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Roscetto E, Di Gennaro D, Ascione T, Galdiero U, Aversa M, Festa E, Catania MR, Balato G. Antiseptics' Concentration, Combination, and Exposure Time on Bacterial and Fungal Biofilm Eradication. Arthroplast Today 2024; 28:101468. [PMID: 39139360 PMCID: PMC11320471 DOI: 10.1016/j.artd.2024.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/20/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024] Open
Abstract
Background This study aims to assess the activity of solutions containing povidone-iodine (PI) and hydrogen peroxide (H2O2) alone or combined on the biofilm of microbial species in the contest of periprosthetic joint infection (PJI). Methods Different antiseptic solutions were tested on 2-day-old biofilms of Gram-positive and Gram-negative bacteria and fungi at 1 and 3 minutes of exposure. The efficacy of these solutions was evaluated by measuring the biofilm metabolic activity by methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) reduction assay. The anti-biofilm effect of 5% PI and 0.3% PI + 0.5% H2O2 was tested on a 5-day-old biofilm using colony-forming unit counts and an XTT reduction assay. Results PI and H2O2 solutions showed concentration-dependent anti-biofilm activity except for E. faecalis. PI at 5% was the most active solution against the 2-day-old biofilm of all test microorganisms. The 0.3% PI + 0.5% H₂O₂ solution had a significant effect only at 3 minutes. The 5% PI and 0.3% PI + 0.5% H₂O₂ effect was evaluated on 5-day-old biofilms. PI at 5% produced a significant reduction in metabolic activity at both 1 and 3 minutes; 0.3% PI + 0.5% H₂O₂ caused a significant activity against all Gram-positive strains after 3 minutes, with a greater metabolic activity reduction than 5% PI. Conclusions In the case of PJI caused by Gram-positive bacteria, 0.3% PI + 0.5% H₂O₂ could be used for wound irrigation for 3 minutes of exposure. In the case of PJI with a different etiological agent or PJI with an unknown etiology, it is advisable to use 5% PI for 1 minute of exposure.
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Affiliation(s)
- Emanuela Roscetto
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Donato Di Gennaro
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
| | - Tiziana Ascione
- Department of Medicine, Service of Infectious Disease, Cardarelli Hospital Naples, Naples, Italy
| | - Umberto Galdiero
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Martina Aversa
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Enrico Festa
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
| | - Maria Rosaria Catania
- Department Molecular Medicine and Medical Biotechnology, “Federico II” University, Naples, Italy
| | - Giovanni Balato
- Section of Orthopaedic Surgery, Department of Public Health, “Federico II” University, Naples, Italy
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MacConnell AE, Levack AE, Brown NM. Biofilm and How It Relates to Prosthetic Joint Infection. Orthop Clin North Am 2024; 55:161-169. [PMID: 38403363 DOI: 10.1016/j.ocl.2023.10.001] [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: 02/27/2024]
Abstract
Prosthetic joint infection following total joint arthroplasty is a devastating complication, resulting in increased morbidity and mortality for the patient. The formation of a biofilm on implanted hardware contributes to the difficulty in successful identification and eradication of the infection. Antibiotic therapy and surgical intervention are necessary for addressing this condition; we present a discussion on different treatment options, including those that are not yet routinely utilized in the clinical setting or are under investigation, to highlight the present and future of PJI management.
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Affiliation(s)
- Ashley E MacConnell
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA.
| | - Ashley E Levack
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
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Rodrigues-Lopes R, Silva F, Torres J. Periprosthetic shoulder infection management: one-stage should be the way: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:722-737. [PMID: 37839627 DOI: 10.1016/j.jse.2023.09.007] [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: 05/20/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty. METHODS Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model. RESULTS After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I2 = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I2 = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03). CONCLUSIONS This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.
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Affiliation(s)
| | - Fábia Silva
- Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
| | - João Torres
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
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Maale GE. CORR Insights®: Next-generation Sequencing Results Require Higher Inoculum for Cutibacterium acnes Detection Than Conventional Anaerobic Culture. Clin Orthop Relat Res 2023; 481:2492-2493. [PMID: 37882098 PMCID: PMC10642878 DOI: 10.1097/corr.0000000000002897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Gerhard Emil Maale
- Clinical Professor, Orthopedics, Oklahoma State University College of Osteopathic Medicine, Plano, TX, USA
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Bastard C, Aïm F, Meyssonnier V, Kerroumi Y, Marion B, Zeller V, Marmor S. One-stage revision for infected shoulder arthroplasty: prospective, observational study of 37 patients. JSES Int 2023; 7:2433-2439. [PMID: 37969534 PMCID: PMC10638573 DOI: 10.1016/j.jseint.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Periprosthetic joint infection is a severe complication of joint replacement surgery. Thus two-stage exchange remains the gold standard, one-stage exchange is now widely recommended. We hypothesized that, for patients with chronic periprosthetic shoulder infection (PSI), treatment with a one-stage exchange would be an effective approach to eradicate infection, relieve pain, and restore function to the involved shoulder. Materials and methods This monocenter cohort study in a Bone and Joint Infection Referral Center (11/2003-05/2020) included all patients with confirmed PSI treated by one-stage revision. Data were extracted from the prospective database, including demographics, infection characteristics, and functional evaluations (range of motion and Constant Score at admission and last follow-up). The primary outcome was the 2-year reinfection-free rate. Results We included 37 patients. The refection-free rate was 5%. The most commonly isolated pathogen was Cutibacterium acnes (68%), isolated alone (15 patients, 41%) or as polymicrobial infections (10 patients, 27%). The Constant Score increased significantly from 24 to 53 (P = .001). Range of motion (forward elevation, abduction) was also significantly improved after surgery. Mean active forward elevation increased significantly by 45° from 60° to 105° postoperatively (P < .001), mean abduction increased by 42° from 55° to 97° (P < .001). Discussion Results from our prospective cohort-extracted series suggest that one-stage revision is a reliable treatment with a low infection recurrence rate. Improved functional outcomes can be achieved with one-stage exchange. Our patients' overall functional results were similar to those previously reported for one-stage revision and better than those reported after two-stage exchange. Patients with multiple previous surgeries seem to have worse functional outcomes than the subgroup without surgery before the index arthroplasty. Conclusions Our results and literature search findings suggest that one-stage revisions effectively eradicate PSIs, with good functional outcomes.
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Affiliation(s)
- Claire Bastard
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Florence Aïm
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Blandine Marion
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
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Yeo PY, Joseph T, Kunnasegaran R. Short-term outcomes of articular cement spacer in the treatment of prosthetic knee joint infections: a retrospective case series. Singapore Med J 2023:386982. [PMID: 37929559 DOI: 10.4103/singaporemedj.smj-2021-389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ping Yen Yeo
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Titus Joseph
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Benda S, Mederake M, Schuster P, Fink B. Diagnostic Value of C-Reactive Protein and Serum White Blood Cell Count during Septic Two-Stage Revision of Total Knee Arthroplasties. Antibiotics (Basel) 2022; 12:antibiotics12010014. [PMID: 36671215 PMCID: PMC9854734 DOI: 10.3390/antibiotics12010014] [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] [Received: 11/08/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS AND METHODS In septic two-stage revision arthroplasty, the timing of reimplantation is crucial for therapeutic success. Recent studies have shown that singular values of C-reactive protein (CRP) and white blood cell count (WBC count) display weak diagnostic value in indicating whether periprosthetic joint infection (PJI) is controlled or not during two-stage revision surgery of knee arthroplasty. Therefore, in addition to the values of CRP and WBC, the course of CRP and WBC counts were compared between groups with and without later reinfection in 95 patients with two-stage revision (TSR) of infected total knee arthroplasties (TKA). Of these patients, 16 had a reinfection (16.84%). RESULTS CRP values decreased significantly after the first stage of TSR in both the reinfection and no-reinfection groups. WBC count values decreased significantly in the no-reinfection group. Decrease in WBC count was not significant in the reinfection group. No significant difference could be found in either the CRP values or the WBC counts at the first stage of TSR, the second stage of TSR, or their difference between stages when comparing groups with and without reinfection. Area under the curve (AUC) values ranging between 0.631 and 0.435 showed poor diagnostic value for the calculated parameters. The courses of CRP over 14 days after the first stage of both groups were similar with near identical AUC. CONCLUSIONS CRP and WBC count as well as their course over 14 days postoperatively are not suitable for defining whether a PJI of the knee is under control or not.
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Affiliation(s)
- Sebastian Benda
- Department of Arthroplasty and Revision Arthroplasty, Orthopaedic Clinic Markgröningen GmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany
| | - Moritz Mederake
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler–Str. 3, 72076 Tübingen, Germany
| | - Philipp Schuster
- Department of Arthroplasty and Revision Arthroplasty, Orthopaedic Clinic Markgröningen GmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany
- Department of Orthopaedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Prof. Ernst Nathan Straße 1, 90419 Nürnberg, Germany
| | - Bernd Fink
- Department of Arthroplasty and Revision Arthroplasty, Orthopaedic Clinic Markgröningen GmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany
- Orthopaedic Department, University-Hospital Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany
- Correspondence: ; Tel.: +49-(0)7145-9153201
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8
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Reddy AK, Norris GR, Nayfa R, Sajjadi NB, Checketts JX, Scott JT, Hartwell M. The presence of person-centered language in orthopedic-related amputation research: a cross-sectional analysis. J Osteopath Med 2022; 123:235-242. [PMID: 36520046 DOI: 10.1515/jom-2022-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Context
Amputations are routine in orthopedics, specifically during trauma and when patients have recurrent surgical site infections. When undergoing amputations, patients must combat the psychosocial factors associated with the loss of an extremity, including stigmatization.
Objectives
This study analyzes the presence of person-centered language (PCL) within amputation-related orthopedic publications in the top orthopedic journals.
Methods
We conducted a cross-sectional analysis with a database search on February 14, 2021 utilizing PubMed. Utilizing a previously published search string, we isolated studies that were published in the top 20 orthopedic journals based on the Google h5-index. In addition to the top 20 orthopedic journals, we included the top two hand and foot & ankle journals in our search to incorporate more amputation literature. Our search yielded 687 returns. The sample was then randomized, and the first 300 studies that fit our inclusion criteria were examined for prespecified non-PCL terminology.
Results
Our results show that 157 (52.2%) studies were adherent to PCL according to the American Medical Association’s Manual of Style 10th Edition (AMAMS). Of the 143 (47.7%) studies that were not adherent to PCL, 51 studies (35.7%) had more than one type of non-PCL language. The term “amputee,” which is being labeled as identity-first language (IFL), was found in 101 articles (33.7%). Further investigation found that 73.3% (74/101) of the studies containing IFL were found to have other non-PCL terms. Of the other studies in the sample, non-PCL was found 34.7% (88/199) of the time. This analysis was done due to the discrepancies in stigmatization of the term “amputee.” No statistical association was found between adherence to PCL and study characteristics.
Conclusions
Our findings show that amputation literature within the top orthopedic journals has limited adherence to PCL. Additionally, the use of the term “amputee,” which is widely accepted by the amputation community, resulted in a greater rate of non-PCL terminology within orthopedic amputation literature. Efforts should be implemented within orthopedics to avoid the use of stigmatizing language, regarding individuals that underwent amputations, to minimize psychosocial stressors.
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Affiliation(s)
- Arjun K. Reddy
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Grayson R. Norris
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Rob Nayfa
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Nicholas B. Sajjadi
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Jared T. Scott
- Department of Orthopedic Surgery , Oklahoma State University Medical Center , Tulsa , OK , USA
| | - Micah Hartwell
- Office of Medical Student Research , Oklahoma State University Center for Health Sciences at Cherokee Nation , Tahlequah , OK , USA
- Department of Psychiatry and Behavioral Sciences , Oklahoma State University Center for Health Sciences , Tulsa , OK , USA
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McPherson E, Jennings J, Yunis O, Harris M, Dipane M, Curtin N, Chowdhry M, Wassef A, Bumgardner J, Noel S. Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads. J Bone Jt Infect 2022; 7:117-125. [PMID: 35620590 PMCID: PMC9128367 DOI: 10.5194/jbji-7-117-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Local antimicrobial delivery via calcium sulfate
(CaSO4) beads is used as an adjunctive treatment for periprosthetic
joint infection. There is limited clinical information describing the
performance of antimicrobial-loaded CaSO4 (ALCS) in large-scale applications. We developed a simulated large joint model to study properties
of eluting ALCS. Methods: The in vitro testing platform was an adapted
standardized model for tribological testing of prosthetic total hips and
total knees (ASTM F732). The model was 70 mL total fluid volume, 25 % bovine serum, and 75 % phosphate-buffered saline, using ISO standard 14242-1 for human synovial fluid simulation. Four brands of CaSO4 were
evaluated. Each 10 mL of CaSO4 was loaded with 1.2 grams (g) of tobramycin and 1 g of vancomycin powders. A 35 mL bead volume, equaling 175 beads, of each product was placed in incubated flasks. The test period was 6 weeks with scheduled interval fluid exchanges. Fluid samples were tested
for antibiotic and calcium concentrations and pH. Results: Antibiotic elution showed an initial burst on Day 1, followed by a logarithmic
reduction over 1 week. Tobramycin fully eluted within 2.5 weeks. Vancomycin showed sustained release over 6 weeks. Calcium ion concentrations were high, with gradual decrease after 3 weeks. All four CaSO4 products
were inherently acidic. Fluid became more acidic with the addition of
antibiotics primarily driven by vancomycin. Discussion: Clinicians should be
cognizant of tobramycin elution burst with ALCS in large loads. The main
driver of acidic pH levels was vancomycin. We propose that joint
complications may result from lowered fluid acidity, and we suggest clinical study of synovial pH.
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Affiliation(s)
- Edward J. McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at
UCLA, Santa Monica, 90404, USA
| | - Jessica A. Jennings
- Department of Biomedical Engineering, University of Memphis, Memphis,
38152, USA
| | - Omar Yunis
- Department of Biomedical Engineering, University of Memphis, Memphis,
38152, USA
| | - Michael A. Harris
- Department of Biomedical Engineering, University of Memphis, Memphis,
38152, USA
| | - Matthew V. Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at
UCLA, Santa Monica, 90404, USA
| | - Nora L. Curtin
- Department of Orthopaedic Surgery, David Geffen School of Medicine at
UCLA, Santa Monica, 90404, USA
| | - Madhav Chowdhry
- Nuffield Department of Primary Care Health Sciences, Kellogg College,
University of Oxford, Oxford, OX1 2JD, UK
| | - Andrew J. Wassef
- Long Beach Lakewood Orthopedic Institute, Long Beach, 90808, USA
| | - Joel D. Bumgardner
- Department of Biomedical Engineering, University of Memphis, Memphis,
38152, USA
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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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Kirschbaum S, Perka C. [Septic revision arthroplasty: how to confirm diagnosis, plan surgery and manage follow-up treatment]. DER ORTHOPADE 2021; 50:995-1003. [PMID: 34652467 DOI: 10.1007/s00132-021-04176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Septic revision arthroplasty represents an interdisciplinary challenge in terms of diagnosis as well as surgical and follow-up treatment. DIAGNOSIS The implementation of a standardized diagnostic algorithm including anamnesis, clinic, imaging, blood sampling and joint aspiration is essential. Depending on the duration of the symptoms acute (< 3 weeks) and chronic (> 3 weeks) infections are distinguished. THERAPY While acute infections show an immature biofilm and can usually be addressed surgically via debridement and changing the mobile parts, chronic infections almost always require a complete change of the implant. This can be done in one or two stages, depending on the general condition of the patient, the pathogen, its resistances as well as the wound conditions. The surgical revision is always followed by a resistance-based antibiotic treatment.
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Affiliation(s)
- Stephanie Kirschbaum
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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12
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Sesquiterpene Lactones from Cotula cinerea with Antibiotic Activity against Clinical Isolates of Enterococcus faecalis. Antibiotics (Basel) 2021; 10:antibiotics10070819. [PMID: 34356740 PMCID: PMC8300741 DOI: 10.3390/antibiotics10070819] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/01/2023] Open
Abstract
Cotula cinerea, belonging to the tribe Anthemideae, is a plant widespread in the Southern hemisphere. It is frequently used in folk medicine in North African countries for several of its medical properties, shown by its extracts and essential oils. The dichloromethane extract obtained from its aerial parts demonstrated antibiotic activity against Enterococcus faecalis and was fractionated by bioguided purification procedures affording five main sesquiterpene lactones. They were identified by spectroscopic methods (NMR and ESIMS data) as guaiantrienolides, i.e., 6-acetoxy-1β-,6-acetoxy-1α-, and 6-acetoxy-10-β-hydroxyguaiantrienolide (1-3), and germacrenolides, i.e., haagenolide and 1,10-epoxyhaagenolide (4 and 5). The absolute configuration was assigned by applying the advanced Mosher's method to haagenolide and by X-ray diffraction analysis to 1,10-epoxyhaagenolide. The specific antibiotic and antibiofilm activities were tested toward the clinical isolates of Enterococcus faecalis. The results showed that compounds 3-5 have antibacterial activity against all the strains of E. faecalis, while compound 2 exhibited activity only toward some strains. Compound 1 did not show this activity but had only antibiofilm properties. Thus, these metabolites have potential as new antibiotics and antibiofilm against drug resistant opportunistic pathogens.
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