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Ando K, Miyahara S, Hanada S, Fukuda K, Saito M, Sakai A, Maruo A, Zenke Y. Effective biofilm eradication in MRSA isolates with aminoglycoside-modifying enzyme genes using high-concentration and prolonged gentamicin treatment. Microbiol Spectr 2024; 12:e0064724. [PMID: 39191399 PMCID: PMC11448082 DOI: 10.1128/spectrum.00647-24] [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: 03/13/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
Bone and soft tissue infections caused by biofilm-forming bacteria, such as methicillin-resistant Staphylococcus aureus (MRSA), remain a significant clinical challenge. While the control of local infection is necessary, systemic treatment is also required, and biofilm eradication is a critical target for successful management. Topical antibiotic treatments, such as antibiotic-loaded bone cement (ALBC), have been used for some time, and continuous local antibiotic perfusion therapy, a less invasive method, has been developed by our group. However, the optimal antibiotics and concentrations for biofilms of clinical isolates are still not well understood. We examined the efficacy of high concentrations of gentamicin against MRSA biofilms and the role of gentamicin resistance genes in biofilm eradication. We collected 101 MRSA samples from a hospital in Japan and analyzed their gene properties, including methicillin and gentamicin resistance, and their minimum biofilm eradication concentration (MBEC) values. Our results showed that high concentrations of gentamicin are effective against MRSA biofilms and that even concentrations lower than the MBEC value could eliminate biofilms after prolonged exposure. We also identified three aminoglycoside/gentamicin resistance genes [aac(6')-aph(2″), aph(3')-III, and ant(4')-IA] and found that the presence or absence of these genes may inform the selection of treatments. It was also found that possession of the aac(6')-aph(2″) gene correlated with the minimum inhibitory concentration/MBEC values of gentamicin. Although this study provides insight into the efficacy of gentamicin against MRSA biofilms and the role of gentamicin resistance genes, careful selection of the optimal treatment strategy is needed for clinical application. IMPORTANCE Our analysis of 101 MRSA clinical isolates has provided valuable insights that could enhance treatment selection for biofilm infections in orthopedics. We found that high concentrations of gentamicin were effective against MRSA biofilms, and even prolonged exposure to concentrations lower than the minimum biofilm eradication concentration (MBEC) value could eliminate biofilms. The presence of the aac(6')-aph(2″) gene, an aminoglycoside resistance gene, was found to correlate with the minimum inhibitory concentration (MIC) and MBEC values of gentamicin, providing a potential predictive tool for treatment susceptibility. These results suggest that extended high concentrations of local gentamicin treatment could effectively eliminate MRSA biofilms in orthopedic infections. Furthermore, testing for gentamicin MIC or the possession of the aac(6')-aph(2″) gene could help select treatment, including topical gentamicin administration and surgical debridement.
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Affiliation(s)
- Kohei Ando
- Department of Emergency and Intensive Care Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Miyahara
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shuhei Hanada
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazumasa Fukuda
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Mitsumasa Saito
- Department of Microbiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiro Maruo
- Department of Orthopedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Yukichi Zenke
- Department of Emergency and Intensive Care Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Sawauchi K, Fukui T, Oe K, Kuroda R, Niikura T, Muratsu H, Maruo A. Management of Infected Tibial Nonunion: Combining Synthetic Bone Grafting with Continuous Local Antibiotic Perfusion (CLAP). AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e945023. [PMID: 39267305 PMCID: PMC11404704 DOI: 10.12659/ajcr.945023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
BACKGROUND Infection control and reconstruction of bone and soft tissue are essential for treating infected nonunion. Continuous local antibiotic perfusion (CLAP) is a drug delivery system that continuously delivers antibiotics at the required concentration, area, and duration. This case report describes the instance of infected nonunion in which infection eradication and bone union were achieved using CLAP and synthetic bone grafting while retaining the implant. CASE REPORT The case was a 31-year-old woman with an infected nonunion. After she underwent osteosynthesis using nail for open fractures of tibia and fibula, bone union remained unachieved, and she exhibited skin defects and draining of pus. Following the removal of the infected granulation tissue from the bone defects, 2 bone marrow needles, serving as intramedullary antibiotic perfusion (iMAP) pins, were inserted into the medullary cavity tibia. A double-lumen tube was placed in the subcutaneous pocket as the intra-soft tissue antibiotic perfusion (iSAP) tube. No bone mobility was observed around the bone defect and nail, and replacement of the implant was not necessary. Beta-tricalcium phosphate was transplanted to the bone defect, and negative pressure wound therapy was applied. Gentamicin was injected continuously through iMAP and iSAP. Finally, the infection was eradicated, and cortical bone bridging was observed without additional surgery or adverse effects. CONCLUSIONS CLAP emerges as a viable treatment option for infected nonunion, as it enables the delivery of antibiotics at a concentration sufficient for infection control while providing the surgeon with flexibility to design the area, dosage, and duration of antibiotic delivery.
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Affiliation(s)
- Kenichi Sawauchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- Department of Orthopaedic Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Hyogo, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Akihiro Maruo
- Department of Orthopaedic Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
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Yamaguchi S, Ueda S, Ichiseki T, Soma D, Kaneuji A, Kawahara N. Effective Management of Methicillin-Resistant Shoulder Septic Arthritis Using Continuous Local Antibiotic Perfusion: A Case Study and Long-Term Follow-Up. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944491. [PMID: 39188139 PMCID: PMC11332963 DOI: 10.12659/ajcr.944491] [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: 03/14/2024] [Revised: 07/04/2024] [Accepted: 06/06/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Septic arthritis of the shoulder is a rare and challenging condition to treat. Typically, arthroscopic debridement is the common approach. Specifically, septic arthritis of the shoulder caused by methicillin-resistant bacteria is extremely difficult to cure due to persistent infection and limited antibiotic options. However, recent studies have demonstrated that continuous local antibiotic perfusion (CLAP) can provide favorable results for bone and soft tissue infections. By administering the antibiotics required to suppress the biofilm, CLAP can effectively treat the infection while sparing the tissue. CASE REPORT A 46-year-old woman undergoing long-term hemodialysis treatment for congenital anomalies of the kidney and urinary tract experienced severe pain in the left shoulder joint during glucocorticoid treatment for amyloid arthritis of the right shoulder. Despite the absence of fever, significant swelling and fluid accumulation were observed in the left shoulder joint, leading to the performance of a puncture. A bacterial examination of the puncture fluid detected methicillin-resistant coagulase-negative Staphylococcus epidermidis (MRCNS). In this report, we present a case in which CLAP was administered for septic arthritis of the shoulder caused by methicillin-resistant bacteria. After irrigation debridement, the patient received intravenous antibiotics and CLAP. Following the initiation of treatment, the dosage of antibiotics was adjusted while performing therapeutic drug monitoring. An early improvement in the inflammatory response and sedation of the infection was observed, with no relapse after 2 years. CONCLUSIONS Septic arthritis can lead to serious functional impairment if left untreated. CLAP is a promising option for managing septic arthritis of the shoulder.
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Affiliation(s)
- Shunya Yamaguchi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Shusuke Ueda
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
- Division of Translational Research, Department of Life Science, Medical Research Institute, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Daisuke Soma
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Uchinada, Ishikawa, Japan
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Zenke Y, Motojima Y, Ando K, Kosugi K, Hamada D, Okada Y, Sato N, Shinohara D, Suzuki H, Kawasaki M, Sakai A. DAIR in treating chronic PJI after total knee arthroplasty using continuous local antibiotic perfusion therapy: a case series study. BMC Musculoskelet Disord 2024; 25:36. [PMID: 38183061 PMCID: PMC10768161 DOI: 10.1186/s12891-024-07165-y] [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: 09/16/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Antimicrobial agents are administered via intramedullary antibiotic perfusion (iMAP)/intrasoft tissue antibiotic perfusion (iSAP) to infected lesions to control osteoarticular and soft tissue infections. Continuous local antibiotic perfusion (CLAP) has been reported to be useful. This study aimed to investigate the outcomes of DAIR combined with CLAP for chronic PJI after total knee arthroplasty performed at our hospital. SUBJECTS AND METHODS Six patients (male; one case, female; five cases, mean age 79.5 years (70-94)) underwent CLAP for chronic PJI after TKA at our hospital between July 2020 and June 2022. They were followable for at least one year after surgery. Seven months (17-219), with a mean follow-up of 24.3 months (12-36). In addition to direct debridement and insert exchange, systemic antimicrobial treatment, and CLAP with gentamicin were performed using NPWT. We investigated the organisms causing the inflammation, the duration of iMAP/iSAP implantation, the maximum daily dose of GM, the maximum GM blood concentration, and the presence or absence of GM-induced adverse events. RESULT Two of six patients had a recurrence of infection at five weeks and five months after initial CLAP and required repeat CLAP treatment, but all patients could preserve their components. The organisms responsible for the flare-ups were MSSA in three cases: ESBL-producing E. coli, mixed MSSA and streptococcal infection, Klebsiella pneumonia in one case each, and unknown pathogens in one case. CLAP therapy for all patients was administered eight times in 6 cases: iMAP, mean: 10.0 days (5-16); iSAP, mean: 19.3 days (15-28); GM dose, mean: 162.5 mg/day (80-240); and GM blood concentration, mean: 1.4 µg/mL (0.2-5.0). Adverse events included one case of reversible acute kidney injury during CLAP in a patient with recurrent infection. DAIR with CLAP for chronic post-TKA infection can be a useful treatment option to preserve components and allow the infection to subside, provided the implant is not markedly loosened.
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Affiliation(s)
- Yukichi Zenke
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan.
| | - Yasuhito Motojima
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Kohei Ando
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Kenji Kosugi
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Daishi Hamada
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Yasuaki Okada
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Naohito Sato
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Daichi Shinohara
- Department of Trauma Reconstruction, University of Occupational and Environmental Health, 1-1 Iseigaoka Yahatanisiku, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan
- Department of Arthroplasty Center, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan
- Department of Arthroplasty Center, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyusyu City Fukuoka Prefecture, Japan
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Ekram B, Tolba E, El-Sayed AF, Müller WEG, Schröder HC, Wang X, Abdel-Hady BM. Cell migration, DNA fragmentation and antibacterial properties of novel silver doped calcium polyphosphate nanoparticles. Sci Rep 2024; 14:565. [PMID: 38177275 PMCID: PMC10766647 DOI: 10.1038/s41598-023-50849-z] [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: 02/12/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024] Open
Abstract
To combat infections, silver was used extensively in biomedical field but there was a need for a capping agent to eliminate its cytotoxic effects. In this study, polymeric calcium polyphosphate was doped by silver with three concentrations 1, 3 or 5 mol.% and were characterized by TEM, XRD, FTIR, TGA. Moreover, cytotoxicity, antibacterial, cell migration and DNA fragmentation assays were done to assure its safety. The results showed that the increase in silver percentage caused an increase in particle size. XRD showed the silver peaks, which indicated that it is present in its metallic form. The TGA showed that thermal stability was increased by increasing silver content. The antibacterial tests showed that the prepared nanoparticles have an antibacterial activity against tested pathogens. In addition, the cytotoxicity results showed that the samples exhibited non-cytotoxic behavior even with the highest doping concentration (5% Ag-CaPp). The cell migration assay showed that the increase in the silver concentration enhances cell migration up to 3% Ag-CaPp. The DNA fragmentation test revealed that all the prepared nanoparticles caused no fragmentation. From the results we can deduce that 3% Ag-CaPp was the optimum silver doped calcium polyphosphate concentration that could be used safely for medical applications.
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Affiliation(s)
- Basma Ekram
- Polymers and Pigments Department, Chemical Industries Research Institute, National Research Centre, Cairo, 12622, Egypt.
| | - Emad Tolba
- Polymers and Pigments Department, Chemical Industries Research Institute, National Research Centre, Cairo, 12622, Egypt
| | - Ahmed F El-Sayed
- Microbial Genetics Department, Biotechnology Research Institute, National Research Centre, Cairo, 12622, Egypt
- Egypt Center for Research and Regenerative Medicine (ECRRM), Cairo, Egypt
| | - Werner E G Müller
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Duesbergweg 6, 55128, Mainz, Germany
| | - Heinz C Schröder
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Duesbergweg 6, 55128, Mainz, Germany
| | - Xiaohong Wang
- ERC Advanced Investigator Grant Research Group at the Institute for Physiological Chemistry, University Medical Center of the Johannes Gutenberg University, Duesbergweg 6, 55128, Mainz, Germany
| | - Bothaina M Abdel-Hady
- Polymers and Pigments Department, Chemical Industries Research Institute, National Research Centre, Cairo, 12622, Egypt
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Mashiko R, Hatta T, Nagashima C. Periprosthetic Joint Infection Following Reverse Shoulder Arthroplasty Treated With Continuous Local Antibiotic Perfusion: A Case Report. Cureus 2023; 15:e49193. [PMID: 38130511 PMCID: PMC10735250 DOI: 10.7759/cureus.49193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Prosthetic joint infection (PJI) is a crucial complication of reverse shoulder arthroplasty (RSA). Continuous local antibiotic perfusion (CLAP) with a high-concentration antimicrobial pharmacy administration method has recently received attention owing to its effectiveness in the treatment of bone and soft tissue infections. We herein report a case of PJI following RSA that was successfully treated with CLAP without removal of the entire implant. A 73-year-old woman with comorbidities of diabetes mellitus and hypertension underwent RSA. The wound was found to be swollen eight weeks after RSA, and purulent content that was positive for Propionibacterium granulosum was identified. Blood samples indicated a mildly elevated inflammatory response. With a diagnosis of PJI spread from the intra-articular to subcutaneous regions without implant loosening, the patient underwent surgical treatment nine weeks after RSA. The contaminated tissues were thoroughly debrided, and the prosthetic joint was preserved by replacing the glenosphere and polyethylene liner. Intra-soft tissue antibiotic perfusion (iSAP) tubes and effluent drains were placed intra-articularly and subcutaneously, and gentamicin was infused continuously for 12 days. In addition, ceftriaxone and rifampicin were administered. The patient was subsequently treated with minocycline and sulfamethoxazole/trimethoprim or clindamycin for eight weeks. The inflammatory reaction became negative six weeks postoperatively, and the patient had no recurrence at 15 months postoperatively. Treatment of PJI is considered a long-lasting, challenging process. This case report supports the feasibility of using CLAP in the treatment of PJI.
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Affiliation(s)
- Ryosuke Mashiko
- Orthopedic Surgery, Joint Surgery, Sports Clinic Ishinomaki, Ishinomaki, JPN
| | - Taku Hatta
- Orthopedic Surgery, Joint Surgery, Sports Clinic Ishinomaki, Ishinomaki, JPN
| | - Chiharu Nagashima
- Traumatology and Reconstructive Surgery Center, Aizu Chuo Hospital, Aizuwakamatsu, JPN
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