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Morovic P, Gonzalez Moreno M, Trampuz A, Karbysheva S. In vitro evaluation of microbial D- and L-lactate production as biomarkers of infection. Front Microbiol 2024; 15:1406350. [PMID: 39176282 PMCID: PMC11340499 DOI: 10.3389/fmicb.2024.1406350] [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: 03/25/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
Mammalian cells produce and metabolize almost exclusively L-lactate, bacterial species have the capacity to produce both D-lactate and L-lactate. The aim of this study was to evaluate the intrinsic production of D- and L-lactate in the most common pathogenic microorganisms causing septic arthritis (SA) and periprosthetic joint infection (PJI) as a potential biomarker for the diagnosis of infection. Following microorganisms were grown according to ATCC culture guides and tested for production of D- and L-lactate: Staphylococcus aureus (ATCC 43300), Staphylococcus epidermidis (ATCC 35984), Enterococcus faecalis (ATCC 19433), Streptococcus pyogenes (ATCC 19615), Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Cutibacterium acnes (ATCC 11827), and Candida albicans (ATCC 90028). Pathogens were inoculated in 8 ml of appropriate liquid media and incubated as planktonic or biofilm form in either aerobic, anaerobic or CO2 atmosphere up to 312 h. D- and L-lactate measurements were performed at different time points: 0, 6, 9, 12 and 24 h, then once per day for slow-growing pathogens. Samples were serially diluted and plated for colony counting. Liquid culture media without microorganisms served as a negative control. Production of D-lactate was observed in all tested microorganisms, whereas no L-lactate was detected in E. coli, P. aeruginosa, and C. albicans. Maximal concentration of D-lactate was produced by S. aureus (10.99 mmol/L), followed by E. coli (1.22 mmol/L), and S. epidermidis (0.48 mmol/L). Maximal L-lactate concentration was observed in S. pyogenes (10.12 mmol/L), followed by S. aureus (9.71 mmol/L), E. faecalis (2.64 mmol/L), and S. epidermidis (2.50 mmol/L). S. epidermidis bacterial biofilm produced significantly higher amount of D- and L-lactate compared to planktonic form (p = 0.015 and p = 0.002, respectively). Our study has demonstrated that the most common pathogenic microorganisms causing SA and PJI have the capability to generate measurable amounts of D-lactate in both planktonic and biofilm form, highlighting the practical value of this biomarker as an indicator for bacterial and fungal infections. In contrast to D-lactate, the absence of L-lactate production in certain tested bacteria, as well as in fungi, suggests that L-lactate is not eligible as a biomarker for diagnosing microbial infections.
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Affiliation(s)
| | | | | | - Svetlana Karbysheva
- Center for Musculoskeletal Surgery (CMSC), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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2
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Jevnikar BE, Khan ST, Huffman N, Pasqualini I, Surace PA, Deren ME, Piuzzi NS. Advancements in treatment strategies for periprosthetic joint infections: A comprehensive review. J Clin Orthop Trauma 2024; 55:102496. [PMID: 39157704 PMCID: PMC11324841 DOI: 10.1016/j.jcot.2024.102496] [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: 03/26/2024] [Revised: 07/03/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Periprosthetic joint infection (PJI) presents a critical challenge in orthopedic care, contributing to significant patient morbidity and healthcare costs. This burden is expected to increase secondary to growing demand for total joint arthroplasty (TJA). Despite the profound significance of PJI, there is currently no universally accepted "gold standard" diagnostic criteria using serum biomarker thresholds; latest criteria fail to differentiate acute infections from chronic or consider time since initial surgery. Furthermore, contemporary PJI treatment, which conventionally requires 2-stage revision surgery in conjunction with rigorous antibiotic treatment, can be particularly taxing on patients. Fortunately, recent years have seen marked evolution in both PJI diagnosis and treatment methods. Contemporary research supports time-dependent serum biomarker thresholds with greater sensitivity and specificity than previously reported, as well as alternative surgical options which may be more suitable for certain patients. The following narrative review aims to describe the significance and pathogenesis of PJI before characterizing current challenges, novel innovations, and the future landscape of PJI diagnosis and management. Here, we spotlight the emerging utility of novel biomarkers and metagenomic next-generation sequencing for diagnosis, advancements in patient-centered surgical outcome prediction tools for PJI risk assessment and prevention, and evolving surgical techniques including 1-stage and a "hybrid" 1.5-stage revision surgeries. Additionally, we explore cutting-edge therapeutic modalities including peptide and bacteriophage-based treatments, intraoperative anti-biofilm gel, the VT-X7 antibiotic pump, and promising immune-based interventions. Ultimately, these advancements hold the potential to revolutionize PJI management, offering hope for improved outcomes and reduced burdens on healthcare systems.
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Affiliation(s)
| | | | - Nickelas Huffman
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA
| | - Ignacio Pasqualini
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA
| | - Peter A. Surace
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA
| | - Matthew E. Deren
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA
| | - Nicolas S. Piuzzi
- Cleveland Clinic Foundation, Department of Orthopaedic Surgery, Cleveland, OH, 44195, USA
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3
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Allison DC. CORR Insights®: High Rates of Treatment Failure and Amputation in Modular Endoprosthesis Prosthetic Joint Infections Caused by Fungal Infections With Candida. Clin Orthop Relat Res 2024; 482:1243-1245. [PMID: 38231012 PMCID: PMC11219143 DOI: 10.1097/corr.0000000000002967] [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: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Daniel C Allison
- Department of Orthopaedic Surgery Cedars-Sinai Medical Center and Department of Pediatric Orthopaedics, Children's Hospital of Los Angeles, Los Angeles, CA, USA
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Lee J, Baek E, Ahn H, Park H, Lee S, Kim S. Diagnostic Performance of a Molecular Assay in Synovial Fluid Targeting Dominant Prosthetic Joint Infection Pathogens. Microorganisms 2024; 12:1234. [PMID: 38930616 PMCID: PMC11206145 DOI: 10.3390/microorganisms12061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Prosthetic joint infection (PJI) is one of the most serious complications of joint replacement surgery among orthopedic surgeries and occurs in 1 to 2% of primary surgeries. Additionally, the cause of PJIs is mostly bacteria from the Staphylococcus species, accounting for more than 98%, while fungi cause PJIs in only 1 to 2% of cases and can be difficult to manage. The current gold-standard microbiological method of culturing synovial fluid is time-consuming and produces false-negative and -positive results. This study aimed to identify a novel, accurate, and convenient molecular diagnostic method. The DreamDX primer-hydrolysis probe set was designed for the pan-bacterial and pan-fungal detection of DNA from pathogens that cause PJIs. The sensitivity and specificity of DreamDX primer-hydrolysis probes were 88.89% (95% CI, 56.50-99.43%) and 97.62% (95% CI, 87.68-99.88%), respectively, compared with the microbiological method of culturing synovial fluid, and receiver operating characteristic (ROC) area under the curve (AUC) was 0.9974 (*** p < 0.0001). It could be concluded that the DreamDX primer-hydrolysis probes have outstanding potential as a molecular diagnostic method for identifying the causative agents of PJIs, and that host inflammatory markers are useful as adjuvants in the diagnosis of PJIs.
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Affiliation(s)
- Jiyoung Lee
- Department of Research & Development, DreamDX Inc., C001, 57, Oryundae-ro, Geumjeong-gu, Busan 46252, Republic of Korea; (J.L.); (E.B.)
| | - Eunyoung Baek
- Department of Research & Development, DreamDX Inc., C001, 57, Oryundae-ro, Geumjeong-gu, Busan 46252, Republic of Korea; (J.L.); (E.B.)
| | - Hyesun Ahn
- Joint & Arthritis Research Center, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea;
| | - Heechul Park
- Department of Clinical Laboratory Science, Hyejeon College, Daehak 1-gil, Hongseong-eup, Hongseong-gun 32244, Republic of Korea;
| | - Suchan Lee
- Joint & Arthritis Research Center, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea;
| | - Sunghyun Kim
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan 46252, Republic of Korea
- Next-Generation Industrial Field-Based Specialist Program for Molecular Diagnostics, Brain Busan 21 Plus Project, Graduate School, Catholic University of Pusan, Busan 46252, Republic of Korea
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Silva NDS, De Melo BST, Oliva A, de Araújo PSR. Sonication protocols and their contributions to the microbiological diagnosis of implant-associated infections: a review of the current scenario. Front Cell Infect Microbiol 2024; 14:1398461. [PMID: 38803573 PMCID: PMC11128543 DOI: 10.3389/fcimb.2024.1398461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Addressing the existing problem in the microbiological diagnosis of infections associated with implants and the current debate about the real power of precision of sonicated fluid culture (SFC), the objective of this review is to describe the methodology and analyze and compare the results obtained in current studies on the subject. Furthermore, the present study also discusses and suggests the best parameters for performing sonication. A search was carried out for recent studies in the literature (2019-2023) that addressed this research topic. As a result, different sonication protocols were adopted in the studies analyzed, as expected, and consequently, there was significant variability between the results obtained regarding the sensitivity and specificity of the technique in relation to the traditional culture method (periprosthetic tissue culture - PTC). Coagulase-negative Staphylococcus (CoNS) and Staphylococcus aureus were identified as the main etiological agents by SFC and PTC, with SFC being important for the identification of pathogens of low virulence that are difficult to detect. Compared to chemical biofilm displacement methods, EDTA and DTT, SFC also produced variable results. In this context, this review provided an overview of the most current scenarios on the topic and theoretical support to improve sonication performance, especially with regard to sensitivity and specificity, by scoring the best parameters from various aspects, including sample collection, storage conditions, cultivation methods, microorganism identification techniques (both phenotypic and molecular) and the cutoff point for colony forming unit (CFU) counts. This study demonstrated the need for standardization of the technique and provided a theoretical basis for a sonication protocol that aims to achieve the highest levels of sensitivity and specificity for the reliable microbiological diagnosis of infections associated with implants and prosthetic devices, such as prosthetic joint infections (PJIs). However, practical application and additional complementary studies are still needed.
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Affiliation(s)
| | | | - Alessandra Oliva
- Dipartimento di Sanità Pubblica e Malattie Infettive - Sapienza University of Rome, Rome, Italy
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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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Tiwari V, Shendre P, Nag S, Mishra M, Roy M, Dwidmuthe S. Peri-prosthetic Joint Infection due to Candida albicans in a Young Immunocompetent Patient - A Rare Case Report. J Orthop Case Rep 2024; 14:160-164. [PMID: 38420226 PMCID: PMC10898703 DOI: 10.13107/jocr.2024.v14.i02.4256] [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] [Received: 11/15/2023] [Revised: 12/23/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction The recent surge in joint replacement surgeries in India, particularly total knee and hip replacements, is notable. The majority of patients undergoing these procedures suffered from knee osteoarthritis or femoral head avascular necrosis. However, this increase in joint replacements has also led to a rise in periprosthetic joint infections (PJI), a severe and costly complication. PJI is responsible for 25% of total knee arthroplasty failures and 15% of total hip arthroplasty failures. Various risk factors, such as diabetes, fractures, and arthritis, are associated with PJI development. Bacterial infections, notably Staphylococcus species, are the primary cause of PJI, but rare fungal infections are often caused by Candida and Aspergillus. There is a lack of clinical trials and limited knowledge about the prevalence and treatment of fungal PJIs. Case Report This report presents a unique case of delayed PJI caused by Candida albicans in an otherwise healthy patient. Conclusion This case report emphasizes the need for further research and standardized treatment guidelines. Treatment typically involves a two-stage revision with extended antifungal therapy. The optimal duration of antifungal treatment remains uncertain.
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Affiliation(s)
- Vivek Tiwari
- Department of Orthopaedics and Joint Replacement, Apollo Sage Hospital, Bhopal, Madhya Pradesh, India
| | - Pooja Shendre
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Soumyabrata Nag
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Meena Mishra
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Mainak Roy
- Department of Orthopaedics, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Samir Dwidmuthe
- Department of Orthopaedics, AIIMS Nagpur, Nagpur, Maharashtra, India
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Tsikopoulos K, Meroni G. Periprosthetic Joint Infection Diagnosis: A Narrative Review. Antibiotics (Basel) 2023; 12:1485. [PMID: 37887186 PMCID: PMC10604393 DOI: 10.3390/antibiotics12101485] [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: 08/27/2023] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Replacement of native joints aims to restore patients' quality of life by relieving pain and improving joint function. While periprosthetic joint infection (PJI) affects a small percentage of patients, with an estimated incidence of 1-9% following primary total joint replacement, this postoperative complication necessitates a lengthy hospitalisation, extended antibiotic treatment and further surgery. It is highlighted that establishing the correct diagnosis of periprosthetic infections is critical in order for clinicians to avoid unnecessary treatments in patients with aseptic failure. Of note, the PJI diagnosis could not purely rely upon clinical manifestations given the fact that heterogeneity in host factors (e.g., age and comorbidities), variability in infection period, difference in anatomical location of the involved joint and discrepancies in pathogenicity/virulence of the causative organisms may confound the clinical picture. Furthermore, intra-operative contamination is considered to be the main culprit that can result in early or delayed infection, with the hematogenous spread being the most prevalent mode. To elaborate, early and hematogenous infections often start suddenly, whereas chronic late infections are induced by less virulent bacteria and tend to manifest in a more quiescent manner. Last but not least, viruses and fungal microorganisms exert a role in PJI pathogenesis.
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Affiliation(s)
- Konstantinos Tsikopoulos
- 1st Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Gabriele Meroni
- One Health Unit, Department of Biomedical, Surgical and Dental Sciences, School of Medicine, University of Milan, 20133 Milan, Italy;
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Yuste I, Luciano FC, Anaya BJ, Sanz-Ruiz P, Ribed-Sánchez A, González-Burgos E, Serrano DR. Engineering 3D-Printed Advanced Healthcare Materials for Periprosthetic Joint Infections. Antibiotics (Basel) 2023; 12:1229. [PMID: 37627649 PMCID: PMC10451995 DOI: 10.3390/antibiotics12081229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
The use of additive manufacturing or 3D printing in biomedicine has experienced fast growth in the last few years, becoming a promising tool in pharmaceutical development and manufacturing, especially in parenteral formulations and implantable drug delivery systems (IDDSs). Periprosthetic joint infections (PJIs) are a common complication in arthroplasties, with a prevalence of over 4%. There is still no treatment that fully covers the need for preventing and treating biofilm formation. However, 3D printing plays a major role in the development of novel therapies for PJIs. This review will provide a deep understanding of the different approaches based on 3D-printing techniques for the current management and prophylaxis of PJIs. The two main strategies are focused on IDDSs that are loaded or coated with antimicrobials, commonly in combination with bone regeneration agents and 3D-printed orthopedic implants with modified surfaces and antimicrobial properties. The wide variety of printing methods and materials have allowed for the manufacture of IDDSs that are perfectly adjusted to patients' physiognomy, with different drug release profiles, geometries, and inner and outer architectures, and are fully individualized, targeting specific pathogens. Although these novel treatments are demonstrating promising results, in vivo studies and clinical trials are required for their translation from the bench to the market.
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Affiliation(s)
- Iván Yuste
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Francis C. Luciano
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Brayan J. Anaya
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Pablo Sanz-Ruiz
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, 28029 Madrid, Spain;
- Department of Surgery, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Almudena Ribed-Sánchez
- Hospital Pharmacy Unit, Hospital General Universitario Gregorio Marañón, 28029 Madrid, Spain;
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Dolores R. Serrano
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
- Instituto Universitario de Farmacia Industrial, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
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Bos MP, van Houdt R, Poort L, van der Stel AX, Peters EJ, Saouti R, Savelkoul P, Budding AE. Rapid Diagnostics of Joint Infections Using IS-Pro. J Clin Microbiol 2023; 61:e0015423. [PMID: 37154734 PMCID: PMC10281151 DOI: 10.1128/jcm.00154-23] [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] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023] Open
Abstract
Diagnosis of bone and joint infections (BJI) relies on microbiological culture which has a long turnaround time and is challenging for certain bacterial species. Rapid molecular methods may alleviate these obstacles. Here, we investigate the diagnostic performance of IS-pro, a broad-scope molecular technique that can detect and identify most bacteria to the species level. IS-pro additionally informs on the amount of human DNA present in a sample, as a measure of leukocyte levels. This test can be performed in 4 h with standard laboratory equipment. Residual material of 591 synovial fluid samples derived from native and prosthetic joints from patients suspected of joint infections that were sent for routine diagnostics was collected and subjected to the IS-pro test. Bacterial species identification as well as bacterial load and human DNA load outcomes of IS-pro were compared to those of culture. At sample level, percent positive agreement (PPA) between IS-pro and culture was 90.6% (95% CI 85.7- to 94%) and negative percent agreement (NPA) was 87.7% (95% CI 84.1 to 90.6%). At species level PPA was 80% (95% CI 74.3 to 84.7%). IS-pro yielded 83 extra bacterial detections over culture for which we found supporting evidence for true positivity in 40% of the extra detections. Missed detections by IS-pro were mostly related to common skin species in low abundance. Bacterial and human DNA signals measured by IS-pro were comparable to bacterial loads and leukocyte counts reported by routine diagnostics. We conclude that IS-pro showed an excellent performance for fast diagnostics of bacterial BJI.
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Affiliation(s)
| | - Robin van Houdt
- Department of Medical Microbiology & Infection Control, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Edgar J. Peters
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Infectious Diseases, Amsterdam Infection & Immunity, Infectious Diseases, Amsterdam, The Netherlands
| | - Rachid Saouti
- Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Savelkoul
- Department of Medical Microbiology & Infection Control, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Microbiology, Infectious Diseases & Infection Prevention, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht UMC, Maastricht, The Netherlands
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Krampitz B, Steiner J, Trampuz A, Kühn KD. Voriconazole Admixed with PMMA-Impact on Mechanical Properties and Efficacy. Antibiotics (Basel) 2023; 12:antibiotics12050848. [PMID: 37237751 DOI: 10.3390/antibiotics12050848] [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: 03/14/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND There are currently no recommendations to direct the optimal diagnosis and treatment of fungal osteoarticular infections, including prosthetic joint infections and osteomyelitis. Active agents (fluconazole; amphotericin B) are regularly applied per os or intravenously. Other drugs such as voriconazole are used less frequently, especially locally. Voriconazole is less toxic and has promising results. Local antifungal medication during primary surgical treatment has been investigated by implanting an impregnated PMMA cement spacer using intra-articular powder or by daily intra-articular lavage. The admixed dosages are rarely based on characteristic values and microbiological and mechanical data. The purpose of this in vitro study is to investigate the mechanical stability and efficacy of antifungal-admixed PMMA with admixed voriconazole at low and high concentrations. METHODS Mechanical properties (ISO 5833 and DIN 53435) as well as efficacy with inhibition zone tests with two Candida spp. were investigated. We tested three separate cement bodies at each measuring time (n = 3) Results: Mixing high dosages of voriconazole causes white specks on inhomogeneous cement surfaces. ISO compression, ISO bending, and DIN impact were significantly reduced, and ISO bending modulus increased. There was a high efficacy against C. albicans with low and high voriconazole concentrations. Against C. glabrata, a high concentration of voriconazole was significantly more efficient than a dose at a low concentration. CONCLUSIONS Mixing voriconazole powder with PMMA (Polymethylmethacrylate) powder homogeneously is not easy because of the high amount of dry voriconazole in the powder formulation. Adding voriconazole (a powder for infusion solutions) has a high impact on its mechanical properties. Efficacy is already good at low concentrations.
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Affiliation(s)
- Barbara Krampitz
- Medical Training and Science, Heraeus Medical GmhH, Hamburger Allee 50, 60486 Frankfurt, Germany
| | - Julia Steiner
- University Hospital for Orthopaedics and Traumatology, Medical University of Graz, 8036 Graz, Austria
| | - Andrej Trampuz
- Infectious Diseases, Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Klaus-Dieter Kühn
- University Hospital for Orthopaedics and Traumatology, Medical University of Graz, 8036 Graz, Austria
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Perni S, Bojan B, Prokopovich P. A retrospective study of risk factors, causative micro-organisms and healthcare resources consumption associated with prosthetic joint infections (PJI) using the Clinical Practice Research Datalink (CPRD) Aurum database. PLoS One 2023; 18:e0282709. [PMID: 36943830 PMCID: PMC10030031 DOI: 10.1371/journal.pone.0282709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/20/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a serious complication after joint replacement surgery and it is associated with risk of mortality and morbidity along with high direct costs. METHODS The Clinical Practice Research Datalink (CPRD) data were utilized to quantify PJI incidence after hip or knee replacement up to 5 years after implant and a variety of risk factors related to patient characteristics, medical and treatment history along with characteristics of the original surgery were analyzed through Cox proportional hazard. RESULTS 221,826 patients (individual joints 283,789) met all the inclusion and exclusion criteria of the study; during the study follow-up period (5 years), 707 and 695 PJIs were diagnosed in hip and knee, respectively. Patients undergoing joint replacement surgery during an unscheduled hospitalization had greater risk of PJI than patients whose surgery was elective; similarly, the risk of developing PJI after a secondary hip or knee replacement was about 4 times greater than after primary arthroplasty when adjusted for all other variables considered. A previous diagnosis of PJI, even in a different joint, increased the risk of a further PJI. Distribution of average LoS per each hospitalization caused by PJI exhibited a right skewed profile with median duration [IQR] duration of 16 days [8-32] and 13 days [7.25-32] for hip and knee, respectively. PJIs causative micro-organisms were dependent on the time between initial surgery and infection offset; early PJI were more likely to be multispecies than later (years after surgery); the identification of Gram- pathogens decreased with increasing post-surgery follow-up. CONCLUSIONS This study offers a contemporary assessment of the budgetary and capacity (number and duration of hospitalizations along with the number of Accident and Emergency (A&E) visits) posed by PJIs in UK for the national healthcare system (NHS). The results to provide risk management and planning tools to health providers and policy makers in order to fully assess technologies aimed at controlling and preventing PJI. The findings add to the existing evidence-based knowledge surrounding the epidemiology and burden of PJI by quantifying patterns of PJI in patients with a relatively broad set of prevalent comorbidities.
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Affiliation(s)
- Stefano Perni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Bsmah Bojan
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, United Kingdom
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Qiao YJ, Li F, Zhang LD, Yu XY, Zhang HQ, Yang WB, Song XY, Xu RL, Zhou SH. Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study. World J Clin Cases 2022; 10:13239-13249. [PMID: 36683646 PMCID: PMC9851019 DOI: 10.12998/wjcc.v10.i36.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a catastrophic complication that can occur following total knee arthroplasty (TKA). Currently, the treatment for PJI mainly includes the use of antibiotics alone, prosthetic debridement lavage, primary revision, secondary revision, joint fusion, amputation, etc.
AIM To explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA.
METHODS The clinical data of 27 patients (3 males and 24 females; age range, 47–80 years; mean age, 66.7 ± 8.0 years; 27 knees) with PJI treated with two-stage revision surgery in our hospital between January 1, 2010 and December 31, 2020 were analyzed retrospectively. The following outcomes were compared for changes between preoperative and last follow-up results: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, knee range of motion (ROM), and infection cure rates.
RESULTS All 27 patients were followed up (range, 13–112 mo). The ESR (14.5 ± 6.3 mm/h) and CRP (0.6 ± 0.4 mg/dL) of the patients at the last follow-up were significantly lower than those at admission; the difference was statistically significant (P < 0.001). The postoperative VAS score (1.1 ± 0.7), HSS score (82.3 ± 7.1), and knee ROM (108.0° ± 19.7°) were significantly improved compared with those before the surgery; the difference was statistically significant (P < 0.001). Of the 27 patients, 26 were cured of the infection, whereas 1 case had an infection recurrence; the infection control rate was 96.3%.
CONCLUSION Two-stage revision surgery can effectively relieve pain, control infection, and retain good joint function in the treatment of PJI after TKA.
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Affiliation(s)
- Yong-Jie Qiao
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Feng Li
- Department of Orthopedics, The 943rd Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Wuwei 733000, Gansu Province, China
| | - Lv-Dan Zhang
- Department of Respiratory Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Xin-Yuan Yu
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Hao-Qiang Zhang
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Wen-Bin Yang
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Xiao-Yang Song
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Rui-Ling Xu
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Sheng-Hu Zhou
- Department of Joint Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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