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Bahmany S, Holst A, Hoogendoorn MH, Oosterhoff M, van Oldenrijk J, Bos PK, Veltman ES, Koch BCP. Quantification of cefuroxime and flucloxacillin in synovial tissue and bone using ultra-performance convergence chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2024; 1241:124169. [PMID: 38815354 DOI: 10.1016/j.jchromb.2024.124169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
After a revision surgery, approximately 1-2 % of patients will develop a periprosthetic joint infection (PJI). During the revision surgery, the infected prosthesis is removed, a debridement is performed and a new or temporary spacer is placed. Additionally, patients are treated with antibiotics during and after the surgery. Adequate exposure of the administered antibiotic to the pathogen is of crucial importance during the treatment of any infection. Inadequately low concentrations are associated with an increase in antibiotic resistance, antibiotic related side effects, treatment failures and prolonged infections. While high concentrations may lead to serious adverse events and potential lasting damage. Despite the importance of optimal dosing, there is a lack of knowledge with respect to the correlation between the plasma concentrations and target site concentrations of the antibiotics. Two of the commonly administered antimicrobial agents during the arthroplasty exchange are cefuroxime and flucloxacillin. Therefore, an accurate, specific, and sensitive quantification method is required in order to assess pharmacokinetics of cefuroxime and flucloxacillin in synovial tissue and bone. The aim of this study is to develop and validate a quantification method for the measurement of cefuroxime and flucloxacillin in human synovial tissue and bone using the UPC2-MS/MS conform Food and Drug Administration guidelines. The method was found linear for both compounds in both matrices (r2 > 0.990) from 1 µg/g to 20 µg/g, except for cefuroxime in bone, which was validated from 1 µg/g to 15 µg/g. We developed and validated a quantification method for cefuroxime and flucloxacillin in synovial tissue and bone using a simple sample preparation and a short analysis run time of 5.0 min, which has been already successfully applied in a clinical study. To our knowledge, no methods have been described earlier for the simultaneous quantification of cefuroxime and flucloxacillin in synovial tissue and bone.
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Affiliation(s)
- S Bahmany
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands.
| | - A Holst
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
| | - M H Hoogendoorn
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
| | - M Oosterhoff
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands
| | - J van Oldenrijk
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopedics and Sports Medicine, the Netherlands
| | - P K Bos
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopedics and Sports Medicine, the Netherlands
| | - E S Veltman
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopedics and Sports Medicine, the Netherlands
| | - B C P Koch
- Erasmus MC, University Medical Center Rotterdam, Department of Hospital Pharmacy, the Netherlands; CATOR, Center for Antimicrobial Treatment Optimization Rotterdam, the Netherlands
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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024; 37:e0010423. [PMID: 38506553 PMCID: PMC11237642 DOI: 10.1128/cmr.00104-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Lu H, Wang W, Xu H, Zhou K, Zhou Z. Efficacy and safety of two-stage revision for patients with culture-negative versus culture-positive periprosthetic joint infection: a single-center retrospective study. BMC Musculoskelet Disord 2024; 25:160. [PMID: 38378509 PMCID: PMC10877912 DOI: 10.1186/s12891-024-07259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The safety and efficacy of two-stage revision for culture-negative PJI remain controversial. This study analyzed outcomes after two-stage revision in patients with culture-negative and culture-positive periprosthetic joint infection (PJI) during follow-up lasting at least two years. METHODS Data were retrospectively analysed patients who underwent hip or knee revision arthroplasty from January 2008 to October 2020 at our medical center. The primary outcome was the re-revision rate, while secondary outcomes were the rates of reinfection, readmission, and mortality. Patients with culture-negative or culture-positive PJI were compared in terms of these outcomes, as well as survival time without reinfection or revision surgery, based on Kaplan‒Meier analysis. RESULTS The final analysis included 87 patients who were followed up for a mean of 72.3 months (range, 24-123 months). The mean age was 58.1 years in the culture-negative group (n = 24) and 59.1 years in the culture-positive group (n = 63). The two groups (culture-negative versus culture-positive) did not differ significantly in rates of re-revision (0.0% vs. 3.2%, p > 0.05), reinfection (4.2% vs. 3.2%, p > 0.05), readmission (8.4% vs. 8.0%, p > 0.05), or mortality (8.3% vs. 7.9%, p > 0.05). They were also similar in survival rates without infection-related complications or revision surgery at 100 months (91.5% in the culture-negative group vs. 87.9% in the culture-positive group; Mantel‒Cox log-rank χ2 = 0.251, p = 0.616). CONCLUSION The two-stage revision proves to be a well-tolerated and effective procedure in both culture-negative and culture-positive PJI during mid to long-term follow-up.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wenqi Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Kai Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
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De Groot J, Brokelman R, Fransen B, Jiya T, Pakvis D. Antibiotic prophylaxis before tissue biopsy has no effect on culture results in presumed aseptic revision total hip arthroplasty. J Bone Jt Infect 2024; 9:67-74. [PMID: 38601000 PMCID: PMC11004665 DOI: 10.5194/jbji-9-67-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/26/2023] [Indexed: 04/12/2024] Open
Abstract
Background: Antibiotic prophylaxis (AP) is considered to be the gold standard for revision total hip arthroplasty (R-THA) due to the high incidence of prosthetic joint infection (PJI). To diagnose PJI, intraoperative tissue biopsies for culture are of particular importance. However, antibiotic interference could theoretically lead to less reliable culture results. Currently, there is no consensus on whether AP should be administered before or after tissue biopsy. In this study, we aimed to investigate the effect of AP timing on culture results and PJI rates in presumed aseptic R-THA. Methods: A retrospective single-center cohort study among 490 patients was performed; 61 patients received AP pre-incision, and 429 patients received AP post-biopsy. At least three intraoperative tissues were sampled for each patient and cultured for a minimum of 2 weeks. Minimum follow-up was 6 months. Epidemiological and clinical data (including culture results and incidence of PJI during follow-up) were gathered and analyzed. Results: Positive (4.9 % vs. 5.4 %, p = 0.89 ) and contaminated culture results (23.0 % vs. 22.6 %, p = 0.95 ) were not significantly different between pre-incisional and post-biopsy AP administration. Post-operative PJI incidence during follow-up was 1.6 % and 3.0 %, respectively. This difference was not statistically significant (p = 0.54 ). Conclusion: Pre-incisional AP administration does not yield fewer culture results compared to post-biopsy AP administration. Although statistically not significant, PJI during follow-up was almost twice as high when AP was withheld until after tissue biopsy. Other literature also supports the additional protective benefit of pre-incisional AP. Therefore, we believe pre-incisional AP administration is preferable for presumed aseptic R-THA.
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Affiliation(s)
- Jesse D. De Groot
- Department of Orthopedic surgery, OCON Orthopedic Clinic, Geerdinksweg 144, 7555 DL Hengelo, the Netherlands
| | - Roy G. B. Brokelman
- Department of Orthopedic surgery, OCON Orthopedic Clinic, Geerdinksweg 144, 7555 DL Hengelo, the Netherlands
| | - Bas L. Fransen
- Department of Orthopedic surgery, OCON Orthopedic Clinic, Geerdinksweg 144, 7555 DL Hengelo, the Netherlands
| | - Tim U. Jiya
- Department of Orthopedic surgery, OCON Orthopedic Clinic, Geerdinksweg 144, 7555 DL Hengelo, the Netherlands
| | - Dean F. M. Pakvis
- Department of Orthopedic surgery, OCON Orthopedic Clinic, Geerdinksweg 144, 7555 DL Hengelo, the Netherlands
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Jia-Wei H, Jing W, Li C, Xiao-Gang Z, Guo-Qing L, Bo-Yong X, Bao-Chao J, Jun-Jie H, Jun Z. Two-dimensional liquid chromatography measurement of meropenem concentration in synovial fluid of patients with periprosthetic joint infection. Biomed Chromatogr 2024; 38:e5778. [PMID: 38073142 DOI: 10.1002/bmc.5778] [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: 10/18/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/26/2024]
Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication following joint replacement surgery. One potential treatment approach for PJI could be the combination of one-stage revision and intra-articular infusion of antibiotics. Meropenem is one of the commonly used intra-articular antibiotics in our institution. Determining the concentration of meropenem in the joint cavity could be crucial for optimizing its local application, effectively eradicating biofilm infection, and improving PJI treatment outcomes. In this study, we developed a simple, precise, and accurate method of two-dimensional liquid chromatography (2D-LC) for determining the concentration of meropenem in human synovial fluid. The method was then validated based on the guidelines of the Food and Drug Administration and the Chinese Pharmacopoeia. Meropenem showed good linearity in the range of 0.31-25.01 μg/mL (r ≥ .999). Selectivity, intra-day and inter-day precision and accuracy, extraction recovery, and stability validation results were all within the acceptance range. This method has been successfully applied to the determination of synovial fluid samples from PJI patients, providing a useful detection method for meropenem therapeutic drug monitoring (TDM) in PJI patients.
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Affiliation(s)
- He Jia-Wei
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wang Jing
- Department of Pharmacy, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cao Li
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhang Xiao-Gang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Guo-Qing
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xu Bo-Yong
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ji Bao-Chao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huang Jun-Jie
- College of Pharmacy, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhao Jun
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Maini L, Genovés V, Furrer R, Cesarovic N, Hierold C, Roman C. An in vitro demonstration of a passive, acoustic metamaterial as a temperature sensor with mK resolution for implantable applications. MICROSYSTEMS & NANOENGINEERING 2024; 10:8. [PMID: 38261856 PMCID: PMC10794229 DOI: 10.1038/s41378-023-00632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 01/25/2024]
Abstract
Wireless medical sensors typically utilize electromagnetic coupling or ultrasound for energy transfer and sensor interrogation. Energy transfer and management is a complex aspect that often limits the applicability of implantable sensor systems. In this work, we report a new passive temperature sensing scheme based on an acoustic metamaterial made of silicon embedded in a polydimethylsiloxane matrix. Compared to other approaches, this concept is implemented without additional electrical components in situ or the need for a customized receiving unit. A standard ultrasonic transducer is used for this demonstration to directly excite and collect the reflected signal. The metamaterial resonates at a frequency close to a typical medical value (5 MHz) and exhibits a high-quality factor. Combining the design features of the metamaterial with the high-temperature sensitivity of the polydimethylsiloxane matrix, we achieve a temperature resolution of 30 mK. This value is below the current standard resolution required in infrared thermometry for monitoring postoperative complications (0.1 K). We fabricated, simulated, in vitro tested, and compared three acoustic sensor designs in the 29-43 °C (~302-316 K) temperature range. With this concept, we demonstrate how our passive metamaterial sensor can open the way toward new zero-power smart medical implant concepts based on acoustic interrogation.
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Affiliation(s)
- Lucrezia Maini
- Micro- and Nanosystems, Department of Mechanical and Process Engineering, ETH Zurich, Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Vicente Genovés
- Translational Cardiovascular Technology, Department of Health Science and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Roman Furrer
- Transport at Nanoscale Interfaces, Swiss Federal Laboratories for Materials Science and Technology, EMPA, Überlandstrasse 129, 8600 Dübendorf, Switzerland
| | - Nikola Cesarovic
- Translational Cardiovascular Technology, Department of Health Science and Technology, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), 13353 Berlin, Germany
| | - Christofer Hierold
- Micro- and Nanosystems, Department of Mechanical and Process Engineering, ETH Zurich, Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Cosmin Roman
- Micro- and Nanosystems, Department of Mechanical and Process Engineering, ETH Zurich, Tannenstrasse 3, 8092 Zurich, Switzerland
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Richter A, Altemeier A, Hold M, Lenhof S, Stauss R, Ettinger M, Omar M. Drain fluid cultures can rule in but cannot rule out infection persistence after surgical treatment of periprosthetic joint infections. J Orthop Sci 2024; 29:177-182. [PMID: 36462996 DOI: 10.1016/j.jos.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is one of the most common reason for implant failure in arthroplasty. Surgical therapy is essential but there is no standardized guideline to determine infection eradication in multiple-step revision surgery. To date, clinical and laboratory inflammation markers and preoperative arthrocentesis are controversial to evaluate the infection status before reimplantation and therefore are often combined. Drain fluid cultures enable a microbiological analysis without need for further invasive procedure after revision surgery. This retrospective study evaluates the diagnostic performance of drain fluid cultures in diagnosing infection persistence according to the MSIS definition of PJI. METHODS Drain samples have been taken after every revision surgery for microbiological testing. Afterwards, the results have been assigned to the infection status according to the diagnostic criteria of the MSIS definition of PJI. RESULTS 1084 revision surgeries in 183 patients have been included, resulting in a total sample size of 1552 drain fluid cultures. Overall sensitivity was 36.0%, specificity was 90.7% and ROC-AUC was 0.63. CONCLUSION Due to a high specificity and a low sensitivity drain fluid cultures can rule in but cannot rule out infection persistence in PJI.
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Affiliation(s)
- Alena Richter
- Orthopaedic Department - DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Anna Altemeier
- Orthopaedic Department - DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Mara Hold
- Orthopaedic Department - DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Stefan Lenhof
- Trauma Department - Hannover Medical School, Carl-Neuberg-Str 130625 Hannover, Germany.
| | - Ricarda Stauss
- Trauma Department - Hannover Medical School, Carl-Neuberg-Str 130625 Hannover, Germany.
| | - Max Ettinger
- Orthopaedic Department - DIAKOVERE Annastift, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany.
| | - Mohamed Omar
- Trauma Department - Hannover Medical School, Carl-Neuberg-Str 130625 Hannover, Germany.
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Balta O, Astan S, Altınayak H, Uçar C, Aytekin FY, Kurnaz R. Can C-Reactive Protein-Lymphocyte Ratio Be Used as a Screening Tool to Confirm the Diagnosis of Periprosthetic Joint Infection? Clin Orthop Surg 2023; 15:917-927. [PMID: 38045571 PMCID: PMC10689224 DOI: 10.4055/cios22313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 08/13/2023] [Accepted: 08/13/2023] [Indexed: 12/05/2023] Open
Abstract
Background This study aimed to investigate whether periprosthetic joint infection (PJI) can be predicted by the C-reactive protein-to-lymphocyte ratio (CLR), whether this ratio increases the accuracy of PJI diagnosis, and whether it is more sensitive than other blood values and ratios. Methods The patients were divided into two groups: the septic revision (SR) group and the aseptic revision (AR) group. In cases of septic revision, the diagnosis of PJI was made based on the criteria proposed by the European Bone and Joint Infection Society (EBJIS). The groups were compared in terms of age, sex, body mass index, comorbidity, and preoperative laboratory results. The sensitivity, specificity, and diagnostic performance of the values and ratios were analyzed and compared. Results The receiver operating characteristic (ROC) analysis for the CLR gave a diagnostic value of 15.52, which provided a sensitivity of 91.1% and a specificity of 64.2% for PJI. The CLR gave lower specificity and higher sensitivity compared to the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values. The ROC analysis showed that the CLR had a similar area under the curve (AUC) with the ESR and CRP (0.808). The CLR had a higher specificity than other ratios (platelet volume ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio) and a higher value of the AUC. In the multivariate analysis, the CLR (hazard ratio, 1.088; 95% confidence interval, 1.063-1.113; p < 0.001) was found to be a significant risk factor. As CLR increased by one unit, the risk of PJI increased by 1.088 times, and it was statistically significant (p < 0.001). Conclusions The findings of this study suggest that CLR can serve as a valuable screening tool for diagnosing PJI. CLR demonstrated higher sensitivity in predicting PJI compared to ESR and CRP, and it exhibited greater specificity than other infection markers.
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Affiliation(s)
- Orhan Balta
- Department of Orthopaedics and Traumatology, Gaziosmanpasa University Hospital, Tokat, Türkiye
| | - Sezer Astan
- Department of Orthopaedics and Traumatology, Tokat State Hospital, Tokat, Türkiye
| | - Harun Altınayak
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Health Sciences University, Samsun, Türkiye
| | - Cihan Uçar
- Department of Orthopedics and Traumatology, Trabzon Kanuni Training and Research Hospital, Trabzon, Türkiye
| | - Feyza Yildiz Aytekin
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Prof. Dr. A. Ilhan Özdemir State Hospital, Giresun, Türkiye
| | - Recep Kurnaz
- Department of Orthopaedics and Traumatology, Acıbadem State Hospital, Eskişehir, Türkiye
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Zheng W, Wu D, Zhang Y, Luo Y, Yang L, Xu X, Luo F. Multifunctional modifications of polyetheretherketone implants for bone repair: A comprehensive review. BIOMATERIALS ADVANCES 2023; 154:213607. [PMID: 37651963 DOI: 10.1016/j.bioadv.2023.213607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023]
Abstract
Polyetheretherketone (PEEK) has emerged as a highly promising orthopedic implantation material due to its elastic modulus which is comparable to that of natural bone. This polymer exhibits impressive properties for bone implantation such as corrosion resistance, fatigue resistance, self-lubrication and chemical stability. Significantly, compared to metal-based implants, PEEK implants have mechanical properties that are closer to natural bone, which can mitigate the "stress shielding" effect in bone implantation. Nevertheless, PEEK is incapable of inducing osteogenesis due to its bio-inert molecular structure, thereby hindering the osseointegration process. To optimize the clinical application of PEEK, researchers have been working on promoting its bioactivity and endowing this polymer with beneficial properties, such as antibacterial, anti-inflammatory, anti-tumor, and angiogenesis-promoting capabilities. Considering the significant growth of research on PEEK implants over the past 5 years, this review aims to present a timely update on PEEK's modification methods. By highlighting the latest advancements in PEEK modification, we hope to provide guidance and inspiration for researchers in developing the next generation bone implants and optimizing their clinical applications.
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Affiliation(s)
- Wenzhuo Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Dongxu Wu
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
| | - Yaowen Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yankun Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Lei Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Xiangrui Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China
| | - Feng Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China School of Stomatology, Sichuan University, Chengdu 610041, China; Department of Prosthodontics, West China School of Stomatology, Sichuan University, Chengdu 610041, China.
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van Schaik TJA, van Meer MPA, de Jong LD, Goosen JHM, Somford MP, van Susante JLC. No difference in bacterial contamination of hip capsule sutures and control sutures in hip arthroplasty surgery. Antimicrob Resist Infect Control 2023; 12:101. [PMID: 37710282 PMCID: PMC10503031 DOI: 10.1186/s13756-023-01305-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Perioperative preventive measures are important to further reduce the rate of periprosthetic joint infections (PJI) in patients undergoing total hip arthroplasty (THA). During THA surgery, joint capsule sutures are commonly placed to optimize exposure and reinsertion of the capsule. Bacterial contamination of these sutures during the procedure poses a potential risk for postoperative infection. In this exploratory study, we assessed the contamination rate of capsule sutures compared to the contamination of the remains of exchanged control sutures at the time of closure. METHODS In 100 consecutive patients undergoing primary THA capsule sutures were exchanged by sterile sutures at the time of capsule closure. Both the original sutures and the remainder of the newly placed (control) sutures were retrieved, collected and cultured for ten days. Types of bacterial growth and contamination rates of both sutures were assessed. RESULTS Sutures from 98 patients were successfully collected and analyzed. Bacterial growth was observed in 7/98 (7.1%) of the capsule sutures versus 6/98 (6.1%) of the control sutures, with a difference of 1% [CI -6-8]. There was no clear pattern in differences in subtypes of bacteria between groups. CONCLUSIONS This study showed that around 7% of capsule sutures used in primary THA were contaminated with bacteria and as such exchange by new sutures at the time of capsule closure could be an appealing PJI preventive measure. However, since similar contamination rates were encountered with mainly non-virulent bacteria for both suture groups, the PJI preventive effect of this measure appears to be minimal.
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Affiliation(s)
- Thomas J A van Schaik
- Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Orthopedic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Maurits P A van Meer
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Lex D de Jong
- Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jon H M Goosen
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Matthijs P Somford
- Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Job L C van Susante
- Department of Orthopedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
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Predoi D, Iconaru SL, Ciobanu CS, Raita MS, Ghegoiu L, Trusca R, Badea ML, Cimpeanu C. Studies of the Tarragon Essential Oil Effects on the Characteristics of Doped Hydroxyapatite/Chitosan Biocomposites. Polymers (Basel) 2023; 15:polym15081908. [PMID: 37112055 PMCID: PMC10142985 DOI: 10.3390/polym15081908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/06/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Due to the emergence of antibiotic-resistant pathogens, the need to find new, efficient antimicrobial agents is rapidly increasing. Therefore, in this study, we report the development of new biocomposites based on zinc-doped hydroxyapatite/chitosan enriched with essential oil of Artemisia dracunculus L. with good antimicrobial activity. Techniques such as scanning electron microscopy (SEM), X-ray diffraction (XRD), energy dispersive X-ray spectroscopy (EDX) and Fourier transform infrared spectroscopy (FTIR) were used in order to evaluate their physico-chemical properties. Our studies revealed that biocomposite materials with nanometric dimension and homogeneous composition could be obtained through an economic and cost-effective synthesis method. The biological assays demonstrated that ZnHA (zinc-doped hydroxyapatite), ZnHACh (zinc-doped hydroxyapatite/chitosan) and ZnHAChT (zinc-doped hydroxyapatite/chitosan enriched with essential oil of Artemisia dracunculus L.) did not exhibit a toxic effect on the cell viability and proliferation of the primary osteoblast culture (hFOB 1.19). Moreover, the cytotoxic assay also highlighted that the cell morphology of the hFOB 1.19 was not altered in the presence of ZnHA, ZnHACh or ZnHAChT. Furthermore, the in vitro antimicrobial studies emphasized that the samples exhibited strong antimicrobial properties against Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923 and Candida albicans ATCC 10231 microbial strains. These results are encouraging for the following development of new composite materials with enhanced biological properties that could promote the osteogenic process of bone healing and also exhibit good antimicrobial properties.
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Affiliation(s)
- Daniela Predoi
- National Institute of Materials Physics, Atomistilor Street, No. 405A, 077125 Magurele, Romania
| | - Simona Liliana Iconaru
- National Institute of Materials Physics, Atomistilor Street, No. 405A, 077125 Magurele, Romania
| | - Carmen Steluta Ciobanu
- National Institute of Materials Physics, Atomistilor Street, No. 405A, 077125 Magurele, Romania
| | - Mariana Stefania Raita
- Faculty of Veterinary Medicine, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 105 Splaiul Independentei, District 5, 050097 Bucharest, Romania
| | - Liliana Ghegoiu
- National Institute of Materials Physics, Atomistilor Street, No. 405A, 077125 Magurele, Romania
| | - Roxana Trusca
- Science and Engineering of Oxide Materials and Nanomaterials, Faculty of Applied Chemistry and Materials Science, University POLITEHNICA of Bucharest, Gh. Polizu 1-7, 011061 Bucharest, Romania
- National Center for Micro and Nanomaterials, University POLITEHNICA of Bucharest, Splaiul Independentei 313, 060042 Bucharest, Romania
| | - Monica Luminita Badea
- Faculty of Horticulture, University of Agronomic Sciences and Veterinary Medicine, 59 Marasti Blvd., 011464 Bucharest, Romania
| | - Carmen Cimpeanu
- Faculty of Land Reclamation and Environmental Engineering, University of Agronomic Sciences and Veterinary Medicine of Bucharest, 59 Marasti Blvd, 011464 Bucharest, Romania
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12
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Kutubi A, O'Brien L, Murphy B, Fitzpatrick P, Hurson C, Rajendran D, Feeney E, Mallon P, Waqas S. A single centre experience of prosthetic joint infection outcomes with outpatient parenteral antimicrobial therapy. Heliyon 2023; 9:e15212. [PMID: 37113779 PMCID: PMC10126847 DOI: 10.1016/j.heliyon.2023.e15212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 03/26/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
Objectives Prosthetic joint infection (PJI) is a serious complication following arthroplasties. This study assessed the clinical outcomes, readmission rates and financial impact of PJIs treated with outpatient parenteral antimicrobial therapy (OPAT). Methods The study used prospectively collected data from the OPAT patient database at a tertiary care Irish hospital for PJI cases managed between 2015 and 2020. Data was analyzed using IBM-SPSS. Results Forty-one patients with PJIs were managed via OPAT over five years, with median age of 71.6 years. Median duration of OPAT was 32 days. Hospital readmission occurred in 34% of cases. Reasons for readmission included progression of infection in 64.3%, unplanned reoperation in 21.4% and planned admission for joint revision in 14.3%. Type 2 Diabetes Mellitus (T2DM) was found to have a statistically significant association with unplanned readmission (OR 8.5, CI 95% 1.1-67.6; p < 0.01). OPAT saved a mean of 27.49 hospital-bed days per patient. 1,127 bed days were saved in total, estimating a total savings of 963,585 euros and median savings of 26,505 euros. Conclusions The readmission rate observed was comparable to international data. Most readmissions were related to primary infections rather than due to OPAT-specific complications. Our main findings were that patients with PJIs can be safely managed via OPAT, and the finding of association between T2DM and increased risk of readmission.
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Affiliation(s)
| | - Luke O'Brien
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Ben Murphy
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Patricia Fitzpatrick
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hurson
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Deepa Rajendran
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Eoin Feeney
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Patrick Mallon
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - Sarmad Waqas
- St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
- Tallaght University Hospital, Dublin 24, Ireland
- Trinity College Dublin, Dublin 2, Ireland
- Corresponding author.
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13
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van Dun SCJ, Verheul M, Pijls BGCW, van Prehn J, Scheper H, Galli F, Nibbering PH, de Boer MGJ. Influence of surface characteristics of implant materials on MRSA biofilm formation and effects of antimicrobial treatment. Front Microbiol 2023; 14:1145210. [PMID: 37152752 PMCID: PMC10159048 DOI: 10.3389/fmicb.2023.1145210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction One of the main causes of treatment failure in bacterial prosthetic joint infections (PJI) is biofilm formation. The topography of the biofilm may be associated with susceptibility to antimicrobial treatment. The aims of this study were to assess differences in topography of biofilms on different implant materials and the correlation thereof with susceptibility to antimicrobial treatment. Methods Methicillin-resistant Staphylococcus aureus (MRSA) 7-day mature biofilms were generated on disks made from titanium alloys (Ti-6Al-7Nb and Ti-6Al-4V), synthetic polymer and orthopedic bone cement, commonly used in implant surgery. The surface topography of these implant materials and the biofilms cultured on them was assessed using atomic force microscopy. This provided detailed images, as well as average roughness (Ra) and peak-to-valley roughness (Rt) values in nanometers, of the biofilm and the material surfaces. Bacterial counts within biofilms were assessed microbiologically. Antimicrobial treatment of biofilms was performed by 24-h exposure to the combination of rifampicin and ciprofloxacin in concentrations of 1-, 5- and 10-times the minimal bactericidal concentration (MBC). Finally, treatment-induced differences in bacterial loads and their correlation with biofilm surface parameters were assessed. Results The biofilm surfaces on titanium alloys Ti-6Al-7Nb (Ra = 186 nm) and Ti-6Al-4V (Ra = 270 nm) were less rough than those of biofilms on silicone (Ra = 636 nm). The highest roughness was observed for biofilms on orthopedic bone cement with an Ra of 1,551 nm. Interestingly, the roughness parameters of the titanium alloys themselves were lower than the value for silicone, whereas the surface of the bone cement was the roughest. Treatment with 1- and 5-times the MBC of antibiotics resulted in inter-material differences in colony forming units (CFU) counts, ultimately showing comparable reductions of 2.4-3.0 log CFU/mL at the highest tested concentration. No significant differences in bacterial loads within MRSA biofilms were observed between the various implant materials, upon exposure to increasing concentrations of antibiotics. Discussion The surface parameters of MRSA biofilms were determined by those of the implant materials on which they were formed. The antibiotic susceptibility of MRSA biofilms on the various tested implant materials did not differ, indicating that the efficacy of antibiotics was not affected by the roughness of the biofilm.
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Affiliation(s)
- Sven C. J. van Dun
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Sven C. J. van Dun,
| | - Mariëlle Verheul
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Bart G. C. W. Pijls
- Department of Orthopedics, Leiden University Medical Center, Leiden, Netherlands
| | - Joffrey van Prehn
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Henk Scheper
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | | | - Peter H. Nibbering
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Mark G. J. de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
- Mark G. J. de Boer,
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14
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Spichler-Moffarah A, Rubin LE, Bernstein JA, O'Bryan J, McDonald E, Golden M. Prosthetic Joint Infections of the Hip and Knee Among the Elderly: A Retrospective Study. Am J Med 2023; 136:100-107. [PMID: 36063860 DOI: 10.1016/j.amjmed.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking. METHODS We compared clinical characteristics, management, and mortality of patients <75 vs ≥75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019. RESULTS Ninety-eight patients (<75 years of age [n = 63]; ≥75 years of age (n = 35) were studied. Groups were similar in terms of etiology, culture-directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those aged ≥75 years. Readmission related to prosthetic joint infection occurred less often in older individuals (P = .005). Deaths within 1 year of diagnosis were rare (n = 4; 4.1%), occurring in older patients and resulting mostly from sepsis. CONCLUSION In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients ≥75 years of age. Although deaths were rare, 1-year mortality was higher in patients aged ≥75. Prospective, multicenter studies are needed to explore risk factors and management strategies of prosthetic joint infection among elderly populations.
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Affiliation(s)
- Anne Spichler-Moffarah
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Lee E Rubin
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jenna A Bernstein
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jane O'Bryan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Conn; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Conn
| | - Erik McDonald
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Marjorie Golden
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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15
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Quantification of vancomycin and clindamycin in human plasma and synovial fluid applying ultra-performance liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1212:123493. [DOI: 10.1016/j.jchromb.2022.123493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
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16
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Lian Q, Zheng S, Shi Z, Li K, Chen R, Wang P, Liu H, Chen Y, Zhong Q, Liu Q, Pan X, Gao J, Gao C, Liu W, Wu X, Zhang Y, Zhang Y, Wang J, Cheng H. Using a degradable three-layer sandwich-type coating to prevent titanium implant infection with the combined efficient bactericidal ability and fast immune remodeling property. Acta Biomater 2022; 154:650-666. [PMID: 36306986 DOI: 10.1016/j.actbio.2022.10.033] [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] [Received: 06/12/2022] [Revised: 09/18/2022] [Accepted: 10/14/2022] [Indexed: 01/24/2023]
Abstract
Titanium (Ti) implant-associated infections are a challenge in orthopedic surgery, for which a series of antibacterial coatings have been designed and fabricated to reduce the risk of bacterial contamination. Herein, we created a degradable three-layer sandwich-type coating to achieve long-term antibacterial effects while simultaneously reconstructing the local immune microenvironment. The vancomycin (Van)-loaded vaterite coating constitutes the outer and inner layers, whereas Interleukin-12 (IL-12)-containing liposomes embedded in sodium alginate constitutes the middle layer. Van, released from the vaterite, demonstrated a favorable and rapid bactericidal ability against the representative methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains. The released IL-12 exhibited the desired immune reconstitution abilities, actively facilitating defenses against subsequent bacterial invasions. Furthermore, the biocompatibility and cell-binding feature of the multifunctional coating was beneficial for achieving solid interface intergradation. Overall, the benefits of the three-layer sandwich-type coating, including the convenient fabrication process, efficient antimicrobial activity, fast immune remodeling property, fine cell-binding feature, and biodegradability, highlight its promising translational potential in preventing implant infection. STATEMENT OF SIGNIFICANCE: To prevent titanium implant infections, researchers have designed various antibacterial coatings. However, most of these coatings focused only on killing the invading bacteria over a limited postoperative period. However, the local immune microenvironment is compromised during surgery. Local immune deflection impedes the ability of the local immune defenses to clear bacteria and limits immune memory building from active defense against long-term subsequent bacterial invasions. Furthermore, these coatings are usually nondegradable and differ substantially from bone components, thereby impairing the integration of the coating and bone interface and generating concerns about implant stability and bacterial contamination. In this work, we synthesized a degradable coating that provides sustained antibacterial activity, promotes immune reconstitution, and simultaneously achieves solid bone integration.
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Affiliation(s)
- Qiang Lian
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Shaowei Zheng
- Department of Orthopedic, Huizhou First Hospital, Guangdong Medical University, Huizhou 516003, China; Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Zhe Shi
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Kangxian Li
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Rong Chen
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Pinkai Wang
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Haibing Liu
- Department of Orthopedic, Affiliated Hengyang Hospital, Southern Medical University (Hengyang Central Hospital), Hengyang 421001, China
| | - Yuhang Chen
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qiang Zhong
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Qi Liu
- South China Advanced Institute for Soft Matter Science and Technology, South China University of Technology, Guangzhou 510640, China
| | - Xin Pan
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jian Gao
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Chenghao Gao
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 43000, China
| | - Weilu Liu
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Xuanpin Wu
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yayun Zhang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 43000, China
| | - Yang Zhang
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Jian Wang
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Hao Cheng
- Department of Orthopedic, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
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17
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Behbahani SB, Kiridena SD, Wijayaratna UN, Taylor C, Anker JN, Tzeng TRJ. pH variation in medical implant biofilms: Causes, measurements, and its implications for antibiotic resistance. Front Microbiol 2022; 13:1028560. [PMID: 36386694 PMCID: PMC9659913 DOI: 10.3389/fmicb.2022.1028560] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/22/2022] [Indexed: 01/28/2023] Open
Abstract
The advent of implanted medical devices has greatly improved the quality of life and increased longevity. However, infection remains a significant risk because bacteria can colonize device surfaces and form biofilms that are resistant to antibiotics and the host's immune system. Several factors contribute to this resistance, including heterogeneous biochemical and pH microenvironments that can affect bacterial growth and interfere with antibiotic biochemistry; dormant regions in the biofilm with low oxygen, pH, and metabolites; slow bacterial growth and division; and poor antibody penetration through the biofilm, which may also be regions with poor acid product clearance. Measuring pH in biofilms is thus key to understanding their biochemistry and offers potential routes to detect and treat latent infections. This review covers the causes of biofilm pH changes and simulations, general findings of metabolite-dependent pH gradients, methods for measuring pH in biofilms, effects of pH on biofilms, and pH-targeted antimicrobial-based approaches.
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Affiliation(s)
| | | | | | - Cedric Taylor
- Department of Biological Sciences, Clemson University, Clemson, SC, United States
| | - Jeffrey N. Anker
- Department of Chemistry, Clemson University, Clemson, SC, United States
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18
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Koutserimpas C, Naoum S, Alpantaki K, Raptis K, Dretakis K, Vrioni G, Samonis G. Fungal Prosthetic Joint Infection in Revised Knee Arthroplasty: An Orthopaedic Surgeon’s Nightmare. Diagnostics (Basel) 2022; 12:diagnostics12071606. [PMID: 35885511 PMCID: PMC9315739 DOI: 10.3390/diagnostics12071606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
Fungal prosthetic joint infections (PJIs), despite the fact that they are rare, represent a devastating complication. Such infections in revised knee arthroplasties pose a unique surgical and medical challenge. A rare case of Candida parapsilosis PJI in revised knee arthroplasty is reported. Furthermore, a thorough review of all published fungal PJIs cases in revised knee arthroplasties is provided. A 72-year-old female with total knee replacement surgery due to osteoarthritis 10 years ago, followed by two revision surgeries six and two years ago due to aseptic loosening, presented with signs and symptoms of septic loosening of the knee components. Resection arthroplasty and cement-spacer placement was performed and periprosthetic tissue cultures yielded Candida parapsilosis. The patient was commenced on proper antifungal treatment (AFT) for six months and then the second stage of the revision surgery was performed successfully. From 2000 to 2022, a total of 46 patients with median age 69 years [interquartile range (IQR = 10)], suffering fungal PJI occurring in revised knee arthroplasty have been reported. The median time from initial arthroplasty to symptoms’ onset was 12 months (IQR = 14). Cultures of local material (52.2%) and histology (6.5%) were the reported diagnostic method, while Candida species were the most commonly isolated fungi. Regarding surgical management, two-stage revision arthroplasty (TSRA) was performed in most cases (54.3%), with median time-interval of six months (IQR = 6) between the two stages. Regarding AFT, fluconazole was the preferred antifungal compound (78.3%), followed by voriconazole and amphotericin B (19.6% each). The median duration of AFT was five months (IQR = 4.5). Infection’s outcome was successful in 38 cases (82.6%). Fungal PJIs, especially in revised knee arthroplasties, are devastating complications. A combination of AFT and TSRA seems to be the treatment of choice. TSRA in these cases poses a special challenge, since major bone defects may be present. Therapeutic procedures remain unclear, thus additional research is needed.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Symeon Naoum
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Traumatology, “Venizeleion” General Hospital of Heraklion, 714-09 Crete, Greece;
| | - Konstantinos Raptis
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 11525 Athens, Greece; (C.K.); (S.N.); (K.R.)
| | - Konstantinos Dretakis
- 2nd Department of Orthopaedics, “Hygeia” General Hospital of Athens, 151-23 Marousi, Greece;
| | - Georgia Vrioni
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115-27 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 71500 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, Neon Faliron, 185-47 Attica, Greece
- Correspondence: ; Tel.: +306-944-437-255
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19
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Liu H, Yu Y, Niu Y. Utility of Human Neutrophil Lipocalin as a Diagnosing Biomarker of Prosthetic Joint Infection: A Clinical Pilot Study. Infect Drug Resist 2022; 15:2393-2400. [PMID: 35528185 PMCID: PMC9075898 DOI: 10.2147/idr.s355180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/29/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose The discrimination of prosthetic joint infection (PJI) from aseptic failure is regarded as a major clinical challenge. The key function of human neutrophil lipocalin (HNL) in regulating bacterial infection rationalizes its potential as a biomarker to diagnose PJI. This work evaluated the accuracy of serum human neutrophil lipocalin as a biomarker to diagnose PJI. Methods This prospective cohort study enrolled altogether 58 patients suffering from miserable knee or hip arthroplasty and receiving revision surgery from 2018 to 2020. Related laboratory and clinical information of these patients were retrieved. Following the Musculoskeletal Infection Society (MSIS) criteria, the diagnosis of PJI was conducted. Collecting preoperative blood samples, we measured HNL by the standard assay. Thereafter, plotting the receiver-operating characteristic curve (ROC), the area under the curve (AUC) values were calculated to analyze the diagnosis accuracy. Results According to the MSIS criteria, 38 cases (65.5%) were classified into the PJI group, while 20 (34.5%) into the aseptic loosening group, with age ranging from 38 to 87 (median, 66.9) years. The median serum HNL level of the PJI patients was 199.01 (range, 85.34–357.79) ng/mL, significantly higher as compared with that of 64.81 (range, 20.73–157.89) ng/mL of the aseptic loosening group. Using the Youden index, the optimal threshold value was 105.1ng/mL, while the specificity, sensitivity, and AUC were 85.0%, 81.6%, and 0.919, respectively. Conclusion Serum HNL is the creditable test that can be employed as the laboratory biomarker to screen PJI. The threshold HNL level is 105.1 ng/mL, which may distinguish PJI from aseptic failure.
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Affiliation(s)
- Hanjiang Liu
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Yali Yu
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, 450000, People’s Republic of China
| | - Yanli Niu
- School of Basic Medical Science, Henan University, Kaifeng, Henan, 475004, People’s Republic of China
- Correspondence: Yanli Niu, School of Basic Medical Science, Henan University, Kaifeng, Henan, 475004, People’s Republic of China, Email
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20
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Anwarali Khan MH, Kow RY, Ramalingam S, Ho JPY, Jaya Raj J, Ganthel Annamalai K, Low CL. COVID-19 Collateral Damage: Management of Periprosthetic Joint Infection in Malaysia. Cureus 2021; 13:e18820. [PMID: 34804677 PMCID: PMC8591933 DOI: 10.7759/cureus.18820] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2021] [Indexed: 01/17/2023] Open
Abstract
Background and objective Periprosthetic joint infection (PJI) is one of the dreaded complications in patients after arthroplasty surgeries, owing to the risk of morbidity and arduous investigations and management associated with it. Nevertheless, as Malaysia is currently battling against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19) pandemic head-on, the treatment for other non-life-threatening diseases including PJI has taken a backseat. In this study, we present a case series of 11 patients with PJI who were managed surgically at the largest tertiary hospital in Malaysia and we hope to shed some light on the difficulties we have encountered during this trying period. Patients and methods Patients with PJIs who underwent surgical intervention during the ongoing COVID-19 pandemic (March 1, 2020, to June 30, 2021) were reviewed and included in this study. The demographic profile of the patients, presenting complaints, prosthesis topography, biochemical investigative findings, surgical interventions, and short-term outcomes were summarized. Results A total of 11 patients were treated surgically at Hospital Kuala Lumpur for PJI. Among them, five patients are still awaiting their second-stage surgeries despite the completion of their antibiotic regimes, and they are fit for the procedure. Conclusion The COVID-19 pandemic has wreaked havoc on the treatment of patients with PJI. In a setting with scarce resources, surgeons should strongly consider single-stage revision surgeries for the treatment of patients with PJI.
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Affiliation(s)
| | - Ren Yi Kow
- Department of Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | | | - Jade Pei Yuik Ho
- Department of Orthopaedics, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Jeffrey Jaya Raj
- Department of Orthopaedics, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Chooi Leng Low
- Department of Radiology, International Islamic University Malaysia, Kuantan, MYS
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Gomes Von Borowski R, Chat S, Schneider R, Nonin-Lecomte S, Bouaziz S, Giudice E, Rigon Zimmer A, Baggio Gnoatto SC, Macedo AJ, Gillet R. Capsicumicine, a New Bioinspired Peptide from Red Peppers Prevents Staphylococcal Biofilm In Vitro and In Vivo via a Matrix Anti-Assembly Mechanism of Action. Microbiol Spectr 2021; 9:e0047121. [PMID: 34704807 PMCID: PMC8549733 DOI: 10.1128/spectrum.00471-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/09/2021] [Indexed: 11/20/2022] Open
Abstract
Staphylococci are pathogenic biofilm-forming bacteria and a source of multidrug resistance and/or tolerance causing a broad spectrum of infections. These bacteria are enclosed in a matrix that allows them to colonize medical devices, such as catheters and tissues, and that protects against antibiotics and immune systems. Advances in antibiofilm strategies for targeting this matrix are therefore extremely relevant. Here, we describe the development of the Capsicum pepper bioinspired peptide "capsicumicine." By using microbiological, microscopic, and nuclear magnetic resonance (NMR) approaches, we demonstrate that capsicumicine strongly prevents methicillin-resistant Staphylococcus epidermidis biofilm via an extracellular "matrix anti-assembly" mechanism of action. The results were confirmed in vivo in a translational preclinical model that mimics medical device-related infection. Since capsicumicine is not cytotoxic, it is a promising candidate for complementary treatment of infectious diseases. IMPORTANCE Pathogenic biofilms are a global health care concern, as they can cause extensive antibiotic resistance, morbidity, mortality, and thereby substantial economic loss. So far, no effective treatments targeting the bacteria in biofilms have been developed. Plants are constantly attacked by a wide range of pathogens and have protective factors, such as peptides, to defend themselves. These peptides are common components in Capsicum baccatum (red pepper). Here, we provide insights into an antibiofilm strategy based on the development of capsicumicine, a natural peptide that strongly controls biofilm formation by Staphylococcus epidermidis, the most prevalent pathogen in device-related infections.
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Affiliation(s)
- Rafael Gomes Von Borowski
- Université de Rennes, CNRS, Institut de Génétique et de Développement de Rennes (IGDR), UMR6290, Rennes, France
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sophie Chat
- Université de Rennes, CNRS, Institut de Génétique et de Développement de Rennes (IGDR), UMR6290, Rennes, France
| | - Rafael Schneider
- Université de Rennes, CNRS, Institut de Génétique et de Développement de Rennes (IGDR), UMR6290, Rennes, France
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Sylvie Nonin-Lecomte
- Université de Paris, CNRS, CiTCoM (Cibles Thérapeutiques et Conception de Médicaments) UMR 8038, Faculté de Pharmacie, Paris, France
| | - Serge Bouaziz
- Université de Paris, CNRS, CiTCoM (Cibles Thérapeutiques et Conception de Médicaments) UMR 8038, Faculté de Pharmacie, Paris, France
| | - Emmanuel Giudice
- Université de Rennes, CNRS, Institut de Génétique et de Développement de Rennes (IGDR), UMR6290, Rennes, France
| | - Aline Rigon Zimmer
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simone Cristina Baggio Gnoatto
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre José Macedo
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Centro de Biotecnologia da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Reynald Gillet
- Université de Rennes, CNRS, Institut de Génétique et de Développement de Rennes (IGDR), UMR6290, Rennes, France
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22
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Macke C, Lenhof S, Graulich T, Örgel M, Omar-Pacha T, Stübig T, Krettek C, Omar M. Low Diagnostic Value of Synovial Aspiration Culture Prior to Reimplantation in Periprosthetic Joint Infection. In Vivo 2021; 35:2409-2416. [PMID: 34182524 DOI: 10.21873/invivo.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to determine the diagnostic value of the synovial aspiration culture prior to reimplantation in two- (or more) stage exchange of periprosthetic joint infection. PATIENTS AND METHODS This was a retrospective study, spanning over ten years including all synovial cultures of patients with two- (or more) stage exchange due to periprosthetic joint infection. RESULTS A total of 183 patients were included, mean age was 66.6 years (range=12.8-93.4 years). Overall sensitivity of synovial aspiration cultures before reimplantation was 56.6%, specificity 84.6%, negative predictive value (NPV) 63.8%, positive predictive value (PPV) 80.2%, area under the curve (AUC) 70.6%. Sensitivity of the knee in comparison to the hip culture was significantly higher, as well as the NPV and the AUC (p=0.038). In case of complete removal of prosthesis, the sensitivity and AUC were significantly reduced, whereas the specificity was comparable with prosthesis in situ, partial removal or complete removal. CONCLUSION Due to the low sensitivity, obtaining several synovial cultures in the prosthesis-free interval to exclude persistence of infection, does not seem reasonable.
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Affiliation(s)
- Christian Macke
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Stefan Lenhof
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Tarek Omar-Pacha
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | - Timo Stübig
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
| | | | - Mohamed Omar
- Trauma Department, Hannover Medical School (MHH), Hannover, Germany
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23
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Garcia D, Gardezi M, Suliman Y, Glasser J, Spake CS, Barrett C, Berns E, Jenkins D, Evans A, Cohen E, Eberson C, Hayda R, Daniels A, Green A, Owens B, Antoci V, Born CT. Fluorescent-conjugated antibodies as rapid ex vivo markers for bacterial presence on orthopedic surgical explants and synovium: A pilot study. J Orthop Res 2021; 39:299-307. [PMID: 33225467 DOI: 10.1002/jor.24924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
Surgical infection is one of the most pressing problems in the field of orthopedic surgery; however, current detection methods are plagued by high costs and long wait times. This study seeks to demonstrate the ability of a novel assay using fluorescently conjugated antibodies and confocal laser scanning microscopy (CLSM) to accurately detect bacterial presence on orthopedic surgical explants, tissue, and synovial fluid in 30 min. Explanted hardware, tissue, and synovial fluid samples suspected to be infected were collected from human subjects with institutional review board consent. Samples were prepared using a 30-min protocol, consisting of rinsing, nonspecific blocking and staining steps, and imaged using CLSM. Images were analyzed using ImageJ (National Institute of Health) to determine the percent area of Gram positive and Gram negative bacteria. Results of the assay were compared to the hospital's microbiological laboratory and Gram staining results. Ninety three samples were collected and tested using the 30-min testing protocol; 75 samples were synovial fluid and 18 were tissue and explants. Seventy four of 75 (98.6%) synovial fluid samples correlated with the hospital laboratory's microbiological findings. Of the 18 explant and tissue samples, our assay found bacterial presence in 14 of 18 samples, while the hospital microbiology laboratory found bacterial presence in 13 of 18 samples. This assay reliably stained and rapidly identified the presence of Gram negative and Gram positive bacteria on surgical explants, tissue and synovial fluid in 30 min. This methodology may serve as a point of service tool for the determination of bacterial presence during surgical procedures.
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Affiliation(s)
- Dioscaris Garcia
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Mursal Gardezi
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Yasmine Suliman
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Jillian Glasser
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Carole Sl Spake
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Caitlin Barrett
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ellis Berns
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Derek Jenkins
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Andrew Evans
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Eric Cohen
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Craig Eberson
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Roman Hayda
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Alan Daniels
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Andrew Green
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Brett Owens
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Valentin Antoci
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
| | - Christopher T Born
- The Diane N. Weiss Center for Orthopedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Brown University Department of Orthopedic Surgery, Providence, Rhode Island, USA
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24
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Silver-Deposited Nanoparticles on the Titanium Nanotubes Surface as a Promising Antibacterial Material into Implants. METALS 2021. [DOI: 10.3390/met11010092] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The main disadvantage of the implants is the associated infections. Therefore, in the long term, the possibility of improving the antibacterial capacity of different types of implants (dental, orthopedic) is being researched. The severity of the problem lies in the increasing bacterial resistance and finding appropriate alternative treatments for infectious diseases, which is an important research field nowadays. The purpose of this review is to draw a parallel between different studies analyzing the antibacterial activity and mechanism of silver nanoparticles (NP Ag) deposited on the titanium nanotubes (NTT), as well as the analysis of the NP Ag toxicity. This review also provides an overview of the synthesis and characterization of TiO2-derived nanotubes (NT). Thus, the analysis aims to present the existing knowledge to better understand the NP Ag implants benefits and their antibacterial activity.
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25
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Li Y, Yang Y, Qing Y, Li R, Tang X, Guo D, Qin Y. Enhancing ZnO-NP Antibacterial and Osteogenesis Properties in Orthopedic Applications: A Review. Int J Nanomedicine 2020; 15:6247-6262. [PMID: 32903812 PMCID: PMC7445529 DOI: 10.2147/ijn.s262876] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/30/2020] [Indexed: 12/29/2022] Open
Abstract
Prosthesis-associated infections and aseptic loosening are major causes of implant failure. There is an urgent need to improve the antibacterial ability and osseointegration of orthopedic implants. Zinc oxide nanoparticles (ZnO-NPs) are a common type of zinc-containing metal oxide nanoparticles that have been widely studied in many fields, such as food packaging, pollution treatment, and biomedicine. The ZnO-NPs have low toxicity and good biological functions, as well as antibacterial, anticancer, and osteogenic capabilities. Furthermore, ZnO-NPs can be easily obtained through various methods. Among them, green preparation methods can improve the bioactivity of ZnO-NPs and strengthen their potential application in the biological field. This review discusses the antibacterial abilities of ZnO-NPs, including mechanisms and influencing factors. The toxicity and shortcomings of anticancer applications are summarized. Furthermore, osteogenic mechanisms and synergy with other materials are introduced. Green preparation methods are also briefly reviewed.
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Affiliation(s)
- Yuehong Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yue Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yun’an Qing
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Ruiyan Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xiongfeng Tang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Deming Guo
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yanguo Qin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
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26
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Ortega-Peña S, Franco-Cendejas R, Aquino-Andrade A, Betanzos-Cabrera G, Sharma A, Rodríguez-Martínez S, Cancino-Diaz ME, Cancino-Diaz JC. Genotypic and phenotypic changes of Staphylococcus epidermidis during relapse episodes in prosthetic joint infections. Braz J Microbiol 2020; 51:601-612. [PMID: 31828715 PMCID: PMC7203359 DOI: 10.1007/s42770-019-00190-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/13/2019] [Indexed: 01/14/2023] Open
Abstract
Staphylococcus epidermidis is a coagulase-negative bacterium capable of causing recurrent relapses in prosthetic joint infection (PJI). The aim of this study was to determine if Staphylococcus epidermidis isolates from patients with recurrent relapses of prosthetic joint infection (PJI) changed genotypically (pulsed-field gel electrophoresis (PFGE) pattern analysis and genes involved in biofilm formation) and phenotypically (antimicrobial resistance, biofilm formation) during the different episodes. Four patients with PJI recurrent relapses were evaluated clinically and microbiologically. Genotypic and phenotypic characteristics of 31 S. epidermidis isolates were determined. In all cases, PJI was treated with antimicrobial therapy and resection of the prosthesis without reimplantation. Months later, all patients had a relapse episode and treated with rifampin plus vancomycin and surgical debridement. Changes in the antibiotics resistance profile in isolates from patients 1 and 2 were observed in the two episodes. Patient 1 had four clones A, B, C, and D that were distributed differentially in the two episodes. Similarly, patients 2 and 3 had two clones and subclones (E-E1 and F-F1, respectively), and patient 4 had only the clone G in both episodes. The clone F formed small-colony variants (SCVs). High level of biofilm formation was found in all clones, except for clones D and G. Clones/subclones showed a genotypic variation in icaA, sdrF, bap, sesI, and embp genes. The principal coordinate analysis showed that all clones/subclones were different. These results showed that the initial infective clone of S. epidermidis from PJI, changed genotypically and phenotypically after a second relapse as a response to the treatment.
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Affiliation(s)
- Silvestre Ortega-Peña
- Laboratory of Infectology, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", 11340, Mexico City, Mexico
- Microbiology and Immunology Departments of Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala S/N, Col. Santo Tomas, Mexico City, Mexico
| | - Rafael Franco-Cendejas
- Laboratory of Infectology, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", 11340, Mexico City, Mexico
| | | | - Gabriel Betanzos-Cabrera
- School of Engineering and Sciences, Tecnologico de Monterrey, Campus Queretaro, Queretaro, Mexico
- Área Académica de Nutrición and Toxicología Clínica, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico
| | - Ashutosh Sharma
- School of Engineering and Sciences, Tecnologico de Monterrey, Campus Queretaro, Queretaro, Mexico
| | - Sandra Rodríguez-Martínez
- Microbiology and Immunology Departments of Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala S/N, Col. Santo Tomas, Mexico City, Mexico
| | - Mario E Cancino-Diaz
- Microbiology and Immunology Departments of Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala S/N, Col. Santo Tomas, Mexico City, Mexico.
| | - Juan Carlos Cancino-Diaz
- Microbiology and Immunology Departments of Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Carpio y Plan de Ayala S/N, Col. Santo Tomas, Mexico City, Mexico.
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27
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Abstract
PURPOSE OF REVIEW Prosthetic joint infections (PJIs) represent one of the most disastrous complications in prosthetic surgery, requiring long hospitalization, prolonged antimicrobial treatment and repeated surgical interventions. No gold standard test to formulate diagnosis exist. A combination of high index of suspicion, physical examination, microbiological and biohumoral investigations is required. Therapeutical approach should be based on a multidisciplinary team. In our center, a two-stage approach is preferred. As regards the choice of the empirical antibiotic backbone, individual risk factors for multiple-drug resistant (MDR) pathogens should be considered. Several studies enhance the possibility to shorten the length of antibiotic couses. RECENT FINDINGS Some interesting improvements have been made in the setting of PJIs management. As regards diagnosis, novel biomarkers and nuclear imaging are acquiring more importance. Molecular biology techniques also offer the possibility to formulate rapid microbiological identification. The pattern of PJIs is evolving towards higher rates of MDR causes. During the last decade, a number of new antibiotic molecules with activity against MDRs have been approved. Some of them are also available either in oral formulation or as long-acting compounds, offering the opportunity for early patient's discharge, with expected healthcare costs saving. SUMMARY Management of PJIs still represents a major threat for clinicians. Improvements in surgical techniques and antibiotic pipeline promise to revolutionize the approach in next years. Despite data from our experience confirm the efficacy of shorter antibiotic courses and the value of new molecules, randomized clinical trials are lacking. More data are needed in order to modify the routine clinical practice.
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28
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Li Y, Yang Y, Li R, Tang X, Guo D, Qing Y, Qin Y. Enhanced antibacterial properties of orthopedic implants by titanium nanotube surface modification: a review of current techniques. Int J Nanomedicine 2019; 14:7217-7236. [PMID: 31564875 PMCID: PMC6733344 DOI: 10.2147/ijn.s216175] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/09/2019] [Indexed: 11/23/2022] Open
Abstract
Prosthesis-associated infections are one of the main causes of implant failure; thus it is important to enhance the long-term antibacterial ability of orthopedic implants. Titanium dioxide nanotubes (TNTs) are biomaterials with good physicochemical properties and biocompatibility. Owing to their inherent antibacterial and drug-loading ability, the antibacterial application of TNTs has received increasing attention. In this review, the process of TNT anodizing fabrication is summarized. Also, the mechanism and the influencing factors of the antibacterial property of bare TNTs are explored. Furthermore, different antibacterial strategies for carrying drugs, as well as modifications to prolong the antibacterial effect and reduce drug-related toxicity are discussed. In addition, antibacterial systems based on TNTs that can automatically respond to infection are introduced. Finally, the currently faced problems are reviewed and potential solutions are proposed. This review provides new insight on TNT fabrication and summarizes the most advanced antibacterial strategies involving TNTs for the enhancement of long-term antibacterial ability and reduction of toxicity.
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Affiliation(s)
- Yuehong Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yue Yang
- Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Ruiyan Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xiongfeng Tang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Deming Guo
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yun'an Qing
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Yanguo Qin
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, People’s Republic of China
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29
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Liu W, Li J, Cheng M, Wang Q, Qian Y, Yeung KW, Chu PK, Zhang X. A surface-engineered polyetheretherketone biomaterial implant with direct and immunoregulatory antibacterial activity against methicillin-resistant Staphylococcus aureus. Biomaterials 2019; 208:8-20. [DOI: 10.1016/j.biomaterials.2019.04.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
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30
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Sebastian S, Malhotra R, Dhawan B. Prosthetic Joint Infection: A Major Threat to Successful Total Joint Arthroplasty. Indian J Med Microbiol 2018; 36:475-487. [DOI: 10.4103/ijmm.ijmm_19_11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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