1
|
Nelson SB, Pinkney JA, Chen AF, Tande AJ. Periprosthetic Joint Infection: Current Clinical Challenges. Clin Infect Dis 2023; 77:e34-e45. [PMID: 37434369 PMCID: PMC11004930 DOI: 10.1093/cid/ciad360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 07/13/2023] Open
Abstract
Over the last several decades, periprosthetic joint infection has been increasing in incidence and is occurring in more complex patients. While there have been advances in both surgical and medical treatment strategies, there remain important gaps in our understanding. Here, we share our current approaches to the diagnosis and management of periprosthetic joint infection, focusing on frequent clinical challenges and collaborative interdisciplinary care.
Collapse
Affiliation(s)
- Sandra B Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jodian A Pinkney
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
2
|
Miranda Calderon L, Alejo T, Santos S, Mendoza G, Irusta S, Arruebo M. Antibody-Functionalized Polymer Nanoparticles for Targeted Antibiotic Delivery in Models of Pathogenic Bacteria Infecting Human Macrophages. ACS APPLIED MATERIALS & INTERFACES 2023; 15:40213-40227. [PMID: 37596966 PMCID: PMC10877563 DOI: 10.1021/acsami.3c07367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
The efficacy of antibody-functionalized poly(d,l-lactide-co-glycolide) (PLGA) nanoparticles (NPs), prepared by nanoprecipitation, carrying rifampicin (RIF) against planktonic, sessile, and intracellular Staphylococcus aureus and Escherichia coli is reported here. A biotinylated anti-S. aureus polyclonal antibody, which binds to structural antigens of the whole bacterium, was functionalized on the surface of RIF-loaded PLGA-based NPs by using the high-affinity avidin-biotin complex. This general strategy allows the binding of commercially available biotinylated antibodies. Coculture models of S. aureus ATCC 25923 and Escherichia coli S17 were used to demonstrate the preferential selectivity of the antibody-functionalized NPs against the Gram-positive bacterium only. At 0.2 μg/mL, complete S. aureus eradication was observed for the antibody-functionalized RIF-loaded NPs, whereas only a 5-log reduction was observed for the nontargeted RIF-loaded NPs. S. aureus is a commensal facultative pathogen having part of its live cycle intracellularly in both phagocytic and nonphagocytic cells. Those intracellular bacterial persisters, named small colony variants, have been postulated as reservoirs of relapsed episodes of infection and consequent treatment failure. At 0.5 μg/mL, the RIF-loaded NPs reduced in 2-log intracellular S. aureus-infecting human macrophages. The ability of those antibody-functionalized nanoparticles to prevent biofilm formation or to reduce the bacterial burden in already-formed mature biofilms is also reported here using S. aureus and E. coli single and cocultured biofilms. In the prevention of S. aureus biofilm formation, the antibody-functionalized NPs exerted a superior inhibition of bacterial growth (up to 2 logs) compared to the nonfunctionalized ones. This study demonstrates the selectivity of the synthesized immunonanoparticles and their antimicrobial efficacy in different scenarios, including planktonic cultures, sessile conditions, and even against intracellular infective pathogens.
Collapse
Affiliation(s)
- Laura
Gabriela Miranda Calderon
- Instituto
de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad
de Zaragoza, Zaragoza 50009, Spain
- Department
of Chemical Engineering, University of Zaragoza, Campus Río Ebro-Edificio
I+D, C/ Poeta Mariano Esquillor S/N, Zaragoza 50018, Spain
| | - Teresa Alejo
- Instituto
de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad
de Zaragoza, Zaragoza 50009, Spain
- Department
of Chemical Engineering, University of Zaragoza, Campus Río Ebro-Edificio
I+D, C/ Poeta Mariano Esquillor S/N, Zaragoza 50018, Spain
| | - Sabas Santos
- Instituto
de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad
de Zaragoza, Zaragoza 50009, Spain
- Department
of Chemical Engineering, University of Zaragoza, Campus Río Ebro-Edificio
I+D, C/ Poeta Mariano Esquillor S/N, Zaragoza 50018, Spain
| | - Gracia Mendoza
- Networking
Research Center on Bioengineering, Biomaterials
and Nanomedicine, CIBER-BBN, Madrid 28029, Spain
- Aragon
Health Research Institute (IIS Aragon), Zaragoza 50009, Spain
| | - Silvia Irusta
- Instituto
de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad
de Zaragoza, Zaragoza 50009, Spain
- Department
of Chemical Engineering, University of Zaragoza, Campus Río Ebro-Edificio
I+D, C/ Poeta Mariano Esquillor S/N, Zaragoza 50018, Spain
- Networking
Research Center on Bioengineering, Biomaterials
and Nanomedicine, CIBER-BBN, Madrid 28029, Spain
| | - Manuel Arruebo
- Instituto
de Nanociencia y Materiales de Aragón (INMA), CSIC-Universidad
de Zaragoza, Zaragoza 50009, Spain
- Department
of Chemical Engineering, University of Zaragoza, Campus Río Ebro-Edificio
I+D, C/ Poeta Mariano Esquillor S/N, Zaragoza 50018, Spain
- Networking
Research Center on Bioengineering, Biomaterials
and Nanomedicine, CIBER-BBN, Madrid 28029, Spain
- Aragon
Health Research Institute (IIS Aragon), Zaragoza 50009, Spain
| |
Collapse
|
3
|
Senneville E, Gachet B, Blondiaux N, Robineau O. Do Anti-Biofilm Antibiotics Have a Place in the Treatment of Diabetic Foot Osteomyelitis? Antibiotics (Basel) 2023; 12:antibiotics12020317. [PMID: 36830229 PMCID: PMC9952315 DOI: 10.3390/antibiotics12020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The choice of antibiotic regimens for use in patients presenting with diabetic foot osteomyelitis and their duration differs according to the situation. Antibiotics play a more important role in the medical option where no infected bone has been resected, while their role is reduced but not negligible in the case of surgical options. Some studies have reported the presence of biofilm structures in bone samples taken from patients with diabetic foot osteomyelitis, which raises the question of the place of anti-biofilm antibiotic regimens in this setting. During the last two decades, clinical studies have suggested a potential benefit for anti-biofilm antibiotics, mainly rifampicin against staphylococci and fluoroquinolones against gram-negative bacilli. However, no data from randomized controlled studies have been reported so far. The present work provides a summary of the available data on the question of the place of anti-biofilm antibiotics for the treatment of diabetic foot osteomyelitis, but also the potential limitations of such treatments.
Collapse
Affiliation(s)
- Eric Senneville
- Infectious Diseases Unit, Gustave Dron Hospital, F-59200 Tourcoing, France
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, F-59000 Lille, France
- EA2694, Lille University, F-59000 Lille, France
- Correspondence: ; Tel.: +33-(0)320694848
| | - Benoit Gachet
- Infectious Diseases Unit, Gustave Dron Hospital, F-59200 Tourcoing, France
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, F-59000 Lille, France
- EA2694, Lille University, F-59000 Lille, France
| | - Nicolas Blondiaux
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, F-59000 Lille, France
- Microbiology Laboratory, Gustave Dron Hospital, F-59200 Tourcoing, France
| | - Olivier Robineau
- Infectious Diseases Unit, Gustave Dron Hospital, F-59200 Tourcoing, France
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, F-59000 Lille, France
- EA2694, Lille University, F-59000 Lille, France
| |
Collapse
|
4
|
Krizsan G, Sallai I, Veres DS, Prinz G, Szeker D, Skaliczki G. Rifampicin resistance and risk factors associated with significantly lower recovery rates after two stage revision in patients with prosthetic joint infection. J Glob Antimicrob Resist 2022; 30:231-236. [PMID: 35764215 DOI: 10.1016/j.jgar.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/07/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022] Open
Abstract
PURPOSE Rifampicin plays a key role in the management of prosthetic joint infections (PJIs), however, the emergence of rifampicin resistance is associated with less favorable clinical outcomes. The purpose of this study was to investigate the impact of rifampicin resistance and other patient-related factors on recovery rates among patients with PJI undergoing two-stage revision. METHODS We reviewed medical records and microbiology reports of 73 patients (41 males and 32 females) undergoing two-stage revision due to PJI between 2017 and 2019. Patient-specific data, co-morbidities and the antibiotic resistance of microbiological isolates were registered. 48 patients had hip, 22 had knee, 2 had shoulder and 1 had elbow joint infection. Obtained data were statistically analyzed with a logistic regression model. RESULTS Rifampicin-sensitive organism was isolated in 53 cases (72.6%). Recovery rate was 92.5% in the sensitive and 60.0% in the resistant group. We observed that rifampicin resistance significantly reduced the probability of recovery. Furthermore, in the rifampicin-sensitive group, the probability of recovery decreased with advancing age with a significant drop above the age of 60 years. The effect of age is negligible in the rifampicin-resistant group. We also found that type 2 diabetes mellitus has a negative effect on recovery. Coagulase-negative Staphylococci were predominant in the rifampicin-sensitive (50% of the isolates) and Gram-negative rods in the resistant group (40%). CONCLUSIONS Rifampicin resistance was associated with lower recovery rates among patients undergoing two-stage revision due to PJI. Higher age and type 2 diabetes mellitus had negative impact on clinical outcome.
Collapse
Affiliation(s)
- Gergely Krizsan
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Imre Sallai
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Daniel Sandor Veres
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Gyula Prinz
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Donat Szeker
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gabor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| |
Collapse
|