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Hanssen JLJ, Gademan MGJ, Wouthuyzen-Bakker M, Davis JS, Dewar D, Manning L, Campbell D, van Prehn J, Miller AO, van der Wal RJP, van der Linden HMJ, Cortés-Penfield NW, Soriano A, de Boer MGJ, Scheper H. Global practice variation of suppressive antimicrobial treatment for prosthetic joint infections: A cross-sectional survey study. J Infect 2024:106316. [PMID: 39413929 DOI: 10.1016/j.jinf.2024.106316] [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: 09/13/2024] [Accepted: 10/09/2024] [Indexed: 10/18/2024]
Abstract
OBJECTIVES To identify global differences in the use of suppressive antimicrobial therapy (SAT) in the management of prosthetic joint infection (PJI). METHODS An online survey was designed to investigate clinician's approach to SAT for PJI, including indications, preferred antimicrobial drugs, dosing, treatment duration and follow-up. The survey was distributed to members of four international (bone and joint) infection societies and study groups. RESULTS Respondents comprised 330 physicians (204 infectious diseases specialists, 110 orthopedic surgeons, 23 clinical microbiologists) from 43 different countries (Europe, n=134, 41%; Oceania n=112, 34%; North America, n=51, 16%; other, n=33, 10%; total response rate 20%). After debridement, antibiotics and implant retention (DAIR) or one-stage revision, SAT would be initiated often or almost always by 38% of respondents from North America, but only in 6% from Europe and 7% from Oceania. First choices of SAT for staphylococcal PJI were oral cephalosporins (39%) and tetracyclines (31%) in North America; tetracyclines (27%) and anti-staphylococcal penicillins (22%) in Europe; and anti-staphylococcal penicillins (55%) in Oceania. There was no global or regional preferred SAT regimen for Gram-negative PJI. Of all respondents, dosage of SAT was never lowered (n=126, 38%), lowered for specific antibiotics (n=125, 38%) or lowered for all antibiotics (n=79, 24%). SAT was prescribed for a lifelong duration (n=43, 13%), a fixed duration (range 6 months-3 years) (n=104, 32%) or for an undetermined duration (n=154, 47%). CONCLUSIONS Approach to SAT in PJI is highly regional, with no consensus regarding the indication, selection, dose, or duration of SAT between physicians worldwide. This reflects the paucity of data and need for high quality studies to define the optimal use of SAT in the treatment of patients with PJI.
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Affiliation(s)
- Jaap L J Hanssen
- Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
| | - Maaike G J Gademan
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, Netherlands
| | - Joshua S Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - David Dewar
- Orthopaedic department, John Hunter Hospital, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - Laurens Manning
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia; Medical School, University Western Australia, Perth, WA, Australia
| | - David Campbell
- Department of Orthopaedic Surgery, Wakefield Orthopaedic Clinic, Australia; The University of Adelaide, Adelaide, South Australia, Australia
| | - Joffrey van Prehn
- Leiden University Center for Infectious Diseases (LU-CID), Medical Microbiology and Infection Control, Leiden University Medical Center, Leiden, Netherlands
| | - Andy O Miller
- Division of Infectious Diseases, Hospital for Special Surgery, New York, New York, USA
| | - Robert J P van der Wal
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Mark G J de Boer
- Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Henk Scheper
- Leiden University Center for Infectious Diseases (LU-CID), Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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Mancheño-Losa M, Murillo O, Benavent E, Sorlí L, Riera M, Cobo J, Benito N, Morata L, Ribera A, Sobrino B, Fernández-Sampedro M, Múñez E, Bahamonde A, Barbero JM, Del Toro MD, Villa J, Rigo-Bonnin R, Luque S, García-Luque I, Oliver A, Esteban J, Lora-Tamayo J. Efficacy and safety of colistin plus beta-lactams for bone and joint infection caused by fluoroquinolone-resistant gram-negative bacilli: a prospective multicenter study. Infection 2024:10.1007/s15010-024-02379-7. [PMID: 39249177 DOI: 10.1007/s15010-024-02379-7] [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: 06/29/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024]
Abstract
OBJECTIVES The prognosis of bone and joint infections (BJI) caused by Gram-negative bacilli (GNB) worsens significantly in the face of fluoroquinolone-resistance. In this setting, scarce pre-clinical and clinical reports suggest that intravenous beta-lactams plus colistin may improve outcome. Our aim was to assess the efficacy and safety of this treatment in a well-characterized prospective cohort. METHODS Observational, prospective, non-comparative, multicenter (14 hospitals) study of adults with BJI caused by fluoroquinolone-resistant GNB treated with surgery and intravenous beta-lactams plus colistin for ≥ 21 days. The primary endpoint was the cure rate. RESULTS Of the 44 cases included (median age 72 years [IQR 50-81], 22 [50%] women), 32 (73%) had an orthopedic device-related infection, including 17 (39%) prosthetic joints. Enterobacterales were responsible for 27 (61%) episodes, and Pseudomonas spp for 17 (39%), with an overall rate of MDR/XDR GNB infections of 27/44 (61%). Patients were treated with colistin plus intravenous beta-lactam for 28 days (IQR 22-37), followed by intravenous beta-lactam alone for 19 days (IQR 5-35). The cure rate (intention-to-treat analysis; median follow-up = 24 months, IQR 19-30) was 82% (95% CI 68%-90%) and particularly, 80% (95% CI 55%-93%) among patients managed with implant retention. Adverse events (AEs) leading to antimicrobial withdrawal occurred in 10 (23%) cases, all of which were reversible. Colistin AEs were associated with higher plasma drug concentrations (2.8 mg/L vs. 0.9 mg/L, p = 0.0001). CONCLUSIONS Combination therapy with intravenous beta-lactams plus colistin is an effective regimen for BJI caused by fluoroquinolone-resistant GNB. AEs were reversible and potentially preventable by close therapeutic drug monitoring.
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Affiliation(s)
- Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
| | - Oscar Murillo
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain.
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Avda. Feixa Llarga S/N, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Benavent
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Avda. Feixa Llarga S/N, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luisa Sorlí
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases. Instituto Hospital del Mar de Investigaciones Médicas (IMIM). Hospital del Mar, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Melchor Riera
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Univeristari Son Espases, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Palma, Spain
| | - Javier Cobo
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Natividad Benito
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Unit, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- The University of Queensland Centre for Clinical Research (UQCCR), Brisbane, Australia
| | - Laura Morata
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques Agust Pi I Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Alba Ribera
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital de Barcelona, Barcelona, Spain
| | - Beatriz Sobrino
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Marta Fernández-Sampedro
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Elena Múñez
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Alberto Bahamonde
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital El Bierzo, Ponferrada, Spain
| | - José María Barbero
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Mª Dolores Del Toro
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, University of Sevilla, Seville, Spain
| | - Jenifer Villa
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
| | - Raül Rigo-Bonnin
- Clinical Laboratory, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sonia Luque
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Pharmacy Department, Hospital del Mar. Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Antonio Oliver
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, Hospital Universitari Son Espases, IdISBa, Palma, Spain
| | - Jaime Esteban
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Department of Microbiology, ISS-Hospital Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Imas12, Madrid, Spain
- Grupo de Estudio de Infecciones Osteoarticulares - Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC - CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Barbero Allende JM, Gómez-Junyent J, Sorlí Redó L, Rodríguez-Pardo D, Murillo Rubio Ó, Fernández Sampedro M, Escudero-Sánchez R, García Gutiérrez M, Portillo ME, Sancho I, Rico Nieto A, Guio Carrión L, Soriano A, Morata Ruiz L. Description of reinfection of joint prosthesis after 2-stage replacement (infection of the 2nd stage prosthesis): A multicenter study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:354-360. [PMID: 37479562 DOI: 10.1016/j.eimce.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery. METHODS Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018. RESULTS We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases). CONCLUSIONS The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate.
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Affiliation(s)
- José M Barbero Allende
- Servicio de Medicina Interna, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC).
| | - Joan Gómez-Junyent
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain; Infectious Pathology and Antimicrobial Research Group (IPAR); Universidad Autónoma de Barcelona (UAB), Barcelona, Spain; CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluisa Sorlí Redó
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain; Infectious Pathology and Antimicrobial Research Group (IPAR); CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Dolors Rodríguez-Pardo
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain; CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Óscar Murillo Rubio
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, Universitat de Barcelona, Barcelona, Spain; Universidad de Barcelona, Barcelona, Spain
| | - Marta Fernández Sampedro
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Enfermedades Infeciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Cantabria, Spain
| | - Rosa Escudero-Sánchez
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Manuel García Gutiérrez
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unidad de Enfermedades Infecciosas y Microbiologia Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - M Eugenia Portillo
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Servicio de Microbiología Clínica, Hospital Universitario de Navarra, Pamplona, Navarra, Spain; Institute of Healthcare Research of Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Ignacio Sancho
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Alicia Rico Nieto
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unidad de Enfermedades Infecciosas y Microbiologia Clínica, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Guio Carrión
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Alex Soriano
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); CIBERINFEC, ISCIII-CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Universidad de Barcelona, Barcelona, Spain; Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona «IDIBAPS», Barcelona, Spain
| | - Laura Morata Ruiz
- Grupo de Estudio de Infección Osteoarticular de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (GEIO-SEIMC); Universidad de Barcelona, Barcelona, Spain; Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona «IDIBAPS», Barcelona, Spain
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Sanne DS, de Cock P, Nick V, Franky B, Boelens J, Huis In 't Veld D. Retrospective analysis of a flucloxacillin oral absorption test in patients requiring flucloxacillin therapy: results and determination of factors associated with adequate absorption. Acta Clin Belg 2024:1-9. [PMID: 39054877 DOI: 10.1080/17843286.2024.2382981] [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: 05/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES Flucloxacillin has the most narrow spectrum to treat staphylococcal infections, but has a large variability in bioavailability which hampers its intravenous (iv) to oral switch. To identify patients with adequate absorption, the use of an oral absorption test (OAT) measuring total plasma concentrations of flucloxacillin before and after an oral dose of 1 gram flucloxacillin, was previously published. The current pilot study aims to evaluate the fraction of patients with adequate absorption using a similar OAT; to assess the therapeutic consequences and to identify potential factors associated with adequate absorption. METHODS Demographic data of adult patients treated with iv flucloxacillin and requiring prolonged therapy were collected retrospectively between May 2020 and November 2021 at Ghent University Hospital. A previously published OAT protocol was used, with addition of a protocol for intermittent dosing of iv flucloxacillin. Adequate absorption was defined as an increase in plasma concentration of at least 10 mg/L. RESULTS The flucloxacillin OAT was performed in 99 patients, of which 62% were men, with a median age of 58 years and 95% received intermittent dosing of iv flucloxacillin. Of the 99 patients, 55% had a result indicating an adequate absorption and 49% of all patients were switched to oral flucloxacillin afterwards. Inadequate absorption was found to be associated with higher Body Mass Index and higher flucloxacillin baseline concentration, while co-administration of acetylsalicylic acid was associated with an adequate absorption. CONCLUSIONS Based on the OAT, 49% of all patients were switched to oral flucloxacillin instead of broader-spectrum anti-staphylococcal antibiotics. This implicates that an OAT could be a valuable antimicrobial stewardship measure by restricting the use of broad-spectrum antibiotics. For each of the associations found, a hypothesis was formulated about the underlying reason or mechanism; these should be confirmed in future studies with prospective and multicentric design.
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Affiliation(s)
- De Smet Sanne
- Department of Internal medicine & Infectious Diseases, Ghent University hospital, Ghent, Belgium
| | - Pieter de Cock
- Department of Pharmacy, Ghent University hospital, Ghent, Belgium
- Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Verougstraete Nick
- Department of Laboratory Medicine, Ghent University hospital, Ghent, Belgium
| | - Buyle Franky
- Department of Pharmacy, Ghent University hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Medical Microbiology, Ghent University hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Diana Huis In 't Veld
- Department of Internal medicine & Infectious Diseases, Ghent University hospital, Ghent, Belgium
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5
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Barbero Allende JM, Fernández Antón E, Gómez-Junyent J, Sorlí Redó L, Rodríguez-Pardo D, Murillo Rubio Ó, Fernández Sampedro M, Escudero-Sánchez R, García Gutiérrez M, Portillo ME, Sancho I, Rico Nieto A, Guio Carrión L, Soriano Viladomiu A, Morata Ruiz L, de Abajo Iglesias FJ. Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case-control study. Eur J Clin Microbiol Infect Dis 2024; 43:1319-1328. [PMID: 38748353 DOI: 10.1007/s10096-024-04838-3] [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: 02/09/2024] [Accepted: 04/22/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI. METHODS Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors. RESULTS We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65). CONCLUSIONS The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.
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Affiliation(s)
- Jose M Barbero Allende
- Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain.
| | - Encarnación Fernández Antón
- Department of Biomedical Sciences (Pharmacology), Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
- Universidad de Alcalá (IRYCIS), Alcalá de Henares, Spain
| | - Joan Gómez-Junyent
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Infectiuos Diseases Department, Hospital del Mar, Barcelona, Spain
- Infectious Pathology and Antimicrobial Research Group (IPAR) (Spain), Universidad Pompeu Fabra, Barcelona, Spain
| | - Lluisa Sorlí Redó
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Infectiuos Diseases Department, Hospital del Mar, Barcelona, Spain
- CEXS-Universitat Pompeu Fabra, Barcelona, Spain
- Infectious Pathology and Antimicrobial Research Group (IPAR), Madrid, Spain
| | - Dolors Rodríguez-Pardo
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario Vall d`Hebron, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Óscar Murillo Rubio
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Fernández Sampedro
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rosa Escudero-Sánchez
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Manuel García Gutiérrez
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Ma Eugenia Portillo
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Department of Clinical Microbiology, Hospital Universitario de Navarra, Pamplona, Spain
- Institute of Healthcare Research of Navarra (IdiSNA), Pamplona, Spain
| | - Ignacio Sancho
- Institute of Healthcare Research of Navarra (IdiSNA), Pamplona, Spain
- Orthopedic Surgery and Traumatology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Alicia Rico Nieto
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario de La Paz, Madrid, Spain
| | - Laura Guio Carrión
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Infectiuos Diseases Department, Hospital Universitario de Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Alex Soriano Viladomiu
- Infectiuos Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Laura Morata Ruiz
- Osteoarticular Infections Study Group, Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
- Infectiuos Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Francisco José de Abajo Iglesias
- Clinical Pharmacology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
- Department of Biomedical Sciences (Pharmacology), Universidad de Alcalá (IRYCIS), Alcalá de Henares, Spain
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Rico Nieto A, Loeches Yagüe B, Quiles Melero I, Talavera Buedo G, Pizones J, Fernández-Baillo Sacristana N. [Translated article] Descriptive study of spinal instrumentation-related infections in a tertiary hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T201-T208. [PMID: 38232934 DOI: 10.1016/j.recot.2024.01.007] [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] [Accepted: 08/11/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. MATERIAL AND METHODS We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. RESULTS Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main aetiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimised according to cultures with a mean duration of 12 weeks. CONCLUSIONS In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
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Affiliation(s)
- A Rico Nieto
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain.
| | - B Loeches Yagüe
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, Spain
| | - I Quiles Melero
- Servicio de Microbiología y Parasitología, Hospital Universitario La Paz, Madrid, Spain
| | - G Talavera Buedo
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, Spain
| | - J Pizones
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, Spain
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Rico Nieto A, Loeches Yagüe B, Quiles Melero I, Talavera Buedo G, Pizones J, Fernández-Baillo Sacristana N. Descriptive study of spinal instrumentation-related infections in a tertiary hospital. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:201-208. [PMID: 37690513 DOI: 10.1016/j.recot.2023.08.019] [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: 07/21/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION Spinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. MATERIAL AND METHODS We conducted a retrospective study in our institution (2011-2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. RESULTS Forty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main etiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimized according to cultures with a mean duration of 12 weeks. CONCLUSIONS In early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.
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Affiliation(s)
- A Rico Nieto
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, España.
| | - B Loeches Yagüe
- Unidad de Infecciosas y Microbiología Clínica, Hospital Universitario La Paz, Madrid, España
| | - I Quiles Melero
- Servicio de Microbiología y Parasitología, Hospital Universitario La Paz, Madrid, España
| | - G Talavera Buedo
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | - J Pizones
- Unidad de Raquis, Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
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Lora-Tamayo J, Mancheño-Losa M, Meléndez-Carmona MÁ, Hernández-Jiménez P, Benito N, Murillo O. Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections: A Narrative Review. Antibiotics (Basel) 2024; 13:293. [PMID: 38666969 PMCID: PMC11047716 DOI: 10.3390/antibiotics13040293] [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: 02/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/29/2024] Open
Abstract
Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy.
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Affiliation(s)
- Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
| | - María Ángeles Meléndez-Carmona
- Department of Microbiology, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Pilar Hernández-Jiménez
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica imas12 Hospital 12 de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, 28041 Madrid, Spain; (M.M.-L.); (P.H.-J.)
| | - Natividad Benito
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane 4072, Australia
| | - Oscar Murillo
- Spanish Group for the Study of Bone and Joint Infections, Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain; (N.B.); (O.M.)
- CIBERINFEC—CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL (Instituto de Investigación Biomédica de Bellvitge), 08908 L’Hospitalet de Llobregat, Spain
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Bakalakos M, Vlachos C, Ampadiotaki MM, Stylianakis A, Sipsas N, Pneumaticos S, Vlamis J. Role of Dithiothreitol in Detection of Orthopaedic Implant-Associated Infections. J Pers Med 2024; 14:334. [PMID: 38672961 PMCID: PMC11050915 DOI: 10.3390/jpm14040334] [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: 02/18/2024] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Orthopaedic implant-associated infections (OIAIs) represent a notable complication of contemporary surgical procedures, exerting a considerable impact on patient outcomes and escalating healthcare expenditures. Prompt diagnosis holds paramount importance in managing OIAIs, with sonication widely acknowledged as the preferred method for detecting biofilm-associated infections. Recently, dithiothreitol (DTT) has emerged as a potential substitute for sonication, owing to its demonstrated ability to impede biofilm formation. This study aimed to compare the efficacy of DTT with sonication in identifying microorganisms within implants. Conducted as a prospective cohort investigation, the study encompassed two distinct groups: patients with suspected infections undergoing implant removal (Group A) and those slated for hardware explantation (Group B). Hardware segments were assessed for biofilm-related microorganisms using both sonication and DTT, with a comparative analysis of the two methods. A total of 115 patients were enrolled. In Group A, no statistically significant disparity was observed between DTT and sonication. DTT exhibited a sensitivity of 89.47% and specificity of 96.3%. Conversely, in Group B, both DTT and sonication fluid cultures yielded negative results in all patients. Consequently, this investigation suggests that DTT holds comparable efficacy to sonication in detecting OIAIs, offering a novel, cost-effective, and readily accessible diagnostic modality for identifying implant-associated infections.
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Affiliation(s)
- Matthaios Bakalakos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | - Christos Vlachos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | | | | | - Nikolaos Sipsas
- Department of Pathophysiology, Laiko General Hospital, National and Kapodistrian University of Athens, School of Medicine, 11527 Athens, Greece
| | - Spiros Pneumaticos
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
| | - John Vlamis
- 3rd Orthopaedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (C.V.); (S.P.); (J.V.)
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Jia-Wei H, Jing W, Li C, Xiao-Gang Z, Guo-Qing L, Bo-Yong X, Bao-Chao J, Jun-Jie H, Jun Z. Two-dimensional liquid chromatography measurement of meropenem concentration in synovial fluid of patients with periprosthetic joint infection. Biomed Chromatogr 2024; 38:e5778. [PMID: 38073142 DOI: 10.1002/bmc.5778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/26/2024]
Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication following joint replacement surgery. One potential treatment approach for PJI could be the combination of one-stage revision and intra-articular infusion of antibiotics. Meropenem is one of the commonly used intra-articular antibiotics in our institution. Determining the concentration of meropenem in the joint cavity could be crucial for optimizing its local application, effectively eradicating biofilm infection, and improving PJI treatment outcomes. In this study, we developed a simple, precise, and accurate method of two-dimensional liquid chromatography (2D-LC) for determining the concentration of meropenem in human synovial fluid. The method was then validated based on the guidelines of the Food and Drug Administration and the Chinese Pharmacopoeia. Meropenem showed good linearity in the range of 0.31-25.01 μg/mL (r ≥ .999). Selectivity, intra-day and inter-day precision and accuracy, extraction recovery, and stability validation results were all within the acceptance range. This method has been successfully applied to the determination of synovial fluid samples from PJI patients, providing a useful detection method for meropenem therapeutic drug monitoring (TDM) in PJI patients.
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Affiliation(s)
- He Jia-Wei
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wang Jing
- Department of Pharmacy, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cao Li
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhang Xiao-Gang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Guo-Qing
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xu Bo-Yong
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ji Bao-Chao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huang Jun-Jie
- College of Pharmacy, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhao Jun
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Corona PS, Pérez M, Vicente M, Pujol O, Amat C, Carrera L. Sequential repeated tibial tubercle osteotomy in a two-stage exchange strategy: a superior approach to treating a chronically infected knee arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3347-3355. [PMID: 37079110 PMCID: PMC10651709 DOI: 10.1007/s00590-023-03548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a tibial tubercle osteotomy (TTO) in a two-stage exchange protocol for knee PJI treatment. METHODS Retrospective cohort study examining patients managed with two-stage arthroplasty due to chronic knee PJI (2010-2019). Performance and timing of the TTO were collected. Primary end-point was infection control with a minimum FU of 12 months and according to internationally accepted criteria. Correlation between TTO timing and reinfection rate was reviewed. RESULTS Fifty-two cases were finally included. Overall success (average follow-up: 46.2 months) was 90.4%. Treatment success was significantly higher among cases addressed using TTO during the second stage (97.1% vs. 76.5%, p value 0.03). Only 4.8% of the patients relapsed after performing a sequential repeated TTO, that is, during both first and second stages, compared to 23.1% cases in which TTO was not done (p value 0.28). No complications were observed among patients in the TTO group with a significant decrease in soft tissue necrosis (p: 0.052). CONCLUSION Sequential repeated tibial tubercle osteotomy during a two-stage strategy is a reasonable option and offers high rates of infection control in complex cases of knee PJI with a low rate of complications.
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Affiliation(s)
- Pablo S Corona
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Pérez
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Surgery Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Matías Vicente
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Oriol Pujol
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carles Amat
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Lluís Carrera
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Surgery Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Maurille C, Michon J, Isnard C, Rochcongar G, Verdon R, Baldolli A. Interest in the combination of antimicrobial therapy for orthopaedic device-related infections due to Enterococcus spp. Arch Orthop Trauma Surg 2023; 143:5515-5526. [PMID: 36988713 DOI: 10.1007/s00402-023-04848-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the management of orthopaedic device-related infections (ODRIs) due to Enterococcus spp. MATERIALS AND METHODS We performed a retrospective cohort study in a French tertiary university hospital. Patients with prosthetic joint- or osteosynthesis-associated infections caused by enterococci from 2013 to 2020 were included. Patients who died within 5 days after surgery; who were in palliative care; or who had osteosynthesis of the hand, foot or vertebra were excluded. RESULTS Thirty-six patients were included, with 24 in the arthroplasty group and 12 in the osteosynthesis material group. Most infections were polymicrobial (63.9%, n = 23). Debridement, antibiotics and implant retention (DAIR) was performed in 30.6% (n = 11), withdrawal of material in 16.7% (n = 6), one-stage exchange in 30.6% (n = 11) and two-stage exchange in 22.2% of cases (n = 8). The antibiotic regimen was amoxicillin in 41.6% (n = 15), rifampicin in 27.8% (n = 10), linezolid in 25% (n = 9) and/or fluoroquinolones in 30.6% (n = 11). Clinical success at 1 year was 67% (18/27). The only variable statistically associated with a decreased risk of clinical failure was a duration of antibiotic therapy of 12 weeks (p = 0.04). Patients with a lower body mass index and age tended to decrease the risk of clinical failure (p = 0.05 and 0.06 respectively). CONCLUSIONS The management of enterococcal ODRIs is complex, and ODRI patients are at high risk for relapse. In our small study, a better outcome was not demonstrated for patients with combination therapy and rifampicin use. Further studies are needed to improve the medico-surgical strategy for treating these infections.
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Affiliation(s)
- Charles Maurille
- Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France.
- Normandie Univ, UNICAEN, UNIROUEN, Inserm UMR 1311 DynaMicURe, 14000, Caen, France.
| | - Jocelyn Michon
- Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Christophe Isnard
- Normandie Univ, UNICAEN, UNIROUEN, Inserm UMR 1311 DynaMicURe, 14000, Caen, France
- Microbiology Department, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Goulven Rochcongar
- Orthopaedics and Traumatology Department, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Renaud Verdon
- Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
- Normandie Univ, UNICAEN, UNIROUEN, Inserm UMR 1311 DynaMicURe, 14000, Caen, France
| | - Aurélie Baldolli
- Department of Infectious Diseases, Normandie University, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
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Kato H, Hagihara M, Asai N, Umemura T, Hirai J, Yamagishi Y, Iwamoto T, Mikamo H. Comparison of microbial detection rates in microbial culture methods versus next-generation sequencing in patients with prosthetic joint infection: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:604. [PMID: 37587529 PMCID: PMC10428596 DOI: 10.1186/s13018-023-03973-5] [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: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Accurate diagnosis of prosthetic joint infection (PJI) enables early and effective treatment. However, there is currently no gold standard test for microbial detection of PJI and traditional synovial fluid culture is relatively insensitive. Recently, it has been reported that sonicating fluid culture and next-generation sequencing (NGS) improve microbial detection rates. Hence, we performed a systematic review and meta-analysis to compare microbial detection rates in microbial culture methods with and without sonication versus NGS. METHODS We systematically searched EMBASE, PubMed, Scopus, CINAHL, and Ichushi databases and other sources (previous reviews) until August 2022. We evaluated the detection rates of pathogens in NGS and microbial cultures using samples of synovial or sonicated fluid. RESULTS Of the 170 citations identified for screening, nine studies were included. Pooled analysis indicated that NGS had the highest detection rate among the microbial detection methods (NGS vs. sonicated, odds ratios [OR] 5.09, 95% confidential interval [CI] 1.67-15.50; NGS vs. synovial, OR 4.52, 95% CI 2.86-7.16). Sonicated fluid culture showed a higher detection rate than synovial fluid culture (OR 2.11, 95% CI 1.23-3.62). CONCLUSION NGS might be useful as a screening tool for culture-negative patients. In clinical settings, sonicated fluid culture is a practical method for diagnosing PJI.
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Affiliation(s)
- Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Pharmacy, Mie University Hospital, Mie, Japan
- Division of Clinical Medical Science, Department of Clinical Pharmaceutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, Aichi, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takumi Umemura
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, Mie, Japan
- Division of Clinical Medical Science, Department of Clinical Pharmaceutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
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Ruiz-Sancho A, Núñez-Núñez M, Castelo-Corral L, Martínez-Marcos FJ, Lois-Martínez N, Abdul-Aziz MH, Vinuesa-García D. Dalbavancin as suppressive antibiotic therapy in patients with prosthetic infections: efficacy and safety. Front Pharmacol 2023; 14:1185602. [PMID: 37448966 PMCID: PMC10337584 DOI: 10.3389/fphar.2023.1185602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
Suppressive antibiotic therapy (SAT) is a strategy to alleviate symptoms and/or to reduce the progression of an infection when other treatment options cannot be used. Dalbavancin, due to its prolonged half-life, enables (bi) weekly dosing. Here, we report our multicenter real-life clinical experience with dalbavancin used as SAT in patients with prosthetic joint or vascular infections. Medical records of all adult patients with documented vascular or orthopedic chronic prosthetic infections, who received dalbavancin as SAT between 2016 and 2018 from four Spanish hospitals were reviewed for inclusion. Descriptive analysis of demographic characteristics, Charlson Comorbidity index, Barthel index, isolated pathogens and indication, concomitant antibiotic use, adverse events, and clinical outcome of SAT were performed. Eight patients were eligible for inclusion, where six patients had prosthetic vascular infections (aortic valve) and two patients had knee prosthetic joint infections. The most common pathogens were methicillin-susceptible Staphylococcus aureus and Enterococcus faecium. All patients had a history of prior antibiotic treatment for the prosthetic infection [median duration of antibiotic days 125 days (IQR, 28-203 days)]. The median number of dalbavancin doses was 29 (IQR, 9-61) and concomitant antibiotic use (n = 5, 62.5%). Clinical success was reported in 75% (n = 6) of patients. Adverse events were reported in two patients (mild renal and hepatic impairment). The median estimated cost savings due to the avoided hospital days was €60185 (IQR, 19,916-94984) per patient. Despite the limitations of our study, this preliminary data provides valuable insight to support further evaluation of dalbavancin for SAT in patients with prosthetic infections in the outpatient setting when alternative treatments are not feasible.
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Affiliation(s)
- Andrés Ruiz-Sancho
- Infectious Diseases Department, University Hospital Clinico San Cecilio, Granada, Spain
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
| | - María Núñez-Núñez
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
- Pharmacy Department, University Hospital Clinico San Cecilio, Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Laura Castelo-Corral
- Infectious Diseases Department, University Hospital Complexo A Coruña, A Coruña, Spain
| | | | | | - Mohd Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - David Vinuesa-García
- Infectious Diseases Department, University Hospital Clinico San Cecilio, Granada, Spain
- Biosanitary Research Institute, Ibs Granada, Granada, Spain
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15
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Garrigós C, Rosso-Fernández CM, Borreguero I, Rodríguez P, García-Albea R, Bravo-Ferrer JM, Rodríguez-Baño J, Del Toro MD. Efficacy and safety of different antimicrobial DURATions for the treatment of Infections associated with Osteosynthesis Material implanted after long bone fractures (DURATIOM): Protocol for a randomized, pragmatic trial. PLoS One 2023; 18:e0286094. [PMID: 37216357 DOI: 10.1371/journal.pone.0286094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Infection associated with osteosynthesis material (IOM) is one of the most feared and challenging complications of trauma surgery and can cause significant functional loss, requiring multiple interventions and excessive consumption of antimicrobials. Evidence is needed about the best surgical procedure and the duration of antibiotic treatment according to the age of the implant or onset of infection symptoms, as it considers the biofilm formation and the state of fracture healing. There were not clinical trials evaluating the optimal duration of antibiotic therapy in IOM when implant is retained. Because there are antibiotics that have proven to be effective for the treatment of infection associated to implant, mainly in PJI, these antibiotics could be used in these infections. Investigating whether shorter duration of treatment is a priority in infectious diseases, as a way to reduce the exposure to antibiotics and help in controlling antimicrobial resistance and avoiding unnecessary adverse events and cost. We aim to describe the hypothesis, objectives, design, variables and procedures for a pragmatic randomized controlled trial comparing different durations of antibiotic treatment in IOM after long bone fractures treated with debridement and implant retention. METHODS AND DESIGN This is a multicenter, open-label, non-inferiority, randomized, controlled, pragmatic phase 3 trial, comparing different durations of antibiotic treatment in IOM after long bone fractures treated with debridement and implant retention. Patients with microbiologically confirmed IOM will be included. Eligible patients are those older than 14 years, with early IOM (up to 2 weeks after the implant surgery) and delayed IOM (between 3 and 10 weeks after the implant surgery) with stabilized fracture and absence of bone exposure who sign the informed consent. Randomization will be 1:1 to receive a short-term antibiotic treatment (8 weeks in early IOM and 12 weeks in delayed IOM) or a long-term antibiotic treatment (12 weeks in early IOM or until fracture healing or implant removal in delayed IOM). The antibiotic treatment will be that used in routine practice by the specialist in infectious diseases. The primary outcome is the composited variable "cure" that includes clinical cure, radiological healing, and definitive soft tissue coverage, which will be evaluated in the test of cure at 12 months after the end of antibiotic therapy. Adverse events, resistance development during therapy and functional status will be collected. A total of 364 patients are needed to show a 10% non-inferiority margin, with 80% power and 5% one-sided significance level. DISCUSSION If the hypothesis of non-inferiority of short vs. long antibiotic treatments is demonstrated, and the efficacy of antibiotics with less ecological impact in long treatments, the impact on reduction of bacterial resistance, toxicity and health costs will be observed. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT05294796) on Jan 26th 2022 and at the European Union Drug Regulating Authorities Clinical Trials (EUDRACT) (2021-003914-38) on Jul 16th 2021. The Sponsor Study Code is DURATIOM.
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Affiliation(s)
- Carmen Garrigós
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Sevilla, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Seville, Spain
- Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | | | - Irene Borreguero
- Unidad de Investigación Clínica y Ensayos Clínicos (CTU), Hospital Virgen del Rocío, Sevilla, Spain
| | - Patricia Rodríguez
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Sevilla, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Seville, Spain
- Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - Raquel García-Albea
- Orthopaedic and Trauma Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Jose María Bravo-Ferrer
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Sevilla, Spain
- Department of Medicine, School of Medicine, University of Sevilla, Seville, Spain
- Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María Dolores Del Toro
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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16
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González CGR, Vega ECD, Martínez SDLV, Minero MV, Urbón JMG, Manzorro ÁG, Martínez EFDG, Sacristán SC, Santiago EB, Alonso AH, Paredes PMGD, Sáez MS. A critical view on the current use of daptomycin in Spain: The daptomise study. J Infect Public Health 2023; 16:1115-1122. [PMID: 37220712 DOI: 10.1016/j.jiph.2023.05.008] [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: 02/22/2023] [Revised: 04/20/2023] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The Study on the Clinical Use of DAPTOMycin in Spain (DAPTOMISE Study) is a national surveillance program of daptomycin use. The objectives of this study are to evaluate the current variability in daptomycin consumption across the different hospitals and the adequacy of therapy, specially focused on underdosing. METHODS All adult and pediatric patients who received, at least, one dose of daptomycin in a single week in 98 institutions in Spain were included. The adequacy of daptomycin use was evaluated with respect to the indication, dosage, adjustments after microbiology results, switching to an oral agent and length of treatment. RESULTS A total of 615 patients received daptomycin during the study week. The prevalence use was 2.3 patients / 100,000 inhabitants per week, 12.4 patients / 1000 admissions and 9.2 Days of Therapy (DOT) / 1000 hospital stays. These rates varied between hospitals: from 0 to 13.9 patients / 100,000 inhabitants, from 0 to 76.1 patients / 1000 admissions and from 0 to 49.4 DOT / 1000 hospital stays. The most frequent infections were bacteremia (31.6 %) and skin and soft tissue infections (17.9 %). Microbiological results were available in only 65.4 % of infections. The most frequent microorganisms were Staphylococcus aureus (192 isolates, of which 87 were resistant to methicillin) and coagulase-negative staphylococci (124 isolates). A total of 136 prescriptions (22.1 %) were underdosed. Dosages < 8 mg/kg were used for 35.6 % of endovascular infections and for 26.2 % of osteoarticular infections. Overall, 57.2 % of prescriptions were not optimal in, at least, one item. Clinical cure rate was 76.1% and mortality attributable to the infection 8.1%. CONCLUSION This is the first registry that identifies the prevalence of use of daptomycin in Spain and shows a high variability in the consumption between the different hospitals. Daptomycin underdosing was present in more than 20 % of cases.
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Affiliation(s)
- Carmen Guadalupe Rodríguez González
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Esther Chamorro de Vega
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Sofía De la Villa Martínez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio Minero
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Álvaro Giménez Manzorro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Sara Cobo Sacristán
- Pharmacy Department. Hospital Universitari de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - Emilio Bouza Santiago
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias, CIBERES (CB06/06/0058), Madrid, Spain
| | - Ana Herranz Alonso
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz García de Paredes
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias, CIBERES (CB06/06/0058), Madrid, Spain
| | - María Sanjurjo Sáez
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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17
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Zhang B, Li M, Liu Y, Zhang B, Liu Z, Chen X, Huo J, Han Y. The diagnostic value of blood sample NGS in patients with early periprosthetic joint infection after total hip arthroplasty. Int Wound J 2023; 20:961-970. [PMID: 36054590 PMCID: PMC10030938 DOI: 10.1111/iwj.13943] [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: 07/26/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/27/2022] Open
Abstract
The diagnostic value of next-generation sequencing (NGS) of blood samples from patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA) was evaluated by comparing it with drainage fluid NGS and bacterial culture. The study was designed as a retrospective diagnostic test. Thirty-six infected patients were diagnosed with PJI according to the Musculoskeletal Infection Society (MSIS) criteria and 57 volunteers were included in our study. NGS and bacterial culture were chosen to detect PJI after THA. Blood samples and drainage fluid were collected for NGS, and the drainage fluid, which was collected at the same time as the NGS drainage fluid sample, was used for bacterial culture. The primary outcomes of interest were sensitivity, specificity, and accuracy. In the infection group, 31 patients showed positive results by blood sample NGS, 33 patients showed positive results by drainage fluid NGS, and 17 patients showed positive bacterial culture results. In the control group, the results of 2 blood sample NGS, 16 drainage fluid NGS, and 3 bacterial cultures were positive. The sensitivity, specificity, and accuracy of the blood sample were 0.86, 0.96, and 0.92, respectively. The sensitivity, specificity, and accuracy of the drainage fluid samples were 0.92, 0.72, and 0.80, respectively. The sensitivity, specificity, and accuracy of bacterial culture were 0.47, 0.95, and 0.79, respectively. The study demonstrated that both the sensitivity and specificity of NGS were higher than those of bacterial culture, regardless of the kind of sample. Compared with drainage fluid NGS, the sensitivity of blood sample NGS was slightly lower (0.86 vs 0.92), but blood sample NGS showed higher specificity (0.96 vs 0.72). In total, the diagnostic value of blood sample NGS was superior to that of drainage fluid NGS and bacterial culture. The majority of infected patients could be identified by blood sample NGS. Moreover, because of its high specificity, blood sample NGS can not only detect infectious bacteria but also distinguish infectious from non-infectious bacteria, which is dramatically different from using drainage fluid NGS.
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Affiliation(s)
- Bingshi Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Mengnan Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yawei Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Binquan Zhang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Zeming Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Jia Huo
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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18
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Rottier W, Seidelman J, Wouthuyzen-Bakker M. Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles. ARTHROPLASTY 2023; 5:10. [PMID: 36864531 PMCID: PMC9979546 DOI: 10.1186/s42836-023-00169-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/16/2023] [Indexed: 03/04/2023] Open
Abstract
The antibiotic treatment of periprosthetic joint infections (PJI) is complicated by the presence of biofilm produced by bacteria on the abiotic surface of the implant. Bacteria within the deeper layers of the biofilm become metabolically less active, resulting in antibiotic tolerance due to several mechanisms. This review describes the basic principles of antibiotic treatment in PJI in relation to the behavior of bacteria within the biofilm. The concept of biofilm-active antibiotics will be explained from an in vitro as well as in vivo perspective. Evidence from clinical studies on biofilm-active antibiotics in PJI will be highlighted, mainly focusing on the role of rifampicin for Gram-positive microorganisms and fluoroquinolones for Gram-negative microorganisms. The optimal treatment duration will be discussed as the timing of switching to oral antibiotic therapy.
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Affiliation(s)
- Wouter Rottier
- grid.4830.f0000 0004 0407 1981Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ the Netherlands
| | - Jessica Seidelman
- grid.26009.3d0000 0004 1936 7961Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27708 USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, the Netherlands.
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19
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Khalifa AA, Hussien SM. The promising role of bacteriophage therapy in managing total hip and knee arthroplasty related periprosthetic joint infection, a systematic review. J Exp Orthop 2023; 10:18. [PMID: 36786898 PMCID: PMC9929010 DOI: 10.1186/s40634-023-00586-z] [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: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Total hip and knee arthroplasty periprosthetic joint infection (PJI) poses a management dilemma owing to the emergence of resistant organisms. A promising option is Bacteriophage therapy (BT) was used as an adjuvant for PJI management, aiming at treating resistant infections, decreasing morbidity, and mortality. The current review aimed to demonstrate the role and safety of using BT as an adjuvant to treat PJIs. METHODS A systematic search was performed through four databases (Embase, PubMed, Web of Science, and Scopus) up to March 2022, according to the predetermined inclusion and exclusion criteria. RESULTS Our systematic review included 11 case reports of 13 patients in which 14 joints (11 TKAs and three THAs) were treated. The patients' average age was 73.7 years, underwent an average of 4.5 previous surgeries. The most common organism was the Staphylococcus aureus species. All patients underwent surgical debridement; for the 13 patients, eight received a cocktail, and five received monophage therapy. All patients received postoperative suppressive antibiotic therapy. After an average follow-up of 14.5 months, all patients had satisfactory outcomes. No recurrence of infection in any patient. Transaminitis complicating BT was developed in three patients, needed stoppage in only one, and the condition was reversible and non-life-threatening. CONCLUSION BT is a safe and potentially effective adjuvant therapy for treating resistant and relapsing PJIs. However, further investigations are needed to clarify some BT-related issues to create effective and reproducible therapeutics. Furthermore, new ethical regulations should be implemented to facilitate its widespread use.
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Affiliation(s)
- Ahmed A. Khalifa
- grid.412707.70000 0004 0621 7833Orthopaedic Department, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523 Egypt ,grid.412707.70000 0004 0621 7833Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Sarah M. Hussien
- grid.412707.70000 0004 0621 7833Qena Faculty of Medicine, South Valley University, Qena, Egypt
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20
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Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections: An Urgent Need. Trop Med Infect Dis 2023; 8:tropicalmed8020113. [PMID: 36828529 PMCID: PMC9959361 DOI: 10.3390/tropicalmed8020113] [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: 12/20/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC24h/MIC < 400 mg × h/L, between 400 and 600 mg × h/L and >600 mg × h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure.
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21
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Determination of the Elution Capacity of Dalbavancin in Bone Cements: New Alternative for the Treatment of Biofilm-Related Peri-Prosthetic Joint Infections Based on an In Vitro Study. Antibiotics (Basel) 2022; 11:antibiotics11101300. [PMID: 36289958 PMCID: PMC9598415 DOI: 10.3390/antibiotics11101300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Antibiotic-loaded bone cement is the most widely used approach for the treatment of biofilm-induced septic sequelae in orthopedic surgery. Dalbavancin is a lipoglycopeptide that acts against Gram-positive bacteria and has a long half-life, so we aimed to assess whether it could be a new alternative drug in antibiotic-loaded bone cement for the treatment of periprosthetic joint infections. We assessed the elution capacity of dalbavancin and compared it with that of vancomycin in bone cement. Palacos®R (Heraeus Medical GmbH, Wehrheim, Germany) bone cement was manually mixed with each of the antibiotics studied at 2.5% and 5%. Three cylinders were obtained from each of the mixtures; these were weighed and incubated in 5 mL phosphate-buffered saline at 37°C under shaking for 1 h, 2 h, 4 h, 8 h, 24 h, 48 h, 168 h, and 336 h. PBS was replenished at each time point. The samples were analyzed using high-performance liquid chromatography (vancomycin) and mass cytometry (dalbavancin). Elution was higher than the minimum inhibitory concentration (MIC)90 for both antibiotics after 14 days of study. The release of vancomycin at 14 days was higher than of dalbavancin at each concentration tested (p = 0.05, both). However, the cumulative release of 5% dalbavancin was similar to that of 2.5% vancomycin (p = 0.513). The elution capacity of dalbavancin reached a cumulative concentration similar to that of vancomycin. Moreover, considering that the MIC90 of dalbavancin is one third that of vancomycin (0.06 mg/L and 2 mg/L, respectively) and given the long half-life of dalbavancin, it may be a new alternative for the treatment of biofilm-related periprosthetic infections when loaded in bone cement.
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22
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Bouji N, Wen S, Dietz M. Intravenous antibiotic duration in the treatment of prosthetic joint infection: systematic review and meta-analysis. J Bone Jt Infect 2022; 7:191-202. [PMID: 36267262 PMCID: PMC9562697 DOI: 10.5194/jbji-7-191-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/20/2022] [Indexed: 08/22/2023] Open
Abstract
Introduction: Long antibiotic courses, including intravenous (IV) and oral administrations, are utilized in prosthetic joint infection (PJI) treatment. This meta-analysis examines the non-inferiority of short courses ( < 4 weeks) of IV antibiotics compared to long courses in treating PJI. Critical review of IV treatment is necessary due to the clinical, physical, and financial burden associated with it and its continued prolonged use in the US without much evidence to support the practice. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), databases were searched using predefined medical subject headings (MeSH). Results: The nine included studies reported 521 total hip arthroplasties (THAs) and 530 total knee arthroplasties (TKAs). There was no significant difference in the overall success rate in short- vs. long-duration IV antibiotics for PJI treatment: odds ratio (OR) of 1.65, 95 % confidence interval (CI) of 0.78-3.46, and p = 0 .18. However, due to the moderate to high heterogeneity (I 2 = 68 %, p < 0.01) amongst studies, an adjusted success rate was calculated after the exclusion of two studies. This showed a statistically significant difference between both groups (OR of 2.45, 95 % CI of 1.21-4.96, p < 0.001) favoring a short course of antibiotics and reflecting a more homogenous population (I 2 = 51 %, p = 0 .06). Conclusion: This study highlights the limited data available for evaluating IV antibiotic duration in the setting of PJI. We found that a shorter duration of IV antibiotics was non-inferior to a longer duration, with an improved OR of 2.45 for treatment success, likely shortening inpatient stay as well as lessening side effects and antimicrobial resistance with a lower cost to patients and overall healthcare.
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Affiliation(s)
- Nour Bouji
- Department of Orthopaedics, School of
Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Sijin Wen
- Department of Epidemiology and BioStatistics, School of Public Health, West Virginia University, Morgantown, WV 26506, USA
| | - Matthew J. Dietz
- Department of Orthopaedics, School of
Medicine, West Virginia University, Morgantown, WV 26506, USA
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Casenaz A, Piroth L, Labattut L, Sixt T, Magallon A, Guilloteau A, Neuwirth C, Amoureux L. Epidemiology and antibiotic resistance of prosthetic joint infections according to time of occurrence, a 10-year study. J Infect 2022; 85:492-498. [PMID: 35933039 DOI: 10.1016/j.jinf.2022.07.009] [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: 11/23/2021] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To describe the microorganisms responsible for prosthetic joint infections (PJIs) and their antimicrobial susceptibilities, and to propose appropriate empirical antimicrobial treatments (EATs) according to time of occurrence METHODS: : This 10-year retrospective study presents the bacterial etiology of 282 consecutive PJIs in a French hospital according to time of occurrence (adapted from Zimmerli's classification: early, <3 months; delayed, 3-12 months; late acute, >12 months with hematogenous seeding or contiguous spread; late chronic, >12 months without hematogenous seeding). The expected efficacy of various EATs was analyzed for each PJI. RESULTS Staphylococci were the most commonly found bacteria (S. aureus (44.3%), coagulase-negative staphylococci (25.2%) with 15.2% and 49.3% methicillin resistance respectively), followed by Gram-negative bacilli (GNB) (17.7%) and streptococci (14.9%). The distribution of species varied between categories, but antibiotics targeting GNBs were required in all categories. Imipenem-vancomycin was the most effective combination (99.3%) but should be reserved for patients with suspected resistant GNB. Cefotaxime-vancomycin was less effective in early/delayed and late PJIs (91.1% and 86.1% respectively), due to resistant GNB and polymicrobial infections. Piperacillin/tazobactam-vancomycin appeared to be appropriate in all situations (>96% efficacy). CONCLUSION Proposing universal recommendations remains challenging, but a good understanding of the local epidemiology is important for optimizing EATs.
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Affiliation(s)
- Alice Casenaz
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France
| | - Lionel Piroth
- Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France; INSERM, CIC1432, Clinical Epidemiology unit; Dijon Bourgogne University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical trials unit, Dijon, France
| | - Ludovic Labattut
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Thibault Sixt
- Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France
| | - Arnaud Magallon
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France
| | - Adrien Guilloteau
- Methodological Support Unit, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Catherine Neuwirth
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France
| | - Lucie Amoureux
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France.
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Kobayashi S, Tagawa S, Ogura T, Kitaoka A, Yasu T. Safety of linezolid, rifampicin, and clindamycin combination therapy in patients with prosthetic joint infection. Drug Discov Ther 2022; 16:142-144. [PMID: 35753771 DOI: 10.5582/ddt.2022.01038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated adverse events in patients with prosthetic joint infections receiving combination therapy with linezolid, rifampicin, and clindamycin for ≥ 7 days. Twenty-two patients were evaluated. The combination therapy was administered for 15.5 (7-29) days at dosages of 1200, 450, and 450-1200 mg/day for linezolid, rifampicin, and clindamycin, respectively. Adverse events (gastrointestinal, eye, and skin disorders; liver damage; myelosuppression; hyponatremia, and others) were recorded. The incidence rates of leukopenia, neutropenia, anemia, thrombocytopenia, and hyponatremia were 36.4%, 31.8%, 40.9%, 18.2%, and 18.2%, respectively. Common Terminology Criteria for Adverse Events version 5.0 Grade 3 neutropenia, anemia, and hyponatremia were observed. The incidence rate of myelosuppression was higher following combination therapy compared with that previously reported following single-drug administration. All patients were discharged after the infection was under control. It is important to monitor these adverse events during combination therapy with the aforementioned agents; these conditions may be relieved by discontinuing linezolid.
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Affiliation(s)
| | - Seiji Tagawa
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Takashi Ogura
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Akira Kitaoka
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
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Kherabi Y, Zeller V, Kerroumi Y, Meyssonnier V, Heym B, Lidove O, Marmor S. Streptococcal and Staphylococcus aureus prosthetic joint infections: are they really different? BMC Infect Dis 2022; 22:555. [PMID: 35715754 PMCID: PMC9206280 DOI: 10.1186/s12879-022-07532-x] [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: 02/14/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Staphylococci and streptococci are the most frequent pathogens isolated from prosthetic joint infections (PJIs). The aim of this study was to analyze the outcome of streptococcal and methicillin-susceptible Staphylococcus aureus (MSSA) PJIs. Methods All monomicrobial streptococcal and MSSA PJIs managed in a French Referral Center (2010–2017) were sampled from the prospective PJIs cohort study. The primary outcome of interest was the cumulative reinfection-free survival at a 2-year follow-up. Results Two hundred and nine patients with 91 streptococcal and 132 staphylococcal infections were analyzed. Patients with streptococcal PJI were older, and infection was more frequently hematogenous. Reinfection-free survival rates at 2-years after all treatment strategies were higher for patients with streptococcal PJI (91% vs 81%; P = .012), but differed according to the strategy. After exchange arthroplasty, no outcome differences were observed (89% vs 93%; P = .878); after debridement, antibiotics and implant retention (DAIR), the reinfection-free survival rate was higher for patients with streptococcal PJI (87% vs 60%; P = .062). For patients managed with prolonged suppressive antibiotic therapy (SAT) alone, those with streptococcal PJIs had a 100% infection-free survival (100% vs 31%; P < .0001). Conclusions Reinfection-free survival after DAIR and SAT was better for patients with streptococcal than those with MSSA PJIs. No difference was observed after prosthesis exchange. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07532-x.
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Affiliation(s)
- Yousra Kherabi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France. .,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.,Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.,Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.,Laboratoire des Centres de Santé et Hôpitaux d'Île-de-France, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Olivier Lidove
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France.,Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020, Paris, France
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26
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Esteban J. Microbiologial diagnosis of prosthetic joint infection: Is there a need for standardization? Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Esteban J. Microbiologial diagnosis of prosthetic joint infection: Is there a need for standardization? ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:287-288. [PMID: 35680346 DOI: 10.1016/j.eimce.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, CIBER de Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain.
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A protocol for periprosthetic joint infections from the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands. ARTHROPLASTY 2022; 4:19. [PMID: 35410299 PMCID: PMC8996586 DOI: 10.1186/s42836-022-00116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery. Treatment success depends on accurate diagnostics, adequate surgical experience and interdisciplinary consultation between orthopedic surgeons, plastic surgeons, infectious disease specialists and medical microbiologists. For this purpose, we initiated the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands in 2014. The establishment of a mutual diagnostic and treatment protocol for PJI in our region has enabled mutual understanding, has supported agreement on how to treat specific patients, and has led to clarity for smaller hospitals in our region for when to refer patients without jeopardizing important initial treatment locally. Furthermore, a mutual PJI patient database has enabled the improvement of our protocol, based on medicine-based evidence from our scientific data. In this paper we describe our NINJA protocol. Level of evidence: III
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Le Vavasseur B, Zeller V. Antibiotic Therapy for Prosthetic Joint Infections: An Overview. Antibiotics (Basel) 2022; 11:486. [PMID: 35453237 PMCID: PMC9025623 DOI: 10.3390/antibiotics11040486] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023] Open
Abstract
Prosthetic joint infection (PJI) is a severe complication after arthroplasty. Its management combines surgical intervention, whose type depends on the clinical situation, and prolonged high-dose antibiotics adapted to the responsible microorganism(s) and the patient. Antibiotics are only one part of the therapeutic regimen and are closely related to the surgical strategy. Their efficacy depends to a large extent on the choice and quality of the surgical procedure, and the quality of the microbiological diagnosis. Although guidelines have been published, many aspects of antibiotic therapy remain poorly established. Choosing the optimal agent(s) is one aspect, with others being optimization of drugs' pharmacokinetic/pharmacodynamic parameters, the choice of administration route, use of monotherapy or combination regimens, therapeutic drug-monitoring and patient education to improve compliance and tolerance. Herein, we address PJI management based on recent literature data, guidelines and the experience of our referral center for complex bone-and-joint infections.
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Affiliation(s)
- Benjamin Le Vavasseur
- Referral Center for Complex Bone and Joint Infections, Diaconesses Croix Saint-Simon Hospital, 75020 Paris, France;
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, 75020 Paris, France
| | - Valérie Zeller
- Referral Center for Complex Bone and Joint Infections, Diaconesses Croix Saint-Simon Hospital, 75020 Paris, France;
- Department of Internal Medicine and Infectious Diseases, Diaconesses Croix Saint-Simon Hospital, 75020 Paris, France
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30
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Logoluso N, Pedrini FA, Morelli I, De Vecchi E, Romanò CL, Pellegrini AV. Megaprostheses for the revision of infected hip arthroplasties with severe bone loss. BMC Surg 2022; 22:68. [PMID: 35216567 PMCID: PMC8876444 DOI: 10.1186/s12893-022-01517-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 01/14/2023] Open
Abstract
Background Periprosthetic hip infections with severe proximal femoral bone loss may require the use of limb salvage techniques, but no agreement exists in literature regarding the most effective treatment. Aim of this study is to analyze the infection eradication rate and implant survival at medium-term follow-up in patients treated with megaprostheses for periprosthetic hip infections with severe bone loss. Methods Twenty-one consecutive patients were retrospectively reviewed at a mean 64-month follow-up (24–120). Functional and pain scores, microbiological, radiological and intraoperative findings were registered. Kaplan Meier survival analysis and log rank test were used for infection free survival and implant survival analyses. Results The infection eradication rate was 90.5%, with an infection free survival of 95.2% at 2 years (95%CI 70.7–99.3) and 89.6%(95%CI 64.3–97.3) at 5 years. Only two patients required major implant revisions for aseptic implant loosening. The most frequent complication was dislocation (38.1%). The major revision-free survival of implants was 95.2% (95%CI 70.7–99.3) at 2 years and 89.6% (95%CI 64.3–97.3) at 5 years. The overall implant survival was 83.35% (CI95% 50.7–93.94) at 2 and 5 years. Subgroup analyses (cemented versus cementless MPs, coated versus uncoated MPs) revealed no significant differences at log rank test, but its reliability was limited by the small number of patients included. Conclusions Proximal femoral arthroplasty is useful to treat periprosthetic hip infections with severe bone loss, providing good functional results with high infection eradication rates and rare major revisions at medium-term follow-up. No conclusions can be drawn on the role of cement and coatings.
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Affiliation(s)
- Nicola Logoluso
- IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections (C.R.I.O. Unit), via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Francesca Alice Pedrini
- Residency Program in Orthopaedics and Traumatology, University of Milan, via Festa del Perdono 7, 20122, Milan, Italy
| | - Ilaria Morelli
- ASST Ovest Milanese, Ospedale di Legnano, UOC Ortopedia e Traumatologia, via Papa Giovanni Paolo II, 20025, Legnano, MI, Italy.
| | - Elena De Vecchi
- IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, via Riccardo Galeazzi 4, 20161, Milan, Italy
| | | | - Antonio Virgilio Pellegrini
- IRCCS Istituto Ortopedico Galeazzi, Centre for Reconstructive Surgery and Osteoarticular Infections (C.R.I.O. Unit), via Riccardo Galeazzi 4, 20161, Milan, Italy
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García-García J, Azuara G, Fraile-Martinez O, García-Montero C, Álvarez-Mon MA, Ruíz-Díez S, Álvarez-Mon M, Buján J, García-Honduvilla N, Ortega MA, De la Torre B. Modification of the Polymer of a Bone Cement with Biodegradable Microspheres of PLGA and Loading with Daptomycin and Vancomycin Improve the Response to Bone Tissue Infection. Polymers (Basel) 2022; 14:polym14050888. [PMID: 35267711 PMCID: PMC8912454 DOI: 10.3390/polym14050888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 12/13/2022] Open
Abstract
Chronic infections are one of the most serious adverse outcomes of prosthetic surgery. Prosthetic revision surgery using a bone cement loaded with antibiotics between the two stages of the surgery is commonly performed. However, this method often fails to reach the minimum inhibitory concentration and promotes antibiotic resistance, thus emphasizing the need for improving the current available therapies. MATERIALS AND METHODS In this study, we performed a study of the in vivo response of a polymer-based construct of poly (lactic-co-glycolic acid) (PLGA) in the solid phase of Palacos R® in combination with vancomycin, daptomycin, and/or linezolid. To test its effectiveness, we applied an in vivo model, using both histological and immunohistochemical analyses to study the bone tissue. RESULTS The presence of PLGA in the combination of vancomycin with daptomycin showed the most promising results regarding the preservation of bone cytoarchitecture and S. aureus elimination. Conversely, the combination of vancomycin plus linezolid was associated with a loss of bone cytoarchitecture, probably related to an increased macrophage response and inefficient antimicrobial activity. CONCLUSIONS The modification of Palacos R® bone cement with PLGA microspheres and its doping with the antibiotic daptomycin in combination with vancomycin improve the tissue response to bone infection.
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Affiliation(s)
- Joaquin García-García
- Service of Orthopedic Surgery of University Hospital Principe de Asturias, 28805 Alcalá de Henares, Madrid, Spain;
| | - Galo Azuara
- Service of Traumatology of University Hospital of Guadalajara, 19002 Guadalajara, Spain;
| | - Oscar Fraile-Martinez
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Cielo García-Montero
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel Angel Álvarez-Mon
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Sara Ruíz-Díez
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
| | - Melchor Álvarez-Mon
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, University Hospital Príncipe de Asturias, (CIBEREHD), 28806 Alcala de Henares, Spain
| | - Julia Buján
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Natalio García-Honduvilla
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
| | - Miguel A. Ortega
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain; (O.F.-M.); (C.G.-M.); (M.A.Á.-M.); (S.R.-D.); (M.Á.-M.); (J.B.); (N.G.-H.)
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid, Spain
- Correspondence:
| | - Basilio De la Torre
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain;
- Service of Traumatology of University Hospital Ramón y Cajal, 28034 Madrid, Spain
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1344-1352. [DOI: 10.1093/jac/dkac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
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Ferry T, Kolenda C, Briot T, Souche A, Lustig S, Josse J, Batailler C, Pirot F, Medina M, Leboucher G, Laurent F. Past and Future of Phage Therapy and Phage-Derived Proteins in Patients with Bone and Joint Infection. Viruses 2021; 13:v13122414. [PMID: 34960683 PMCID: PMC8708067 DOI: 10.3390/v13122414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/29/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Phage-derived therapies comprise phage therapy and the use of phage-derived proteins as anti-bacterial therapy. Bacteriophages are natural viruses that target specific bacteria. They were proposed to be used to treat bacterial infections in the 1920s, before the discovery and widespread over-commercialized use of antibiotics. Phage therapy was totally abandoned in Western countries, whereas it is still used in Poland, Georgia and Russia. We review here the history of phage therapy by focusing on bone and joint infection, and on the development of phage therapy in France in this indication. We discuss the rationale of its use in bacterial infection and show the feasibility of phage therapy in the 2020s, based on several patients with complex bone and joint infection who recently received phages as compassionate therapy. Although the status of phage therapy remains to be clarified by health care authorities, obtaining pharmaceutical-grade therapeutic phages (i.e., following good manufacturing practice guidelines or being “GMP-like”) targeting bacterial species of concern is essential. Moreover, multidisciplinary clinical expertise has to determine what could be the relevant indications to perform clinical trials. Finally “phage therapy 2.0” has to integrate the following steps: (i) follow the status of phage therapy, that is not settled and defined; (ii) develop in each country a close relationship with the national health care authority; (iii) develop industrial–academic partnerships; (iv) create academic reference centers; (v) identify relevant clinical indications; (vi) use GMP/GMP-like phages with guaranteed quality bioproduction; (vii) start as salvage therapy; (vii) combine with antibiotics and adequate surgery; and (viii) perform clinical trials, to finally (ix) demonstrate in which clinical settings phage therapy provides benefit. Phage-derived proteins such as peptidoglycan hydrolases, polysaccharide depolymerases or lysins are enzymes that also have anti-biofilm activity. In contrast to phages, their development has to follow the classical process of medicinal products. Phage therapy and phage-derived products also have a huge potential to treat biofilm-associated bacterial diseases, and this is of crucial importance in the worldwide spread of antimicrobial resistance.
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Affiliation(s)
- Tristan Ferry
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
- StaPath Team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69008 Lyon, France
- Correspondence:
| | - Camille Kolenda
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
- StaPath Team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69008 Lyon, France
| | - Thomas Briot
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
| | - Aubin Souche
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
- StaPath Team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69008 Lyon, France
| | - Sébastien Lustig
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
| | - Jérôme Josse
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
- StaPath Team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69008 Lyon, France
| | - Cécile Batailler
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
| | - Fabrice Pirot
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Laboratoire de Recherche et Développement de Pharmacie Galénique Industrielle, Faculté de Pharmacie, EA 4169 “Fonctions Physiologiques et Pathologiques de la Barrière Cutanée”, Université Claude-Bernard Lyon 1, 8, Avenue Rockefeller, CEDEX 08, 69373 Lyon, France
| | - Mathieu Medina
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
| | - Gilles Leboucher
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
| | - Frédéric Laurent
- Hospices Civils de Lyon, 69004 Lyon, France; (C.K.); (T.B.); (A.S.); (S.L.); (J.J.); (C.B.); (F.P.); (M.M.); (G.L.); (F.L.)
- Université Claude Bernard Lyon 1, 69100 Villeurbanne, France
- Centre de Références des IOA Complexes de Lyon, CRIOAc Lyon, 69004 Lyon, France
- StaPath Team, Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, 69008 Lyon, France
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Basile G, Gallina M, Passeri A, Gaudio RM, Castelnuovo N, Ferrante P, Calori GM. Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics. J Orthop Traumatol 2021; 22:44. [PMID: 34751836 PMCID: PMC8578522 DOI: 10.1186/s10195-021-00607-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Prosthetic joint infections (PJI) represent one of the major problems in orthopedic prosthetic surgery. The incidence of PJIs varies according to the site of intervention, and different published case studies report occurrence at 0.5 to 3.0% in the event of first implants, with a significant greater risk in the case of prosthesis revisions. The diagnosis of prosthetic infections is seldom simple, needing a multi-specialist approach, which includes the accurate collection of patient anamnesis, its clinical evaluation, the evaluation of inflammation biomarkers, and the use of imaging techniques. It is essential to identify the bacteria responsible for the infection not only for an accurate diagnosis, but also to select the correct antibiotic treatment. Failure to identify the bacteria involved makes it impossible to establish targeted systemic antibiotic therapy. In developed countries such as Italy, the right to health is guaranteed by the Constitution, where the institutions that provide health services must be staffed by a team of medical professionals that can guarantee the safest possible health pathways. Risk management represents the set of actions aimed at improving the quality of the care provided, the adherence to guidelines and good care practices with the final objective of guaranteeing patients' safety. All hospitals, including the ones where prosthetic orthopedic surgery is performed, must adopt clinical risk management procedures which, through prospective tools aimed at preventing errors and complications and by retrospective methods, permit the identification of critical points in the different phases of the process and propose actions for improvement. The constant increase in litigation for malpractice in Western countries, especially in Italy, calls for special attention to the problem of PJIs and the in-depth assessment of medico-legal problems, also considering the new legislative initiatives in the field of medical malpractice. Hospitals need to tackle the onset of PJIs in a transparent and linear fashion by constantly informing the patient on their progress.
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Affiliation(s)
- Giuseppe Basile
- Trauma Surgery IRCCS Orthopaedic Institute Galeazzi, Piazza Tricolore 2, 20129 Milano, Italy
| | - Mario Gallina
- Trauma Surgery IRCCS Orthopaedic Institute Galeazzi, Piazza Tricolore 2, 20129 Milano, Italy
| | | | - Rosa Maria Gaudio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | | | - Pasquale Ferrante
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giorgio Maria Calori
- Department of Reconstructive and Prothesic Revision-Surgery and Sepsis, San Gaudenzio Clinic-High Speciality Institute, Novara, Italy
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Bourbotte-Salmon F, Ferry T, Cardinale M, Servien E, Rongieras F, Fessy MH, Bertani A, Laurent F, Buffe-Lidove M, Batailler C, Lustig S. Rotating Hinge Knee Arthroplasty for Revision Prosthetic-Knee Infection: Good Functional Outcomes but a Crucial Need for Superinfection Prevention. Front Surg 2021; 8:551814. [PMID: 34616767 PMCID: PMC8488173 DOI: 10.3389/fsurg.2021.551814] [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: 05/14/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Management of chronic infection following total knee arthroplasty (TKA) is challenging. Rotating hinged prostheses are often required in this setting due to severe bone loss, ligamentous insufficiency, or a combination of the two. The nature of the mechanical and septic complications occurring in this setting has not been well-described. The aim of this study was to evaluate patient outcomes using a hinge knee prosthesis for prosthetic knee infections and to investigate risk factors for implant removal. Methods: This was a retrospective cohort study that included all patients treated in our tertiary level referral center between January 2009 and December 2016 for prosthetic knee infection with a hinge knee prosthesis. Only patients with a minimum 2-year of follow-up were included. Functional evaluation was performed using international knee society (IKS) "Knee" and "Function" scores. Survival analysis comparing implant removal risks for mechanical and septic causes was performed using Cox univariate analysis and Kaplan-Meier curves. Risk factors for implant removal and septic failure were assessed. Results: Forty-six knees were eligible for inclusion. The majority of patients had satisfactory functional outcomes as determined by mean IKS scores (mean knee score: 70.53, mean function score: 46.53 points, and mean knee flexion: 88.75°). The 2-year implant survival rate was 89% but dropped to 65% at 7 years follow-up. The risk of failure (i.e., implant removal) was higher for septic etiology compared to mechanical causes. Patients with American society of anesthesiologists (ASA) score>1, immunosuppression, or with peripheral arterial diseases had a higher risk for septic failure. Patients with acute infection according to the Tsukayamaclassification had a higher risk of failure. Of the 46 patients included, 19 (41.3%) had atleast one infectious event on the surgical knee and most of these were superinfections (14/19) with new pathogens isolated. Among pathogens responsible for superinfections (i) cefazolin and gentamicin were both active in six of the cases but failed to prevent the superinfection; (ii) cefazolin and/or gentamicin were not active in eight patients, leading to alternative systemic and/or local antimicrobial prophylaxis consideration. Conclusions: Patients with chronic total knee arthroplasty (TKA) infection, requiring revision using rotating hinge implant, had good functional outcomes but experienced a high rate of septic failure, mostly due to bacterial superinfection. These patients may need optimal antimicrobial systemic prophylaxis and innovative approaches to reduce the rate of superinfection.
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Affiliation(s)
| | - Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Mickaël Cardinale
- Department of Anesthesiology and Intensive Care, Hôpital d'Instruction des Armées Saint-Anne, Toulon, France
| | - Elvire Servien
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
| | - Frédéric Rongieras
- Department of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Michel-Henry Fessy
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Traumatologic surgery, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Antoine Bertani
- Department of Orthopaedic and Traumatologic Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix Rousse, Lyon, France
| | - Margaux Buffe-Lidove
- Department of Physical and Rehabilitation Medicine, Hôpital d'Instruction des Armées Desgenettes, Lyon, France
| | - Cécile Batailler
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department of Orthopaedic and Sport Surgery, Hôpital de la Croix Rousse, Lyon, France
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Mancheño-Losa M, Lora-Tamayo J, Fernández-Sampedro M, Rodríguez-Pardo D, Muñoz-Mahamud E, Soldevila L, Palou M, Barbero JM, Del Toro MD, Iribarren JA, Sobrino B, Rico-Nieto A, Guío-Carrión L, Gómez L, Escudero-Sánchez R, García-País MJ, Jover-Sáenz A, Praena J, Baraia-Etxaburu JM, Auñón Á, Múñez-Rubio E, Murillo O. Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort. J Infect 2021; 83:542-549. [PMID: 34509512 DOI: 10.1016/j.jinf.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/14/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. METHODS A retrospective, observational, multicenter study was performed during 2007-2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. RESULTS 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3-13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03-12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91-7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90-6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. CONCLUSION Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
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Affiliation(s)
- Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid.
| | - Marta Fernández-Sampedro
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Dolors Rodríguez-Pardo
- Department of Infectious Diseases, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Laura Soldevila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Mariona Palou
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Sabadell, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - José María Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María Dolores Del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, University of Seville, Institute of Biomedicine of Seville (IBiS), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, IIS BioDonostia, San Sebastián, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Beatriz Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alicia Rico-Nieto
- Department of Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Laura Guío-Carrión
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Lucía Gómez
- Department of Infectious Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Rosa Escudero-Sánchez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María José García-País
- Department of Infectious Diseases, Hospital Universitario Lucus Augusti, Lugo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Julia Praena
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Josu Miren Baraia-Etxaburu
- Department of Infectious Diseases, Hospital Universitario de Basurto, Bilbao, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Álvaro Auñón
- Department of Orthopedics and Trauma Surgery, Hospital Universitario Fundación Jiménez-Díaz, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid
| | - Elena Múñez-Rubio
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid
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He JW, Wang J, Cao L, Zhang XG, Li GQ, Xu BY, Ji BC, Ge SY, Yang JH. Serum and Synovial Vancomycin Concentrations in Patients with Prosthetic Joint Infection after Intra-articular Infusion. Eur J Drug Metab Pharmacokinet 2021; 46:637-643. [PMID: 34275127 DOI: 10.1007/s13318-021-00705-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Vancomycin is one of the most commonly used antibiotics for intra-articular (IA) infusion in the treatment of prosthetic joint infection (PJI). This study aimed to preliminarily investigate the serum and synovial vancomycin concentrations in patients with PJI after IA infusion. METHODS In total, 16 patients who developed PJI were enrolled in this study; 14 of the patients were treated with IA infusion of vancomycin postoperatively, while the other 2 patients received intravenous (IV) infusion of vancomycin alone. Chemiluminescent immunoassay assay (CLIA) and high-performance liquid chromatography (HPLC) were used to determine the serum and synovial vancomycin concentrations, respectively. RESULTS Administration of vancomycin 0.5 g once daily (qd) IA maintained a high vancomycin trough concentration in synovial fluid before the next IA dose, regardless of whether it was given in combination with IV administration. The combination vancomycin 0.5 g qd IA + vancomycin 1 g every 12 h (q12h) IV yielded relatively good trough concentrations of vancomycin in both serum and synovial fluid. The mean trough serum vancomycin concentration of patients who used vancomycin 1 g q12h IV therapy was above 10 μg/mL; however, no vancomycin was detected in their synovial fluid. CONCLUSIONS The rational use of IA vancomycin infusion may help to achieve effective therapeutic concentrations of vancomycin in the serum and synovial fluid of patients with PJI.
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Affiliation(s)
- Jia-Wei He
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyu Mountain Road, Urumqi, 830054, Xinjiang, China
| | - Jing Wang
- Department of Pharmacy, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Xiao-Gang Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Guo-Qing Li
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Bo-Yong Xu
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Bao-Chao Ji
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Si-Ya Ge
- College of Pharmacy, Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Jian-Hua Yang
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, No. 137 South Liyu Mountain Road, Urumqi, 830054, Xinjiang, China.
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Dalbavancin for the Treatment of Prosthetic Joint Infections: A Narrative Review. Antibiotics (Basel) 2021; 10:antibiotics10060656. [PMID: 34072670 PMCID: PMC8227288 DOI: 10.3390/antibiotics10060656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 01/18/2023] Open
Abstract
Dalbavancin (DAL) is a lipoglycopeptide with bactericidal activity against a very wide range of Gram-positive microorganisms. It also has unique pharmacokinetic properties, namely a prolonged half-life (around 181 h), which allows a convenient weekly dosing regimen, and good diffusion in bone tissue. These features have led to off-label use of dalbavancin in the setting of bone and joint infection, including prosthetic joint infections (PJI). In this narrative review, we go over the pharmacokinetic and pharmacodynamic characteristics of DAL, along with published in vitro and in vivo experimental models evaluating its activity against biofilm-embedded bacteria. We also examine published experience of osteoarticular infection with special attention to DAL and PJI.
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Low prevalence of tissue detection of cefepime and daptomycin used as empirical treatment during revision for periprosthetic joint infections: results of a prospective multicenter study. Eur J Clin Microbiol Infect Dis 2021; 40:2285-2294. [PMID: 34014434 DOI: 10.1007/s10096-021-04277-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Data demonstrating that antibiotics administered intraoperatively in patients with surgical revision for periprosthetic joint infection achieve concentrations exceeding minimal inhibitory concentrations of the identified bacteria at the surgical site when the new implant is inserted are lacking. We prospectively included patients with periprosthetic joint infection operated with one- or two-stage replacement during which cefepime (2g)-daptomycin (10mg/kg) combination was administered intravenously as intraoperative empirical antibiotic treatment. Three biopsies (two bones and one synovial membrane) were taken from each patient just before the insertion of the new implant. Eighteen adults of median age 68 years were included. Knee was involved in 10 patients (55.6%) and surgery consisted in one-/two-stage replacement in 11/7 patients. A tourniquet was used during the intervention in the 10 patients with knee prosthesis. Among 54 tissue samples, cefepime and daptomycin were detected respectively in 35 (64.8%) and 21 (38.9%) cases (P=0.01). A total of 17 bacteria dominated by staphylococci (n=14) were identified in 10 patients; tissue inhibitory quotient calculated in 51 samples was >1 in 22 cases (43.1%) for cefepime and in 16 cases (31.4%) for daptomycin. The proportion of tissue samples with detectable antibiotic was significantly higher in hip versus knee prosthesis (P=0.03). The present study suggests that intraoperative empirical administration of cefepime-daptomycin combination during septic prosthetic joint replacement results in a high proportion of tissue samples in which at least one of the two antibiotics was not detected or at a low concentration despite satisfactory concomitant blood serum concentrations.
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Ferry T, Batailler C, Souche A, Cassino C, Chidiac C, Perpoint T, le Corvaisier C, Josse J, Gaillard R, Roger J, Kolenda C, Lustig S, Laurent F. Arthroscopic "Debridement and Implant Retention" With Local Administration of Exebacase (Lysin CF-301) Followed by Suppressive Tedizolid as Salvage Therapy in Elderly Patients for Relapsing Multidrug-Resistant S. epidermidis Prosthetic Knee Infection. Front Med (Lausanne) 2021; 8:550853. [PMID: 34055817 PMCID: PMC8163228 DOI: 10.3389/fmed.2021.550853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Exebacase, a recombinantly produced lysin has recently (i) reported proof-of-concept data from a phase II study in S. aureus bacteremia and (ii) demonstrated antibiofilm activity in vitro against S. epidermidis. In patients with relapsing multidrug-resistant (MDR) S. epidermidis prosthetic knee infection (PKI), the only surgical option is prosthesis exchange. In elderly patients who have undergone several revisions, prosthesis explantation could be associated with definitive loss of function and mortality. In our BJI reference regional center, arthroscopic debridement and implant retention with local administration of exebacase (LysinDAIR) followed by suppressive tedizolid as salvage therapy is proposed for elderly patients with recurrent MDR S. epidermidis PKI with no therapeutic option or therapeutic dead end (for whom revision or transfemoral amputation is not feasible and no other oral option is available). Each use was decided in agreement with the French health authority and in accordance with the local ethics committee. A written consent was obtained for each patient. Exebacase (75 mg/mL; 30 mL) was administered directly into the joint during arthroscopy. Four patients (79-89 years old) were treated with the LysinDAIR procedure. All had several previous prosthetic knee revisions without prosthesis loosening. Three had relapsing PKI despite suppressive antibiotics following open DAIR. Two had clinical signs of septic arthritis; the two others had sinus tract. After the LysinDAIR procedure, no adverse events occurred during arthroscopy; all patients received daptomycin 8 mg/kg and linezolid 600 mg bid (4-6 weeks) as primary therapy, followed by tedizolid 200 mg/day as suppressive therapy. At 6 months, recurrence of the sinus tract occurred in the two patients with sinus tract at baseline. After >1 year follow up, the clinical outcome was favorable in the last two patients with total disappearance of clinical signs of septic arthritis even if microbiological persistence was detected in one of them. Exebacase has the potential to be used in patients with staphylococci PKI during arthroscopic DAIR as salvage therapy to improve the efficacy of suppressive antibiotics and to prevent major loss of function.
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Affiliation(s)
- Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Cécile Batailler
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Aubin Souche
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cara Cassino
- ContraFect Corporation, Yonkers, NY, United States
| | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Thomas Perpoint
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Josse
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Romain Gaillard
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Julien Roger
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Camille Kolenda
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence Pour la Prise en Charge des Infections Ostéo-Articulaires Complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de Bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Ferry T, Kolenda C, Batailler C, Gaillard R, Gustave CA, Lustig S, Fevre C, Petitjean C, Leboucher G, Laurent F. Case Report: Arthroscopic "Debridement Antibiotics and Implant Retention" With Local Injection of Personalized Phage Therapy to Salvage a Relapsing Pseudomonas Aeruginosa Prosthetic Knee Infection. Front Med (Lausanne) 2021; 8:569159. [PMID: 34026768 PMCID: PMC8132876 DOI: 10.3389/fmed.2021.569159] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 03/18/2021] [Indexed: 12/16/2022] Open
Abstract
Bacteriophages are viruses that specifically target bacteria. They are considered to have a high potential in patients with prosthetic joint infection (PJI), as they have a synergistic anti-biofilm activity with antibiotics. We report here the case of an 88-year-old man (63 kg) with relapsing Pseudomonas aeruginosa prosthetic knee infection. The patient had severe alteration of the general status and was bedridden with congestive heart failure. As prosthesis explantation and/or exchange was not feasible, we proposed to this patient the use of phage therapy to try to control the disease in accordance with the local ethics committee and the French National Agency for Medicines and Health Products Safety (ANSM). Three phages, targeting P. aeruginosa, were selected based on their lytic activity on the patient's strain (phagogram). Hospital pharmacist mixed extemporaneously the active phages (initial concentration 1 ml of 1 × 1010 PFU/ml for each phage) to obtain a cocktail of phages in a suspension form (final dilution 1 × 109 PFU/ml for both phages). Conventional arthroscopy was performed and 30 cc of the magistral preparation was injected through the arthroscope (PhagoDAIR procedure). The patient received intravenous ceftazidime and then oral ciprofloxacin as suppressive antimicrobial therapy. Under this treatment, the patient rapidly improved with disappearance of signs of heart failure and pain of the left knee. During the follow-up of 1 year, the local status of the left knee was normal, and its motion and walking were unpainful. The present case suggests that the PhagoDAIR procedure by arthroscopy has the potential to be used as salvage therapy for patients with P. aeruginosa relapsing PJI, in combination with suppressive antimicrobial therapy. A Phase II clinical study deserves to be performed to confirm this hypothesis.
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Affiliation(s)
- Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Camille Kolenda
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cécile Batailler
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Romain Gaillard
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Claude-Alexandre Gustave
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | | | - Gilles Leboucher
- Service de Pharmacie Hospitalière, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, Ecole Normale Supérieure de Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de référence des staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Le Maréchal M, Cavalli Z, Batailler C, Gonzalez JF, Ferreira A, Lustig S, Ferry T, Courjon J. Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization. BMC Infect Dis 2021; 21:401. [PMID: 33933020 PMCID: PMC8088082 DOI: 10.1186/s12879-021-06075-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. RESULTS Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90-92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. CONCLUSIONS Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
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Affiliation(s)
- Marion Le Maréchal
- Centre Hospitalier de Grenoble, Grenoble, France
- Université de Grenoble-Alpes, Grenoble, France
| | - Zoé Cavalli
- Hôpital de Mercy, Centre Hospitalier Régional de Metz-Thionville, Ars-Laquenexy, France
| | | | - Jean-François Gonzalez
- Université Côte d'Azur, Nice, France
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France
| | - André Ferreira
- Société Française de chirurgie de la hanche et du genou, Paris, France
| | | | - Tristan Ferry
- Claude Bernard University Lyon 1, Villeurbanne, France
- CRIOAc Lyon, Lyon, France
| | - Johan Courjon
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France.
- Infectiologie, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France.
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Escolà-Vergé L, Rodríguez-Pardo D, Corona PS, Pigrau C. Candida Periprosthetic Joint Infection: Is It Curable? Antibiotics (Basel) 2021; 10:antibiotics10040458. [PMID: 33920619 PMCID: PMC8073246 DOI: 10.3390/antibiotics10040458] [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: 03/15/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023] Open
Abstract
Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable.
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Affiliation(s)
- Laura Escolà-Vergé
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Correspondence: ; Tel.: +34-932-746-090; Fax: +34-934-894-091
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
| | - Pablo S. Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain; (D.R.-P.); (C.P.)
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), 28003 Madrid, Spain
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Staphylococcus aureus Internalization in Osteoblast Cells: Mechanisms, Interactions and Biochemical Processes. What Did We Learn from Experimental Models? Pathogens 2021; 10:pathogens10020239. [PMID: 33669789 PMCID: PMC7922271 DOI: 10.3390/pathogens10020239] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Bacterial internalization is a strategy that non-intracellular microorganisms use to escape the host immune system and survive inside the human body. Among bacterial species, Staphylococcus aureus showed the ability to interact with and infect osteoblasts, causing osteomyelitis as well as bone and joint infection, while also becoming increasingly resistant to antibiotic therapy and a reservoir of bacteria that can make the infection difficult to cure. Despite being a serious issue in orthopedic surgery, little is known about the mechanisms that allow bacteria to enter and survive inside the osteoblasts, due to the lack of consistent experimental models. In this review, we describe the current knowledge about S. aureus internalization mechanisms and various aspects of the interaction between bacteria and osteoblasts (e.g., best experimental conditions, bacteria-induced damages and immune system response), focusing on studies performed using the MG-63 osteoblastic cell line, the best traditional (2D) model for the study of this phenomenon to date. At the same time, as it has been widely demonstrated that 2D culture systems are not completely indicative of the dynamic environment in vivo, and more recent 3D models—representative of bone infection—have also been investigated.
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Corona PS, Vicente M, Carrera L, Rodríguez-Pardo D, Corró S. Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. Bone Joint J 2020; 102-B:1682-1688. [PMID: 33249903 DOI: 10.1302/0301-620x.102b12.bjj-2020-0792.r1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. METHODS A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better. RESULTS A total of 162 chronic PJIs were included in the study. After a mean follow-up of 57.3 months (12.1 to 115.7), 18 patients (11.1%) did not undergo reimplantation, due either to medical issues (10), the patient's choice (4), or death (4). When only considering those who underwent reimplantation, the success rate was 80.6%. However, when those who did not undergo reimplantation were included, the success rate dropped to 71.6%. Advanced age, American Society of Anesthesiologists grade ≥ III, McPherson's C host, and Gram-negative related PJI were independent risk factors for retention of the spacer. The mortality was higher in the non-reimplanted group. CONCLUSION The real success rate of two-stage revision may not be as high as previously reported. The exclusion of patients who do not undergo reimplantation resulted in a 9% overestimation of the success rate in this series. Many comorbidity-related risk factors for retention of the spacer were identified, as well as higher death rates in this group. Efforts should be made to optimize these patients medically in order to increase reimplantation and success rates, while decreasing mortality. Cite this article: Bone Joint J 2020;102-B(12):1682-1688.
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Affiliation(s)
- Pablo S Corona
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Carrera
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Rodríguez-Pardo
- Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Infectious Diseases Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sebastián Corró
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Mur I, Jordán M, Rivera A, Pomar V, González JC, López-Contreras J, Crusi X, Navarro F, Gurguí M, Benito N. Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study. Antibiotics (Basel) 2020; 9:antibiotics9120872. [PMID: 33291401 PMCID: PMC7762011 DOI: 10.3390/antibiotics9120872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. METHODS In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THA), total knee arthroplasties (TKA) and partial hip arthroplasty (PHA) were analysed separately. RESULTS A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26-7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12-13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01-9.20; p = 0.047). CONCLUSIONS Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.
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Affiliation(s)
- Isabel Mur
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
| | - Marcos Jordán
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Alba Rivera
- Department of Microbiology, Hospital Santa Creu i Sant Pau, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; (A.R.); (F.N.)
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - José Carlos González
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Joaquín López-Contreras
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
| | - Xavier Crusi
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (M.J.); (J.C.G.); (X.C.)
| | - Ferran Navarro
- Department of Microbiology, Hospital Santa Creu i Sant Pau, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain; (A.R.); (F.N.)
| | - Mercè Gurguí
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Natividad Benito
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau–Institut d’Investigació Biomèdica Sant Pau, 08025 Barcelona, Spain; (I.M.); (V.P.); (J.L.-C.); (M.G.)
- Department of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), 28003 Madrid, Spain
- Correspondence: ; Tel.: +34-93-556-56-24; Fax: +34-93-553-71-40
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Ferry T, Kolenda C, Batailler C, Gustave CA, Lustig S, Malatray M, Fevre C, Josse J, Petitjean C, Chidiac C, Leboucher G, Laurent F. Phage Therapy as Adjuvant to Conservative Surgery and Antibiotics to Salvage Patients With Relapsing S. aureus Prosthetic Knee Infection. Front Med (Lausanne) 2020; 7:570572. [PMID: 33304911 PMCID: PMC7701306 DOI: 10.3389/fmed.2020.570572] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To report the management of three consecutive patients with relapsing Staphylococcus aureus prosthetic knee infection (PKI) for whom explantation was not feasible who received a phage therapy during a “Debridement Antibiotics and Implant Retention” (DAIR) procedure followed by suppressive antimicrobial therapy. Methods: Each case was discussed individually in our reference center and with the French National Agency (ANSM). The lytic activity of three phages targeting S. aureus, which was produced with a controlled and reproducible process, was assessed before surgery (phagogram). A hospital pharmacist extemporaneously assembled the phage cocktail (1 ml of 1 × 1010 PFU/ml for each phage) as “magistral” preparation (final dilution 1 × 109 PFU/ml), which was administered by the surgeon directly into the joint, after the DAIR procedure and joint closure (PhagoDAIR procedure). Results: Three elderly patients were treated with the PhagoDAIR procedure. Phagograms revealed a high susceptibility to at least two of the three phages. During surgery, all patients had poor local conditions including pus in contact to the implant. After a prolonged follow-up, mild discharge of synovial fluid persisted in two patients, for whom a subsequent DAIR was performed showing only mild synovial inflammation without bacterial persistence or super-infection. The outcome was finally favorable with a significant and impressive clinical improvement of the function. Conclusions: The PhagoDAIR procedure has the potential to be used as salvage for patients with relapsing S. aureus PKI, in combination with suppressive antibiotics to avoid considerable loss of function. This report provides preliminary data supporting the setup of a prospective multicentric clinical trial.
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Affiliation(s)
- Tristan Ferry
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Camille Kolenda
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Cécile Batailler
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Claude-Alexandre Gustave
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Matthieu Malatray
- Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Josse
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | | | - Christian Chidiac
- Service des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Gilles Leboucher
- Service de Pharmacie Hospitalière, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- Université Claude Bernard Lyon 1, Lyon, France.,Centre interrégional de Référence pour la prise en charge des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,CIRI - Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France.,Institut des Agents Infectieux, Laboratoire de bactériologie, Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
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Marmor S, Kerroumi Y, Meyssonnier V, Lhotellier L, Mouton A, Graff W, Zeller V. One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy. Front Med (Lausanne) 2020; 7:540929. [PMID: 33178708 PMCID: PMC7596676 DOI: 10.3389/fmed.2020.540929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/08/2020] [Indexed: 01/03/2023] Open
Abstract
Background: Prosthetic hip infection (PHI) is a disastrous scenario after an arthroplasty. International guidelines contraindicate one-stage exchange arthroplasty for fistulizing chronic prosthetic hip infection (FCPHI), nevertheless few surgical teams, mostly from Europe, support one stage procedure for this indication. Questions/Purposes: Analysis of infection recurrence and implant failure of a series of FCPHIs treated with one stage arthroplasty. Patients and Methods: Sixty-six FCPHIs treated with one-stage exchange arthroplasty were prospectively followed up at least 2 years. Clinical, radiological and bacteriological signs suggestive of reinfection were sought, as well as implant failures and PHI related deaths. Results: Thirty-four females and thirty-two males with median age of 69.5 years [61–77] and BMI of 26 kg/m2 [22-31] were included. Fistulae were productive in 50 patients (76%). Staphylococcus was responsible for 45% of PHI and 21% were polymicrobial. Twenty-nine patients (44%) received preoperative antibiotic therapy. After a median 60-month follow-up [35–82], 3 patients (4.5%) presented reinfection (two new infections, one relapse) and 3 patients experienced implant failure (1 femoral fracture, 1 stem breakage, 1 recurrent dislocation). One death was related to PHI. After a minimum of 2 years, the infection control rate was of 95.3% (±0.02). Conclusion: One-stage exchange arthroplasty for FCPHIs showed a good infection control rate similar to that of non-fistulizing PHI. Systematic preoperative microbiological documentation with joint aspiration and, in some specific cases, the use of preoperative antibiotic therapy are among the optimizations accounting for the success of the one-stage arthroplasty. In light of these results, and those of other studies, international recommendations could evolve. Level of Evidence: Descriptive therapeutic prospective cohort study. Level of evidence: IV.
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Affiliation(s)
- Simon Marmor
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, Paris, France.,Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Younes Kerroumi
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, Paris, France.,Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Vanina Meyssonnier
- Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Luc Lhotellier
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, Paris, France.,Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Antoine Mouton
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, Paris, France.,Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Wilfrid Graff
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, Paris, France.,Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
| | - Valérie Zeller
- Referral Center for Osteoarticular Infections, Diaconesses Croix Saint-Simon Hospital, Paris, France
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49
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Muñoz-Gallego I, Viedma E, Esteban J, Mancheño-Losa M, García-Cañete J, Blanco-García A, Rico A, García-Perea A, Ruiz Garbajosa P, Escudero-Sánchez R, Sánchez Somolinos M, Marín Arriaza M, Romanyk J, Barbero JM, Arribi Vilela A, González Romo F, Pérez-Jorge C, M. Arana D, Monereo A, Domingo D, Cordero J, Sánchez Romero MI, García Viejo MÁ, Lora-Tamayo J, Chaves F. Genotypic and Phenotypic Characteristics of Staphylococcus aureus Prosthetic Joint Infections: Insight on the Pathogenesis and Prognosis of a Multicenter Prospective Cohort. Open Forum Infect Dis 2020; 7:ofaa344. [PMID: 33005695 PMCID: PMC7519778 DOI: 10.1093/ofid/ofaa344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is the leading cause of prosthetic joint infection (PJI). Beyond the antibiogram, little attention has been paid to the influence of deep microbiological characteristics on patient prognosis. Our aim was to investigate whether microbiological genotypic and phenotypic features have a significant influence on infection pathogenesis and patient outcome. METHODS A prospective multicenter study was performed, including all S. aureus PJIs (2016-2017). Clinical data and phenotypic (agr functionality, β-hemolysis, biofilm formation) and genotypic characteristics of the strains were collected. Biofilm susceptibility to antimicrobials was investigated (minimal biofilm eradication concentration [MBEC] assay). RESULTS Eighty-eight patients (39.8% men, age 74.7 ± 14.1 years) were included. Forty-five had early postoperative infections (EPIs), 21 had chronic infections (CPIs), and 19 had hematogenous infections (HIs). Twenty (22.7%) were caused by methicillin-resistant S. aureus. High genotypic diversity was observed, including 16 clonal complexes (CCs), with CC5 being the most frequent (30.7%). agr activity was greater in EPI than CPI (55.6% vs 28.6%; P = .041). Strains causing EPI were phenotypically and genotypically similar, regardless of symptom duration. Treatment failure (36.5%) occurred less frequently among cases treated with implant removal. In cases treated with debridement and implant retention, there were fewer failures among those who received combination therapy with rifampin. No genotypic or phenotypic characteristics predicted failure, except vancomycin minimal inhibitory concentration ≥1.5 mg/L (23.1% failure vs 3.4%; P = .044). MBEC50 was >128 mg/L for all antibiotics tested and showed no association with prognosis. CONCLUSIONS S. aureus with different genotypic backgrounds is capable of causing PJI, showing slight differences in clinical presentation and pathogenesis. No major microbiological characteristics were observed to influence the outcome, including MBEC.
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Affiliation(s)
- Irene Muñoz-Gallego
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Esther Viedma
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Sevilla, Spain
| | - Jaime Esteban
- Servicio de Microbiología, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Mikel Mancheño-Losa
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Joaquín García-Cañete
- Servicio de Medicina Interna-Urgencias, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Antonio Blanco-García
- Servicio de Medicina Interna-Urgencias, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Alicia Rico
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
| | | | - Patricia Ruiz Garbajosa
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Sevilla, Spain
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rosa Escudero-Sánchez
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Sevilla, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mar Sánchez Somolinos
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín Arriaza
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain
| | - Juan Romanyk
- Servicio de Microbiología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - José María Barbero
- Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ana Arribi Vilela
- Servicio de Microbiología, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Conchita Pérez-Jorge
- Servicio de Microbiología, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - David M. Arana
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Alfonso Monereo
- Servicio de Medicina Interna, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Diego Domingo
- Servicio de Microbiología, Hospital Universitario de La Princesa, Madrid, Spain
| | - José Cordero
- Servicio de Traumatología, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Jaime Lora-Tamayo
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Sevilla, Spain
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Fernando Chaves
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Sevilla, Spain
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Pall E, Roman A. Lactoferrin Functionalized Biomaterials: Tools for Prevention of Implant-Associated Infections. Antibiotics (Basel) 2020; 9:E522. [PMID: 32824241 PMCID: PMC7459815 DOI: 10.3390/antibiotics9080522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Tissue engineering is one of the most important biotechnologies in the biomedical field. It requires the application of the principles of scientific engineering in order to design and build natural or synthetic biomaterials feasible for the maintenance of tissues and organs. Depending on the specific applications, the selection of the proper material remains a significant clinical concern. Implant-associated infection is one of the most severe complications in orthopedic implant surgeries. The treatment of these infections is difficult because the surface of the implant serves not only as a substrate for the formation of the biofilm, but also for the selection of multidrug-resistant bacterial strains. Therefore, a promising new approach for prevention of implant-related infection involves development of new implantable, non-antibiotic-based biomaterials. This review provides a brief overview of antimicrobial peptide-based biomaterials-especially those coated with lactoferrin.
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Affiliation(s)
- Emoke Pall
- Life Science Institute, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca 400372, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania;
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