty was changed from cefuroxime to gentamicin. Gentamicin was chosen following a review of the sensitivity profiles of all the organisms isolated from infected primary arthoplasties. METHODS From January 2002 to September 2007, 6094 patients (Group 1) undergoing primary hip and knee arthroplasty received three doses of Cefuroxime as prophylaxis; while from October 2007 to February 2009, 2101 patients (Group 2) received single dose Gentamicin (4.5 mg/kg). We studied the rate of CDAD as well as several other postoperative complications, including rate of return to theatre (RTT), before and after the change. FINDINGS There was an insignificant fall in CDAD from 0.18% to 0% (p=0.08) in Group 2, however there was a statistically significant increase in pneumonia (0.67-1.33%, p<0.01), acute renal failure (ARF) requiring HDU admission (0.07-0.33%, p<0.01) and RTT (1.08-1.95%, p<0.01) in this group. RTT for proven infection increased from 0.66% to 1.52% (p<0.01). CONCLUSIONS We conclude that Gentamicin 4.5 mg/kg alone should not be used as prophylaxis for primary joint arthroplasty as it does not reduce CDAD significantly but increases the risk of other postoperative complications. We have changed our prophylaxis to low dose gentamicin (3 mg/kg) combined with Teicoplanin 400 mg given once.
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Affiliation(s)
- A Sprowson
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK
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29
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Influence of Co-Cr particles and Co-Cr ions on the growth of staphylococcal biofilms. Int J Artif Organs 2012; 34:759-65. [PMID: 22094554 DOI: 10.5301/ijao.5000031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE In the last decades, hip prostheses with a metal-on-metal (MOM) bearing have been implanted by orthopedic surgeons worldwide. However, concerns are now raised towards the metal particles and degradation products released by MOM-bearings into surrounding tissue, although effects of Co-Cr wear on infection are also unknown. Therefore, we here determine the viable volumes of staphylococcal biofilms formed on polystyrene in the absence and presence of Co-Cr particles and Co-Cr ions. METHODS Three clinically derived and two commercially available staphylococcal strains were grown in the presence of 2 mg/mL Co-Cr particles or 1000/500 µg/L Co-Cr ions derived from Co-Cr salts or from particle supernatant, under static and dynamic growth conditions. A dynamic model simulates the conditions that apply for biofilm formation in the human body, as synovial fluid in mobile patients with hip prostheses is in constant motion with accompanying shear rates. Images of 24 h old biofilms were made with confocal laser scanning microscopy and analyzed with the mathematical computer program COMSTAT, yielding the biovolume of a biofilm. X-ray photoelectron spectroscopy was performed on the particles to study their elemental surface composition. RESULTS Most isolates showed a tendency of reduced biofilm growth in the presence of Co-Cr particles compared to growth during exposure to metal ions, but this was only significant in one strain under the dynamic growth condition (Staphylococcus aureus 7388). Characterization of the outer surface of the particles revealed a Co-Cr oxide layer enriched by Mo relative to the bulk concentration. CONCLUSIONS MOM bearings produce metal particles which were found to possess antibacterial characteristics under dynamic growth conditions. Further research is needed towards the clinical relevance of this finding.
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30
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Yamada K, Matsumoto K, Tokimura F, Okazaki H, Tanaka S. Are bone and serum cefazolin concentrations adequate for antimicrobial prophylaxis? Clin Orthop Relat Res 2011; 469:3486-94. [PMID: 21968901 PMCID: PMC3210253 DOI: 10.1007/s11999-011-2111-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 09/19/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified. QUESTIONS/PURPOSES We asked whether 2 g of cefazolin would enable effective serum and bone concentrations relative to the current minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus. PATIENTS AND METHODS We enrolled 43 patients (THA, n = 16; TKA, n = 27) scheduled for primary THAs and primary TKAs. Subjects were given 2 g of cefazolin intravenously before incision. One blood sample and two bone samples were collected from each subject before tourniquet deflation before any additional dose. All samples were assayed at the same laboratory. Minimum inhibitory concentration values were defined based on nationwide surveys. RESULTS Mean (± standard deviation) serum concentration was 170.3 ± 51.3 μg/mL (range, 99.3-370.3 μg/mL). Mean bone concentration was 32.3 ± 15.2 μg/g (range, 11.4-70.0 μg/g) in THA, and 16.0 ± 10.4 μg/g (range, 6.3-46.3 μg/g) in TKA. All serum and bone concentrations exceeded the minimum inhibitory concentration for methicillin-sensitive S. aureus, but some serum levels were marginal and no bone levels exceeded the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus. CONCLUSIONS Our data suggest intravenous administration of 2 g of cefazolin achieves the minimum inhibitory concentration for methicillin-sensitive S. aureus in serum and bone, but not the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus in bone, resulting in a potential risk of deep surgical site infections in THAs and TKAs.
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Affiliation(s)
- Koji Yamada
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Kunihiro Matsumoto
- Department of Medication Use Analysis and Clinical Research, Meiji Pharmaceutical University, Tokyo, Japan
| | - Fumiaki Tokimura
- Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Hiroshi Okazaki
- Department of Orthopaedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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31
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D'Angelo F, Negri L, Binda T, Zatti G, Cherubino P. The use of a preformed spacer in two-stage revision of infected hip arthroplasties. Musculoskelet Surg 2011; 95:115-120. [PMID: 21479729 DOI: 10.1007/s12306-011-0128-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 03/24/2011] [Indexed: 05/30/2023]
Abstract
Two-stage revision with the use of an antibiotic-loaded cement spacer has spread widely as a successful treatment for THA infection. Between 1999 and 2008, 28 patients with infected THA were treated with two-stage implant revision using a preformed spacer. The spacer was left in situ for 5.5 months (range 1-13 months), and the patients were allowed to walk with partial weight bearing. At a mean follow-up of 53 months (range 18-106 months), recurrence of infection was observed in only one patient. Complications were observed in five patients: three spacer dislocations, one distal femoral fracture occurred during stem removal, and one femoral artery pseudo-aneurysm. The mean HHS increased from 43 points (range 13-77) to 82 points (range 35-96). Though small prospective studies are reported in literature, good eradication rate and good functional outcomes encourage for the use of an antibiotic-loaded cement spacer. The industrial production ensures procedure standardization, well-defined physical and chemical properties to the device and eliminates time necessary to intraoperatory manufacturing.
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Affiliation(s)
- F D'Angelo
- Department of Orthopaedic and Traumatologic Sciences, University of Insubria, Varese, Italy.
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32
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Song W, Ren W, Wan C, Esquivel AO, Shi T, Blasier R, Markel DC. A novel strontium-doped calcium polyphosphate/erythromycin/poly(vinyl alcohol) composite for bone tissue engineering. J Biomed Mater Res A 2011; 98:359-71. [DOI: 10.1002/jbm.a.33127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 03/27/2011] [Accepted: 04/08/2011] [Indexed: 11/08/2022]
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33
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Stoodley P, Conti SF, DeMeo PJ, Nistico L, Melton-Kreft R, Johnson S, Darabi A, Ehrlich GD, Costerton JW, Kathju S. Characterization of a mixed MRSA/MRSE biofilm in an explanted total ankle arthroplasty. ACTA ACUST UNITED AC 2011; 62:66-74. [PMID: 21332826 DOI: 10.1111/j.1574-695x.2011.00793.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bacterial biofilms have been observed in many prosthesis-related infections, and this mode of growth renders the infection both difficult to treat and especially difficult to detect and diagnose using standard culture methods. We (1) tested a novel coupled PCR-mass spectrometric (PCR-MS) assay (the Ibis T5000) on an ankle arthroplasty that was culture negative on preoperative aspiration and then (2) confirmed that the Ibis assay had in fact detected a viable multispecies biofilm by further micrographic and molecular examinations, including confocal microscopy using Live/Dead stain, bacterial FISH, and reverse-transcriptase-PCR (RT-PCR) assay for bacterial mRNA. The Ibis technology detected Staphylococcus aureus, Staphylococcus epidermidis, and the methicillin resistance gene mecA in soft tissues associated with the explanted hardware. Viable S. aureus were confirmed using RT-PCR, and viable cocci in the biofilm configuration were detected microscopically on both tissue and hardware. Species-specific bacterial FISH confirmed a polymicrobial biofilm containing S. aureus. A novel culture method recovered S. aureus and S. epidermidis (both methicillin resistant) from the tibial metal component. These observations suggest that molecular methods, particularly the new Ibis methodology, may be a useful adjunct to routine cultures in the detection of biofilm bacteria in prosthetic joint infection.
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Affiliation(s)
- Paul Stoodley
- Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA
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34
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Patti BN, Lindeque BGP. Antibiotic-loaded acrylic bone cement in the revision of septic arthroplasty: where's the evidence? Orthopedics 2011; 34:210. [PMID: 21410104 DOI: 10.3928/01477447-20110124-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Brianna N Patti
- Department of Orthopedic Surgery, University of Colorado Health Sciences Center, Denver, Colorado, USA
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35
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Ahmad R, Tham J, Naqvi SGA, Butt U, Dixon J. Supports used for positioning of patients in hip arthroplasty: is there an infection risk? Ann R Coll Surg Engl 2010; 93:130-2. [PMID: 21092415 DOI: 10.1308/003588411x12851639107755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Infection after joint arthroplasty is a disastrous complication. Implants used in hip arthroplasty increase the risk of infection from organisms of low pathogenicity. Potential reservoirs, that have not been assessed as yet, are the supports used for patient positioning in hip arthroplasty. The purpose of this study was to assess these supports for presence of bacterial pathogens. SUBJECTS AND METHODS We studied 40 supports used in 20 hip arthroplasty procedures. Tryptone soya agar plates were used to sample these supports. All agar plates were incubated at 37 °C for 48 h. RESULTS Of the 20 anterior supports, 17 (85%) showed bacterial colonisation; of the 20 posterior supports, 10 (50%) had bacterial colonisation. Fourteen (52%) supports were contaminated with one organism, 9 (33%) with two organisms, three (11%) with three organisms and one (4%) with four organisms. Coagulase-negative staphylococci were the most common isolated organisms (61%) followed by coryneforms (10%) and bacilli (10%). Anterior supports had two times more colony forming units compared to the posterior supports. CONCLUSIONS This study showed contamination of supports used for positioning patients during hip arthroplasty. It reflects poor cleaning practice and certainly raises the possibility that a high bacterial load on these supports may contribute to higher infection rates in hip arthroplasties. The study raises concerns related to contamination of supports, as there is a potential for cross-infection, wound problems, and deep sepsis around implants which could be disastrous. While colonisation does not equate with infection, we suggest thorough cleaning of the supports before and after every surgical procedure.
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Affiliation(s)
- Riaz Ahmad
- Department of Orthopaedics, Weston General Hospital, Weston Super Mare, UK.
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36
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Brock HS, Moodie PG, Hendricks KJ, McIff TE. Compression strength and porosity of single-antibiotic cement vacuum-mixed with vancomycin. J Arthroplasty 2010; 25:990-7. [PMID: 19679443 DOI: 10.1016/j.arth.2009.06.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 06/17/2009] [Indexed: 02/01/2023] Open
Abstract
We evaluated the ultimate compression strength (UCS), porosity, and fracture surface roughness of 2 commercially available single-antibiotic bone cements vacuum-mixed with additional amounts of vancomycin (2, 4, 6, and 8 g). At least 8 g could be added to Palacos R + 0.5 g gentamicin (UCS = 75.04 +/- 6.64 MPa) and no more than 6 g to Simplex P + 1 g tobramycin (UCS = 78.93 +/- 4.98 MPa) to maintain a UCS above the International Organization for Standardization minimum standard (70 MPa). Increasing vancomycin concentration correlated with a decrease in porosity but showed a trend towards greater fracture surface roughness.
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Affiliation(s)
- Hugh S Brock
- Department of Orthopedic Surgery, The University of Kansas Medical Center, Kansas City, USA
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37
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Nickinson RSJ, Board TN, Gambhir AK, Porter ML, Kay PR. The microbiology of the infected knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2009; 34:505-10. [PMID: 19458950 DOI: 10.1007/s00264-009-0797-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Accepted: 04/23/2009] [Indexed: 12/16/2022]
Abstract
We describe the results of a retrospective analysis of patients with microbiologically proven infection, who underwent revision TKA between 1994 and 2008. Of the 121 patients included in the study, 61 (50%) were male and 60 (50%) were female. The mean age was 71 (range 42-88) years. The most common organisms identified were Coagulase negative Staphylococcus (CNS) (49%) and Staphylococcus aureus (SA) (13%). The prevalence of CNS appears to be increasing, while that of SA and other organisms is decreasing. Vancomycin and teicoplanin were the most effective antibiotics with overall sensitivity rates of 100% and 96%, respectively. The results of our theoretical model suggest that gentamicin combined with vancomycin is the most effective empirical regimen. Staphylococcal species are the most common organisms encountered in deep infection of the knee. Gentamicin combined with vancomycin offers the most comprehensive protection and potentially allows for infected knee arthoplasties to be treated with a one-stage procedure.
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Affiliation(s)
- R S J Nickinson
- Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Appley Bridge, Wigan, Lancashire, UK.
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38
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Kanellakopoulou K, Papadopoulos A, Varvaroussis D, Varvaroussis A, Giamarellos-Bourboulis EJ, Pagonas A, Stergiou A, Papadelis P, Nikolaidis V, Giamarellou H. Efficacy of teicoplanin for the prevention of surgical site infections after total hip or knee arthroplasty: a prospective, open-label study. Int J Antimicrob Agents 2009; 33:437-40. [DOI: 10.1016/j.ijantimicag.2008.10.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 10/10/2008] [Accepted: 10/16/2008] [Indexed: 11/26/2022]
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39
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Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged Bacterial Culture to Identify Late Periprosthetic Joint Infection: A Promising Strategy. Clin Infect Dis 2008; 47:1403-9. [DOI: 10.1086/592973] [Citation(s) in RCA: 365] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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40
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Hosman AH, van der Mei HC, Bulstra SK, Busscher HJ, Neut D. Metal‐on‐metal bearings in total hip arthroplasties: Influence of cobalt and chromium ions on bacterial growth and biofilm formation. J Biomed Mater Res A 2008; 88:711-6. [DOI: 10.1002/jbm.a.31922] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anton H. Hosman
- Department of Biomedical Engineering, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Orthopaedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Henny C. van der Mei
- Department of Biomedical Engineering, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Sjoerd K. Bulstra
- Department of Orthopaedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Henk J. Busscher
- Department of Biomedical Engineering, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Orthopaedic Surgery, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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