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Anh Thu PN, Men NH, Thi Vo CD, Van Toi V, Truong PL. A simple and rapid colorimetric detection of Staphylococcus aureus relied on the distance-dependent optical properties of silver nanoparticles. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:2913-2920. [PMID: 38660999 DOI: 10.1039/d3ay02189k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The quick and accurate diagnosis of pathogens has appeared as a pressing issue in clinical diagnostics, environmental monitoring, and food safety. The available assays are suffering from limited capacities in simple, fast, low-cost, and on-site detection to increase prevention and proper treatment. Herein, we address these challenges by developing a simple, speedy, affordable, and ultrasensitive nanoplasmonic biosensor for colorimetric detection of cDNA from staphylococcal RNA relying on the distance-dependent optical features of silver nanostructures for the measurement of color variations and spectral shifts owing to the plasmon coupling generated by the cross-linking accumulation of AgNPs. The method described utilizes silver nanoparticles (AgNPs) immobilized with two different single-stranded oligonucleotides (ssDNA1 and ssDNA2) that specifically recognize the target DNA. Sandwich hybridization of target DNA with ssDNA1 and ssDNA2 induced color variations and spectral shifts of AgNPs, whereas test samples without the target DNA remained yellow as the initial color of colloidal silver. The designed nanoplasmonic biosensor demonstrated high specificity with the detection limit (LOD) of ∼1.8 amol target DNA (∼106 molecules per test) in the broad linear dynamic range from 0.01 to 100 nM, and LOD down to a few cells was attained for amplified bacterial nucleic acids and a linear range from 102 CFU mL-1 to 107 CFU mL-1. The sensing approach showed great potential for the timely diagnosis of pathogens in low-density samples, and it has considerable merits over traditional culture approaches and qPCR techniques.
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Affiliation(s)
- Phan Ngoc Anh Thu
- Faculty of Biology and Biotechnology, University of Science, Ho Chi Minh City 700000, Vietnam
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
| | - Nguyen Hoang Men
- Department of Physics and Biophysics, Faculty of Basic Science, Can Tho University of Medicine and Pharmacy, Can Tho city 900000, Vietnam
| | - Cam-Duyen Thi Vo
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
- School of Biomedical Engineering, International University, Ho Chi Minh City 700000, Vietnam.
| | - Vo Van Toi
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
- School of Biomedical Engineering, International University, Ho Chi Minh City 700000, Vietnam.
| | - Phuoc Long Truong
- Vietnam National University, Ho Chi Minh City 700000, Vietnam
- School of Biomedical Engineering, International University, Ho Chi Minh City 700000, Vietnam.
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Suran S, Kamyar N, Huang K, Foroutan F, Balakrishna Pillai P, Liu X, Vaughan J, Wilson D, Day PJ, Nair RR. Tunable Release of Ions from Graphene Oxide Laminates for Sustained Antibacterial Activity in a Biomimetic Environment. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2304850. [PMID: 38686680 DOI: 10.1002/smll.202304850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/29/2024] [Indexed: 05/02/2024]
Abstract
Silver has long been recognized for its potent antimicrobial properties, but achieving a slow and longer-term delivery of silver ions presents significant challenges. Previous efforts to control silver ion dosages have struggled to sustain release for extended periods in biomimetic environments, especially in the presence of complex proteins. This challenge is underscored by the absence of technology for sustaining antimicrobial activity, especially in the context of orthopedic implants where long-term efficacy, extending beyond 7 days, is essential. In this study, the tunable, slow, and longer-term release of silver ions from the two-dimensional (2D) nanocapillaries of graphene oxide (GO) laminates incorporated with silver ions (Ag-GO) for antimicrobial applications are successfully demonstrated. To closely mimic a physiologically relevant serum-based environment, a novel in vitro study model using 100% fetal bovine serum (FBS) is introduced as the test medium for microbiology, biocompatibility, and bioactivity studies. To emulate fluid circulation in a physiological environment, the in vitro studies are challenged with serum exchange protocols on different days. The findings show that the Ag-GO coating can sustainably release silver ions at a minimum dosage of 10 µg cm-2 day-1, providing an effective and sustained antimicrobial barrier for over ten days.
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Affiliation(s)
- Swathi Suran
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Negin Kamyar
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Kun Huang
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Farzad Foroutan
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Premlal Balakrishna Pillai
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
| | - Xuzhao Liu
- Department of Materials, University of Manchester/Photon Science Institute, University of Manchester, Manchester, M13 9PL, UK
| | - John Vaughan
- T. J. Smith and Nephew Limited, 101 Hessle Road, Hull, HU3 2BN, UK
| | - Darren Wilson
- T. J. Smith and Nephew Limited, 101 Hessle Road, Hull, HU3 2BN, UK
| | - Philip J Day
- Manchester Institute of Biotechnology & Division of Evolution, Infection & Genomic Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Rahul R Nair
- National Graphene Institute & Department of Chemical Engineering, University of Manchester, Manchester, M13 9PL, UK
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Ugwummadu C, Schmidt E, Hoeprich M, Bonta A, Ridgway K, Walker L, Witkowski J, Weinstein J, Cooper MR. Improving Compliance with Preoperative Nasal Povidone-Iodine to Prevent Surgical Site Infection in Vascular and Neurosurgery Services in a Community Teaching Hospital. Am J Med Qual 2024; 39:59-68. [PMID: 38403957 DOI: 10.1097/jmq.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Surgical site infections (SSI) remain a cause of morbidity, prolonged hospitalization, surgical readmission, and death. Nasal colonization with methicillin-resistant Staphylococcal aureus is a frequent cause of device-related SSI and nasal mupirocin has been used for prevention. More recently, povidone-iodine nasal swabs have become an alternative. It is cheaper, ensures compliance and there are no concerns regarding antimicrobial resistance. However, its adoption was suboptimal in a community hospital system in southwestern Ohio, especially in neurosurgery and vascular surgery. Quality improvement techniques, including solicitation of stakeholder input, surgeons and perioperative nurses' education, and the use of reminders to order and administer the povidone-iodine nasal swabs improved physician ordering and nurse administration compliance, leading to fewer infections. The interventions continued after the project was completed, sustaining decreases in neurosurgery and vascular surgery, and fewer SSI through the first years of the pandemic. Despite the complexity of these surgeries, simple interventions were effective in addressing the problem.
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Affiliation(s)
| | | | | | | | | | | | - Julia Witkowski
- Department of Healthcare Quality and Safety, Jefferson College of Population Health
| | | | - Mary Reich Cooper
- Department of Healthcare Quality and Safety, Jefferson College of Population Health
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4
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Whelan L, Leal J, Leslie M, Barkema HW, Ocampo W, May ER. Patient compliance with the implementation of a decolonization strategy for Staphylococcus aureus in hip and knee replacements. Am J Infect Control 2024; 52:207-213. [PMID: 37355096 DOI: 10.1016/j.ajic.2023.06.016] [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: 04/17/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND A preoperative, in-community antimicrobial decolonization protocol combining chlorohexidine gluconate (CHG) sponges and mupirocin ointment to reduce surgical site infections amongst hip and knee replacement patients has been adopted in Alberta, Canada. Patient compliance with the protocol is essential for effectiveness. It is, therefore, important to understand patterns, and reasons why, patients do, and do not, comply. METHODS A descriptive survey of patients having elective total hip or knee replacement at seven clinics in Alberta was conducted to determine patient compliance and reasons for noncompliance. Descriptive statistics and multivariate logistic regression were computed. RESULTS Patient compliance was assessed in 3,427 patients. There were no differences in compliance based on the baseline protocols and enhanced protocols, but there was a difference based on clinic location. The odds of compliance with three CHG sponges were 4.47 times higher in rural versus urban clinics (P < .001). The most common reason for noncompliance for patients instructed to use 3 CHG sponges was "patient forgot". CONCLUSIONS Compliance did not change when enhanced protocols were introduced; however, compliance differed by clinic location. Reasons for noncompliance included "sponges not provided", "patient forgot", and "surgery date moved". Results may inform clinics on areas where improvements could be made to increase patient compliance.
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Affiliation(s)
- Lindsay Whelan
- Strategic Clinical Network, Alberta Health Services, AMR-One Health Consortium, Departments of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Jenine Leal
- Departments of Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, O'Brien Institute for Public Health, University of Calgary, AMR-One Health Consortium, Infection Prevention and Control, Alberta Health Services, Calgary, AB, Canada
| | - Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, and School of Public Policy, University of Calgary, AMR-One Health Consortium, Calgary, AB, Canada
| | - Herman W Barkema
- Departments of Production Animal Health, Faculty of Veterinary Medicine and Cumming School of Medicine, University of Calgary, AMR-One Health Consortium, One Health at UCalgary, University of Calgary Biostatistics Centre, Calgary, AB, Canada; Departments of Medicine, W21 Research and Innovation Centre, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Wrechelle Ocampo
- W21C Research and Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Elissa R May
- Departments of Medicine, and Community Health Sciences, and Microbiology Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Departments of Medicine, University of Calgary, O'Brien Institute for Public Health and Snyder Institute for Chronic Diseases, AMR-One Health Consortium, Calgary, AB, Canada
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5
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Tang X, Shi W, Qian Y, Ge Z. Effect of suture closure and staple closure on postoperative wound complications in patients undergoing knee replacement surgery: A meta-analysis. Int Wound J 2024; 21:e14372. [PMID: 37679956 PMCID: PMC10782053 DOI: 10.1111/iwj.14372] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
The purpose of this meta-analysis is to determine if the application of stitching in the closed area of the knee arthroplasty remains significantly superior to that of the staples. Data sources: EMBASE, Cochrane Libraryand, publications, and the Web of Science. Patients were treated with staples for closure of their wounds, or with conventional stitches for closure of wounds. The main findings were surgical site infection, wound dehiscence, and cutting time. The secondary results were the time to completion, the duration of the hospitalization, and the time to discharge. We incorporated the SIX trial into the meta-analyses with Review Manager V.5.3. The hazard ratio was computed as a therapeutic outcome with respect to the heterogeneity. For more than 50% of heterogeneous samples, we employed a stochastic effect model. The results showed that there was no significant difference in the degree of infection, the degree of dehiscence, the length of the cut and the degree of satisfaction of the wound. But the time to close the wound and the time to operate were significantly different. The time needed to close the wound was shorter than that of the suture (OR, -227. 22; 95% CI, -238. 74, -215. 69 p < 0. 0001); The time taken to replace the knee was also significantly lower among those who had been stapled sutures (OR, -5.46; 95% CI, -10. 43, -0.49 p = 0. 03). Wound closing materials are an afterthought for many orthopaedic surgeons. Together, the findings from a number of comparative studies indicate that the selection of wound closure materials might affect the outcome of the surgery. The evidence, however, is weak because of the heterogeneous approach adopted in earlier research. This study program is intended to provide guidance on how to select the best wound closure material for the purpose of identifying if there is any difference in the incidence of injuries among traditional stitches and staples.
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Affiliation(s)
- Xiongfei Tang
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Wenfeng Shi
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Yuening Qian
- Department of OrthopaedicsHaining People's HospitalHainingChina
| | - Zhen Ge
- Department of OrthopaedicsHaining People's HospitalHainingChina
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6
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Li D, Ding S, Li J, Liao X, Ru K, Liu L, Shang W. Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer. Front Cell Infect Microbiol 2023; 13:1286313. [PMID: 37953798 PMCID: PMC10634473 DOI: 10.3389/fcimb.2023.1286313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI. Methods This retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics. Results Compared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher. Conclusion This study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.
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Affiliation(s)
| | | | | | | | | | | | - Wenjing Shang
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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7
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Yeramosu T, Young P, Cinats DJ, Toney CB, Satpathy J, Patel TT, Kates SL, Perdue PW. Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study. J Orthop Trauma 2023; 37:469-474. [PMID: 37053112 PMCID: PMC10524202 DOI: 10.1097/bot.0000000000002617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE (1) To assess the rate of fracture-related infection (FRI) and unplanned reoperation of disinfecting and prepping in the external fixator (Ex-Fix) instrument during definitive open reduction and internal fixation (ORIF) of pilon fractures treated by a staged protocol and (2) to determine whether the amount of time from external fixation to ORIF influences the risk of FRI. DESIGN Retrospective cohort study. SETTING Level 1 academic trauma center. PATIENTS One hundred thirty-three patients who underwent operative treatment for pilon fracture between 2010 and 2020. INTERVENTION External fixation and ORIF with or without the Ex-Fix prepped in situ during definitive fixation. MAIN OUTCOME MEASUREMENTS FRI and unplanned reoperation rates. RESULTS 133 patients were enrolled, of which 47 (35.3%) had Ex-Fix elements prepped in situ. There was an overall infection rate of 23.3% and unplanned reoperation rate of 11.3%, and there was no significant difference in rates between the 2 cohorts. Patients with Ex-Fix elements prepped in situ who developed an FRI had a higher rate of MRSA and MSSA . Diabetes ( P = 0.0019), open fracture ( P = 0.0014), and longer (≥30 days) interval to ORIF ( P = 0.0001) were associated with postoperative FRI. CONCLUSIONS Prepping elements of the Ex-Fix in situ did not lead to an increase in rates of FRI or unplanned reoperation. Although diabetes and open fracture were associated with FRI risk, a stronger association was a longer interval of Ex-Fix utilization before definitive internal fixation, specifically 30 days or greater. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Teja Yeramosu
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Porter Young
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - David J. Cinats
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Clarence B. Toney
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Jibanananda Satpathy
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Tejas T. Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Stephen L. Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul W. Perdue
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Chakraborty S, Katsifis G, Roohani I, Boyer C, McKenzie D, Willcox MDP, Chen R, Kumar N. Electrostatic and Covalent Binding of an Antibacterial Polymer to Hydroxyapatite for Protection against Escherichia coli Colonization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5045. [PMID: 37512322 PMCID: PMC10385198 DOI: 10.3390/ma16145045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023]
Abstract
Orthopedic-device-related infections are notorious for causing physical and psychological trauma to patients suffering from them. Traditional methods of treating these infections have relied heavily on antibiotics and are becoming ineffectual due to the rise of antibiotic-resistant bacteria. Mimics of antimicrobial peptides have emerged as exciting alternatives due to their favorable antibacterial properties and lack of propensity for generating resistant bacteria. In this study, the efficacy of an antibacterial polymer as a coating material for hydroxyapatite and glass surfaces, two materials with wide ranging application in orthopedics and the biomedical sciences, is demonstrated. Both physical and covalent modes of attachment of the polymer to these materials were explored. Polymer attachment to the material surfaces was confirmed via X-ray photoelectron spectroscopy and contact angle measurements. The modified surfaces exhibited significant antibacterial activity against the Gram-negative bacterium E. coli, and the activity was retained for a prolonged period on the surfaces of the covalently modified materials.
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Affiliation(s)
| | - Georgio Katsifis
- School of Physics, University of Sydney, Sydney, NSW 2006, Australia
| | - Iman Roohani
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Cyrille Boyer
- School of Chemical Engineering, UNSW Sydney, Sydney, NSW 2052, Australia
| | - David McKenzie
- School of Physics, University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Renxun Chen
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
| | - Naresh Kumar
- School of Chemistry, UNSW Sydney, Sydney, NSW 2052, Australia
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Ren SQ, Ma Y, Fu LL, Hu KZ, Liang HR, Yu B, Tang GH. A comparative 18F-FDG and an anti-PD-L1 probe PET/CT imaging of implant-associated Staphylococcus aureus osteomyelitis. Front Cell Infect Microbiol 2023; 13:1182480. [PMID: 37293208 PMCID: PMC10244720 DOI: 10.3389/fcimb.2023.1182480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
Background Early and accurate diagnosis of infection-induced osteomyelitis, which often involves increased PD-L1 expression, is crucial for better treatment outcomes. Radiolabeled anti-PD-L1 nuclear imaging allows for sensitive and non-invasive whole-body assessments of PD-L1 expression. This study aimed to compare the efficacy of 18F-FDG and an 18F-labeled PD-L1-binding peptide probe (18F-PD-L1P) in PET imaging of implant-associated Staphylococcus aureus osteomyelitis (IAOM). Methods In this study, we synthesized an anti-PD-L1 probe and compared its efficacy with 18F-FDG and 18F-PD-L1P in PET imaging of implant-associated Staphylococcus aureus osteomyelitis (IAOM). The %ID/g ratios (i.e., radioactivity ratios between the infected and non-infected sides) of both probes were evaluated for sensitivity and accuracy in post-infected 7-day tibias and post-infected 21 days, and the intensity of 18F-PD-L1P uptake was compared with pathological changes measured by PD-L1 immunohistochemistry (IHC). Results Compared with 18F-FDG, 18F-PDL1P demonstrated higher %ID/g ratios for both post-infected 7-day tibias (P=0.001) and post-infected 21 days (P=0.028). The intensity of 18F-PD-L1P uptake reflected the pathological changes of osteomyelitic bones. In comparison to 18F-FDG, 18F-PDL1P provides earlier and more sensitive detection of osteomyelitis caused by S. aureus. Conclusion Our findings suggest that the 18F-PDL1P probe is a promising tool for the early and accurate detection of osteomyelitis caused by S. aureus.
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Affiliation(s)
- Shu-Qi Ren
- GuangDong Medical Products Administration (GDMPA) Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuan Ma
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Li-Lan Fu
- GuangDong Medical Products Administration (GDMPA) Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kong-Zhen Hu
- GuangDong Medical Products Administration (GDMPA) Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao-Ran Liang
- GuangDong Medical Products Administration (GDMPA) Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gang-Hua Tang
- GuangDong Medical Products Administration (GDMPA) Key Laboratory for Quality Control and Evaluation of Radiopharmaceuticals, Department of Nuclear Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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10
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Zeng M, Xu Z, Song ZQ, Li JX, Tang ZW, Xiao S, Wen J. Diagnosis and treatment of chronic osteomyelitis based on nanomaterials. World J Orthop 2023; 14:42-54. [PMID: 36844379 PMCID: PMC9945247 DOI: 10.5312/wjo.v14.i2.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
Chronic osteomyelitis is a painful and serious disease caused by infected surgical prostheses or infected fractures. Traditional treatment includes surgical debridement followed by prolonged systemic antibiotics. However, excessive antibiotic use has been inducing rapid emergence of antibiotic-resistant bacteria worldwide. Additionally, it is difficult for antibiotics to penetrate internal sites of infection such as bone, thus limiting their efficacy. New approaches to treat chronic osteomyelitis remain a major challenge for orthopedic surgeons. Luckily, the development of nanotechnology has brought new antimicrobial options with high specificity to infection sites, offering a possible way to address these challenges. Substantial progress has been made in constructing antibacterial nanomaterials for treatment of chronic osteomyelitis. Here, we review some current strategies for treatment of chronic osteomyelitis and their underlying mechanisms.
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Affiliation(s)
- Ming Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie-Xiao Li
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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11
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Muacevic A, Adler JR. Intranasal Mupirocin to Reduce Surgical Site Infection Post Cardiac Surgery: A Review of the Literature. Cureus 2023; 15:e33678. [PMID: 36793816 PMCID: PMC9924705 DOI: 10.7759/cureus.33678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Sternal wound infections after cardiac surgery are associated with high rates of morbidity and mortality. One of the known risk factors of sternal wound infection is Staphylococcus aureus colonisation. Intranasal mupirocin decolonisation therapy implemented pre-operatively appears to be an effective preventative measure in reducing sternal wound infections post-cardiac surgery. Therefore, the main aim of this review is to evaluate the current literature regarding the use of intranasal mupirocin before cardiac surgery and its impact on sternal wound infection rates.
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12
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Influence of chitosan and chitosan oligosaccharide on dual antibiotic-loaded bone cement: In vitro evaluations. PLoS One 2022; 17:e0276604. [PMID: 36449553 PMCID: PMC9710798 DOI: 10.1371/journal.pone.0276604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate the effect of incorporating chitosan (Ch) and chitosan oligosaccharides (ChO) into the commercially premixed antibiotic-loaded bone cement (ALBC). We compare antibiotic release profiles, antibacterial activity, and mechanical properties among different ALBC formulations. The hypothesis was that increasing the amount of Ch and ChO in the cement mixture would increase the antibiotics released and bacterial control. ALBC mixed with Ch or ChO may create a greater effect due to its superior dissolving property. MATERIALS AND METHODS The bone cement samples used in this project were made from Copal® G+V composed of vancomycin and gentamicin. To prepare the Ch and the ChO mixed bone cement samples, different amounts of Ch and ChO were added to the polymethylmethacrylate matrix with three concentrations (1%, 5%, and 10%). Drug elution assay, antimicrobial assay, in vitro cytotoxicity, and mechanical properties were conducted. RESULTS Bone cement samples made from Copal® G+V alone or combined with Ch or ChO can release vancomycin and gentamicin into the phosphate-buffered saline. Mixing ChO into the bone cements can increase the amount of drug released more than Ch. ChO 10% gave the highest amount of antibiotics released. All samples showed good antibacterial properties with good biocompatibility in vitro. The microhardness values of the Ch and ChO groups increased significantly compared to the control group. In all groups tested, the microhardness of bone cements was reduced after the drug eluted out. However, this reduction of the Ch and ChO groups was in line with the control. INTERPRETATION Various attempts have been made to improve the ALBC efficacy. In our study, the best bone cement formulation was bone cement mixed with ChO (10%), which had the highest drug release profiles, was biocompatible, and contained antibacterial properties with acceptable mechanical properties. This phenomenon could result from the superior water solubility of the ChO. When ChO leaves the bone cement specimens, it generates pores that could act as a path that exposes the bone cement matrix to the surrounding medium, increasing antibiotic elution. From all above, ChO is a promising substance that could be added to ALBC in order to increase the drug elution rate. However, more in vitro and in vivo experiments are needed before being used in the clinic.
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Li Q, Gao Y, Zhang J, Tang Y, Yangyong S, Wu L, Wu H, Shen M, Liu X, Han L, Xu Z. Crosslinking and functionalization of acellular patches via the self-assembly of copper@tea polyphenol nanoparticles. Regen Biomater 2022; 9:rbac030. [PMID: 35665201 PMCID: PMC9157057 DOI: 10.1093/rb/rbac030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/01/2022] [Accepted: 04/17/2022] [Indexed: 11/13/2022] Open
Abstract
Decellularization is a promising technique to produce natural scaffolds for tissue engineering applications. However, non-crosslinked natural scaffolds disfavor application in cardiovascular surgery due to poor biomechanics and rapid degradation. Herein, we proposed a green strategy to crosslink and functionalize acellular scaffolds via the self-assembly of copper@tea polyphenol nanoparticles (Cu@TP NPs), and the resultant nanocomposite acellular scaffolds were named as Cu@TP-dBPs. The crosslinking degree, biomechanics, denaturation temperature and resistance to enzymatic degradation of Cu@TP-dBPs were comparable to those of glutaraldehyde crosslinked decellularized bovine pericardias (Glut-dBPs). Furthermore, Cu@TP-dBPs were biocompatible and had abilities to inhibit bacterial growth and promote the formation of capillary-like networks. Subcutaneous implantation models demonstrated that Cu@TP-dBPs were free of calcification and allowed for host cell infiltration at Day 21. Cardiac patch graft models confirmed that Cu@TP-dBP patches showed improved ingrowth of functional blood vessels and remodeling of extracellular matrix at Day 60. These results suggested that Cu@TP-dBPs not only had comparable biomechanics and biostability to Glut-dBPs, but also had several advantages over Glut-dBPs in terms of anticalcification, remodeling and integration capabilities. Particularly, they were functional patches possessing antibacterial and proangiogenic activities. These material properties and biological functions made Cu@TP-dBPs a promising functional acellular patch for cardiovascular applications.
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Affiliation(s)
- Qin Li
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Yuan Gao
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Jiajun Zhang
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Yangfeng Tang
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Shun Yangyong
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Lujia Wu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Hao Wu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Meifang Shen
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Xiaohong Liu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
| | - Lin Han
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Lab, Institute of Cardiothoracic Surgery, Changhai Hospital, Shanghai, China
- Institute of Cardiovascular Surgery, Changhai Hospital, Shanghai, China
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14
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Crespi Z, Hasan AI, Pearl A, Ismail A, Awad ME, Irfan FB, Jaffar M, Patel P, Saleh KJ. Current Guidelines and Practice Recommendations to Prevent Hospital-Acquired Conditions After Major Orthopaedic Surgeries. JBJS Rev 2022; 10:01874474-202203000-00012. [PMID: 35290253 DOI: 10.2106/jbjs.rvw.21.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» In 2016, a total of 48,771 hospital-acquired conditions (HACs) were reported in U.S. hospitals. These incidents resulted in an excess cost of >$2 billion, which translates to roughly $40,000 per patient with an HAC. » Current guidelines for the prevention of venous thromboembolism and surgical site infection consist primarily of antithrombotic prophylaxis and antiseptic technique, respectively. » The prevention of catheter-associated urinary tract infection (CA-UTI) and in-hospital falls and trauma is done best via education. In the case of CA-UTI, this consists of training staff about the indications for catheters and their timely removal when they are no longer necessary, and in the case of in-hospital falls and trauma, advising the patient and family about the patient's fall risk and communicating the fall risk to the health-care team. » Blood incompatibility is best prevented by implementation of a pretransfusion testing protocol. Pressure ulcers can be prevented via patient positioning, especially during surgery, and via postoperative skin checks.
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Affiliation(s)
- Zachary Crespi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Ahmad I Hasan
- School of Medicine, Wayne State University, Detroit, Michigan.,FAJR Scientific, Northville, Michigan
| | - Adam Pearl
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Aya Ismail
- FAJR Scientific, Northville, Michigan.,University of Michigan, Dearborn, Michigan
| | - Mohamed E Awad
- FAJR Scientific, Northville, Michigan.,NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Furqan B Irfan
- Michigan State University-College of Osteopathic Medicine, Detroit, Michigan
| | - Muhammed Jaffar
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Padmavathi Patel
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Khaled J Saleh
- FAJR Scientific, Northville, Michigan.,Michigan State University-College of Osteopathic Medicine, Detroit, Michigan.,Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
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15
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Stevanović MM, Filipović N, Kuzmanović M, Tomić N, Ušjak D, Milenković M, Zheng K, Stampfl J, Boccaccini AR. Synthesis and characterization of a collagen-based composite material containing selenium nanoparticles. J Biomater Appl 2022; 36:1800-1811. [DOI: 10.1177/08853282211073731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Multidrug-resistant bacterial strains represent an emerging global health threat and a great obstacle for bone tissue engineering. One of the major components of the extracellular matrix of the bone is a collagen protein, while selenium is an element that has antimicrobial potential, and is also important for bone metabolism and bone health. Here we represent the incorporation of selenium nanoparticles (SeNPs) synthesized by the green chemical reduction method into collagen gels to produce a composite material, collagen/SeNPs, with antimicrobial properties. The samples were comprehensively characterized by zeta potential measurements, dynamic light scattering inductively coupled plasma-mass spectrometry (ICP-MS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), optical microscopy, field-emission scanning electron microscopy (FE-SEM), and differential scanning calorimetry The cytotoxicity of the SeNPS, as well as collagen/SeNPs, was tested on the MRC-5 cells. It was revealed that collagen/SeNPS expressed a lower cytotoxic effect. Collagen/SeNPs showed significant antibacterial activity against all tested Gram-positive strains, the major causative agents of orthopedic infections as well as Candida albicans. Furthermore, three-dimensional β-tricalcium phosphate (3D-TCP) scaffolds were fabricated by a well-established 3D printing (lithography) method, and afterward preliminary coated by newly-synthesized SeNPs or collagen/SeNPs. In addition, uncoated 3D-TCP scaffolds as well as coated by collagen/SeNPs were subjected to biofilm formation. The production of Staphylococcus aureus biofilm on coated scaffolds by collagen/SeNPs was significantly reduced compared to the uncoated ones.
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Affiliation(s)
- Magdalena M Stevanović
- Institute of Technical Sciences of the Serbian Academy of Sciences and Arts, Beograd, Serbia
| | - Nenad Filipović
- Institute of Technical Sciences of the Serbian Academy of Sciences and Arts, Beograd, Serbia
| | - Maja Kuzmanović
- Institute of Technical Sciences of the Serbian Academy of Sciences and Arts, Beograd, Serbia
| | - Nina Tomić
- Institute of Technical Sciences of the Serbian Academy of Sciences and Arts, Beograd, Serbia
| | - Dušan Ušjak
- Department of Microbiology and Immunology, University of Belgrade Faculty of Pharmacy, Beograd, Serbia
| | - Marina Milenković
- Department of Microbiology and Immunology, University of Belgrade Faculty of Pharmacy, Beograd, Serbia
| | - Kai Zheng
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Juergen Stampfl
- Institute of Materials Science and Technology, TU Wien, Wien, Austria
| | - Aldo R Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Erlangen, Germany
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16
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Adkins JM, Ahmar RA, Yu HD, Musick ST, Alberico AM. Comparison of Antimicrobial Activity Between Bacitracin-Soaked Sutures and Triclosan Coated Suture. J Surg Res 2022; 270:203-207. [PMID: 34700295 PMCID: PMC8931739 DOI: 10.1016/j.jss.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 08/22/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND With the easily available option for surgeons to soak their suture in antibiotic irrigation solution intraoperatively in mind, this study was designed to evaluate the ability of suture soaked in bacitracin irrigation solution to inhibit the growth of Staphylococcus aureus and Methicillin-resistant Staphylococcus aureus. MATERIALS AND METHODS Using standard experimental procedure, sterile suture was soaked in Bacitracin, and dried for 10 min or 6 h, incubated for 24 h on inoculated plates, and examined for zone of inhibition around the suture. This was compared to control unsoaked suture and antimicrobial suture (AMS) currently on the market to determine if the minor intraoperative procedural change of placing suture in antibiotic irrigation solution instead of on the sterile table could confer comparable antimicrobial activity. RESULTS The study found the Bacitracin-soaked suture (BSS) consistently inhibited the growth of the test organisms. For both organisms, the BSS exhibited a significantly larger zone of inhibition compared to the unsoaked control suture (P < 0.0001). However, both the AMS currently on the market, and a bacitracin aliquot, exhibited significantly larger zones of inhibition compared to both drying times of the BSS (P < 0.0001). CONCLUSIONS Placing sutures in a bacitracin irrigation solution intraoperatively instead of directly on the sterile table can achieve some of the in vitro antimicrobial effect seen from AMS currently on the market. This may result in reduced rates of surgical site infections and associated costs without major procedural change and at reduced overhead.
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Affiliation(s)
- Jeremy M Adkins
- Department of Neurosurgery, University of Kentucky College of Medicine, Lexington, West Virginia; Department of Neurosurgery, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | - Roy Al Ahmar
- Department of Biomedical Sciences, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | - Hongwei D Yu
- Department of Biomedical Sciences, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia; Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | - Shane T Musick
- Department of Neurosurgery, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia.
| | - Anthony M Alberico
- Department of Neurosurgery, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
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17
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Surgical site infection prevention through bundled interventions in hip replacement surgery: A systematic review. Int J Surg 2021; 95:106149. [PMID: 34687953 DOI: 10.1016/j.ijsu.2021.106149] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Bundles have shown to improve patient outcomes in several settings. Surgical site infections (SSIs) following joint replacement surgery are associated with severe outcomes. We aimed to determine the effectiveness of non-pathogen specific bundled interventions in reducing SSIs after hip arthroplasty procedures. MATERIALS AND METHODS A systematic review and meta-analysis were conducted according to the PRISMA statement guidelines (PROSPERO registration number CRD42020203031). PubMed, Embase and Cochrane databases were searched for studies evaluating SSI prevention bundles in hip replacement surgery, excluding studies evaluating pathogen-specific bundles. Records were independently screened by two authors. The primary outcome was the SSI rate in intervention and control groups or before and after bundle implementation. Secondary outcomes of interest were bundle compliance and the number and type of bundle components. A meta-analysis was conducted using raw data, by calculating pooled relative risk (RR) SSI estimates to assess the impact of bundled interventions on SSI reduction. RESULTS Eleven studies were included in the qualitative review and four studies comprising over 20 000 patients were included in the quantitative synthesis. All included studies found bundles were associated with reduced SSI rates. The pooled RR estimated from the fixed-effects model was 0.76 (95% confidence interval 0.61-0.96, p 0.022) with 49.8% heterogeneity. CONCLUSIONS Results support the effectiveness of non-pathogen specific bundled interventions in preventing SSIs following hip arthroplasty. A "core" group of evidence-based elements for bundle development were identified.
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18
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Maruo A, Oda T, Miya H, Muratsu H, Fukui T, Oe K, Kuroda R, Niikura T. Intra-medullary antibiotics perfusion (iMAP) for the control of fracture-related infection early after osteosynthesis. J Orthop Surg (Hong Kong) 2021; 29:23094990211051492. [PMID: 34654344 DOI: 10.1177/23094990211051492] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In our hospital, cases of bone and soft tissue infections have been treated with continuous local antibiotics perfusion that allows for continuous circulation of antibiotics throughout the infected lesion. We termed this treatment "intramedullary antibiotics perfusion (iMAP)" for bone infection such as fracture-related infection (FRI) and "intrasoft tissue antibiotics perfusion" for soft tissue infection. Many cases are treated with both modalities. To introduce iMAP, this study focused on the patients with FRI treated with iMAP and reviewed their treatment outcomes. METHODS We included 10 patients with FRI treated with iMAP between 2004 and 2017. The iMAP needles were inserted near the infected lesion, and an aminoglycoside antimicrobial was continuously administered. Patient characteristics, pathogenic bacteria, administered antibiotics, duration of administration, concentrations of antibiotics in blood and leachate fluid, fracture union rate, implant retention rate, and complications were studied. RESULTS The mean age of patients was 59.9 years, and the mean follow-up period was 2.5 years. Affected bones were the tibia (n = 8), humerus (n = 1), and fibula (n = 1). Deep infections developed on average 29.9 days after osteosynthesis. Pathogenic bacteria were methicillin-susceptible Staphylococcus aureus (n = 6), methicillin-resistant S. aureus (n = 2), and unknown (n = 2). Average iMAP duration was 17.1 days. In all patients, infection was eradicated while preserving the implants, and fracture union was achieved without complications. CONCLUSION iMAP is a novel local drug delivery system allowing high concentrations of antibiotics to be administered without complications and is useful in the treatment of FRI.
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Affiliation(s)
- Akihiro Maruo
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Takahiro Oda
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidetoshi Miya
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Hirotsugu Muratsu
- Department of Orthopaedic Surgery, 38240Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Keisuke Oe
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, 538585Kobe University Graduate School of Medicine, Kobe, Japan
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19
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Wang L, Ji Q, Hu X. Role of targeted and universal mupirocin-based decolonization for preventing surgical-site infections in patients undergoing cardiothoracic surgery: A systematic review and meta-analysis. Exp Ther Med 2021; 21:416. [PMID: 33747157 PMCID: PMC7967856 DOI: 10.3892/etm.2021.9860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
The purpose of the present study was to provide a systematic literature review and pool evidence on the efficacy of mupirocin-based decolonization protocol in reducing surgical-site infections (SSIs) in patients undergoing cardiothoracic (CT) surgery based on their Staphylococcus (S.) aureus carrier state. The PubMed, Embase, Ovid, BioMed Central, Cochrane Central Register of Controlled Trials and Google Scholar databases were searched for studies comparing mupirocin-based decolonization with controls for reducing SSIs in patients following CT surgery. Studies were grouped based on the targeted population of intervention, i.e. carriers or all patients. A total of 17 studies were included. Of these, 8 studies used targeted mupirocin-based decolonization, while universal decolonization was performed in 9 studies. The results were conflicting for studies performing targeted decolonization and it was not possible to perform a meta-analysis due to non-homogenous studies. Pooled analysis of 34,859 patients indicated that universal mupirocin-based decolonization significantly reduced the risk of all SSIs [risk ratio (RR): 0.54; 95% CI: 0.40,0.75; I2=73.35%]. The intervention significantly reduced the risk of superficial SSIs (RR: 0.37; 95% CI: 0.25,0.55; I2=0%) but not of deep SSIs (RR: 0.45; 95% CI: 0.19,1.09; I2=80.67%). The results indicated a significantly reduced risk of S. aureus SSIs (SA-SSIs) with mupirocin-based decolonization (RR: 0.44; 95% CI: 0.32,0.61; I2=0%) but not for methicillin-resistant S. aureus (MRSA-SSIs; RR: 0.25; 95% CI: 0.05,1.28; I2=79.07%). Evidence on the role of targeted mupirocin-based decolonization to reduce SSIs after CT surgery was non-coherent and inconclusive. Analysis of low-quality retrospective studies suggested that universal mupirocin-based decolonization may reduce all SSIs, superficial SSIs and SA-SSIs, but not deep SSIs or MRSA-SSIs in patients after CT surgery.
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Affiliation(s)
- Li Wang
- Departments of Operating Room, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu 222002, P.R. China
| | - Qi Ji
- Departments of Operating Room, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu 222002, P.R. China
| | - Xiaoyan Hu
- Departments of Tongguan Operating Room, The First People's Hospital of Lianyungang City, Lianyungang, Jiangsu 222002, P.R. China
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20
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Palka L, Mazurek-Popczyk J, Arkusz K, Baldy-Chudzik K. Susceptibility to biofilm formation on 3D-printed titanium fixation plates used in the mandible: a preliminary study. J Oral Microbiol 2020; 12:1838164. [PMID: 33194115 PMCID: PMC7598999 DOI: 10.1080/20002297.2020.1838164] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/11/2020] [Accepted: 10/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background: In the oral and maxillofacial surgery, fixation plates are commonly used for the stabilization of bone fragments. Additive manufacturing has enabled us to design and create personalized fixation devices that would ideally fit any given fracture. Aim: The aim of the present preliminary study was to assess the susceptibility of 3D-printed titanium fixation plates to biofilm formation. Methods: Plates were manufactured using selective laser melting (SLM) from Ti-6Al-4 V. Reference strains of Streptococcus mutans, Staphyloccocus epidermidis, Staphylococcus aureus, Lactobacillus rhamnosus, and Candida albicans, were tested to evaluate the material's susceptibility to biofilm formation over 48 hours. Biofilm formations were quantified by a colorimetric method and colony-forming units (CFU) quantification. Scanning electron microscopy (SEM) visualized the structure of the biofilm. Results: Surface analysis revealed the average roughness of 102.75 nm and irregular topography of the tested plates. They were susceptible to biofilm formation by all tested strains. The average CFUs were as follows: S. mutans (11.91 x 107) > S.epidermidis (4.45 x 107) > S. aureus (2.3 x 107) > C.albicans (1.22 x 107) > L. rhamnosus (0.78 x 107). Conclusions: The present preliminary study showed that rough surfaces of additively manufactured titanium plates are susceptible to microbial adhesion. The research should be continued in order to compare additively manufactured plates with other commercially available osteotomy plates. Therefore, we suggest caution when using this type of material.
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Affiliation(s)
- Lukasz Palka
- Private Dental Practice, Zary, Poland
- ScienceBioTech, Wrocław, Poland
| | - Justyna Mazurek-Popczyk
- Department of Microbiology and Molecular Biology, Institute of Health Sciences, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Katarzyna Arkusz
- Department of Biomedical Engineering, Institute of Materials and Biomedical Engineering, Faculty of Mechanical Engineering, University of Zielona Góra, Zielona Góra, Poland
| | - Katarzyna Baldy-Chudzik
- Department of Microbiology and Molecular Biology, Institute of Health Sciences, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
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21
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Dewan KC, Dewan KS, Navale SM, Gordon SM, Svensson LG, Gillinov AM, Rich JB, Bakaeen F, Soltesz EG. Implications of Methicillin-Resistant Staphylococcus aureus Carriage on Cardiac Surgical Outcomes. Ann Thorac Surg 2020; 110:776-782. [PMID: 32387036 DOI: 10.1016/j.athoracsur.2020.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Staphylococcus aureus remains the most common cause of sternal surgical site infections (SSIs). Opinions on the postoperative implications of preoperative methicillin-resistant S aureus (MRSA) colonization currently differ. This study aimed to investigate whether MRSA carriage affects postoperative outcomes and safety of operation. METHODS A total of 1,774,811 cardiac surgical patients from 2009 to 2014 were identified from the National Inpatient Sample database. Among these patients, 5798 (0.33%) were MRSA carriers. Propensity-score matching was used to determine the effect of MRSA colonization on outcomes. RESULTS MRSA carriers did not differ in age or sex from noncarriers, but they more often presented for urgent surgery (P < .001). Among matched pairs, there was no difference in mortality (P = .76), stroke, SSIs, pneumonia, renal failure, cardiac complications, respiratory failure, or prolonged mechanical ventilation. MRSA infection (P < .001), MRSA septicemia (P = 0.03), and blood transfusion (P = .003) occurred more often among MRSA carriers. There was no increase in cost (P = .12), but the hospital length of stay was longer (P = .005). Predictors of MRSA infection among carriers included age older than 85 years, rural hospital location, and diabetes. Carriers with endocarditis and drug abuse were at highest risk for MRSA infection. CONCLUSIONS MRSA carriers undergoing cardiac surgery are not at higher risk for mortality or SSIs and can expect outcomes similar to those of noncarriers. Higher rates of postoperative MRSA infection and septicemia among carriers, although still very low, support the need for selective preoperative screening and prophylaxis when possible.
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Affiliation(s)
- Krish C Dewan
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karan S Dewan
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey B Rich
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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22
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Mejia A, Solitro G, Gonzalez E, Parekh A, Gonzalez M, Amirouche F. Pullout Strength After Multiple Reinsertions in Radial Bone Fixation. Hand (N Y) 2020; 15:393-398. [PMID: 30188185 PMCID: PMC7225890 DOI: 10.1177/1558944718795510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Due to bone cutting loss from self-tapping screws (STS), progressive destruction of bone can occur with each reinsertion during surgery. When considering the use of jigs that utilize multiple insertions such as those seen in ulnar and radial shortening osteotomy systems, or scenarios where a screw needs to be removed and reinserted due to some technical issue, this can be concerning, as multiple studies examining the effects of multiple reinsertions and the relationship between insertional torque and pullout strength have had mixed results. Methods: Insertional torque and pullout strength were experimentally measured following multiple reinsertions of STS for up to 5 total insertions for various densities and locations along radial sawbone shafts. Results: Torque and pullout strength were significantly greater in middle segments of the radial shaft. Our trials corroborate previous literature regarding a significant reduction in fixation between 1 and 2 insertions; beyond this, there was no significant difference between pullout strength across all segment locations as well as bone densities for 3 to 5 insertions. There was a moderate to high correlation of insertional torque to pullout strength noted across all bone densities and segments (Pearson r = 0.663, P < .001). Conclusion: While reinsertion of STS between 1 and 2 insertions has been shown to significantly differ in pullout strength, beyond this, there does not appear to be a significant difference in up to 5 insertions at any specific region of radial bone across a range of sawbone densities. Further insertions may be considered with caution.
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Affiliation(s)
| | | | | | - Amit Parekh
- University of Illinois at Chicago, USA,Amit Parekh, 835 South Wolcott Avenue, Room E-270, Chicago, IL 60612, USA.
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Reza A, Sutton JM, Rahman KM. Effectiveness of Efflux Pump Inhibitors as Biofilm Disruptors and Resistance Breakers in Gram-Negative (ESKAPEE) Bacteria. Antibiotics (Basel) 2019; 8:antibiotics8040229. [PMID: 31752382 PMCID: PMC6963839 DOI: 10.3390/antibiotics8040229] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022] Open
Abstract
Antibiotic resistance represents a significant threat to the modern healthcare provision. The ESKAPEE pathogens (Enterococcus faecium., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), in particular, have proven to be especially challenging to treat, due to their intrinsic and acquired ability to rapidly develop resistance mechanisms in response to environmental threats. The development of biofilm has been characterised as an essential contributing factor towards antimicrobial-resistance and tolerance. Several studies have implicated the involvement of efflux pumps in antibiotic resistance, both directly, via drug extrusion and indirectly, through the formation of biofilm. As a result, the underlying mechanism of these pumps has attracted considerable interest due to the potential of targeting these protein structures and developing novel adjunct therapies. Subsequent investigations have revealed the ability of efflux pump-inhibitors (EPIs) to block drug-extrusion and disrupt biofilm formation, thereby, potentiating antibiotics and reversing resistance of pathogen towards them. This review will discuss the potential of EPIs as a possible solution to antimicrobial resistance, examining different challenges to the design of these compounds, with an emphasis on Gram-negative ESKAPEE pathogens.
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Affiliation(s)
- Akif Reza
- Institute of Pharmaceutical Science, King’s College London, London, SE1 9NH, UK;
| | - J. Mark Sutton
- National Infections Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK;
| | - Khondaker Miraz Rahman
- Institute of Pharmaceutical Science, King’s College London, London, SE1 9NH, UK;
- Correspondence: ; Tel.: +44-(0)207-848-1891
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Sakr A, Brégeon F, Mège JL, Rolain JM, Blin O. Staphylococcus aureus Nasal Colonization: An Update on Mechanisms, Epidemiology, Risk Factors, and Subsequent Infections. Front Microbiol 2018; 9:2419. [PMID: 30349525 PMCID: PMC6186810 DOI: 10.3389/fmicb.2018.02419] [Citation(s) in RCA: 250] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Abstract
Up to 30% of the human population are asymptomatically and permanently colonized with nasal Staphylococcus aureus. To successfully colonize human nares, S. aureus needs to establish solid interactions with human nasal epithelial cells and overcome host defense mechanisms. However, some factors like bacterial interactions in the human nose can influence S. aureus colonization and sometimes prevent colonization. On the other hand, certain host characteristics and environmental factors can predispose to colonization. Nasal colonization can cause opportunistic and sometimes life-threatening infections such as surgical site infections or other infections in non-surgical patients that increase morbidity, mortality as well as healthcare costs.
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Affiliation(s)
- Adèle Sakr
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France.,Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Pharmacologie Intégrée et Interface Clinique et Industriel, Institut des Neurosciences Timone - UMR AMU-INSERM 1106, Aix-Marseille Université, Marseille, France
| | - Fabienne Brégeon
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France
| | - Jean-Louis Mège
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France
| | - Jean-Marc Rolain
- Faculté de Médecine et de Pharmacie, IRD, APHM, MEPHI, IHU Méditerranée Infection, Aix-Marseille Université, Marseille, France
| | - Olivier Blin
- Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Pharmacologie Intégrée et Interface Clinique et Industriel, Institut des Neurosciences Timone - UMR AMU-INSERM 1106, Aix-Marseille Université, Marseille, France
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De Pieri A, Ribeiro S, Tsiapalis D, Eglin D, Bohner M, Dubruel P, Procter P, Zeugolis DI, Bayon Y. Joint academic and industrial efforts towards innovative and efficient solutions for clinical needs. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:129. [PMID: 30066293 DOI: 10.1007/s10856-018-6136-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
The 4th Translational Research Symposium (TRS) was organised at the annual meeting of the European Society for Biomaterials (ESB) 2017, Athens, Greece, with a focus on 'Academia-Industry Clusters of Research for Innovation Catalysis'. Collaborations between research institutes and industry can be sustained in several ways such as: European Union (EU) funded consortiums; syndicates of academic institutes, clinicians and industries; funding from national governments; and private collaborations between universities and companies. Invited speakers from industry and research institutions presented examples of these collaborations in the translation of research ideas or concepts into marketable products. The aim of the present article is to summarize the key messages conveyed during these lectures. In particular, emphasis is put on the challenges to appropriately identify and select unmet clinical needs and their translation by ultimately implementing innovative and efficient solutions achieved through joint academic and industrial efforts.
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Affiliation(s)
- Andrea De Pieri
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Proxy Biomedical Ltd., Coilleach, Spiddal, Galway, Ireland
| | - Sofia Ribeiro
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Medtronic Sofradim Production, Trevoux, France
| | - Dimitrios Tsiapalis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Galway Ireland (NUI Galway), Galway, Ireland
| | - David Eglin
- AO Research Institute Davos, Clavadelerstrasse 8, 7270, Davos, Switzerland
| | - Marc Bohner
- RMS Foundation, Bischmattstrasse 12, P.O. Box 203, 2544, Bettlach, Switzerland
| | - Peter Dubruel
- Polymer Chemistry & Biomaterials Research Group, Ghent University, Krijgslaan 281 S4 Bis, Ghent, 9000, Belgium
| | - Philip Procter
- CPP SARL Divonne les Bains, 01220, Divonne les Bains, France
- Applied Materials Science, Dept Eng. Sciences, Uppsala University, 752 37, Uppsala, Sweden
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), National University of Galway Ireland (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), National University of Galway Ireland (NUI Galway), Galway, Ireland
| | - Yves Bayon
- Medtronic Sofradim Production, Trevoux, France.
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Chereddy KK, Vandermeulen G, Préat V. PLGA based drug delivery systems: Promising carriers for wound healing activity. Wound Repair Regen 2018; 24:223-36. [PMID: 26749322 DOI: 10.1111/wrr.12404] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 12/19/2015] [Indexed: 01/10/2023]
Abstract
Wound treatment remains one of the most prevalent and economically burdensome healthcare issues in the world. Current treatment options are limited and require repeated administrations which led to the development of new therapeutics to satisfy the unmet clinical needs. Many potent wound healing agents were discovered but most of them are fragile and/or sensitive to in vivo conditions. Poly(lactic-co-glycolic acid) (PLGA) is a widely used biodegradable polymer approved by food and drug administration and European medicines agency as an excipient for parenteral administrations. It is a well-established drug delivery system in various medical applications. The aim of the current review is to elaborate the applications of PLGA based drug delivery systems carrying different wound healing agents and also present PLGA itself as a wound healing promoter. PLGA carriers encapsulating drugs such as antibiotics, anti-inflammatory drugs, proteins/peptides, and nucleic acids targeting various phases/signaling cycles of wound healing, are discussed with examples. The combined therapeutic effects of PLGA and a loaded drug on wound healing are also mentioned.
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Affiliation(s)
- Kiran Kumar Chereddy
- Catholic University of Louvain, Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Brussels, Belgium
| | - Gaëlle Vandermeulen
- Catholic University of Louvain, Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Brussels, Belgium
| | - Véronique Préat
- Catholic University of Louvain, Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Brussels, Belgium
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Costa-Almeida R, Franco AR, Pesqueira T, Oliveira MB, Babo PS, Leonor IB, Mano JF, Reis RL, Gomes ME. The effects of platelet lysate patches on the activity of tendon-derived cells. Acta Biomater 2018; 68:29-40. [PMID: 29341933 DOI: 10.1016/j.actbio.2018.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/04/2017] [Accepted: 01/09/2018] [Indexed: 02/06/2023]
Abstract
Platelet-derived biomaterials are widely explored as cost-effective sources of therapeutic factors, holding a strong potential for endogenous regenerative medicine. Particularly for tendon repair, treatment approaches that shift the injury environment are explored to accelerate tendon regeneration. Herein, genipin-crosslinked platelet lysate (PL) patches are proposed for the delivery of human-derived therapeutic factors in patch augmentation strategies aiming at tendon repair. Developed PL patches exhibited a controlled release profile of PL proteins, including bFGF and PDGF-BB. Additionally, PL patches exhibited an antibacterial effect by preventing the adhesion, proliferation and biofilm formation by S. aureus, a common pathogen in orthopaedic surgical site infections. Furthermore, these patches supported the activity of human tendon-derived cells (hTDCs). Cells were able to proliferate over time and an up-regulation of tenogenic genes (SCX, COL1A1 and TNC) was observed, suggesting that PL patches may modify the behavior of hTDCs. Accordingly, hTDCs deposited tendon-related extracellular matrix proteins, namely collagen type I and tenascin C. In summary, PL patches can act as a reservoir of biomolecules derived from PL and support the activity of native tendon cells, being proposed as bioinstructive patches for tendon regeneration. STATEMENT OF SIGNIFICANCE Platelet-derived biomaterials hold great interest for the delivery of therapeutic factors for applications in endogenous regenerative medicine. In the particular case of tendon repair, patch augmentation strategies aiming at shifting the injury environment are explored to improve tendon regeneration. In this study, PL patches were developed with remarkable features, including the controlled release of growth factors and antibacterial efficacy. Remarkably, PL patches supported the activity of native tendon cells by up-regulating tenogenic genes and enabling the deposition of ECM proteins. This patch holds great potential towards simultaneously reducing post-implantation surgical site infections and promoting tendon regeneration for prospective in vivo applications.
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Pattern-coated titanium bone fixation plate for dual delivery of vancomycin and alendronate. Macromol Res 2017. [DOI: 10.1007/s13233-017-5073-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Prior Staphylococcus Aureus Nasal Colonization: A Risk Factor for Surgical Site Infections Following Decolonization. J Am Acad Orthop Surg 2016; 24:880-885. [PMID: 27832042 DOI: 10.5435/jaaos-d-16-00165] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Staphylococcus aureus (S aureus) decolonization regimens are being used to mitigate the risk of surgical site infection (SSI). However, their efficacy is controversial, with mixed results reported in the literature. METHODS Before undergoing primary total knee arthroplasty (TKA), total hip arthroplasty (THA), or spinal fusion, 13,828 consecutive patients were screened for nasal S aureus and underwent a preoperative decolonization regimen. Infection rates of colonized and noncolonized patients were compared using unadjusted logistic regression. An adjusted regression analysis was performed to determine independent risk factors for SSI. RESULTS The rate of SSI in colonized patients was 4.35% compared with only 2.39% in noncolonized patients. In our TKA cohort, unadjusted logistic regression identified S aureus colonization to be a significant risk factor for SSI (odds ratio [OR], 2.9; P < 0.001). After controlling for other potential confounders including age, body mass index, tobacco use, and American Society of Anesthesiologists score, an SSI was 3.8 times more likely to develop in patients colonized with S aureus (OR, 3.8; P = 0.0025). The THA and spine colonized patients trended toward higher risk in both unadjusted and adjusted models; however, the results were not statistically significant. DISCUSSION The results of our study suggest that decolonization may not be fully protective against SSI. The risk of infection after decolonization is not lowered to the baseline of a noncolonized patient. LEVEL OF EVIDENCE Level IV.
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Krishnan R, MacNeil SD, Malvankar-Mehta MS. Comparing sutures versus staples for skin closure after orthopaedic surgery: systematic review and meta-analysis. BMJ Open 2016; 6:e009257. [PMID: 26792213 PMCID: PMC4735308 DOI: 10.1136/bmjopen-2015-009257] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine whether there still remains a significant advantage in the use of sutures to staples for orthopaedic skin closure in adult patients. DESIGN Systematic Review/ Meta-Analysis. DATA SOURCES MEDLINE-OVID, EMBASE-OVID, CINAHL and Cochrane Library. Grey and unpublished literature was also explored by searching: International Clinical Trial Registry, Grey Matters BIOSIS Previews, Networked Digital Library of Theses and Dissertations, ClinicalTrials.gov, UK Clinical Trials Gateway, UK Clinical Research Network Study Portfolio, Open Grey, Grey Literature Report, and Web of Science. SELECTION CRITERIA Articles were from any country, written in English and published after 1950. We included all randomised control trials and observational studies comparing adults (≥ 18 years) undergoing orthopaedic surgery who either received staples or sutures for skin closure. The primary outcome was the incidence of surgical site infection. Secondary outcomes included closure time, inflammation, length of stay, pain, abscess formation, necrosis, discharge, wound dehiscence, allergic reaction and health-related quality of life. RESULTS 13 studies were included in our cumulative meta-analysis conducted using Review Manager V.5.0. The risk ratio was computed as a measure of the treatment effect taking into account heterogeneity. Random-effect models were applied. There was no significant difference in infection comparing sutures to staples. The cumulative relative risk was 1.06 (0.46 to 2.44). In addition, there was no difference in infection comparing sutures to staples in hip and knee surgery, respectively. Lastly, except for closure time, there was no significant difference in secondary outcomes comparing sutures to staples. CONCLUSIONS Except for closure time, there was no significant difference in superficial infection and secondary outcomes comparing sutures to staples was found. Given that there may in fact be no difference in effect between the two skin closure and the methodological limitations of included studies, authors should begin to consider the economic and logistic implications of using staples or sutures for skin closure. PROSPERO REGISTRATION NUMBER CRD42015017481.
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Affiliation(s)
- Rohin Krishnan
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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De Vecchi E, Bottagisio M, Bortolin M, Toscano M, Lovati AB, Drago L. Improving the Bacterial Recovery by Using Dithiothreitol with Aerobic and Anaerobic Broth in Biofilm-Related Prosthetic and Joint Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 973:31-39. [DOI: 10.1007/5584_2016_51] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gu FF, Han LZ, Chen X, Wang YC, Shen H, Wang JQ, Tang J, Zhang J, Ni YX. Molecular characterization of Staphylococcus aureus from surgical site infections in orthopedic patients in an orthopedic trauma clinical medical center in Shanghai. Surg Infect (Larchmt) 2015; 16:97-104. [PMID: 25761082 DOI: 10.1089/sur.2014.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of surgical site infections (SSIs). The aim of our study was to characterize molecularly S. aureus isolates from SSIs in orthopedic patients in Shanghai, China. METHODS Eighty-two S. aureus isolates (46 methicillin-susceptible Staphylococcus aureus [MSSA] and 36 MRSA) were collected from SSIs in orthopedic patients. Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines and a variety of clinically important toxin genes were detected. The sequence type, spa type, and agr group were determined to analyze the genotypes of all the isolates collected. In addition, MRSA isolates were characterized by staphylococcal cassette chromosome mec (SCCmec) type as well. RESULTS The strains showed susceptibility to antibiotics such as teicoplanin, minocycline, quinupristin-dalfopristin, linezolid, mupirocin, and vancomycin. Ten pvl-positive isolates (three MRSA and seven MSSA) were found among all isolates. Eight community-associated MRSA (CA-MRSA) isolates were found, six of which belonged to ST59-MRSA-IV but most MRSA isolates (20/36, 55.6%) belonged to ST239-MRSA-III-t030/t037 with a wide range of antibiotic resistance. By contrast, MSSA isolates were more diverse in both molecular characterizations and virulence factors, with eight MSSA isolates harboring more than six toxin genes detected. CONCLUSIONS ST239-MRSA-III-t030/t037 was the epidemic clone, and healthcare-associated MRSA (HA-MRSA) strains might be the major pathogen causing S. aureus SSIs in orthopedic patients.
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Affiliation(s)
- Fei-Fei Gu
- 1 Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai, China
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Baratz MD, Hallmark R, Odum SM, Springer BD. Twenty Percent of Patients May Remain Colonized With Methicillin-resistant Staphylococcus aureus Despite a Decolonization Protocol in Patients Undergoing Elective Total Joint Arthroplasty. Clin Orthop Relat Res 2015; 473:2283-90. [PMID: 25690169 PMCID: PMC4457751 DOI: 10.1007/s11999-015-4191-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Staphylococcus aureus is the most commonly isolated organism in periprosthetic joint infection (PJI). Resistant strains such as methicillin-resistant S aureus (MRSA) are on the rise, and many programs have instituted decolonization protocols. There are limited data on the success of S aureus nasal decolonization programs and their impact on PJI. QUESTIONS/PURPOSES The purposes of this study were to (1) determine the proportion of patients successfully decolonized using a 2-week protocol; (2) compare infection risks between our surveillance and decolonization protocol group against a historical control cohort to evaluate changes in proportions of S aureus infections; and (3) assess infection risk based on carrier type, comparing S aureus carriers with noncarrier controls. METHODS We retrospectively evaluated a group of 3434 patients who underwent elective primary and revision hip and knee arthroplasty over a 2-year period; each patient in the treatment group underwent a surveillance protocol, and a therapeutic regimen of mupurocin and chlorhexidine was instituted when colonization criteria were met. A 2009 to 2010 comparative historical cohort was chosen as the control group. We compared risks of infection between our treatment group and the historical control cohort. Furthermore, in patients who developed surgical site infections (SSIs), we compared the proportions of each S aureus type between the two cohorts. Finally, we compared infection rates based on carrier status. Surveillance for infection was carried out by the hospital infection control coordinator using the Centers for Disease Control and Prevention (CDC) criteria. During the time period of this study, the CDC defined hospital-acquired infection related to a surgical procedure as any infection diagnosed within 1 year of the procedure. With the numbers available, we had 41% power to detect a difference of 0.3% in infection rate between the treatment and control groups. To achieve 80% power, a total of 72,033 patients would be needed. RESULTS Despite the protocol, 22% (26 of 121) of patients remained colonized with MRSA. With the numbers available, there were no differences in infection risk between the protocoled group (27 of 3434 [0.8%]) and the historical control group (33 of 3080 [1.1%]; relative risk [RR], 0.74; 95% confidence interval [CI], 0.44-1.22; p = 0.28). In terms of infecting organism in those who developed SSI, S aureus risk decreased slightly (treatment: 13 of 3434 patients [0.38%]; control: 21 of 3080 patients [0.68%]; RR, 0.56; CI, 0.28-1.11; p = 0.11). Within the protocoled group, carriers had a slightly higher risk of developing SSI (carrier: seven of 644 [1.1%]; noncarrier: 18 of 2763 [0.65%]; RR, 1.77; CI, 0.74-4.24; p = 0.20). CONCLUSIONS The screening and decolonization protocol enabled a substantial reduction in nasal carriage of MRSA, but some patients remained colonized. However, our nasal decolonization protocol before elective total joint arthroplasty did not demonstrate a decrease in the proportion of patients developing SSI. Future meta-analyses and systematic reviews will be needed to pool the results of studies like these to ascertain whether small improvements in infection risk are achieved by protocols like ours and to determine whether any such improvements warrant the costs and potential risks of surveillance and intervention. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Michael D. Baratz
- />OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28209 USA
| | - Ruth Hallmark
- />Novant Health Charlotte Orthopedic Hospital, Charlotte, NC USA
| | - Susan M. Odum
- />OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28209 USA
| | - Bryan D. Springer
- />OrthoCarolina Hip and Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28209 USA
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Aamot HV, Stavem K, Skråmm I. No change in the distribution of types and antibiotic resistance in clinical Staphylococcus aureus isolates from orthopaedic patients during a period of 12 years. Eur J Clin Microbiol Infect Dis 2015; 34:1833-7. [PMID: 26076750 DOI: 10.1007/s10096-015-2420-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Staphylococcus aureus (S. aureus) is the most common cause of bone and joint infections. However, limited information is available on the distribution of S. aureus geno- and phenotypes causing orthopaedic infections. The aim of this study was to identify the dominating types causing infections in orthopaedic patients, investigate if the characteristics of these types changed over time and examine if different types were more often associated with surgical site infection (SSI) than primary infection (non-SSI). All clinical S. aureus isolates collected from orthopaedic patients from 2000 through 2011 at Akershus University Hospital, Norway, were characterised by S. aureus protein A (spa) typing and tested for antibiotic resistance. A total of 548 patients with orthopaedic S. aureus infections were included, of which 326 (59 %) had SSI and 222 (41 %) had non-SSI. The median age was 62 years [range 2-97 years] and 54 % were male. Among the 242 unique spa types, t084 was the most common (7 %). Penicillin resistance was identified in 75 % of the isolates, whereas the resistances to the other antibiotics tested were <5 %. Three isolates (0.5 %) were resistant to methicillin. There was no significant difference in the distribution of geno- and phenotypes over time and there was no difference in types between SSI and non-SSI. In this large collection of S. aureus from orthopaedic patients, the S. aureus infections, regardless of origin, were heterogeneous, mainly resistant to penicillin, stable over time and consisted of similar types as previously found in both carrier and other patient populations.
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Affiliation(s)
- H V Aamot
- Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway,
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van Vugt JLA, Coelen RJS, van Dam DW, Winkens B, Derikx JPM, Heddema ER, Stoot JHMB. Nasal carriage of Staphylococcus aureus among surgeons and surgical residents: a nationwide prevalence study. Surg Infect (Larchmt) 2015; 16:178-82. [PMID: 25826230 DOI: 10.1089/sur.2014.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Staphylococcus aureus nasal carriage is an independent risk factor for developing nosocomial infections and for developing surgical site infection (SSI) in particular. The number of post-operative nosocomial S. aureus infections can be reduced by screening patients and decolonizing nasal carriers. In addition to patients, health care workers may also be S. aureus nasal carriers. The aim of this study was to explore S. aureus nasal carriage rates among surgeons. METHODS Nasal swabs were collected from surgeons and surgical residents during a national surgical congress. The control group consisted of non-hospitalized patients. Staphylococcus aureus carriage was detected using selective chromogenic agars by use of a fully automated inoculator. Suspected colonies were identified further by positive catalase and slide coagulation reactions. RESULTS Samples were collected from 366 surgeons and surgical residents and 950 control patients. The S. aureus nasal carriage rate among surgeons and residents was significantly greater compared with the control group (45.4% versus 30.8%, odds ratio [OR] 1.86 [1.45-2.38], p<0.001). No significant difference in carriage rate was found between surgeons and residents (46.8% versus 43.3%, p=0.769) and years of experience as a surgeon was not associated with a greater carriage rate. Male gender was an independent risk factor for carriage among physicians odds ratio ([OR] 1.90 [95% confidence interval 1.19-3.01], p=0.007). CONCLUSIONS The nationwide rate of S. aureus nasal carriage among surgeons and surgical residents proved to be significantly greater compared with a non-hospitalized patient control group. Male gender is an independent risk factor for carriage among physicians. Future studies are needed to investigate the possible relation with nosocomial post-operative S. aureus infections.
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Affiliation(s)
- Jeroen L A van Vugt
- 1 Department of Surgery, Orbis Medical Center , Sittard-Geleen, The Netherlands
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Tian J, Shen S, Zhou C, Dang X, Jiao Y, Li L, Ding S, Li H. Investigation of the antimicrobial activity and biocompatibility of magnesium alloy coated with HA and antimicrobial peptide. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:66. [PMID: 25631264 DOI: 10.1007/s10856-015-5389-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/26/2014] [Indexed: 06/04/2023]
Abstract
Implant-associated infection is one of the biggest problems in orthopedic surgery. Antimicrobial peptides (AMPs) are well-known components of the innate immunity and less susceptible to the development of pathogen resistance compared to conventional antibiotics. Magnesium alloys as potential biodegradable bone implants have been received much attention in biomaterials field. This study investigated the deposition of calcium phosphate (CaP) coatings and loading of AMPs on the magnesium alloy surface by a biomimetic method. Scanning electron microscope (SEM) results presented that a microporous and plate-like CaP coating was processed on the magnesium alloy surface. X-ray diffractometry (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis showed the main component of coating was hydroxyapatite (HA). Degradation assay in vitro showed that the HA coating deposited onto the magnesium alloy was corroded more slowly than the bare one. The amount of AMP loaded in the HA coating was 11.16±1.99 μg/cm2. The AMP loaded onto HA coatings had slow release for 7 days. The AMP-loaded coating showed antimicrobial activity against Staphylococcus aureus. Its bacterial inhibition rate exceeded 50% after 4 days and the antibacterial effect was sustained for 7 days. The coated magnesium alloys loaded with AMP could improve rat bone marrow mesenchymal stem cells (rBMMSCs) proliferation. Furthermore, it could also promote alkaline phosphatase (ALP) activity of rBMMSCs. Both radiographic evaluation and histopathology analysis demonstrated that implantation of the coated magnesium alloy into the rabbit femoral condyle had promoted bone repair and showed anti-inflammatory effect. The results showed that the AMP loaded onto HA coatings on the magnesium alloy surface could be considered an ideal orthopedic implant against S. aureus infection.
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Affiliation(s)
- Jinhuan Tian
- Department of Materials Science and Engineering, Jinan University, Guangzhou, 510630, China
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Aiken SS, Cooper JJ, Florance H, Robinson MT, Michell S. Local release of antibiotics for surgical site infection management using high-purity calcium sulfate: an in vitro elution study. Surg Infect (Larchmt) 2015; 16:54-61. [PMID: 25148101 PMCID: PMC4363816 DOI: 10.1089/sur.2013.162] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to characterize the elution of four antibiotics from pharmaceutical-grade calcium sulfate beads and show that the eluted antibiotics retained efficacy. METHODS Calcium sulfate was combined with gentamicin, tobramycin, vancomycin, or rifampicin (ratio: 20 g of calcium sulfate, to 240 mg, 500 mg, 900 mg, and 600 mg of antibiotic, respectively). Three grams of beads were immersed in 4 mL of sterile phosphate-buffered saline (PBS) at 37°C. At each time point (4, 8, 24 h; 2, 7, 14, 28, 42 d), eluates were removed for analysis by liquid chromatography-mass spectrometry. The antimicrobial efficacy of antibiotics combined with calcium sulfate beads after 42 d was tested by a modified Kirby-Bauer disc diffusion assay. RESULTS All samples showed a generally exponential decay in the eluted antibiotic concentration. At the first time point, both gentamicin and tobramycin had eluted to a peak concentration of approximately 10,000 mcg/mL. For rifampicin, the peak concentration occurred at 24 h, whereas for vancomycin, it occurred at 48 h. The eluted concentrations exceeded the minimum inhibitory concentration for common periprosthetic joint infection pathogens for the entire span of the 42 study days. Mass spectrometry confirmed all antibiotics were unchanged when eluted from the calcium sulfate carrier. Antimicrobial efficacy was unaltered after 42 d in combination with calcium sulfate at 37°C. CONCLUSIONS Pharmaceutical-grade calcium sulfate has the potential for targeted local release of tobramycin, gentamicin, vancomycin, and rifampicin over a clinically meaningful time period.
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Affiliation(s)
- Sean S. Aiken
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - John J. Cooper
- Biocomposites Ltd., Keele Science Park, Staffordshire, United Kingdom
| | - Hannah Florance
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Matthew T. Robinson
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Stephen Michell
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Yokoyama Y, Matsumoto K, Ikawa K, Watanabe E, Yamamoto H, Imoto Y, Morikawa N, Takeda Y. Pharmacokinetics of Prophylactic Ampicillin–Sulbactam and Dosing Optimization in Patients Undergoing Cardiovascular Surgery with Cardiopulmonary Bypass. Biol Pharm Bull 2015; 38:1817-21. [DOI: 10.1248/bpb.b15-00334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuta Yokoyama
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
- Department of Clinical Pharmacotherapy, Hiroshima University
| | - Kazuaki Matsumoto
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy, Hiroshima University
| | - Erika Watanabe
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Hiroyuki Yamamoto
- Department of Thoracic, Cardiovascular and Hepato-Biliary-Pancreatic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Yutaka Imoto
- Department of Thoracic, Cardiovascular and Hepato-Biliary-Pancreatic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Yasuo Takeda
- Department of Clinical Pharmacy and Pharmacology, Graduate School of Medical and Dental Sciences, Kagoshima University
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Kino H, Suzuki H, Yamaguchi T, Notake S, Oishi T, Ito Y, Nakamura K, Miyazaki H, Matsumoto T, Uemura K, Matsumura A. Central nervous system infection caused by vancomycin-intermediate Staphylococcus aureus (SCCmec type IV, ST8). J Infect Chemother 2014; 20:643-6. [PMID: 25012468 DOI: 10.1016/j.jiac.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/14/2014] [Accepted: 06/12/2014] [Indexed: 11/26/2022]
Abstract
A 77-year-old Japanese man with a history of surgical treatment of chronic subdural hemorrhage was hospitalized for drainage of a subdural abscess and brain abscess in the right occipital area. Pus obtained from both the subdural abscess and brain abscess grew vancomycin-intermediate Staphylococcus aureus (VISA) (minimum inhibitory concentration = 4 μg/mL), which was confirmed by population analysis. The SCCmec type and sequence type were subsequently identified as IV and ST8, respectively. The VISA strains were both sensitive to levofloxacin, clindamycin, minocycline, and linezolid. The patient was successfully treated with linezolid and discharged on day 51 after admission. We herein describe the first reported case of a brain abscess and subdural abscess caused by VISA in Japan.
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Affiliation(s)
- Hiroyoshi Kino
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Hiromichi Suzuki
- Division of Infectious Diseases, Department of Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan.
| | - Tetsuo Yamaguchi
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Shigeyuki Notake
- Department of Clinical Microbiology, Miroku Medical Laboratory Inc., Nagano, Japan
| | - Tsuyoshi Oishi
- Department of Infectious Diseases, Ibaraki Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Kazuhiro Nakamura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Haruko Miyazaki
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | | | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, University of Tsukuba Hospital, Ibaraki, Japan
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Skråmm I, Fossum Moen AE, Årøen A, Bukholm G. Surgical Site Infections in Orthopaedic Surgery Demonstrate Clones Similar to Those in Orthopaedic Staphylococcus aureus Nasal Carriers. J Bone Joint Surg Am 2014; 96:882-888. [PMID: 24897735 DOI: 10.2106/jbjs.m.00919] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Staphylococcus aureus is the main microbial pathogen in orthopaedic infections, and it adds considerable extra costs to the national health-care system each year. Nasal carriers of Staphylococcus aureus have an increased risk of invasive disease, including surgical site infection. The purpose of the present study was to investigate whether the Staphylococcus aureus carrier clones found in patients undergoing elective orthopaedic surgery were the same as the clones found in isolates from orthopaedic patients with Staphylococcus aureus surgical site infections. METHODS Patients admitted for elective orthopaedic surgery underwent nasal cultures for Staphylococcus aureus. Further, orthopaedic patients with a deep surgical site infection caused by Staphylococcus aureus were characterized using the same genotyping methods: multilocus sequence typing and staphylococcal protein A typing. RESULTS Multilocus sequence typing revealed a large number of genotypes in the two populations. However, 85% of nasal carriers and 90% of surgical site infection isolates could be classified into the same four multilocus sequence typing clonal complexes. The risk of Staphylococcus aureus surgical site infection in nasal carriers compared with non-carriers was 5.8 times higher (95% confidence interval, 1.5 to 23.1 times). Of the nasal carriers, 6.3% (95% confidence interval, 1.7% to 10.9% [seven of 111 patients]) developed a deep Staphylococcus aureus surgical site infection, and all but one patient had identical genotypes in the nasal and surgical site infection isolates. CONCLUSIONS Staphylococcus aureus isolates from nasal carriers and patients with surgical site infection clustered into the same few multilocus sequence typing clonal complexes. This finding confirms the existence of some commonly occurring Staphylococcus aureus clones in different population groups within a geographically restricted area. The almost complete individual concordance between Staphylococcus aureus genotypes in carriers who developed a deep surgical site infection strongly supports transmission from the nose, skin surfaces, and other endogenous body regions as a possible route. CLINICAL RELEVANCE Surgical site infections might be more frequently caused by endogenous transmission than was previously assumed. Perioperative preventive efforts must focus more on this route to further decrease the risk of postoperative orthopaedic infections.
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Affiliation(s)
- Inge Skråmm
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Aina E Fossum Moen
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Asbjørn Årøen
- Departments of Orthopedic Surgery (I.S. and A.A.) and Clinical Molecular Biology and Laboratory Sciences (EpiGen) (I.S. and A.E.F.M.), Division of Surgery, Akershus University Hospital, Sykehusvn 25, N-1478 Lørenskog, Norway. E-mail address for I. Skråmm:
| | - Geir Bukholm
- Department of Infection Prevention, Oslo University Hospital, Kirkevn 166, Postboks 4950, Nydalen, N-0424 Oslo, Norway
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Abd Rashid AH, Ramli R, Ibrahim S. Clostridium perfringens surgical site infection after osteotomy for knee deformity correction in a non-immunocompromised child. Surg Infect (Larchmt) 2014; 15:656-8. [PMID: 24828080 DOI: 10.1089/sur.2012.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Clostridium perfringens myonecrosis following an elective surgical procedure in a previously healthy child is a rare incident. METHODS Case report and literature review. RESULTS A two-year old boy admitted for elective bilateral osteotomies of tibiae was detected to be febrile at day one post-operatively with crepitus felt at his left ankle. An emergency wound debridement was performed followed by a course of antibiotics. Clostridium perfringens was isolated from tissue culture. His wound was later covered with a split-thickness skin graft. CONCLUSION Clostridium perfringens infection following a surgical procedure in a healthy child is rare. A high index of suspicion is important to recognize this debilitating infection.
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Affiliation(s)
- Abdul Halim Abd Rashid
- 1 Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia , Kuala Lumpur, Malaysia
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Jain RK, Shukla R, Singh P, Kumar R. Epidemiology and risk factors for surgical site infections in patients requiring orthopedic surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:251-4. [DOI: 10.1007/s00590-014-1475-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/23/2014] [Indexed: 01/04/2023]
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Li GQ, Guo FF, Ou Y, Dong GW, Zhou W. Epidemiology and outcomes of surgical site infections following orthopedic surgery. Am J Infect Control 2013; 41:1268-71. [PMID: 23890741 DOI: 10.1016/j.ajic.2013.03.305] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after surgeries, usually leading to increased health care costs. Therefore, we evaluated the efficiency of current preoperative antibiotic prophylaxis and risk factors of SSIs in the orthopedic wards in a major teaching hospital in China. METHODS We retrospectively reviewed a population of 2,061 patients who underwent orthopedic surgeries between January 2010 and January 2012 and examined the bacterial isolates and their resistance patterns associated with orthopedic infections. Moreover, a multivariate logistic regression was used to identify independent risk factors for SSIs. RESULTS Thirty-three out of the 45 clinical SSIs were culture positive, and a total of 35 bacterial strains was isolated, among which, 65.72% (n= 23) were gram-positive isolates, and 34.28% (n = 12) were gram-negative bacteria. Significantly, 68.6% of all bacterial isolates were resistant to cefuroxime. Additionally, this study found that diabetes mellitus (odds ratio [OR], 7.539), smoking (OR, 2.378), duration of surgeries longer than 3 hours (OR, 3.633), absence of antibiotic prophylaxis (OR, 6.562), and previous operations (OR, 2.190) were crucial independent risk factors associated with a significant increase in the development rate of SSIs following orthopedic incisional operations. CONCLUSION Our data suggested that appropriate modifications to antibiotic prophylaxis regimens should be considered. Furthermore, tightening glucose control, stopping smoking, providing proper antibiotic prophylaxis, and shortening surgery time are promising approaches to reduce the SSIs rate.
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Affiliation(s)
- Guo-qing Li
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
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Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 2013; 84:5-12. [DOI: 10.1016/j.jhin.2012.12.014] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/31/2012] [Indexed: 01/05/2023]
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Brubaker AL, Rendon JL, Ramirez L, Choudhry MA, Kovacs EJ. Reduced neutrophil chemotaxis and infiltration contributes to delayed resolution of cutaneous wound infection with advanced age. THE JOURNAL OF IMMUNOLOGY 2013; 190:1746-57. [PMID: 23319733 DOI: 10.4049/jimmunol.1201213] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advanced age is associated with alterations in innate and adaptive immune responses, which contribute to an increased risk of infection in elderly patients. Coupled with this immune dysfunction, elderly patients demonstrate impaired wound healing with elevated rates of wound dehiscence and chronic wounds. To evaluate how advanced age alters the host immune response to cutaneous wound infection, we developed a murine model of cutaneous Staphylococcus aureus wound infection in young (3-4 mo) and aged (18-20 mo) BALB/c mice. Aged mice exhibit increased bacterial colonization and delayed wound closure over time compared with young mice. These differences were not attributed to alterations in wound neutrophil or macrophage TLR2 or FcγRIII expression, or age-related changes in phagocytic potential and bactericidal activity. To evaluate the role of chemotaxis in our model, we first examined in vivo chemotaxis in the absence of wound injury to KC, a neutrophil chemokine. In response to a s.c. injection of KC, aged mice recruited fewer neutrophils at increasing doses of KC compared with young mice. This paralleled our model of wound infection, where diminished neutrophil and macrophage recruitment was observed in aged mice relative to young mice despite equivalent levels of KC, MIP-2, and MCP-1 chemokine levels at the wound site. This reduced leukocyte accumulation was also associated with lower levels of ICAM-1 in wounds from aged mice at early time points. These age-mediated defects in early neutrophil recruitment may alter the dynamics of the inflammatory phase of wound healing, impacting macrophage recruitment, bacterial clearance, and wound closure.
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Affiliation(s)
- Aleah L Brubaker
- Burn and Shock Trauma Institute, Loyola University Chicago Health Sciences Division, Maywood, IL 60153, USA
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Boisseau D, Alfandari S, Gauzit R, Rabaud C, Stahl JP. Staphylococcus aureus nasal carriage during the infectious diseases national congress in France. Med Mal Infect 2012; 42:435-9. [PMID: 22959772 DOI: 10.1016/j.medmal.2012.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/11/2012] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Screening for (methicillin-sensitive [MSSA] or -resistant [MRSA]) Staphylococcus aureus (SA) nasal carriage in health care workers in contact with fragile patients is a recurrent question. We wanted to assess carriage among infectious diseases healthcare workers. METHODS Voluntary health care workers were recruited during the 2010 Yearly French Congress (Journées Nationales d'Infectiologie, JNI). An anonymous double nasal swab was performed followed by PCR examination (GeneXpert MRSA/SA nasal tests) carried out on the Cepheid stand. Health care workers were also asked to fill in a questionnaire. Results were available 1 hour later but kept anonymous. RESULTS One hundred and fifty-two tests and questionnaires were selected. MRSA was isolated from four health care workers (2.4%). MSSA was isolated from 52 health care workers (34.2%). Sex, clinical activity of health care workers, hospital size, and systematic screening of patients did not affect carriage. CONCLUSIONS The prevalence of MSSA in nasal carriage in France is similar to the European one but the prevalence of MRSA is higher. This raises the question of a targeted decolonization in health care workers.
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Waldow T, Szlapka M, Hensel J, Plötze K, Matschke K, Jatzwauk L. Skin sealant InteguSeal® has no impact on prevention of postoperative mediastinitis after cardiac surgery. J Hosp Infect 2012; 81:278-82. [DOI: 10.1016/j.jhin.2012.04.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 04/27/2012] [Indexed: 11/30/2022]
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Grammatico-Guillon L, Baron S, Gettner S, Lecuyer AI, Gaborit C, Rosset P, Rusch E, Bernard L. Bone and joint infections in hospitalized patients in France, 2008: clinical and economic outcomes. J Hosp Infect 2012; 82:40-8. [PMID: 22738613 DOI: 10.1016/j.jhin.2012.04.025] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 04/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adult bone and joint infections (BJIs) often require repeated and prolonged hospitalizations and are considered as a serious public health issue. AIM To describe the epidemiology and economical outcomes of BJI in France. METHODS BJI hospitalizations with selected demographic, medical, and economic parameters from the French national hospital database for the year 2008 were identified. Overall patient characteristics and hospital stays for BJI underwent univariate analysis. Risk factors for device-associated infections were identified using multiple logistic regression modelling. FINDINGS Of all hospitalizations in France, 0.2% were BJI-related, representing 54.6 cases per 100,000 population, with a higher prevalence in males (sex ratio: 1.54). BJIs were more often native (68%) than device-associated (32%). The mean age was 63.1 years. Only 39% of hospital discharges had microbiological information coded; Staphylococcus spp. were isolated in 66% of those cases. Obesity, Staphylococcus spp., male sex and age >64 years were important risk factors for device-associated infections, whereas diabetes and ulcer sores were significantly associated with native infections. The case fatality was 4.6%. Intensive care unit stays were needed in 6% of cases. Readmissions to hospital occurred in 19% of cases, with significantly longer stays for device-associated infections than for native BJIs (18.9 vs 16.8 days). The cost of BJIs was €259 million, or about €7,000 per hospitalization in 2008. CONCLUSIONS This is the largest BJI study to date. The high economic burden of BJIs was mostly associated with more frequent and prolonged hospitalizations, high morbidity, and complexity of care.
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Dépistage de Staphylococcus aureus résistant à la méthicilline (SARM) par biologie moléculaire (Cepheid GeneXpert IL, GeneOhm BD, LightCycler Roche, Hyplex Evigene I2A) versus dépistage par culture : stratégie économico-pratique pour le laboratoire. ACTA ACUST UNITED AC 2012; 60:208-13. [DOI: 10.1016/j.patbio.2011.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 05/23/2011] [Indexed: 11/21/2022]
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Molecular characterisation of methicillin-sensitive Staphylococcus aureus from deep surgical site infections in orthopaedic patients. Eur J Clin Microbiol Infect Dis 2012; 31:1999-2004. [DOI: 10.1007/s10096-011-1532-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 12/16/2011] [Indexed: 11/26/2022]
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