1
|
Longo UG, Lalli A, Bandini B, Angeletti S, Lustig S, Budhiparama NC. The influence of gut microbiome on periprosthetic joint infections: State-of-the art. J ISAKOS 2024; 9:353-361. [PMID: 38272392 DOI: 10.1016/j.jisako.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Early periprosthetic joint infection constitutes one of the most frightening complications of joint replacement. Recently, some evidence has highlighted the potential link between dysregulation of the gut microbiota and degenerative diseases of joints. It has been hypothesized that microbiome dysbiosis may increase the risk of periprosthetic joint infection by facilitating bacterial translocation from these sites to the bloodstream or by impairing local or systemic immune responses. Although the processes tying the gut microbiome to infection susceptibility are still unknown, new research suggests that the presurgical gut microbiota-a previously unconsidered component-may influence the patient's ability to resist infection. Exploring the potential impact of the microbiome on periprosthetic joint infections may therefore bring new insights into the pathogenesis and therapy of these disorders. For a successful therapy, a proper surgical procedure in conjunction with an antibacterial concept is essential. As per the surgical approach, different treatment strategies include surgical irrigation, debridement, antibiotic therapy, and implant retention with or without polyethylene exchange. Other alternatives could be one-stage or two-stage revisions surgery. Interventions that either directly target gut microbes as well as interventions that modify the composition and/or function of the commensal microbes represent an innovative and potentially successful field to be explored. In recent times, innovative therapeutic methods have arisen in the realm of microbiome restoration and the management of gut-related ailments. These progressive approaches offer fresh perspectives on tackling intricate microbial imbalances in the gastrointestinal tract. These emerging therapies signify a shift towards more precise and individualized approaches to microbiome restoration and the management of gut-related disorders. Once a more advanced knowledge of the pathways linking the gut microbiota to musculoskeletal tissues is gained, relevant microbiome-based therapies can be developed. If dysbiosis is proven to be a significant contributor, developing treatments for dysbiosis may represent a new frontier in the prevention of periprosthetic joint infections.
Collapse
Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Benedetta Bandini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Silvia Angeletti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy.
| | - Sebastien Lustig
- Orthopaedic Department, Lyon North University Hospital, Hôpital de La Croix Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France.
| | - Nicolaas Cyrillus Budhiparama
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Unversitas Airlangga, Jl. Mayjend. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia; Department of Orthopaedics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.
| |
Collapse
|
2
|
Suardi V, Baroni D, Shahein AHA, Morena V, Logoluso N, Mangiavini L, Pellegrini AV. Microbiology of Prosthetic Joint Infections: A Retrospective Study of an Italian Orthopaedic Hospital. Antibiotics (Basel) 2024; 13:399. [PMID: 38786128 PMCID: PMC11117340 DOI: 10.3390/antibiotics13050399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
The most frequent cause of periprosthetic infections (PJIs) is intraoperative contamination; hence, antibiotic prophylaxis plays a crucial role in prevention. Modifications to standard prophylaxis can be considered if there is a high incidence of microorganisms resistant to current protocols. To date, very few studies regarding microbial etiology have been published in Italy. In this single-center, retrospective study conducted at IRCCS Ospedale Galeazzi-Sant'Ambrogio in Milan, we analyzed hip, knee, and shoulder PJIs in patients undergoing first implantation between 1 January 17 and 31 December 2021. The primary aim was to derive a local microbiological case history. The secondary aim was to evaluate the adequacy of preoperative antibiotic prophylaxis in relation to the identified bacteria. A total of 57 PJIs and 65 pathogens were identified: 16 S. aureus, 15 S. epidermidis, and 10 other coagulase-negative staphylococci (CoNS), which accounted for 63% of the isolations. A total of 86.7% of S. epidermidis were methicillin-resistant (MRSE). In line with other case reports, we found a predominance of staphylococcal infections, with a lower percentage of MRSA than the Italian average, while we found a high percentage of MRSE. We estimated that 44.6% of the bacteria isolated were resistant to cefazolin, our standard prophylaxis. These PJIs could be prevented by using glycopeptide alone or in combination with cefazolin, but the literature reports conflicting results regarding the adequacy of such prophylaxis. In conclusion, our study showed that in our local hospital, our standard antibiotic prophylaxis is ineffective for almost half of the cases, highlighting the importance of defining specific antibiotic guidelines based on the local bacterial prevalence of each institution.
Collapse
Affiliation(s)
- Virginia Suardi
- IRCCS Ospedale Galeazzi–Sant’Ambrogio, 20157 Milan, Italy; (V.S.); (N.L.); (A.V.P.)
| | - Daniele Baroni
- Department of Orthopedics and Traumatology, Alessandro Manzoni Hospital, 23900 Lecco, Italy;
| | | | - Valentina Morena
- Infectious Disease Unit, Alessandro Manzoni Hospital, 23900 Lecco, Italy;
| | - Nicola Logoluso
- IRCCS Ospedale Galeazzi–Sant’Ambrogio, 20157 Milan, Italy; (V.S.); (N.L.); (A.V.P.)
| | - Laura Mangiavini
- IRCCS Ospedale Galeazzi–Sant’Ambrogio, 20157 Milan, Italy; (V.S.); (N.L.); (A.V.P.)
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | | |
Collapse
|
3
|
Eriksson HK, Lazarinis S, Järhult JD, Hailer NP. Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin. Antibiotics (Basel) 2023; 12:1589. [PMID: 37998791 PMCID: PMC10668653 DOI: 10.3390/antibiotics12111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
It is unknown how rifampicin resistance in staphylococci causing a periprosthetic joint infection (PJI) affects outcomes after debridement, antibiotics, and implant retention (DAIR). We thus aimed to compare the risk of relapse in DAIR-treated early PJI caused by staphylococci with or without rifampicin resistance. In total, 81 patients affected by early PJI were included, and all patients were treated surgically with DAIR. This was repeated if needed. The endpoint of relapse-free survival was estimated using the Kaplan-Meier method, and Cox regression models were fitted to assess the risk of infection relapse for patients infected with rifampicin-resistant bacteria, adjusted for age, sex, type of joint, and type of index surgery. In patients with rifampicin-resistant staphylococci, relapse was seen in 80% after one DAIR procedure and in 70% after two DAIR procedures. In patients with rifampicin-sensitive bacteria, 51% had an infection relapse after one DAIR procedure and 33% had an infection relapse after two DAIR procedures. Patients with rifampicin-resistant staphylococcal PJI thus had an increased adjusted risk of infection relapse of 1.9 (95% CI: 1.1-3.6, p = 0.04) after one DAIR procedure compared to patients with rifampicin-sensitive bacteria and a 4.1-fold (95% CI: 1.2-14.1, p = 0.03) increase in risk of infection relapse after two DAIR procedures. Staphylococcal resistance to rifampicin is associated with inferior outcomes after DAIR. These findings suggest that DAIR may not be a useful strategy in early PJI caused by rifampicin-resistant staphylococci.
Collapse
Affiliation(s)
- Hannah K. Eriksson
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
| | - Stergios Lazarinis
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
| | - Josef D. Järhult
- Zoonosis Science Center, Department of Medical Sciences, Uppsala University, 751 83 Uppsala, Sweden;
| | - Nils P. Hailer
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, 751 83 Uppsala, Sweden; (S.L.); (N.P.H.)
| |
Collapse
|
4
|
Murphy CA, Bowler PG, Chowdhury MF. 'Granulitis': defining a common, biofilm-induced, hyperinflammatory wound pathology. J Wound Care 2023; 32:22-28. [PMID: 36630113 DOI: 10.12968/jowc.2023.32.1.22] [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: 01/12/2023]
Abstract
The hard-to-heal (chronic) wound condition, now believed to be inextricably linked to the presence of microbial biofilm, has posed challenges in translating scientific understanding to clinical practice in recent decades. During this time, multiple descriptive terms of the wound pathology have been described, including critical colonisation, biofilm infection and inflammatory stasis. However, the absence of naming this disease state as a specifically identified condition that is tangible to treat has led to some confusion and delay in possible therapeutic approaches. When there is clinical uncertainty of wound status, antibiotics are too often inappropriately administered as a precaution. We therefore propose that introducing the term 'granulitis' (inflamed, unhealthy granulation tissue) could be used to identify the biofilm-induced, persistent inflammatory wound condition. This will help to raise clinician and public awareness of the condition, guide appropriate and prompt local wound hygiene, and encourage allocation of adequate resources to improve wound healing outcomes globally.
Collapse
Affiliation(s)
| | | | - M Fahad Chowdhury
- The Ottawa Hospital, Ottawa, ON, Canada.,Department of Medicine, Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
5
|
Spichler-Moffarah A, Rubin LE, Bernstein JA, O'Bryan J, McDonald E, Golden M. Prosthetic Joint Infections of the Hip and Knee Among the Elderly: A Retrospective Study. Am J Med 2023; 136:100-107. [PMID: 36063860 DOI: 10.1016/j.amjmed.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking. METHODS We compared clinical characteristics, management, and mortality of patients <75 vs ≥75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019. RESULTS Ninety-eight patients (<75 years of age [n = 63]; ≥75 years of age (n = 35) were studied. Groups were similar in terms of etiology, culture-directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those aged ≥75 years. Readmission related to prosthetic joint infection occurred less often in older individuals (P = .005). Deaths within 1 year of diagnosis were rare (n = 4; 4.1%), occurring in older patients and resulting mostly from sepsis. CONCLUSION In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients ≥75 years of age. Although deaths were rare, 1-year mortality was higher in patients aged ≥75. Prospective, multicenter studies are needed to explore risk factors and management strategies of prosthetic joint infection among elderly populations.
Collapse
Affiliation(s)
- Anne Spichler-Moffarah
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Lee E Rubin
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jenna A Bernstein
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jane O'Bryan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Conn; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Conn
| | - Erik McDonald
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Marjorie Golden
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| |
Collapse
|
6
|
Ometti M, Delmastro E, Salini V. Management of prosthetic joint infections: a guidelines comparison. Musculoskelet Surg 2022; 106:219-226. [PMID: 34989981 DOI: 10.1007/s12306-021-00734-7] [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: 03/21/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the last decade, the number of prosthetic joint replacements has been rising each year and this growing trend is related to the increased number of prosthetic joint infections (PJI). As PJI represent a devastating condition for the patient, physicians must identify the best treatment option for each case. Guidelines are not always clear regarding the most appropriate therapy pathway as they differ in many parameters. MATERIALS AND METHODS Aim of this article is to compare the different indications as reported by four major Academic Societies: the Infectious Disease Society of America, the American Academy of Orthopaedic Surgeons, and the Musculoskeletal Infection Society (MSIS) which published the guideline in partnership with the European Bone And Joint Infection Society. CONCLUSIONS PJI Guidelines differ in many parameters, therefore the choice of treatment for each case does not appear immediate; it would be desirable that, in the next few years, new scientific evidence will help clarify the indications of the most effective therapeutic protocols for PJI to determine the ultimate surgical strategy for every single patient.
Collapse
Affiliation(s)
- M Ometti
- Department of Orthopaedics and Traumatology, San Raffaele Hospital, Milan, Italy
| | - E Delmastro
- Vita-Salute San Raffaele University, Milan, Italy.
| | - V Salini
- Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
7
|
The reasons for and mortality of patients unable to receive reimplantation after resection arthroplasty for chronic hip periprosthetic infection. INTERNATIONAL ORTHOPAEDICS 2021; 46:465-472. [PMID: 34746981 DOI: 10.1007/s00264-021-05254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Two-stage exchange arthroplasty is a feasible treatment for chronic PJI (periprosthetic joint infection) of total hip arthroplasty (THA). However, there are large numbers of patients who are unable to ultimately receive reimplantation after resection arthroplasty owing to uncontrolled infection and multiple comorbidities. The purpose of the current study was to identify patient-related risk factors and reasons for being unable to undergo revision THA. METHODS Individuals undergoing resection arthroplasty for chronic PJI treatment from 2013 to 2020 at our institution were retrospectively reviewed. A variety of patient comorbidities, laboratory data, isolated pathogens, and follow-up status were collected for analysis. RESULTS A total of 84 patients (46 men and 38 women) with a 2.7 ± 2.1-year follow-up were analyzed. Thirty-eight (45.2%) patients eventually underwent revision THA, while the other 46 (54.8%) did not receive reimplantation during follow-up. The patients without receiving reimplantation had higher Charlson comorbidity index (CCI) score (3.1 ± 2.9 versus 1.2 ± 1.5; p = 0.001). Lower cumulative incidence of receiving reimplantation was observed in patients with chronic kidney disease (log-rank test, p = 0.019), anemia (p = 0.011), presence of initial fever (p = 0.030), and oxacillin-resistant strain infection (p = 0.030). The most common reasons for not receiving reimplantation were uncontrolled infection, unstable medical conditions, and death. The patients without reimplantation had a relatively higher mortality rate (log-rank test, p = 0.002). CONCLUSION Chronic hip PJI with poor medical conditions or oxacillin-resistant strain infection decreased the chance of undergoing revision surgery. These patients had unfavourable outcomes and a higher mortality rate after resection arthroplasty.
Collapse
|
8
|
Paz Z, Zhu C, Lieber SB, Fowler ML, Shmerling RH. Presentation and Outcomes of Peri-Prosthetic Joint Infection: A Comparison of Culture-Positive and Culture-Negative Disease. Surg Infect (Larchmt) 2021; 22:828-835. [PMID: 33689447 DOI: 10.1089/sur.2020.302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Peri-prosthetic joint infection (PJI) is a debilitating and costly complication of joint replacement. Synovial fluid cultures are negative in up to 25% of PJI cases. The purpose of this study was to compare the clinical characteristics and outcomes of culture negative and culture positive PJI. Patients and Methods: We conducted a retrospective study including all patients aged 18 and older admitted to a single tertiary-care hospital between 1998 and 2015 diagnosed with PJI and treated with antibiotic agents and surgery. Results: One hundred ninety-six patients with PJI were identified; 48 (24.5%) were culture-negative (CN) and 148 (75.5%) were culture-positive (CP). The groups were similar in age and presence of associated comorbidities. Fever was more common among the CP patients (CN, 23.8%; CP, 38.4%; p = 0.03) as was sepsis defined by Sepsis-2 criteria (CN, 12.8%; CP, 28.7%; p = 0.03). Patients who were CP had higher synovial white blood cell (WBC) count (CN, 30,500 per milliliter; CP, 95,400 per milliliter; p < 0.01), a longer length of stay (CN, 3.8%; CP,7.9%; p = 0.02), and fewer alternative diagnoses established within one year (CN, 25.0%; CP, 2.7%; p < 0.01). Our logistic regression models also found that CP patients had an adjusted odds ratio (OR) of 2.59 for rehabilitation placement with 95% confidence interval (CI) of 1.15-5.83 and adjusted OR of 0.04 for an alternative diagnosis within one year with 95% CI, 0.009-0.22 compared with their CN counterparts. Conclusions: This study suggests that patients with CN PJI have less severe disease, better outcomes, and higher rates of alternative diagnoses within one year.
Collapse
Affiliation(s)
- Ziv Paz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Clara Zhu
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sarah B Lieber
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | | |
Collapse
|
9
|
Sosa BR, Niu Y, Turajane K, Staats K, Suhardi V, Carli A, Fischetti V, Bostrom M, Yang X. 2020 John Charnley Award: The antimicrobial potential of bacteriophage-derived lysin in a murine debridement, antibiotics, and implant retention model of prosthetic joint infection. Bone Joint J 2020; 102-B:3-10. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1590.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims Current treatments of prosthetic joint infection (PJI) are minimally effective against Staphylococcus aureus biofilm. A murine PJI model of debridement, antibiotics, and implant retention (DAIR) was used to test the hypothesis that PlySs2, a bacteriophage-derived lysin, can target S. aureus biofilm and address the unique challenges presented in this periprosthetic environment. Methods The ability of PlySs2 and vancomycin to kill biofilm and colony-forming units (CFUs) on orthopaedic implants were compared using in vitro models. An in vivo murine PJI model of DAIR was used to assess the efficacy of a combination of PlySs2 and vancomycin on periprosthetic bacterial load. Results PlySs2 treatment reduced 99% more CFUs and 75% more biofilm compared with vancomycin in vitro. A combination of PlySs2 and vancomycin in vivo reduced the number of CFUs on the surface of implants by 92% and in the periprosthetic tissue by 88%. Conclusion PlySs2 lysin was able to reduce biofilm, target planktonic bacteria, and work synergistically with vancomycin in our in vitro models. A combination of PlySs2 and vancomycin also reduced bacterial load in periprosthetic tissue and on the surface of implants in a murine model of DAIR treatment for established PJI. Cite this article: Bone Joint J 2020;102-B(7 Supple B):3–10.
Collapse
Affiliation(s)
| | - YingZhen Niu
- Hospital for Special Surgery, New York, New York, USA
- Hebei Medical University Third Affiliated Hospital, Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | | | - Kevin Staats
- Hospital for Special Surgery, Department of Orthopedics and Trauma Surgery, New York, New York, USA
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Vienna, Austria
| | | | - Alberto Carli
- Hospital for Special Surgery, New York, New York, USA
| | | | | | - Xu Yang
- Hospital for Special Surgery, New York, New York, USA
| |
Collapse
|
10
|
Wimmer MD, Hischebeth GTR, Randau TM, Gathen M, Schildberg FA, Fröschen FS, Kohlhof H, Gravius S. Difficult-to-treat pathogens significantly reduce infection resolution in periprosthetic joint infections. Diagn Microbiol Infect Dis 2020; 98:115114. [PMID: 32712505 DOI: 10.1016/j.diagmicrobio.2020.115114] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/17/2023]
Abstract
Periprosthetic joint infection (PJI) is a feared complication after arthroplasty. Our hypothesis was that PJI caused by difficult-to-treat (DTT) pathogens has a worse outcome compared with non-DTT PJI. Routine clinical data on 77 consecutive patients with confirmed PJI treated with 2-stage exchange arthroplasty were placed in DTT and non-DTT PJI groups and analyzed. The main outcome variable was that the patient was definitively free of infection after 2 years. We found definitive infection resolution in 31 patients in the DTT group (68.9%) and 28 patients (87.5%) in the non-DTT group (P < 0.05). The necessity for revision surgery until assumed resolution of infection was significantly more frequent in the DTT group with 4.72 ± 3.03 operations versus 2.41 ± 3.02 operations in the non-DTT group (P < 0.05). PJI caused by DTT bacteria is associated with significantly higher numbers of revision operations and significantly inferior definitive infection resolution.
Collapse
Affiliation(s)
- Matthias D Wimmer
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Gunnar T R Hischebeth
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany.
| | - Thomas M Randau
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Martin Gathen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank A Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank S Fröschen
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Hendrik Kohlhof
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Sascha Gravius
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of the University of Heidelberg, Mannheim, Germany
| |
Collapse
|
11
|
Becker A, Kreitmann L, Triffaut-Fillit C, Valour F, Mabrut E, Forestier E, Lesens O, Cazorla C, Descamps S, Boyer B, Chidiac C, Lustig S, Montbarbon E, Batailler C, Ferry T. Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with a debridement, antibiotics and implant retention (DAIR): a retrospective multicenter study in France. J Bone Jt Infect 2020; 5:28-34. [PMID: 32117687 PMCID: PMC7045531 DOI: 10.7150/jbji.40333] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/12/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction: In patients undergoing a « debridement, antibiotics, and implant retention » (DAIR) procedure for acute staphylococcal prosthetic joint infection (PJI), post-operative treatment with rifampin has been associated with a higher probability of success.(1,2) However, it is not known whether it is the total dose, delay of introduction or length of therapy with rifampin that is most strongly associated with the observed improved outcomes. Methods: A multicentric, retrospective cohort study of patients with acute staphylococcal hip and knee PJI treated with DAIR between January 2011 and December 2016. Failure of the DAIR procedure was defined as persistent infection, need for another surgery or death. We fitted logistic and Cox regression multivariate models to identify predictors of DAIR failure. We compared Kaplan-Meier estimates of failure probability in different levels of the 3 variables of interest - total dose, delay of introduction or length of therapy with rifampin - with the log-rank test. Results: 79 patients included (median age 71 years [63.5-81]; 55 men [70%]), including 54 (68%) DAIR successes and 25 (32%) DAIR failures. Patients observed for a median of 435 days [IQR 107.5-834]. Median ASA score significantly lower in DAIR successes than in DAIR failures (2 vs. 3, respectively p = 0.011). Bacterial cultures revealed 65 (82.3%) S. aureus and 16 (20.3%) coagulase negative staphylococci, with 2 patients being infected simultaneously with S. aureus and CNS. Among S. aureus isolates, 7 (10.8%) resistant to methicillin; 2 (3.1 %) resistant to rifampin. Median duration of antimicrobial therapy was 85 days [IQR 28.5-97.8]. Fifty-eight patients (73.4%) received rifampin at a median dose of 14.6 mg/kg/day |IQR 13-16.7], started at a median delay of 8.5 days [IQR, 4-7.5] after debridement surgery. Twenty-one patients (26.6%) developed a drug-related adverse event, leading to rifampin interruption in 6 of them (7.6% of total cohort). Determinants of DAIR failure were rifampin use (HR 0.17, IC [0.06, 0.45], p-value <0.001), association of rifampin with a fluoroquinolone (HR 0.19, IC [0.07, 0.53], p-value = 0.002) and duration of rifampin therapy (HR 0.97, IC [0.95, 1], p-value = 0.022). We did not observe a significant difference between DAIR successes and failures in rifampin use, dose and delay of introduction. In a multivariate Cox model, only duration of rifampin therapy was significantly associated with DAIR failure. Kaplan Meier estimate of DAIR failure probability was significantly higher in patients receiving less than 14 days of rifampin in comparison with those receiving more than 14 days of rifampin (p = 0.0017). Conclusion: Duration of rifampin therapy is a key determinant of improved outcomes in early-onset acute prosthetic joint infection due to Staphylococcus treated with DAIR.
Collapse
Affiliation(s)
- A Becker
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France).,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France)
| | - L Kreitmann
- Service de Réanimation Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - C Triffaut-Fillit
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France).,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France)
| | - F Valour
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France).,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France).,Université Claude Bernard Lyon 1, Lyon, France.,Inserm U1111, Centre international de recherche en Infectiologie (CIRI), Université Claude-Bernard Lyon 1, Lyon, France
| | - E Mabrut
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France)
| | - E Forestier
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Métropole Savoie, Chambéry (France)
| | - O Lesens
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) Gabriel Montpied, Clermont-Ferrand (France)
| | - C Cazorla
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de Saint-Etienne (France)
| | - S Descamps
- Service de Chirurgie Orthopédique, Centre hospitalier universitaire (CHU) Gabriel Montpied, Clermont-Ferrand (France)
| | - B Boyer
- Service de Chirurgie Orthopédique, Centre hospitalier universitaire (CHU) de Saint-Etienne (France)
| | - C Chidiac
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France).,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France).,Université Claude Bernard Lyon 1, Lyon, France
| | - S Lustig
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France).,Université Claude Bernard Lyon 1, Lyon, France.,Service de Chirurgie Orthopédique, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France)
| | - E Montbarbon
- Service de Chirurgie Orthopédique, Centre hospitalier Métropole Savoie, Chambéry (France)
| | - C Batailler
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France).,Université Claude Bernard Lyon 1, Lyon, France.,Service de Chirurgie Orthopédique, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France)
| | - T Ferry
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier universitaire (CHU) de la Croix Rousse, Hospices Civils de Lyon (HCL), Lyon (France).,Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc) de Lyon (France).,Université Claude Bernard Lyon 1, Lyon, France.,Inserm U1111, Centre international de recherche en Infectiologie (CIRI), Université Claude-Bernard Lyon 1, Lyon, France
| |
Collapse
|
12
|
Yan CH, Arciola CR, Soriano A, Levin LS, Bauer TW, Parvizi J. Team Approach: The Management of Infection After Total Knee Replacement. JBJS Rev 2019; 6:e9. [PMID: 29664872 DOI: 10.2106/jbjs.rvw.17.00058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chun Hoi Yan
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Spain
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Ratka C, Weigl P, Henrich D, Koch F, Schlee M, Zipprich H. The Effect of In Vitro Electrolytic Cleaning on Biofilm-Contaminated Implant Surfaces. J Clin Med 2019; 8:jcm8091397. [PMID: 31500093 PMCID: PMC6780638 DOI: 10.3390/jcm8091397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/20/2022] Open
Abstract
Purpose: Bacterial biofilms are a major problem in the treatment of infected dental and orthopedic implants. The purpose of this study is to investigate the cleaning effect of an electrolytic approach (EC) compared to a powder-spray system (PSS) on titanium surfaces. Materials and Methods: The tested implants (different surfaces and alloys) were collated into six groups and treated ether with EC or PSS. After a mature biofilm was established, the implants were treated, immersed in a nutritional solution, and streaked on Columbia agar. Colony-forming units (CFUs) were counted after breeding and testing (EC), and control (PSS) groups were compared using a paired sample t-test. Results: No bacterial growth was observed in the EC groups. After thinning to 1:1,000,000, 258.1 ± 19.9 (group 2), 264.4 ± 36.5 (group 4), and 245.3 ± 40.7 (group 6) CFUs could be counted in the PSS groups. The difference between the electrolytic approach (test groups 1, 3, and 5) and PSS (control groups 2, 4, and 6) was statistically extremely significant (p-value < 2.2 × 10−16). Conclusion: Only EC inactivated the bacterial biofilm, and PSS left reproducible bacteria behind. Within the limits of this in vitro test, clinical relevance could be demonstrated.
Collapse
Affiliation(s)
- Christoph Ratka
- Department of Prosthodontics, Goethe University, 60590 Frankfurt am Main, Germany.
| | - Paul Weigl
- Department of Prosthodontics, Goethe University, 60590 Frankfurt am Main, Germany.
| | - Dirk Henrich
- Department of Trauma, Hand & Reconstructive Surgery, Goethe University, 60590 Frankfurt am Main, Germany.
| | - Felix Koch
- Private Practice, and Department of Maxillofacial Surgery, Goethe University, 60590 Frankfurt am Main, Germany.
| | - Markus Schlee
- Private Practice, and Department of Maxillofacial Surgery, Goethe University, 60590 Frankfurt am Main, Germany.
| | - Holger Zipprich
- Department of Prosthodontics, Goethe University, 60590 Frankfurt am Main, Germany.
| |
Collapse
|
14
|
Stévignon T, Mouton A, Meyssonnier V, Kerroumi Y, Yazigi A, Aubert T, Lhotellier L, Le Strat V, Passeron D, Graff W, Zeller V, Heym B, Marmor S. Haematogenous prosthetic knee infections: Prospective cohort study of 58 patients. Orthop Traumatol Surg Res 2019; 105:647-651. [PMID: 31047841 DOI: 10.1016/j.otsr.2019.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a rare (incidence, 0.15% to 0.9%) but serious complication of knee arthroplasty. Haematogenous PJI of the knee (KhPJI) which accounts for 10% of cases, has been less studied than PJI due to other mechanisms. The primary objective of this study in patients with KhPJI of the knee was to determine the 2-year infection eradication failure rate after either exchange arthroplasty or arthrotomy/synovectomy/irrigation (ASI), combined with prolonged peri-operative antibiotic therapy, at a referral centre for complex osteo-articular infections. HYPOTHESIS ASI within 2 weeks after symptom onset and one-stage exchange arthroplasty produce similar 2-year success rates in patients with KhPJI of the knee. MATERIAL AND METHODS A prospective observational cohort study was performed in patients managed for PJI of the knee between 2003 and 2015. The primary outcome measure was the occurrence of a septic event or of KhPJI -related death during a minimum follow-up of 2 years. RESULTS Of 265 patients with PJI after total knee arthroplasty, 58 (22.1%) had KhPJI with onset more than 3 months after the last arthroplasty procedure and were included in the study. Among them, one-third had immune deficiencies. The most common causative organisms were streptococci (n=25, 43%) and Staphylococcusaureus (n=20, 34%). The primary focus of infection was identified in only 64% of patients and was most often cutaneous (n=19, 33%) or dental (n=11, 19%). A septic event or KhPJI-related death occurred in 5/34 (15%) patients after one-stage exchange arthroplasty and 6/19 (32%) patients after ASI within 15 days after symptom onset (p=0.03). Patient characteristics, type of prosthesis, and causative organism were not significantly associated with failure to eradicate the infection. CONCLUSION ASI carried a high failure rate despite being performed within 15 days after symptom onset. One-stage exchange arthroplasty seems to be the best surgical option, particularly as the exact time of symptom onset may be difficult to determine. Identifying and eradicating the primary focus of infection is crucial. LEVEL OF EVIDENCE II, low-powered prospective cohort study.
Collapse
Affiliation(s)
- Thomas Stévignon
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - Antoine Mouton
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Younes Kerroumi
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Alexandre Yazigi
- Service de chirurgie oncologique, institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France
| | - Thomas Aubert
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Luc Lhotellier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vincent Le Strat
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Dorick Passeron
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Wilfrid Graff
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Valérie Zeller
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Béate Heym
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| |
Collapse
|
15
|
Bonacker J, Darowski M, Haar P, Westphal T, Bergschmidt P. Periprosthetic Tibial Fracture with Nonunion and Ascending Prosthetic Joint Infection: A Case Report of an Individual Treatment Strategy. J Orthop Case Rep 2019; 8:3-8. [PMID: 30915283 PMCID: PMC6424315 DOI: 10.13107/jocr.2250-0685.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Periprosthetic fractures are severe injuries that demand the surgeon’s full expertise and special diagnostic and therapeutic strategies. A major complication is the occurrence of an infectious nonunion, including an ascending infection from the fracture site to the arthroplasty. Case Report: This case report presents on a patient with a well-functioning revision total knee arthroplasty (TKA) who suffered a periprosthetic tibia fracture. Initial treatment with plating failed and the fracture had to be revised due to an infectious non-union with a multidrug-resistant Staphylococcus epidermidis, and its eradication was complicated by septic loosening of the patient’s knee arthroplasty. After multiple revisions of the nonunion, a two-stage exchange arthroplasty with a partial replacement of the distal femur due to a bone defect was necessary to obtain an acceptable result. Conclusion: The objective of this case report is to present an individual surgical strategy in a complex case of periprosthetic fracture and TKA with major complications. It is shown that the infection of the bone and implants is a challenging situation for surgical treatment. There is still no optimal management strategy due to missing standards as well as controversies in treatment.
Collapse
Affiliation(s)
- Johannes Bonacker
- Department of Traumatology, Orthopaedics and Hand Surgery, Klinikum Südstadt Rostock, Südring 81, 18059 Rostock, Germany
| | - Martin Darowski
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str. 142, 18057 Rostock, Germany
| | - Patrick Haar
- Department of Traumatology, Orthopaedics and Hand Surgery, Klinikum Südstadt Rostock, Südring 81, 18059 Rostock, Germany
| | - Thomas Westphal
- Department of Traumatology, Orthopaedics and Hand Surgery, Klinikum Südstadt Rostock, Südring 81, 18059 Rostock, Germany
| | - Philipp Bergschmidt
- Department of Traumatology, Orthopaedics and Hand Surgery, Klinikum Südstadt Rostock, Südring 81, 18059 Rostock, Germany.,Department of Orthopaedics, University Medicine Rostock, Doberaner Str. 142, 18057 Rostock, Germany
| |
Collapse
|
16
|
Lane MA, Ganeshraj N, Gu A, Warren DK, Burnham CAD. Lack of Additional Diagnostic Yield of 16s rRNA Gene PCR for Prosthetic Joint Infections. J Appl Lab Med 2019; 4:224-228. [PMID: 31639667 DOI: 10.1373/jalm.2018.027003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/06/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Medical management of prosthetic joint infections (PJIs) relies on the identification of causative organisms through traditional culture-based approaches to guide therapy. However, diagnosis of many PJIs remains challenging, with many clinically apparent infections remaining culture-negative. Molecular diagnostics have the potential to increase diagnostic yield, particularly among culture-negative PJIs. METHODS Bone, tissue, or synovial fluid from patients with clinically identified PJIs were collected for inclusion in this study. Samples were assessed with traditional cultures and classified as culture-positive or -negative after 48 h. Samples subsequently underwent a Staphylococcus aureus-/Kingella kingae-specific PCR followed by a 16s rRNA gene PCR. RESULTS A total of 77 unique patients with clinically identified PJIs contributed a total of 89 samples for inclusion in the study. There were 54 culture-negative and 35 culture-positive samples evaluated. The sensitivity and specificity of S. aureus PCR in culture-positive samples was 57.1% (95% CI, 34.1%-78.1%) and 92.9% (95% CI, 66.1%-98.9%), respectively. Among culture-positive samples, 16s rRNA gene PCR correctly identified 3 of 21 (14.3%) samples with S. aureus and 2 of 5 (40%) samples with Streptococcus spp. All molecular tests were negative in those with clinically identified, culture-negative PJI. CONCLUSIONS Our study suggests that these diagnostic tools have a limited role in PJI diagnosis.
Collapse
Affiliation(s)
- Michael A Lane
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO;
| | - Neeraja Ganeshraj
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Alice Gu
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Carey-Ann D Burnham
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
17
|
Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46:971-988. [PMID: 30683987 PMCID: PMC6450843 DOI: 10.1007/s00259-019-4263-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022]
Abstract
Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM). Electronic supplementary material The online version of this article (10.1007/s00259-019-4263-9) contains supplementary material, which is available to authorized users.
Collapse
|
18
|
Korkerdsup T, Ngarmukos T, Sungkanuparph S, Phuphuakrat A. Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes. J Arrhythm 2018; 34:632-639. [PMID: 30555607 PMCID: PMC6288561 DOI: 10.1002/joa3.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied. METHODS A retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case-control study was performed to determine the factors associated with CIED infection. RESULTS Incidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0-75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter-defibrillator, and cardio-resynchronization therapy-related infection, respectively. Gram-positive cocci were the most common organism (24 episodes, 44.4%). Gram-negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72-633.62; P = 0.003 and OR 19.99, 95% CI 1.28-333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52-85.73; P = 0.018). CONCLUSIONS In Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.
Collapse
Affiliation(s)
- Theerawat Korkerdsup
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Tachapong Ngarmukos
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical InstituteFaculty of Medicine Ramathibodi HospitalMahidol UniversitySamut PrakanThailand
| | - Angsana Phuphuakrat
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| |
Collapse
|
19
|
Hu X, Huang YY, Wang Y, Wang X, Hamblin MR. Antimicrobial Photodynamic Therapy to Control Clinically Relevant Biofilm Infections. Front Microbiol 2018; 9:1299. [PMID: 29997579 PMCID: PMC6030385 DOI: 10.3389/fmicb.2018.01299] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022] Open
Abstract
Biofilm describes a microbially-derived sessile community in which microbial cells are firmly attached to the substratum and embedded in extracellular polymeric matrix. Microbial biofilms account for up to 80% of all bacterial and fungal infections in humans. Biofilm-associated pathogens are particularly resistant to antibiotic treatment, and thus novel antibiofilm approaches needed to be developed. Antimicrobial Photodynamic therapy (aPDT) had been recently proposed to combat clinically relevant biofilms such as dental biofilms, ventilator associated pneumonia, chronic wound infections, oral candidiasis, and chronic rhinosinusitis. aPDT uses non-toxic dyes called photosensitizers (PS), which can be excited by harmless visible light to produce reactive oxygen species (ROS). aPDT is a multi-stage process including topical PS administration, light irradiation, and interaction of the excited state with ambient oxygen. Numerous in vitro and in vivo aPDT studies have demonstrated biofilm-eradication or substantial reduction. ROS are produced upon photo-activation and attack adjacent targets, including proteins, lipids, and nucleic acids present within the biofilm matrix, on the cell surface and inside the microbial cells. Damage to non-specific targets leads to the destruction of both planktonic cells and biofilms. The review aims to summarize the progress of aPDT in destroying biofilms and the mechanisms mediated by ROS. Finally, a brief section provides suggestions for future research.
Collapse
Affiliation(s)
- Xiaoqing Hu
- State Key Laboratory of Food Science and Technology, School of Biotechnology, Jiangnan University, Wuxi, China
- International Joint Laboratory on Food Safety, Jiangnan University, Wuxi, China
- The Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
| | - Ying-Ying Huang
- The Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
| | - Yuguang Wang
- The Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiaoyuan Wang
- State Key Laboratory of Food Science and Technology, School of Biotechnology, Jiangnan University, Wuxi, China
| | - Michael R. Hamblin
- The Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, United States
- Department of Dermatology, Harvard Medical School, Boston, MA, United States
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management. RECENT FINDINGS Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial. A high clinical index of suspicion for PJI combined with data from multiple preoperative and intraoperative tests enables timely diagnosis and treatment. Biomarkers, molecular methods, and implant sonication are currently adjunctive to traditional diagnostic techniques. Shorter courses of antimicrobial therapies as well as the role of chronic suppressive therapy need confirmation by randomized controlled trials. Existing practices for preoperative dental prophylaxis and treatment of asymptomatic bacteriuria warrant revision based on evidence arguing against risk for PJI.
Collapse
Affiliation(s)
- C L Abad
- Department of Medicine, Section of Infectious Diseases, University of the Philippines, Philippine General Hospital, Taft Ave., Manila, Philippines
| | - A Haleem
- Department of Internal Medicine, Division of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, WI, 53705, USA.
| |
Collapse
|
21
|
Aleman J, Moojen DJF, van Ogtrop ML, Poolman RW, Franssen EJF. Long-term Conventionally Dosed Vancomycin Therapy In Patients With Orthopaedic Implant-related Infections Seems As Effective And Safe As Long-term Penicillin Or Clindamycin Therapy. A Retrospective Cohort Study Of 103 Patients. J Bone Jt Infect 2018; 3:82-86. [PMID: 29761071 PMCID: PMC5949572 DOI: 10.7150/jbji.20279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/03/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives: Antimicrobial therapy is one of the cornerstones of orthopaedic implant-related infections (OIRI) treatment. Infections with Gram-positive bacteria are often treated with vancomycin, penicillin or clindamycin. A recent IDSA guideline suggests increasing the dose of vancomycin to increase the trough vancomycin target serum concentrations. This is deemed necessary because of an observed decrease in vancomycin susceptibility among Gram-positive bacteria. However, elevated vancomycin concentrations are correlated with the risk of nephrotoxicity, especially with prolonged therapy. Compared to most countries, rates of resistance against antibiotics among bacteria in the Netherlands are lower for currently available antibiotics, therefore lower target concentrations of vancomycin are probably efficacious for the treatment of infections. In this study we evaluated the efficacy and safety of long-term conventionally dosed vancomycin therapy, as an initial therapy for OIRI, and compared this with long-term penicillin and clindamycin therapy, as initial therapy, in patients with Gram-positive orthopaedic implant-related infections. Methods: A retrospective, observational study was conducted in 103 adult patients treated for OIRI, with vancomycin, penicillin or clindamycin for at least 10 days. The target trough serum concentration of vancomycin was 10-15 mg/l. Results: 74% of our patients were treated successfully with vancomycin, as initial therapy, (no reinfection within 1 year) versus 55% of our patients treated with either an antibiotic of the penicillin class (mostly flucloxacillin) or clindamycin (p=0.08), as initial therapy. For patients treated with vancomycin we observed a serum creatinine increase of 6 μmol/l, for patients treated with either an antibiotic of the penicillin class or clindamycin the serum creatinine increase was 4 μmol/l (p=0.395). Conclusions: In our population of patients with OIRI long-term treatment with conventionally dosed vancomycin, as initial therapy, was not significantly less effective and safe as long-term treatment with an antibiotic of the penicillin class or clindamycin, as initial therapy.
Collapse
Affiliation(s)
- Jacomien Aleman
- Department of Clinical Pharmacy, OLVG Amsterdam (currently in HOH, Oranjestad Aruba)
| | | | | | | | - Eric J F Franssen
- Department of Clinical Pharmacy, OLVG Amsterdam (currently in HOH, Oranjestad Aruba)
| |
Collapse
|
22
|
Andrea A, Molchanova N, Jenssen H. Antibiofilm Peptides and Peptidomimetics with Focus on Surface Immobilization. Biomolecules 2018; 8:E27. [PMID: 29772735 PMCID: PMC6022873 DOI: 10.3390/biom8020027] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022] Open
Abstract
Bacterial biofilms pose a major threat to public health, as they are associated with at least two thirds of all infections. They are highly resilient and render conventional antibiotics inefficient. As a part of the innate immune system, antimicrobial peptides have drawn attention within the last decades, as some of them are able to eradicate biofilms at sub-minimum inhibitory concentration (MIC) levels. However, peptides possess a number of disadvantages, such as susceptibility to proteolytic degradation, pH and/or salinity-dependent activity and loss of activity due to binding to serum proteins. Hence, proteolytically stable peptidomimetics were designed to overcome these drawbacks. This paper summarizes the current peptide and peptidomimetic strategies for combating bacteria-associated biofilm infections, both in respect to soluble and surface-functionalized solutions.
Collapse
Affiliation(s)
- Athina Andrea
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark.
| | - Natalia Molchanova
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark.
| | - Håvard Jenssen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, 4000 Roskilde, Denmark.
| |
Collapse
|
23
|
Rheumatoid Arthritis, Disease Modifying Agents, and Periprosthetic Joint Infection: What Does a Joint Surgeon Need to Know? J Arthroplasty 2018; 33:1258-1264. [PMID: 29325724 DOI: 10.1016/j.arth.2017.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/22/2017] [Accepted: 11/15/2017] [Indexed: 02/01/2023] Open
Abstract
The incidence of periprosthetic joint infection (PJI) among patients with rheumatoid arthritis (RA) is 1.6× greater than in patients undergoing the same procedure for osteoarthritis. This higher risk "may" be due to the immunosuppressive therapies for RA patients including corticosteroids, such as prednisone, and disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. There is a debate about the role of DMARDs in increasing the incidence of subsequent PJI. Studies show conflicting results, with some demonstrating no significant increase in the rates of PJI and some finding otherwise. The International Consensus Meeting on PJI recommended that DMARDs should be halted prior to an elective total joint arthroplasty based on their half-life. Moreover, the International Consensus Meeting stated that cessation of immunosuppressant medications should be performed in consultation with and under the direction of the treating physician. In this review, we aimed to provide an introduction to the available treatment options and cover the recommendations on the treatment protocols for RA patients who undergo elective total joint arthroplasty.
Collapse
|
24
|
Graves N, Wloch C, Wilson J, Barnett A, Sutton A, Cooper N, Merollini K, McCreanor V, Cheng Q, Burn E, Lamagni T, Charlett A. A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review. Health Technol Assess 2018; 20:1-144. [PMID: 27468732 DOI: 10.3310/hta20540] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies. OBJECTIVES To compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives. DESIGN The study comprised a systematic review and cost-effectiveness decision analysis. SETTING 77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012. INTERVENTIONS Nine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre. MAIN OUTCOME MEASURES Change in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs). DATA SOURCES Literature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966-2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted. REVIEW METHODS English-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies. RESULTS Twelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care Excellence Methods for Development of NICE Public Health Guidance ( http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4 ), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1-9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes. CONCLUSIONS T6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies. LIMITATIONS A wide range of evidence sources was synthesised and there is large uncertainty in the conclusions. FUNDING The National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).
Collapse
Affiliation(s)
- Nicholas Graves
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Jennie Wilson
- College of Nursing, Midwifery and Healthcare, University of West London, London, UK
| | - Adrian Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Alex Sutton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nicola Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Katharina Merollini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Victoria McCreanor
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Qinglu Cheng
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Edward Burn
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | | | | |
Collapse
|
25
|
Wang J, Wang Q, Shen H, Zhang X. Comparable outcome of culture-negative and culture-positive periprosthetic hip joint infection for patients undergoing two-stage revision. INTERNATIONAL ORTHOPAEDICS 2018; 42:469-477. [DOI: 10.1007/s00264-018-3783-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 11/30/2022]
|
26
|
Chang YJ, Lee MS, Lee CH, Lin PC, Kuo FC. Daptomycin treatment in patients with resistant staphylococcal periprosthetic joint infection. BMC Infect Dis 2017; 17:736. [PMID: 29187163 PMCID: PMC5707892 DOI: 10.1186/s12879-017-2842-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Resistant staphylococcal organisms remain a serious problem in the treatment of periprosthetic joint infection (PJI). Higher failure rates have been reported when vancomycin was used. The purpose of this study was to assess the clinical dosage, effect, and safety of daptomycin in patients with resistant staphylococcal PJI. METHODS We retrospectively enrolled patients with hip or knee PJI who were treated with daptomycin in our institution (n = 16) from January 2013 to December 2014 with a minimum follow-up of 2 years. The patients received daptomycin when glycopeptide could not be used due to multiple resistance, any adverse reaction, chronic kidney disease stage 3 or worse, and previous treatment failure with glycopeptide or empirical therapy. RESULTS These patients received daptomycin at a median dose of 8.3 mg∕kg per day for a median duration of 14 days. The overall treatment success rate was 87.5% (14 of 16 cases) after a median follow-up period of 27 months. In the subgroups of acute and chronic PJI, the success rate was 80% and 91%, respectively. One patient developed asymptomatic transient serum aspartate transaminase (AST) elevation. No severe side effects such as myositis, acute renal failure due to rhabdomyolysis or eosinophilic pneumonia were found in our series. CONCLUSION Relatively high daptomycin doses combined with adequate surgical intervention were effective in treating resistant staphylococcal PJI. Daptomycin is an option worthy of consideration in PJI patients for whom glycopeptide treatment is unsuitable. Further prospective randomized comparative study is needed in the future.
Collapse
Affiliation(s)
- Yu-Jui Chang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan
| | - Mel S Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- College of Medicine, Chang Gung University, Kaohsiung, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Chun Lin
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, Taiwan. .,College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
| |
Collapse
|
27
|
Multifunctional bioactive glass and glass-ceramic biomaterials with antibacterial properties for repair and regeneration of bone tissue. Acta Biomater 2017; 59:2-11. [PMID: 28676434 DOI: 10.1016/j.actbio.2017.06.046] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/26/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023]
Abstract
Bioactive glasses (BGs) and related glass-ceramic biomaterials have been used in bone tissue repair for over 30years. Previous work in this field was comprehensively reviewed including by their inventor Larry Hench, and the key features and properties of BGs are well understood. More recently, attention has focused on their modification to further enhance the osteogenic behaviour, or further compositional changes that may introduce additional properties, such as antimicrobial activity. Evidence is emerging that BGs and related glass-ceramics may be modified in such a way as to simultaneously introduce more than one desirable property. The aim of this review is therefore to consider the evidence that these more recent inorganic modifications to glass and glass-ceramic biomaterials are effective, and whether or not these new compositions represent sufficiently versatile systems to underpin the development of a new generation of truly multifunctional biomaterials to address pressing clinical needs in orthopaedic and dental surgery. Indeed, a number of classical glass compositions exhibited antimicrobial activity, however the structural design and the addition of specific ions, i.e. Ag+, Cu+, and Sr2+, are able to impart a multifunctional character to these systems, through the combination of, for example, bioactivity with bactericidal activity. STATEMENT OF SIGNIFICANCE In this review we demonstrate the multifunctional potential of bioactive glasses and related glass-ceramics as biomaterials for orthopaedic and craniofacial/dental applications. Therefore, it considers the evidence that the more recent inorganic modifications to glass and glass-ceramic biomaterials are able to impart antimicrobial properties alongside the more classical bone bonding and osteoconduction. These properties are attracting a special attention nowadays that bacterial infections are an increasing challenge in orthopaedics. We also focus the manuscript on the versatility of these systems as a basis to underpin the development of a new generation of truly multifunctional biomaterials to address pressing clinical needs in orthopaedic, craniofacial and dental surgery.
Collapse
|
28
|
Vilchez-Cavazos F, Villarreal-Villarreal G, Peña-Martinez V, Acosta-Olivo C. Management of periprosthetic infections. World J Clin Infect Dis 2017; 7:11-20. [DOI: 10.5495/wjcid.v7.i2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/06/2016] [Accepted: 01/22/2017] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infection (PJI) is considered one of the most challenging complications compromising patient health and is considered an economic burden. Despite all strategies PJI prevalence is between 1%-2%. Considerable efforts have been investigated in the past decade to diminish or erradicate PJI prevalence. This article manages the definition of PJI and the new major and minor criteria from Parvizi et al Then a scientific analysis of every minor and major criteria. Multidisciplinary management is reccommended according to guidelines. A numerous of surgical options exist each and everyone with its indications, contraindications and specific antibiotic therapy regimen. Surgical options are: (1) irrigation and cleaning with retention of the prosthesis with a success rate 0%-89%; (2) single-stage revision surgery with a succes rate of > 80%; and (3) two-stage revision surgery (authors preferred method) with a succes rate of 87%. Radical treatment options like arthrodesis and amputation are reserved for specific group of patients, with a succes rate varying from 60%-100%. The future of PJI is focused on improving the diagnostic tools and to combat biofilm. The cornerstone of management consists in a rapid diagnosis and specific therapy. This article presents the most current diagnostic and treatment criteria as well as the different surgical treatment options depending on the type of infection, bacterial virulence and patient comorbidities.
Collapse
|
29
|
He R, Yang L, Guo L, Chen H, Zhang Y, Jiang DM. Management of Acute Hematogenous Infection Following Total Knee Arthroplasty: A Case Series of 11 Patients. Orthop Surg 2017; 8:475-482. [PMID: 28032700 DOI: 10.1111/os.12297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/05/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Acute hematogenous infection is a devastating complication that can occur after total knee arthroplasty (TKA). The best strategies for management of this infection remain controversial. Two-stage revision has been well described as the gold standard for the management of chronic late infections. However, there is a paucity of information presently available on the management and outcomes of patients treated for acute hematogenous infections. The purpose of the present study was to report the outcome of acute hematogenous infections following TKA with the treatment of irrigation, debridement, and retention of the prosthetic components. METHODS Eleven patients who had been diagnosed with acute hematogenous infection of the knee following TKA underwent irrigation and debridement between 2002 and 2012. To improve the efficiency of irrigation, a vacuum constriction device was used and the most sensitive antibiotics were injected into the irrigation saline. The mean age of the 11 patients was 56.3 ± 11.8 years (range, 35-73 years), with 2 male patients (18.2%) and 9 female patients (81.8%). The diagnosis at primary operation was osteoarthritis in three cases, rheumatoid arthritis in seven and osteoarthritis (OA) secondary to fracture in 1. They had pain and swell with the acute onset of pain after a previously well-functioning TKA, and met the Musculoskeletal Infection Society (MSIS) criteria for prosthetic joint infection. Before the onset of symptoms in the operated knees, patients had a history of bacteriaemia, and blood culture was consistent with the culture result of local infection. Failure was defined as: (i) death before the end of antibiotic treatment; (ii) a further surgical intervention for treatment of infection was needed; and (iii) life-long antibiotic treatment, or chronic infection. The prosthesis survivorship, Knee Society Score (KSS) and the factors that may lead to the infection recurrence, such as type of bacteria, age, sex, rheumatoid arthritis, history of diabetes, and interval surgery time, were analyzed. RESULTS Among the 11 patients, the most common infecting organisms were staphylococcal and streptococcus species. The 2 staphylococcal species cases included: Staphylococcus epidermidis (1) and Staphylococcus aureus (1); The 7 Streptococcus species cases included: Streptococcus agalactiae (1), β-Hemolytic Streptococcus (1), Streptococcus pneumonia (3), Streptococcus dysgalactiae (1), Viridans streptococci (1) and Enterobacter cloacae (1). The survivorship at the endpoint was 9 in 2 years. The survival rate for patients with a staphylococcal infection was 0%, and 100% for patients infected with non-staphylococcus species, with a mean KSS of 72.6 points. The duration of symptoms prior to operation and the type of pathogen affected the outcome (P = 0.00). CONCLUSIONS Patients who developed an acute hematogenous infection with non-staphylococcus species following operative debridement and continuous irrigation with prosthetic retention had satisfactory outcomes, but patients infected with staphylococcal had poor results. To improve the success rate of treatment, patients should be treated as soon as possible and individually according to the bacterial culture results.
Collapse
Affiliation(s)
- Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China.,Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hao Chen
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Ying Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Dian-Ming Jiang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
30
|
Mühlhofer HML, Pohlig F, Kanz KG, Lenze U, Lenze F, Toepfer A, Kelch S, Harrasser N, von Eisenhart-Rothe R, Schauwecker J. Prosthetic joint infection development of an evidence-based diagnostic algorithm. Eur J Med Res 2017; 22:8. [PMID: 28274250 PMCID: PMC5343418 DOI: 10.1186/s40001-017-0245-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/24/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps. METHODS We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms. RESULTS From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807. CONCLUSIONS The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.
Collapse
Affiliation(s)
- Heinrich M. L. Mühlhofer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Pohlig
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Ulrich Lenze
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Florian Lenze
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas Toepfer
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Sarah Kelch
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Norbert Harrasser
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Johannes Schauwecker
- Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| |
Collapse
|
31
|
Kheir MM, Tan TL, Higuera C, George J, Della Valle CJ, Shen M, Parvizi J. Periprosthetic Joint Infections Caused by Enterococci Have Poor Outcomes. J Arthroplasty 2017; 32:933-947. [PMID: 27789094 DOI: 10.1016/j.arth.2016.09.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The definitive treatment and outcome of periprosthetic joint infection (PJI) caused by Enterococcus species is unknown. We performed a multi-institutional study to analyze the characteristics and treatment outcomes of patients with enterococcal PJI and to define an effective treatment protocol. METHODS We retrospectively reviewed all PJIs at 3 institutions between 1999 and 2014 using an electronic query followed by manual chart review. We included patients who met the Musculoskeletal Infection Society's criteria for PJI and had at least 1 positive intraoperative culture for any Enterococcus species. We identified 87 patients who had 12-month follow-up or treatment failure (mean, 4.03 years). Treatment failure was based on Delphi consensus criteria described previously. Kaplan-Meier survivorship analyses were performed. We assumed an alpha level of 0.05 for statistical significance. RESULTS The overall incidence of enterococcal PJI was 4.2%. The overall treatment success rate was 51.7% (45 of 87 patients). Thirteen cases (14.9%) that failed treatment had adverse outcomes including salvage procedures and PJI-related mortality. Treatment success rates stratified by procedure were 62.8%, 39.4%, and 45.5% for 2-stage exchange arthroplasty, irrigation and debridement, and 1-stage exchange arthroplasty, respectively (P = .037). Antibiotic treatment was heterogeneous; although combination antibiotics demonstrated a trend toward higher treatment success, it was not statistically different from monotherapy regimens (P = .174). CONCLUSION Enterococcal PJI has a high rate of treatment failure. Surgeons and patients should be aware of the difficulty in managing this condition and its dismal treatment outcomes. Although antibiotic treatment was heterogeneous, there was a trend toward higher success rates when combination antibiotic therapy was used.
Collapse
Affiliation(s)
- Michael M Kheir
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carlos Higuera
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jaiben George
- Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Mary Shen
- Midwest Orthopaedics at Rush University, Chicago, Illinois
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
32
|
Si S, Durkin MJ, Mercier MM, Yarbrough ML, Liang SY. Successful Treatment of Prosthetic Joint Infection due to Vancomycin-resistant Enterococci with Tedizolid. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017; 25:105-107. [PMID: 28428726 PMCID: PMC5393450 DOI: 10.1097/ipc.0000000000000469] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Few antibiotic options exist for the management of infections due to vancomycin-resistant enterococci (VRE). We describe a case involving the safe and successful use of tedizolid, a new oxazolidinone, to treat VRE prosthetic joint infection.
Collapse
Affiliation(s)
- Sheng Si
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Michael J. Durkin
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Maureen M. Mercier
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
| | - Melanie L. Yarbrough
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Stephen Y. Liang
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
33
|
Parsaei S, Keeney J, Marschall J. Infections of Prosthetic Joints and Related Problems. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
34
|
Kini SG, Gabr A, Das R, Sukeik M, Haddad FS. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections. Open Orthop J 2016; 10:579-588. [PMID: 28144371 PMCID: PMC5226970 DOI: 10.2174/1874325001610010579] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/26/2016] [Accepted: 07/15/2016] [Indexed: 01/15/2023] Open
Abstract
Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following hip and knee surgery. The diagnostic workflow of PJI includes detailed clinical examination, serum markers, imaging and aspiration/biopsy of the affected joint. The goals of treatment are eradication of the infection, alleviation of pain, and restoration of joint function. Surgical management of PJI consists of debridement, antibiotics and implant retention (DAIR) and single or two-stage revision procedures. Two-stage revision remains the gold standard for treatment of PJIs. We aim to discuss the two stage procedure in this article and report the outcomes. Methods: The first stage of the two stages consists of removal of all components and associated cement with aggressive debridement and placement of an antibiotic-loaded cement spacer. Patients are then treated with variable periods of parenteral antibiotics, followed by an antibiotic free period to help ensure the infection has been eradicated. If the clinical evaluation and serum inflammatory markers suggest infection control, then the second stage can be undertaken and this involves removal of the cement spacer, repeat debridement, and placement of a new prosthesis. Results: Common themes around the two-stage revision procedure include timing of the second stage, antibiotics used in the interim period, length of the interim period before consideration of reimplantation and close liaising with microbiologists. Conclusion: Successful eradication of infection and good functional outcome using the two stage procedure is dependent on a multidisciplinary approach and having a standard reproducible startegy.
Collapse
Affiliation(s)
- Sunil Gurpur Kini
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Ayman Gabr
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Rishi Das
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Mohamed Sukeik
- Department of Trauma and Orthopaedics, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - Fares Sami Haddad
- Department of Trauma and Orthopaedics, University College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| |
Collapse
|
35
|
Geng L, Xu M, Yu L, Li J, Zhou Y, Wang Y, Chen J. Risk factors and the clinical and surgical features of fungal prosthetic joint infections: A retrospective analysis of eight cases. Exp Ther Med 2016; 12:991-999. [PMID: 27446310 PMCID: PMC4950886 DOI: 10.3892/etm.2016.3353] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/01/2016] [Indexed: 12/16/2022] Open
Abstract
Fungal prosthetic joint infections (PJI) and reports of their clinical investigation are rare. In addition, there has been little evidence regarding the outcome of the two-stage exchange protocol for the treatment of fungal PJI. In order to investigate the risk factors and clinical, microbiological and pathological features of fungal PJIs, as well as the effects of the two-stage exchange protocol on their outcome, the present study analyzed eight retrospective fungal PJI cases, involving four cases affecting the hips and four affecting the knees, between May 2000 and March 2012. In all cases, a cemented spacer saturated with antimicrobials was used during the two-stage exchange protocol, and systematic antifungal agents were administrated during the interim period. The average follow-up duration was 4.4 years. Of the eight cases, six had undergone additional surgery on the infected joint prior to infection with the fungus. Following histological analyses, it was determined that the average number of polymorphonuclear cells in the three patients infected with a fungus was only <5/high power field (HPF; magnification, ×400), and that of the five patients with a hybrid infection was >5/HPF. The average Harris Hip scores or Hospital for Special Surgery knee scores were 43.6 preoperatively and 86 at the last follow-up. The two-stage exchange protocol was performed eight times in seven cases, with a failure rate of 12.5%. The remaining case was successfully treated by resection arthroplasty. The average duration of antifungal agent administration during the interim period in five of the eight cases was 1.5 months. For three of the patients, the duration of antifungal agent administration was prolonged until the c-reactive protein levels were decreased to normal. The average duration of spacer implantation into the joint was 4.3 months. The results of the present study suggested that undergoing surgery on a prosthetic joint may be a potential risk factor for the development of fungal PJI. In addition, infiltration of polymorphonuclear leukocytes into the site of the infection may not occur at the same rate as bacterial PJI. Therefore, a two-stage exchange protocol with implantation of a cement spacer saturated with antimicrobials may be considered an effective therapeutic strategy for the treatment of fungal PJI.
Collapse
Affiliation(s)
- Lei Geng
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Meng Xu
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Ligang Yu
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Jie Li
- Department of Pathology, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Yonggang Zhou
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Yan Wang
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Jiying Chen
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, Beijing 100853, P.R. China
| |
Collapse
|
36
|
Perez-Jorge C, Gomez-Barrena E, Horcajada JP, Puig-Verdie L, Esteban J. Drug treatments for prosthetic joint infections in the era of multidrug resistance. Expert Opin Pharmacother 2016; 17:1233-46. [PMID: 27054293 DOI: 10.1080/14656566.2016.1176142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Despite many advances, the management of prosthetic joint infection is still a complex issue. Moreover, in recent years the problem of antimicrobial resistance has emerged as an important challenge. AREAS COVERED We analysed recent advances in different aspects of prosthetic joint infections. The importance of biofilms needs to be considered for antibiotic selection because, when embedded in these structures, bacteria acquire resistant behaviour. Moreover, the presence of resistance mechanisms in some species of organisms increases the difficulty of management. In this sense, the growing importance of methicillin-resistant staphylococci, multidrug-resistant Enterobacteriaceae or Pseudomonas aeruginosa is of increasing concern. Together with these organisms, others with constitutive resistance against most antibiotics (like Enterococcus sp., mycobacteria or fungi) represent a similar problem for selection of therapy. Research into new materials that can be used as drug carriers opens a new field for management of these infections and will likely come to the front line in the coming years. EXPERT OPINION Individualised therapies should carefully consider the aetiology, pathogenesis and antimicrobial susceptibility. Satisfactory clinical outcome could be further fostered by enhancing the multidisciplinary approach, with better collaboration in the antibiotic selection and the surgical management.
Collapse
Affiliation(s)
- Concepcion Perez-Jorge
- a Bone and Joint Infection Unit, Department of Clinical Microbiology , IIS-Fundacion Jimenez Diaz, UAM , Madrid , Spain
| | - Enrique Gomez-Barrena
- b Department of Orthopaedic Surgery , IdiPaz-Hospital La Paz Institute for Health Research, UAM , Madrid , Spain
| | - Juan-Pablo Horcajada
- c Service of Infectious Diseases, Hospital del Mar, CEXS Universitat Pompeu Fabra , Institut Hospital del Mar d'Investigacions Mèdiques , Barcelona , Spain
| | - Lluis Puig-Verdie
- d Department of Orthopaedic Surgery , Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques , Barcelona , Spain
| | - Jaime Esteban
- a Bone and Joint Infection Unit, Department of Clinical Microbiology , IIS-Fundacion Jimenez Diaz, UAM , Madrid , Spain
| |
Collapse
|
37
|
Singh H, Thomas S, Agarwal S, Arya SC, Srivastav S, Agarwal N. Total knee arthroplasty in women with asymptomatic urinary tract infection. J Orthop Surg (Hong Kong) 2015; 23:298-300. [PMID: 26715704 DOI: 10.1177/230949901502300307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare early outcome after total knee arthroplasty (TKA) in women with a positive or negative urine culture. METHODS 128 women underwent bilateral (n=89) or unilateral (n=39) primary TKA. Diabetes mellitus was present in 38%, obesity in 53%, and asymptomatic urinary tract infection (positive urine culture) in 36% of women. Women with a positive or negative urine culture were compared. RESULTS In the 46 women with a positive urine culture, Escherichia coli (n=29) and Klebsiella (n=17) were grown. Women with a positive or negative urine culture were comparable in terms of the incidence of diabetes (28% vs. 43%, p=0.1), obesity (52% vs. 54%, p=0.87), fever (9% vs. 15%, p=0.32), leucocytosis (28% vs. 17%, p=0.13), and delayed wound healing (0% vs. 1%, p=0.45). CONCLUSION Women with or without a positive urine culture had comparable early complication rates following TKA.
Collapse
|
38
|
Felgueiras HP, Aissa IB, Evans MDM, Migonney V. Contributions of adhesive proteins to the cellular and bacterial response to surfaces treated with bioactive polymers: case of poly(sodium styrene sulfonate) grafted titanium surfaces. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:261. [PMID: 26449451 DOI: 10.1007/s10856-015-5596-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/01/2015] [Indexed: 05/25/2023]
Abstract
The research developed on functionalized model or prosthetic surfaces with bioactive polymers has raised the possibility to modulate and/or control the biological in vitro and in vivo responses to synthetic biomaterials. The mechanisms underlying the bioactivity exhibited by sulfonated groups on surfaces involves both selective adsorption and conformational changes of adsorbed proteins. Indeed, surfaces functionalized by grafting poly(sodium styrene sulfonate) [poly(NaSS)] modulate the cellular and bacterial response by inducing specific interactions with fibronectin (Fn). Once implanted, a biomaterial surface is exposed to a milieu of many proteins that compete for the surface which dictates the subsequent biological response. Once understood, this can be controlled by dictating exposure of active binding sites. In this in vitro study, we report the influence of binary mixtures of proteins [albumin (BSA), Fn and collagen type I (Col I)] adsorbed on poly(NaSS) grafted Ti6Al4V on the adhesion and differentiation of MC3T3-E1 osteoblast-like cells and the adhesion and proliferation of Staphylococcus aureus (S. aureus). Outcomes showed that poly(NaSS) stimulated cell spreading, attachment strength, differentiation and mineralization, whatever the nature of protein provided at the interface compared with ungrafted Ti6Al4V (control). While in competition, Fn and Col I were capable of prevailing over BSA. Fn played an important role in the early interactions of the cells with the surface, while Col I was responsible for increased alkaline phosphatase, calcium and phosphate productions associated with differentiation. Poly(NaSS) grafted surfaces decreased the adhesion of S. aureus and the presence of Fn on these chemically altered surfaces increased bacterial resistance ≈70% compared to the ungrafted Ti6Al4V. Overall, our study showed that poly(NaSS) grafted Ti6Al4V selectively adsorbed proteins (particularly Fn) promoting the adhesion and differentiation of osteoblast-like cells while reducing bacterial adhesion to create a bioactive surface with potential for orthopaedic applications.
Collapse
Affiliation(s)
- Helena P Felgueiras
- Laboratoire de "Chimie, Structures et Propriétés de Biomatériaux et d'Agents Thérapeutiques" (CSPBAT) - UMR CNRS 7244, Institut Galilée, Université Paris 13, Sorbonne Paris Cité, 99 avenue JB Clément, 93430, Villetaneuse, France
| | - Ines Ben Aissa
- Laboratoire de "Chimie, Structures et Propriétés de Biomatériaux et d'Agents Thérapeutiques" (CSPBAT) - UMR CNRS 7244, Institut Galilée, Université Paris 13, Sorbonne Paris Cité, 99 avenue JB Clément, 93430, Villetaneuse, France
| | - Margaret D M Evans
- CSIRO Biomedical Materials Program, 11 Julius Avenue, North Ride, Sydney, NSW, 2113, Australia
| | - Véronique Migonney
- Laboratoire de "Chimie, Structures et Propriétés de Biomatériaux et d'Agents Thérapeutiques" (CSPBAT) - UMR CNRS 7244, Institut Galilée, Université Paris 13, Sorbonne Paris Cité, 99 avenue JB Clément, 93430, Villetaneuse, France.
| |
Collapse
|
39
|
Cury RDPL, Cinagawa EHT, Camargo OPA, Honda EK, Klautau GB, Salles MJC. TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2015; 23:239-43. [PMID: 26981029 PMCID: PMC4775473 DOI: 10.1590/1413-785220152305138774] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 10/30/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. METHODS We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010. RESULTS In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. CONCLUSION The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
Collapse
Affiliation(s)
| | | | | | - Emerson Kiyoshi Honda
- Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil
| | | | - Mauro José Costa Salles
- Faculdade de Medicina da Santa Casa de Misericórdia de São Paulo (SCMSP), São Paulo, SP, Brazil
| |
Collapse
|
40
|
De Angelis G, Mutters NT, Minkley L, Holderried F, Tacconelli E. Prosthetic joint infections in the elderly. Infection 2015; 43:629-37. [PMID: 26096951 DOI: 10.1007/s15010-015-0806-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/08/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Recent age-projection showed that the number of elderly is expected to rise significantly over the next decades worldwide. Accordingly, the prevalence of chronic and degenerative diseases will increase, among them osteoarthritis, resulting in more and older patients undergoing total joint arthroplasty and thereby also being at risk for associated complications. Among those, prosthetic joint infections are feared as threatening complication with a mortality approaching 8 % and causing long-term antibiotic therapy, immobilization and often account for operative revision. MATERIALS AND METHODS This review summarizes epidemiological, microbiological, and therapeutic aspects of prosthetic joint infection in the elderly population. CONCLUSION Considering the increase in the number of PJIs in the forthcoming years in most countries, a common action to reduce the associated morbidity and mortality is strongly encouraged in Europe.
Collapse
Affiliation(s)
- G De Angelis
- Department of Microbiology, Catholic University, largo A. Gemelli 8, 00164, Rome, Italy
| | - N T Mutters
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - L Minkley
- Division of Infectious Diseases, Department of Internal Medicine I, Raum 925, Ebene 3 Gebäude Nord, Tübingen University Hospital, Otfried-Müller-Straße 12, 72076, Tübingen, Germany
| | - F Holderried
- Division of Infectious Diseases, Department of Internal Medicine I, Raum 925, Ebene 3 Gebäude Nord, Tübingen University Hospital, Otfried-Müller-Straße 12, 72076, Tübingen, Germany
| | - E Tacconelli
- Division of Infectious Diseases, Department of Internal Medicine I, Raum 925, Ebene 3 Gebäude Nord, Tübingen University Hospital, Otfried-Müller-Straße 12, 72076, Tübingen, Germany.
| |
Collapse
|
41
|
Cha MS, Cho SH, Kim DH, Yoon HK, Cho HS, Lee DY, Lee SH, Hwang SC. Two-Stage Total Knee Arthroplasty for Prosthetic Joint Infection. Knee Surg Relat Res 2015; 27:82-9. [PMID: 26060606 PMCID: PMC4458487 DOI: 10.5792/ksrr.2015.27.2.82] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 04/13/2015] [Accepted: 05/04/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE This retrospective review was conducted to identify prognostic factors for two-stage reimplantation for infected total knee arthroplasty (TKA) and the rate of reinfection following revision TKA. MATERIALS AND METHODS Out of 88 patients diagnosed with post-TKA infection between 1998 and 2011, 76 underwent two-stage reimplantation and were reviewed in this study. The 76 patients were divided into two groups-those who experienced reinfection and those who did not. Comorbidities, culture results, and inflammation indices were analyzed and compared between the two groups. RESULTS Of the 76 patients who underwent a two-stage reimplantation, 18 (23.7%) experienced reinfection. Patients with more than three comorbidities had significantly higher reinfection rates than those with less than three comorbidities (47.1% vs. 4.8%, p=0.032). The reinfection rate between the culture positive prosthetic joint infection group and the culture negative prosthetic joint infection group was not significantly different (p=0.056). Inflammation indices (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]) showed a statistically significant difference between patients with reinfection and those without reinfection at 4 weeks after the first-stage surgery. CONCLUSIONS Reimplantation must be carefully performed when the risk of reinfection is high, particularly in patients with more than three systemic or local comorbidities and higher inflammation indices (ESR and CRP) prior to revision TKA.
Collapse
Affiliation(s)
- Min Seok Cha
- Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Korea
| | - Se Hyun Cho
- Department of Orthopaedic Surgery, SKY Hospital, Seoul, Korea
| | - Dong Hee Kim
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Hong Kwon Yoon
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Ho Seung Cho
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Yeong Lee
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Hyuk Lee
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Jinju, Korea
| |
Collapse
|
42
|
Drago L, Vassena C, Fenu S, De Vecchi E, Signori V, De Francesco R, Romanò CL. In vitro antibiofilm activity of bioactive glass S53P4. Future Microbiol 2015; 9:593-601. [PMID: 24957087 DOI: 10.2217/fmb.14.20] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM This work aimed to investigate the ability of different formulations of bioactive glass (BAG)-S53P4 to interfere with bacterial biofilm produced on prosthetic material by methicillin-resistant Staphylococcus aureus and multi-drug-resistant Pseudomonas aeruginosa. MATERIALS & METHODS Antibiofilm activity of three formulations of bioglass was assessed at different time points through two different analyses: Crystal Violet and confocal laser scanning microscopy assays. RESULTS Significant differences in the whole biofilm were observed between BAG-S53P4-treated and control samples, while no marked changes in antibiofilm activity were observed among the tested formulations. Data from colorimetric assay were confirmed by confocal laser scanning microscopy analysis, which evidenced the significant reduction in biomass and a decrease of total cell volume when both S. aureus and P. aeruginosa biofilms were treated with BAG-S53P4. CONCLUSION BAG-S53P4 can be considered as an excellent adjuvant in the treatment of prosthetic infections related to biofilm.
Collapse
Affiliation(s)
- Lorenzo Drago
- Laboratory of Clinical Chemistry & Microbiology, IRCCS Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161 Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
43
|
Cooper MP, Lessa F, Brems B, Shoulson R, York S, Peterson A, Noble-Wang J, Duffy R, McDonald LC. Outbreak ofEnterococcus gallinarumInfections After Total Knee Arthroplasty. Infect Control Hosp Epidemiol 2015; 29:361-3. [DOI: 10.1086/529213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In September 2006, we investigated a cluster of 9 patients who developedEnterococcus gallinaruminfection after total knee arthroplasty. Isolates recovered from these patients were from the same outbreak strain. Although all 9 patients were monitored by the same healthcare personnel, were given spinal anesthesia, and had the same specific type of wound irrigation procedure performed during their hospitalization, the source or sources of these infections were not identified.
Collapse
|
44
|
Risk factors for failure in early prosthetic joint infection treated with debridement. Influence of etiology and antibiotic treatment. J Appl Biomater Funct Mater 2014; 12:129-34. [PMID: 25199072 DOI: 10.5301/jabfm.5000209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSES The aim of the present study was to evaluate the importance of isolated microorganisms according to the Gram stain and the type of antibiotic received on the outcome of early prosthetic joint infection (PJI) treated with debridement, antibiotics and implant retention (DAIR). METHODS From January 1999 to December 2009, all patients with an early PJI were prospectively registered in a database and they were retrospectively reviewed for this study. RESULTS During the study period, 160 patients met the inclusion criteria of the study. After a mean (SD) post-debridement follow-up of 5.2 (2.5) years, 117 patients (73.1%) were considered to be in remission and 43 (26.9%) were classified as failure. Variables associated with failure were liver cirrhosis (66.7% vs. 22.8%, p=0.001), diagnosis within the first 30 days from arthroplasty (30.4% vs. 8.0%, p=0.020), C-reactive protein (CRP) >12 mg/dl (46.7% vs. 21.2%, p=0.005), microorganism isolated in all deep samples (31.1% vs. 16.0%, p=0.047) and Gram-negative (GN) infection not treated with a fluoroquinolone (57.1% vs. 20.0%, P=0.004). Gram-positive (GP) infection not treated with rifampin was close to be statistically significantly associated with failure (34.4% vs. 19.2%, p=0.067). A multivariate analysis identified liver cirrhosis (OR: 12.4 CI95%: 3.1-49.7, p<0.001), CRP-value (OR: 1.06 CI95%: 1.0-1.11, p=0.049), and when a GN-infection was not treated with a fluoroquinolone (OR: 6.5, CI95%: 1.8-23.8, p=0.005) as independent predictors of failure. CONCLUSION The remission rate of PJI treated with DAIR after 3 years of follow-up was 73%. The main predictors of failure were liver cirrhosis, the selected antibiotic most specially fluoroquinolones for GN and rifampin for GP infections, the C-reactive protein and the number of samples culture positive as a potential surrogate markers of bacterial density.
Collapse
|
45
|
Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection. Case Rep Infect Dis 2014; 2014:142428. [PMID: 25431708 PMCID: PMC4241309 DOI: 10.1155/2014/142428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/09/2014] [Indexed: 11/17/2022] Open
Abstract
This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis). To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections.
Collapse
|
46
|
Connaughton A, Childs A, Dylewski S, Sabesan VJ. Biofilm Disrupting Technology for Orthopedic Implants: What's on the Horizon? Front Med (Lausanne) 2014; 1:22. [PMID: 25705632 PMCID: PMC4335381 DOI: 10.3389/fmed.2014.00022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 07/29/2014] [Indexed: 11/29/2022] Open
Abstract
The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases, the use of antibiotics alone has even made the bacteria more resistant to treatment. Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study, we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then, we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future.
Collapse
Affiliation(s)
| | - Abby Childs
- Western Michigan University Homer Stryker MD School of Medicine , Kalamazoo, MI , USA
| | - Stefan Dylewski
- Michigan State University College of Human Medicine , Grand Rapids, MI , USA
| | - Vani J Sabesan
- Western Michigan University Homer Stryker MD School of Medicine , Kalamazoo, MI , USA
| |
Collapse
|
47
|
Ascione T, Pagliano P, Mariconda M, Rotondo R, Balato G, Toro A, Barletta V, Conte M, Esposito S. Factors related to outcome of early and delayed prosthetic joint infections. J Infect 2014; 70:30-6. [PMID: 25077990 DOI: 10.1016/j.jinf.2014.07.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 01/19/2023]
Abstract
UNLABELLED In this prospective study, we evaluate the impact of adherence to a diagnostic and therapeutic protocol on prosthetic joint infections (PJI) diagnostic accuracy and outcome. PATIENTS AND METHODS Patients with early or delayed PJI referred over a 5-year period were included. Diagnosis was based on characteristic clinical signs, radiographic findings and microbiological evidence. Antibiotics were chosen on the basis of microbiological findings, and drugs active against methicillin-resistant staphylococci were administered if no microbiological evidence had been obtained. RESULTS Inclusion criteria were met in 159 cases (median age 64 years, males 45%). 56 were early infections and 103 delayed infections. Comorbidities were reported in 99 (62%) cases. Positive cultures were obtained in 122/159 (77%), coagulase-negative staphylococci were cultured in 20%, Staphylococcus aureus in 28%, and Pseudomonas aeruginosa in 7%. In early infections, cure rate after debridement and antibiotic therapy was 80%. In delayed infections, cure rate after two-stage exchange was 85%. Of 28 patients with delayed infection treated with antibiotics without surgery, only 8 (29%) infections were suppressed 48 weeks after treatment discontinuation. Rifampin afforded a better outcome. CONCLUSION Appropriate diagnostic and surgical procedures and microbiologically driven antibiotic therapy including rifampin are recommended to improve diagnostic accuracy and outcome.
Collapse
Affiliation(s)
- T Ascione
- Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy.
| | - P Pagliano
- Department of Infectious Diseases, D. Cotugno Hospital, AORN Dei Colli, Naples, Italy
| | - M Mariconda
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - R Rotondo
- Department of Orthopaedic Surgery, C.T.O. Hospital, AORN Dei Colli, Naples, Italy
| | - G Balato
- Department of Orthopaedic Surgery, "Federico II" University, Naples, Italy
| | - A Toro
- Department of Orthopaedic Surgery, Sarno Hospital, Sarno, Italy
| | - V Barletta
- Department of Orthopaedic Surgery, "S. Michele" Clinic, Maddaloni, Italy
| | - M Conte
- Department of Microbiology, AORN Dei Colli, Naples, Italy
| | - S Esposito
- Department of Infectious Diseases, University of Salerno, Italy
| |
Collapse
|
48
|
Deep Infection With Candida albicans Following Total Hip Replacement. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a1eeae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Vassena C, Fenu S, Giuliani F, Fantetti L, Roncucci G, Simonutti G, Romanò CL, De Francesco R, Drago L. Photodynamic antibacterial and antibiofilm activity of RLP068/Cl against Staphylococcus aureus and Pseudomonas aeruginosa forming biofilms on prosthetic material. Int J Antimicrob Agents 2014; 44:47-55. [DOI: 10.1016/j.ijantimicag.2014.03.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 11/30/2022]
|
50
|
Cooper EC, Curtis N, Cranswick N, Gwee A. Pristinamycin: old drug, new tricks? J Antimicrob Chemother 2014; 69:2319-25. [DOI: 10.1093/jac/dku167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|