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Putnis SE, Klasan A, Bott B, Ridley W, Hudson B, Coolican MRJ. The Microbiology of Knee Prosthetic Joint Infection and its Influence on Persistent Infection. J Knee Surg 2024; 37:834-842. [PMID: 38830606 DOI: 10.1055/a-2337-2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a severe complication causing a significant burden. The study aims were to establish the epidemiology of microorganisms in TKA PJI, the rate of persistent infection requiring further surgery, and the risk factors for this. Microbiological specimens between June 2002 and March 2017 at five regional hospital sites were identified with revision TKA procedures in the National Joint Replacement Registry. The time between procedures, type of revision strategy, and any subsequent further revision operations were collected. At minimum 2-year follow-up, 174 revision TKA were identified, with a mean patient age of 69 ± 11 years. A broad range of pathogens were identified. Fifty cases (29%) had persistent infection requiring at least one further operative procedure, 13 cases required 3 or more. Coagulase-negative Staphylococcus species (CNS) was seen most with failed surgery, polymicrobial infections also posing a significant risk factor. The best chance of a successful PJI surgical strategy was < 12 months from primary TKA, with the greatest risk between 3 and 5 years (p < 0.05). Younger age significantly increased the risk of further surgery (p < 0.05). Management varied; 103 (59%) debridement, antibiotic therapy and implant retention, with further surgery in 29%; 45 (17%) single-stage revision, with further surgery in 13%; and 26 (15%) two-stage revision, with further surgery in 12%. This study presents the most common causative pathogens for PJI in TKA, and the high rate of persistent infection after initial revision surgery. Risk factors for persistent infection and further revision surgery were polymicrobial and CNS infections, patients who presented between 3 and 5 years following primary TKA, and younger age. This study therefore raises important risk factors and areas for future research to reduce the burden of multiple operations after PJI.
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Affiliation(s)
- Sven E Putnis
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
- Trauma & Orthopaedic Department, Bristol Royal Infirmary, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
- Avon Orthopaedic Centre, Bristol, United Kingdom
| | - Antonio Klasan
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
- Trauma & Orthopaedic Department, AUVA UKH Hospitals Steiermark, Graz, Austria
- Johannes Kepler University, Linz, Austria
| | - Brendan Bott
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
| | - William Ridley
- Sydney Orthopaedic Research Institute, Chatswood, Sydney, Australia
| | - Bernard Hudson
- Department of Microbiology & Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
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Thejeel B, Coles Z, Li Q, Nguyen JT, Carli AV, Miller TT. When to lavage in the absence of a sonographically visible joint effusion in painful total knee arthroplasty: a retrospective longitudinal study. Skeletal Radiol 2024; 53:2279-2284. [PMID: 38514473 DOI: 10.1007/s00256-024-04657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To determine if knee arthroplasty without sonographically visible effusion needs to undergo lavage to rule out infection. METHODS Patients were accrued by a retrospective search of a longitudinally maintained radiology database looking for patients referred for ultrasound guided aspiration of suspected TKA infection. Clinical presentations, laboratory tests, intraoperative findings, and follow-up were reviewed. RESULTS Four hundred sixty-nine patients were included (mean age of 67 years (range, 36-91)) including 251 females. Four hundred three patients had effusions, of which 57 were infected based on ultrasound-guided and surgical aspirates. Sixty-four patients lacked effusions, of which 47 underwent lavage at the clinicians' request, with 6/47 infected. Nineteen patients without effusion were not lavaged at the clinicians' request due to low suspicion, and none were infected. Patients with positive lavage cultures all had clinical risk factors. Infection rates were significantly higher in patients with joint effusion and clinical suspicion for infection compared to absent joint effusion and absent clinical suspicion. A significantly higher proportion of patients with hyperemia or moderate-severe synovial thickening on ultrasound were symptomatic and had joint effusion and positive joint cultures. Aspiration of native fluid had 85% sensitivity and 100% specificity while lavage had a sensitivity of 57% and specificity of 100%. Negative predictive value for native aspirates was 94% compared to 86% for lavage. CONCLUSION A TKA with low clinical suspicion of infection does not need to undergo lavage in the absence of a sonographically visible effusion.
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Affiliation(s)
- Bashiar Thejeel
- Hospital for Special Surgery Department of Radiology and Imaging, 535 E 70Th Street, New York, NY, 10021, USA
| | - Zachary Coles
- Hospital for Special Surgery Department of Orthopedic Surgery, 535 E 70Th Street, New York, NY, 10021, USA
| | - Qian Li
- Hospital for Special Surgery Biostatistics Core, 535 E 70Th Street, New York, NY, 10021, USA
| | - Joesph T Nguyen
- Hospital for Special Surgery Biostatistics Core, 535 E 70Th Street, New York, NY, 10021, USA
| | - Alberto V Carli
- Hospital for Special Surgery Department of Orthopedic Surgery, 535 E 70Th Street, New York, NY, 10021, USA
| | - Theodore T Miller
- Hospital for Special Surgery Department of Radiology and Imaging, 535 E 70Th Street, New York, NY, 10021, USA.
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Lee J, Baek E, Ahn H, Park H, Lee S, Kim S. Diagnostic Performance of a Molecular Assay in Synovial Fluid Targeting Dominant Prosthetic Joint Infection Pathogens. Microorganisms 2024; 12:1234. [PMID: 38930616 PMCID: PMC11206145 DOI: 10.3390/microorganisms12061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
Prosthetic joint infection (PJI) is one of the most serious complications of joint replacement surgery among orthopedic surgeries and occurs in 1 to 2% of primary surgeries. Additionally, the cause of PJIs is mostly bacteria from the Staphylococcus species, accounting for more than 98%, while fungi cause PJIs in only 1 to 2% of cases and can be difficult to manage. The current gold-standard microbiological method of culturing synovial fluid is time-consuming and produces false-negative and -positive results. This study aimed to identify a novel, accurate, and convenient molecular diagnostic method. The DreamDX primer-hydrolysis probe set was designed for the pan-bacterial and pan-fungal detection of DNA from pathogens that cause PJIs. The sensitivity and specificity of DreamDX primer-hydrolysis probes were 88.89% (95% CI, 56.50-99.43%) and 97.62% (95% CI, 87.68-99.88%), respectively, compared with the microbiological method of culturing synovial fluid, and receiver operating characteristic (ROC) area under the curve (AUC) was 0.9974 (*** p < 0.0001). It could be concluded that the DreamDX primer-hydrolysis probes have outstanding potential as a molecular diagnostic method for identifying the causative agents of PJIs, and that host inflammatory markers are useful as adjuvants in the diagnosis of PJIs.
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Affiliation(s)
- Jiyoung Lee
- Department of Research & Development, DreamDX Inc., C001, 57, Oryundae-ro, Geumjeong-gu, Busan 46252, Republic of Korea; (J.L.); (E.B.)
| | - Eunyoung Baek
- Department of Research & Development, DreamDX Inc., C001, 57, Oryundae-ro, Geumjeong-gu, Busan 46252, Republic of Korea; (J.L.); (E.B.)
| | - Hyesun Ahn
- Joint & Arthritis Research Center, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea;
| | - Heechul Park
- Department of Clinical Laboratory Science, Hyejeon College, Daehak 1-gil, Hongseong-eup, Hongseong-gun 32244, Republic of Korea;
| | - Suchan Lee
- Joint & Arthritis Research Center, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul 07999, Republic of Korea;
| | - Sunghyun Kim
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan 46252, Republic of Korea
- Next-Generation Industrial Field-Based Specialist Program for Molecular Diagnostics, Brain Busan 21 Plus Project, Graduate School, Catholic University of Pusan, Busan 46252, Republic of Korea
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Slawaska-Eng D, Giglio V, Gazendam AM, Schneider P, Bernthal N, Ghert M. Central Adjudication Committee and Clinical Site Investigator Agreement on Outcomes in the PARITY Trial: A Secondary Analysis of the PARITY Trial Data. J Bone Joint Surg Am 2023; 105:73-78. [PMID: 37466583 DOI: 10.2106/jbjs.22.01363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND The detection of a surgical site infection (SSI) in patients with metal implants requires a high degree of clinical acumen. The inherent subjectivity of SSI diagnosis poses a challenge in the design of surgical trials because this subjectivity raises concern for outcome assessment bias. Central Adjudication Committees (CACs) are often utilized to minimize the variability in outcome assessment. Little research has been done to determine the reliability of outcome assessment in trials utilizing a CAC. In the present study, we determined the agreement between the study CAC and the clinical site investigators for the primary and secondary outcome assessments. METHODS The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial was a multicenter, blinded, parallel 2-arm, randomized controlled trial that aimed to determine the effect of a 5-day versus 1-day postoperative prophylactic antibiotic regimen on the rate of SSI in patients undergoing surgical excision of tumors in the femur or tibia. The blinded PARITY CAC adjudicated all primary and secondary outcomes identified during the 1-year study follow-up. In the present secondary analysis, the Cohen kappa statistic was utilized to determine the level of agreement. RESULTS The primary outcome of SSI diagnosis demonstrated a substantial level of agreement between the CAC and the site investigators (0.699; 95% confidence interval [CI], 0.595 to 0.803]). Categorization of the SSI (i.e., superficial, deep, or organ space) showed moderate agreement (0.470; 95% CI, 0.382 to 0.558). Secondary outcomes such as the types of reoperations and the indication for reoperation typically showed substantial to almost perfect agreement, whereas antibiotic-related complications showed fair agreement (0.241; 95% CI, 0.000 to 0.474). CONCLUSIONS Although there was a substantial level of agreement between the PARITY CAC and site investigators on the diagnosis of an SSI, as well as typically at least substantial agreement on the causes and types of reoperations, there was less agreement regarding the type of SSI and the occurrence of an antibiotic-related complication. Therefore, the CAC appears to have provided value when adjudicating the depth of infection and when determining the causality of medical complications associated with antibiotics. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Rahardja R, Zhu M, Davis JS, Manning L, Metcalf S, Young SW. Success of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infection Following Primary Total Knee Arthroplasty: Results from a Prospective Multicenter Study of 189 Cases. J Arthroplasty 2023:S0883-5403(23)00370-4. [PMID: 37084921 DOI: 10.1016/j.arth.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND This study aimed to identify the success rate of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infection (PJI) in a large prospective cohort of patients undergoing total knee arthroplasty (TKA). The ability for different PJI classification systems to predict success was assessed. METHODS Prospective data recorded in the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) study was analyzed. 189 newly diagnosed knee PJIs were managed with DAIR between July 2014 and December 2017. Patients were prospectively followed up for 2 years. A strict definition of success was used, requiring the patient being alive with documented absence of infection, no ongoing antibiotics and the index prosthesis in place. Success was compared against the Coventry (early PJI = ≤1 month), International Consensus Meeting (early = ≤90 days), Auckland (early = <1 year), and Tsukayama (early = ≤1 month, hematogenous = >1 month with <7 days symptoms, chronic = >1 month with >7 days symptoms) classifications. RESULTS DAIR success was 45% (85/189) and was highest in early PJIs defined according to the Coventry (adjusted odds ratio [aOdds Ratio (OR)] = 3.9, P=0.01), the ICM (aOR = 3.1, p=0.01), and the Auckland classifications (aOR = 2.6, P=0.01). Success was lower in both hematogenous (aOR = 0.4, P=0.03) and chronic infections (aOR = 0.1, P=0.003). CONCLUSION Time since primary TKA is an important predictor of DAIR success. Success was highest in infections occurring <1 month of the primary TKA and progressively decreased as time since the primary TKA increased.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Mark Zhu
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joshua S Davis
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Laurens Manning
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia
| | - Sarah Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Fourcade C, Gomez-Brouchet A, Bouige A, Krin G, Bicart-See A, Marlin P, Gautie L, Giordano G, Bonnet E. Can we rely on histopathological results for the diagnostic of prosthetic joint infection? Infect Dis Now 2023; 53:104706. [PMID: 37030627 DOI: 10.1016/j.idnow.2023.104706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Histopathology is one of the diagnostic criteria for prosthetic joint infection (PJI) proposed by all academic societies. The aim of this study was to compare histopathological and microbiological results from samples taken intraoperatively at the same site in patients with suspected or proven PJI. PATIENTS AND METHODS We conducted a monocenter retrospective study including all patients having undergone surgery from 2007 to 2015 with suspected or proven PJI. During surgery, both histopathological and microbiological samples were taken. Patients with a history of antimicrobial treatment 2 weeks prior to surgery were excluded. We considered as major criteria and gold standard for PJI diagnosis the presence of a sinus tract communication and/or the same microorganism in at least two cultures. RESULTS Finally, 181 patients who underwent 309 surgeries were included. The median number of samples per surgery was 4 (interquartile range (IQR) = 3-5) for histopathology and 5 (IQR=4-6) for microbiology. Major criteria were observed in 177 patients (57.3%), while positive histology in at least one intraoperative sample was present in 119 (38.5%). The concordance was 74%. The sensitivity and specificity of histopathology were 61% and 92% respectively. Available "histopathology-culture" sample pairs numbered 1247. Among them, positive histopathology was found in 292 samples (23%) and culture in 563 (45%). Concordance was 64%. The highest correlation was observed for very early infection (< 1 month) (OR: 9.1, 95% CI: 3.6-23) and for virulent microorganisms, such as Staphylococcus aureus (OR: 7.8, 95% CI: 5.2-11.8), Streptococci (OR:7.8; 95% CI: 4-15.2) or Enterobacterales (OR: 7.4; 95% CI: 4.2-13.1). CONCLUSION Histopathologic examination is a valuable criterion for PJI diagnosis, but it may lack sensitivity for chronic infections or due to low-virulence pathogens.
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Jinno Y, Stocchero M, Toia M, Papia E, Ahmad M, Becktor JP. Impact of salivary contamination during implant placement with different surface characteristics in native and augmented bone: An in vivo study in sheep calvaria model. Clin Oral Implants Res 2023; 34:254-262. [PMID: 36695016 DOI: 10.1111/clr.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/04/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate whether salivary contamination during placement of implants with different surface characteristics affects osseointegration in native and in augmented bone areas. MATERIALS AND METHODS Forty eight implants with machined surface (MS) and 48 implants with moderately rough surface (RS) were tested in the calvaria of 12 sheep. At the first surgery, 64 bony critical defects were randomly created and were subsequently augmented with two materials (autogenous or bovine bone). After 5 weeks of graft healing, 8 implants were placed per sheep, in native bone and in the centre of the augmented defects. Forty eight implants were soaked with saliva before placement (contaminated group [CG]), while 48 implants were not (non-contaminated group [NCG]). Five weeks after implant placement, bone-to-implant contact (BIC) and bone material area fraction occupancy (BMAFO) were calculated histomorphometrically. RESULTS Saliva contamination showed a significant negative effect (p = .000) on BIC, especially in augmented areas. RS showed significant positive effect on BIC, compared to MS (p = .000), while there were no significant differences for different bone conditions (p = .103). For BMAFO, the contamination showed a significantly negative affect (p = .000), while there were no significant differences for surface characteristics (p = .322) and for bone condition (p = .538). CONCLUSION Saliva contamination during dental implant placement has a negative effect on osseointegration in augmented areas. Moderately rough surface has a possible advantage in the aspect of initial bone to implant contact. However, it seems to be advisable to avoid saliva contamination especially for implants placed in augmented bone areas.
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Affiliation(s)
- Yohei Jinno
- Department of Oral & Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden.,Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dentistry, Kyushu University, Fukuoka, Japan
| | - Michele Stocchero
- Department of Oral & Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Marco Toia
- Department of Oral & Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Evaggelia Papia
- Department of Materials Science and Technology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Marianne Ahmad
- Department of Oral & Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Jonas Peter Becktor
- Department of Oral & Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
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Kutsuno S, Hayashi I, Yu L, Yamada S, Hisatsune J, Sugai M. Non-deacetylated poly- N-acetylglucosamine-hyperproducing Staphylococcus aureus undergoes immediate autoaggregation upon vortexing. Front Microbiol 2023; 13:1101545. [PMID: 36699608 PMCID: PMC9868172 DOI: 10.3389/fmicb.2022.1101545] [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: 11/18/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Biofilms are microbial communities of cells embedded in a matrix of extracellular polymeric substances generated and adhering to each other or to a surface. Cell aggregates formed in the absence of a surface and floating pellicles that form biofilms at the air-liquid interface are also considered to be a type of biofilm. Staphylococcus aureus is a well-known cause of biofilm infections and high-molecular-weight polysaccharides, poly-N-acetylglucosamine (PNAG) is a main constituent of the biofilm. An icaADBC operon comprises major machinery to synthesize and extracellularly secrete PNAG. Extracellular PNAG is partially deacetylated by IcaB deacetylase, and the positively charged PNAG hence interacts with negatively charged cell surface to form the major component of biofilm. We previously reported a new regulator of biofilm (Rob) and demonstrated that Rob binds to a unique 5-bp motif, TATTT, present in intergenic region between icaADBC operon and its repressor gene icaR in Yu et al. The deletion of the 5-bp motif induces excessive adherent biofilm formation. The real function of the 5-bp motif is still unknown. In an attempt to isolate the 5-bp motif deletion mutant, we isolated several non-adherent mutants. They grew normally in turbid broth shaking culture but immediately auto-aggregated upon weak vortexing and sedimented as a lump resulting in a clear supernatant. Whole genome sequencing of the mutants identified they all carried mutations in icaB in addition to deletion of the 5-bp motif. Purification and molecular characterization of auto-aggregating factor in the culture supernatant of the mutant identified that the factor was a massively produced non-deacetylated PNAG. Therefore, we created a double deficient strain of biofilm inhibitory factors (5-bp motif, icaR, rob) and icaB to confirm the aggregation phenomenon. This peculiar phenomenon was only observed in Δ5bpΔicaB double mutant but not in ΔicaR ΔicaB or ΔrobΔicaB mutant. This study explains large amount of extracellularly produced non-deacetylated PNAG by Δ5bpΔicaB double mutation induced rapid auto-aggregation of S. aureus cells by vortexing. This phenomenon indicated that Staphylococcus aureus may form biofilms that do not adhere to solid surfaces and we propose this as a new mechanism of non-adherent biofilm formation of S. aureus.
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Affiliation(s)
- Shoko Kutsuno
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Ikue Hayashi
- Research Facility, Hiroshima University Faculty of Dentistry, Hiroshima, Japan
| | - Liansheng Yu
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Sakuo Yamada
- Department of Medical Technology, Faculty of Health Sciences & Technology, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Junzo Hisatsune
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Motoyuki Sugai
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan,Department of Antimicrobial Resistance, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan,*Correspondence: Motoyuki Sugai,
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Gelderman SJ, Faber C, Kampinga GA, Jutte PC, Ploegmakers JJW, Glaudemans AWJM, Wouthuyzen-Bakker M. A high prevalence of Cutibacterium acnes infections in scoliosis revision surgery, a diagnostic and therapeutic dilemma. Spine Deform 2023; 11:319-327. [PMID: 36282416 PMCID: PMC9970938 DOI: 10.1007/s43390-022-00599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate if serum inflammatory markers or nuclear imaging can accurately diagnose a chronic spinal instrumentation infection (SII) prior to surgery. METHODS All patients who underwent revision of spinal instrumentation after a scoliosis correction between 2017 and 2019, were retrospectively evaluated. The diagnostic accuracy of serum C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) and Technetium-99m-methylene diphosphonate (99mTc-MDP) 3-phase bone scintigraphy (TPBS) to diagnose infection were studied. Patients with an acute infection or inadequate culture sampling were excluded. SII was diagnosed if ≥ 2 of the same microorganism(s) were isolated from intra-operative tissue cultures. RESULTS 30 patients were included. The indication for revision surgery was pseudoarthrosis in the majority of patients (n = 15). 22 patients (73%) were diagnosed with SII. In all infected cases, Cutibacterium acnes was isolated, including 5 cases with a polymicrobial infection. The majority of patients had low inflammatory parameters preoperatively. For CRP > 10.0 mg/L, the sensitivity was 9.1% and specificity 100%; for ESR > 30 mm/h, the sensitivity was 9.1% and specificity 100%. The diagnostic accuracy for nuclear imaging was 64% for the FDG-PET/CT and 67% for the TPBS to diagnose infection. CONCLUSIONS The prevalence of SII in patients undergoing revision spinal surgery is high, with Cutibacterium acnes as the main pathogen. No diagnostic tests could be identified that could accurately diagnose or exclude SII prior to surgery. Future studies should aim to find more sensitive diagnostic modalities to detect low-grade inflammation.
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Affiliation(s)
- Stefan J. Gelderman
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christhoper Faber
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Greetje A. Kampinga
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul C. Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joris J. W. Ploegmakers
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W. J. M. Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Meinshausen AK, Färber J, Illiger S, Macor P, Lohmann CH, Bertrand J. C9 immunostaining as a tissue biomarker for periprosthetic joint infection diagnosis. Front Immunol 2023; 14:1112188. [PMID: 36895567 PMCID: PMC9989178 DOI: 10.3389/fimmu.2023.1112188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023] Open
Abstract
Background Culture-negative periprosthetic joint infections (PJI) are often false diagnosed as aseptic implant failure leading to unnecessary revision surgeries due to repeated infections. A marker to increase the security of e PJI diagnosis is therefore of great importance. The aim of this study was to test C9 immunostaining of periprosthetic tissue as a novel tissue-biomarker for a more reliable identification of PJI, as well as potential cross-reactivity. Method We included 98 patients in this study undergoing septic or aseptic revision surgeries. Standard microbiological diagnosis was performed in all cases for classification of patients. Serum parameters including C-reactive protein (CRP) serum levels and white blood cell (WBC) count were included, and the periprosthetic tissue was immunostained for C9 presence. The amount of C9 tissue staining was evaluated in septic versus aseptic tissue and the amount of C9 staining was correlated with the different pathogens causing the infection. To exclude cross-reactions between C9 immunostaining and other inflammatory joint conditions, we included tissue samples of a separate cohort with rheumatoid arthritis, wear particles and chondrocalcinosis. Results The microbiological diagnosis detected PJI in 58 patients; the remaining 40 patients were classified as aseptic. Serum CRP values were significantly increased in the PJI cohort. Serum WBC was not different between septic and aseptic cases. We found a significant increase in C9 immunostaining in the PJI periprosthetic tissue. To test the predictive value of C9 as biomarker for PJI we performed a ROC analyses. According to the Youden's criteria C9 is a very good biomarker for PJI detection with a sensitivity of 89% and a specificity of 75% and an AUC of 0.84. We did not observe a correlation of C9 staining with the pathogen causing the PJI. However, we observed a cross reactivity with the inflammatory joint disease like rheumatoid arthritis and different metal wear types. In addition, we did not observe a cross reactivity with chondrocalcinosis. Conclusion Our study identifies C9 as a potential tissue-biomarker for the identification of PJI using immunohistological staining of tissue biopsies. The use of C9 staining could help to reduce the number of false negative diagnoses of PJI.
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Affiliation(s)
- Ann-Kathrin Meinshausen
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jacqueline Färber
- Institute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sebastian Illiger
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Paolo Macor
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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11
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Stamm J, Weißelberg S, Both A, Failla AV, Nordholt G, Büttner H, Linder S, Aepfelbacher M, Rohde H. Development of an artificial synovial fluid useful for studying Staphylococcus epidermidis joint infections. Front Cell Infect Microbiol 2022; 12:948151. [PMID: 35967857 PMCID: PMC9374174 DOI: 10.3389/fcimb.2022.948151] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus epidermidis is a major causative agent of prosthetic joint infections (PJI). The ability to form biofilms supports this highly selective pathogenic potential. In vitro studies essentially relying on phenotypic assays and genetic approaches have provided a detailed picture of the molecular events contributing to biofilm assembly. A major limitation in these studies is the use of synthetic growth media, which significantly differs from the environmental conditions S. epidermidis encounters during host invasion. Building on evidence showing that growth in serum substantially affects S. epidermidis gene expression profiles and phenotypes, the major aim of this study was to develop and characterize a growth medium mimicking synovial fluid, thereby facilitating research addressing specific aspects related to PJI. Using fresh human plasma, a protocol was established allowing for the large-scale production of a medium that by biochemical analysis matches key characteristics of synovial fluid and therefore is referred to as artificial synovial fluid (ASF). By analysis of biofilm-positive, polysaccharide intercellular adhesion (PIA)-producing S. epidermidis 1457 and its isogenic, PIA- and biofilm-negative mutant 1457-M10, evidence is provided that the presence of ASF induces cluster formation in S. epidermidis 1457 and mutant 1457-M10. Consistent with the aggregative properties, both strains formed multilayered biofilms when analyzed by confocal laser scanning microscopy. In parallel to the phenotypic findings, expression analysis after growth in ASF found upregulation of genes encoding for intercellular adhesins (icaA, aap, and embp) as well as atlE, encoding for the major cell wall autolysin being responsible for eDNA release. In contrast, growth in ASF was associated with reduced expression of the master regulator agr. Collectively, these results indicate that ASF induces expression profiles that are able to support intercellular adhesion in both PIA-positive and PIA-negative S. epidermidis. Given the observation that ASF overall induced biofilm formation in a collection of S. epidermidis isolates from PJI, the results strongly support the idea of using growth media mimicking host environments. ASF may play an important role in future studies related to the pathogenesis of S. epidermidis PJI.
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Affiliation(s)
- Johanna Stamm
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | - Samira Weißelberg
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | - Anna Both
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | | | - Gerhard Nordholt
- Institute for Clinical Chemistry, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Henning Büttner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | - Stefan Linder
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Hamburg, Germany
- Deutsches Zentrum für Infektionsmedizin, Standort Hamburg-Lübeck-Borstel, Hamburg, Germany
- *Correspondence: Holger Rohde,
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12
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Tao J, Yan Z, Pu B, Chen M, Hu X, Dong H. Comparison of dynamic and static spacers for the treatment of infections following total knee replacement: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:348. [PMID: 35840986 PMCID: PMC9284771 DOI: 10.1186/s13018-022-03238-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Revision surgery is the most common treatment for patients who develop infection after total knee arthroplasty (TKA). Two types of spacers are often used in revision surgery: dynamic spacers and static spacers. The comparative efficacy of these two types of spacers on knee prosthesis infections is not well established. Therefore, we carried out a systematic evaluation and meta-analysis with the aim of comparing the difference in efficacy between dynamic and static spacers. Methods We conducted the literature search in PubMed, Web of Science, Cochrane Library, and Embase databases. The articles searched were clinical study comparing the difference in efficacy between dynamic spacers and static spacers for the treatment of prosthetic infections occurring after total knee arthroplasty. Results We conducted a literature search and screening based on the principles of PICOS. Ultimately, 14 relevant clinical studies were included in our current study. We use infection control rate as the primary evaluation indicator. The KSS knee scores (KSSs), KSS functional scores, bone loss and range of motion (ROM) are secondary indicators of evaluation. Thirteen of these included studies reported the infection control rates, with no significant difference between dynamic and static shims (RR: 1.03; 95% Cl 0.98, 1.09; P = 0.179 > 0.05). The KSSs were reported in 10 articles (RR: 5.98; 95% CI 0.52, 11.43; P = 0.032 < 0.05). Six articles reported the KSS functional scores (RR: 13.90; 95% CI 4.95, 22.85; P = 0.02 < 0.05). Twelve articles reported the ROM (RR: 17.23. 95% CI 10.18, 24.27; P < 0.0001). Six articles reported the bone loss (RR: 2.04; 95% CI 1.11, 3.77; P = 0.022 < 0.05). Conclusion Current evidence demonstrates that dynamic spacers are comparable to static spacers in controlling prosthetic joint infection. In terms of improving the functional prognosis of the knee joint, dynamic spacers are more effective than static spacers.
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Affiliation(s)
- Jiasheng Tao
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Number12, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Zijian Yan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Number12, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Bin Pu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Number12, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Ming Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Number12, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Xiaorong Hu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Number12, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China
| | - Hang Dong
- Department of TCM Orthopedics, Hospital for First Affiliated Hospital of Guangzhou University of Chinese Medicine, Number16, Jichang Road, Baiyun District, Guangzhou, 510405, Guangdong Province, China.
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13
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Yakkanti RR, Vanden Berge D, Summers SH, Mansour KL, Lavin AC, Hernandez VH. Extended Postoperative Prophylactic Antibiotics for Primary and Aseptic Revision Total Joint Arthroplasty: A Systematic Review. J Am Acad Orthop Surg 2022; 30:e822-e832. [PMID: 35245256 DOI: 10.5435/jaaos-d-21-00977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Limited literature is available about the effects of extended (>24 hours) antibiotic use after primary and aseptic revision total joint arthroplasty (TJA) on rates of periprosthetic joint infection (PJI). The purpose of this study was to systematically review the outcomes of extended prophylactic antibiotic use. METHODS A systematic search on PubMed and EMBASE databases was done in August 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles that met inclusion criteria were screened by two separate authors. Basic patient demographics, route of delivery, type, dose, frequency of the antibiotic, rates of PJI, and length of stay were extracted. RESULTS A total of 11 articles published from 1979 to 2021 were included in the final analysis. Two studies evaluated aseptic revisions, seven evaluated primary TJA, and two studies evaluated both. Five studies were randomized controlled trials, one multicenter nonrandomized trial, and five retrospective cohort studies. All 11 studies used a cephalosporin or a penicillin antibiotic in both the control and cohort groups. Five studies used intravenous (IV) antibiotics, one study used oral (PO) antibiotics, and the other five studies used both IV and PO antibiotics. Length of stay was reported in three studies, all using IV antibiotics. All 11 studies evaluated rates of PJI, while four studies evaluated included rates of superficial surgical site infections. Four studies showed a statistically significant decrease in PJI when compared with a control group, while seven studies showed no statistically significant difference. CONCLUSION There is conflicting evidence regarding the benefit of extended (>24 hours) antibiotics, IV or PO, after TJA. As of now, current guidelines do not support the use of extended antibiotics; future prospective clinical trials are needed to help support these claims.
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Affiliation(s)
- Ramakanth R Yakkanti
- From the Department of Orthopaedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL (Yakkanti, Vanden Berge, Mansour, Lavin, and Hernandez), and the Department of Orthopaedic Surgery, Washington University, St. Louis, MO (Summers)
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14
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A protocol for periprosthetic joint infections from the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands. ARTHROPLASTY 2022; 4:19. [PMID: 35410299 PMCID: PMC8996586 DOI: 10.1186/s42836-022-00116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery. Treatment success depends on accurate diagnostics, adequate surgical experience and interdisciplinary consultation between orthopedic surgeons, plastic surgeons, infectious disease specialists and medical microbiologists. For this purpose, we initiated the Northern Infection Network for Joint Arthroplasty (NINJA) in the Netherlands in 2014. The establishment of a mutual diagnostic and treatment protocol for PJI in our region has enabled mutual understanding, has supported agreement on how to treat specific patients, and has led to clarity for smaller hospitals in our region for when to refer patients without jeopardizing important initial treatment locally. Furthermore, a mutual PJI patient database has enabled the improvement of our protocol, based on medicine-based evidence from our scientific data. In this paper we describe our NINJA protocol. Level of evidence: III
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15
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Simms AJ, Kobayashi T, Schwartzhoff PV, Sekar P. Prosthetic hip infection due to Campylobacter jejuni. BMJ Case Rep 2022; 15:e248240. [PMID: 35272991 PMCID: PMC8915350 DOI: 10.1136/bcr-2021-248240] [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] [Accepted: 02/25/2022] [Indexed: 11/03/2022] Open
Abstract
A woman in her 60s with a left hip prosthesis was presented with left hip pain and fever. She had an elevated white blood cell count and inflammatory markers. Synovial fluid Gram stain demonstrated curved Gram-negative rods identified as Campylobacter jejuni The patient initially refused surgery and after 3 months underwent one-stage exchange after which she was treated with 12 weeks of levofloxacin. Her inflammatory markers normalised and she was clinically doing well at her 6-month follow-up. C. jejuni is a rare cause of prosthetic joint infection and should be included in the differential diagnosis when a patient has risk factors even without significant preceding gastrointestinal symptoms. Per most recent Infectious Diseases Society of America guidelines, treatment after one-stage revision includes 4-6 weeks of intravenous antimicrobials followed by possible oral suppression therapy, while the European guidelines recommend 12 weeks of orally bioavailable antibiotics.
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Affiliation(s)
- Andrew Joseph Simms
- Internal Medicine, Infectious Diseases, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Takaaki Kobayashi
- Internal Medicine, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Patrick V Schwartzhoff
- Internal Medicine, Carver College of Medicine, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Internal Medicine, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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16
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Guchhait KC, Manna T, Barai M, Karmakar M, Nandi SK, Jana D, Dey A, Panda S, Raul P, Patra A, Bhattacharya R, Chatterjee S, Panda AK, Ghosh C. Antibiofilm and anticancer activities of unripe and ripe Azadirachta indica (neem) seed extracts. BMC Complement Med Ther 2022; 22:42. [PMID: 35152903 PMCID: PMC8843028 DOI: 10.1186/s12906-022-03513-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/07/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Antibiotic resistances of pathogens and breast cancer warrant the search for new alternative strategies. Phytoextracts can eradicate microbe-borne diseases as well as cancer with lower side effects compared to conventional antibiotics. AIM Unripe and ripe Azadirachta indica (neem) seed extracts were explored as potential antibiofilm and anticancer agents in combating multidrug-resistant infectious bacteria as well as anticancer agents against the MDR breast cancer cell lines. METHODS Shed-dried neem seeds (both unripe and ripe) were pulverized and extracted using methanol. The chemical components were identified with FTIR and gas chromatography - mass spectrometry. Antibiofilm activity of neem seed extracts were assessed in terms of minimum biofilm inhibitory concentration (MBIC), minimum biofilm eradication concentration (MBEC), and fluorescence microscopic studies on Staphylococcus aureus and Vibrio cholerae. Bacterial cells were studied by fluorescence microscopy using acridine orange/ethidium bromide as the staining agents. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values were evaluated to observe the antibacterial activities. Cytotoxicity of the extracts against human blood lymphocytes and the anticancer activity against drug-resistant breast cancer cell lines were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and fluorescence-activated cell sorting (FACS) studies. RESULTS 4-Ethyl-2-hydroxy-2-cyclopentene-1-one, phthalic acid, and 2-hexyl-tetrahydro thiophane were the major compounds in unripe neem seed, whereas 3,5-dihydroxy-6-methyl-2,3-dihydro-4-H-pyran-4-one and 4-ethylbenzamide were predominant in ripe neem seed. Triazine derivatives were also common for both the extracts. MBIC values of unripe and ripe neem seed extracts for S. aureus are 75 and 100 µg/mL, respectively, and for V. cholerae, they are 100 and 300 µg/mL, respectively. MBEC values of unripe and ripe seed extracts are 500 and 300 µg/mL, respectively for S. aureus and for V. cholerae the values are 700 and 500 µg/mL, respectively. Fluorescence microscopic studies at 16 and 24 h, after bacterial culture, demonstrate enhanced antibiofilm activity for the ripe seed extract than that of the unripe seeds for both the bacteria. MTT assay reveals lower cytotoxicity of both the extracts towards normal blood lymphocytes, and anticancer activity against breast cancer cell line (MDA-MB-231) with superior activity of ripe seed extract. FACS studies further supported higher anticancer activity for ripe seed extract. CONCLUSIONS Methanolic extract of neem seeds could substantially inhibit and eradicate biofilm along with their potent antibacterial and anticancer activities. Both the extracts showed higher antibiofilm and antibacterial activity against S. aureus (gram-positive) than V. cholerae (gram-negative). Moreover, ripe seed extract showed higher antibiofilm and anticancer activity than unripe extracts.
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Affiliation(s)
- Kartik Chandra Guchhait
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Tuhin Manna
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Manas Barai
- Department of Chemistry, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Monalisha Karmakar
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Sourav Kumar Nandi
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata, 700094, West Bengal, India
| | - Debarati Jana
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Aditi Dey
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Suman Panda
- Department of Biophysics, Bose Institute, P-1/12 CIT Road, Scheme VIIM, Kankurgachi, Kolkata, 700054, West Bengal, India
| | - Priyanka Raul
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India
| | - Anuttam Patra
- Chemistry of Interfaces Group, Luleå University of Technology, SE- 97187, Luleå, Sweden
| | - Rittwika Bhattacharya
- Department of Molecular Biology, Netaji Subhas Chandra Bose Cancer Research Institute, 3081 Nayabad, Kolkata, 700094, West Bengal, India
| | - Subhrangsu Chatterjee
- Department of Biophysics, Bose Institute, P-1/12 CIT Road, Scheme VIIM, Kankurgachi, Kolkata, 700054, West Bengal, India
| | - Amiya Kumar Panda
- Department of Chemistry, Vidyasagar University, Midnapore, 721102, West Bengal, India
- Sadhu Ram Chand Murmu University of Jhargram, Jhargram, 721507, West Bengal, India
| | - Chandradipa Ghosh
- Department of Human Physiology, Vidyasagar University, Midnapore, 721102, West Bengal, India.
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17
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Staats A, Burback PW, Eltobgy M, Parker DM, Amer AO, Wozniak DJ, Wang SH, Stevenson KB, Urish KL, Stoodley P. Synovial Fluid-Induced Aggregation Occurs across Staphylococcus aureus Clinical Isolates and is Mechanistically Independent of Attached Biofilm Formation. Microbiol Spectr 2021; 9:e0026721. [PMID: 34523997 PMCID: PMC8557890 DOI: 10.1128/spectrum.00267-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
Rapid synovial fluid-induced aggregation of Staphylococcus aureus is currently being investigated as an important factor in the establishment of periprosthetic joint infections (PJIs). Pathogenic advantages of aggregate formation have been well documented in vitro, including recalcitrance to antibiotics and protection from host immune defenses. The objective of the present work was to determine the strain dependency of synovial fluid-induced aggregation by measuring the degree of aggregation of 21 clinical S. aureus isolates cultured from either PJI or bloodstream infections using imaging and flow cytometry. Furthermore, by measuring attached bacterial biomass using a conventional crystal violet assay, we assessed whether there is a correlation between the aggregative phenotype and surface-associated biofilm formation. While all of the isolates were stimulated to aggregate upon exposure to bovine synovial fluid (BSF) and human serum (HS), the extent of aggregation was highly variable between individual strains. Interestingly, the PJI isolates aggregated significantly more upon BSF exposure than those isolated from bloodstream infections. While we were able to stimulate biofilm formation with all of the isolates in growth medium, supplementation with either synovial fluid or human serum inhibited bacterial surface attachment over a 24 h incubation. Surprisingly, there was no correlation between the degree of synovial fluid-induced aggregation and quantity of surface-associated biofilm as measured by a conventional biofilm assay without host fluid supplementation. Taken together, our findings suggest that synovial fluid-induced aggregation appears to be widespread among S. aureus strains and mechanistically independent of biofilm formation. IMPORTANCE Bacterial infections of hip and knee implants are rare but devastating complications of orthopedic surgery. Despite a widespread appreciation of the considerable financial, physical, and emotional burden associated with the development of a prosthetic joint infection, the establishment of bacteria in the synovial joint remains poorly understood. It has been shown that immediately upon exposure to synovial fluid, the viscous fluid in the joint, Staphylococcus aureus rapidly forms aggregates which are resistant to antibiotics and host immune cell clearance. The bacterial virulence associated with aggregate formation is likely a step in the establishment of prosthetic joint infection, and as such, it has the potential to be a potent target of prevention. We hope that this work contributes to the future development of therapeutics targeting synovial fluid-induced aggregation to better prevent and treat these infections.
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Affiliation(s)
- Amelia Staats
- Department of Microbiology, The Ohio State University, Columbus, Ohio, USA
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Peter W. Burback
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Mostafa Eltobgy
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Dana M. Parker
- Arthritis and Arthroplasty Design Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amal O. Amer
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Daniel J. Wozniak
- Department of Microbiology, The Ohio State University, Columbus, Ohio, USA
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
| | - Shu-Hua Wang
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kurt B. Stevenson
- Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kenneth L. Urish
- Arthritis and Arthroplasty Design Group, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- National Centre for Advanced Tribology at Southampton (nCATS), National Biofilm Innovation Centre (NBIC), Department of Mechanical Engineering, University of Southampton, United Kingdom
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18
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Abstract
Formation of microbial biofilms has long been implicated in the occurrence of periprosthetic joint infections (PJIs). Despite the widespread acknowledgment of the severity of these infections, much is still unknown regarding the underlying mechanisms of biofilm establishment and proliferation in the joint space. The presence of these resilient, complex communities poses many clinical challenges with respect to prevention, diagnosis, and treatment practices. Mature biofilms are known to be highly recalcitrant to antibiotic therapeutics as well as host immune system mediated clearance. A comprehensive understanding of biofilms in the unique joint environment at the molecular level will provide clinicians valuable insight into how best to combat them. As each stage in the process of biofilm establishment has the potential for clinical intervention, this review will provide a sequential analysis of the existing literature, following each step in the formation cycle. New insights into bacterial survival mechanisms from antimicrobial challenge and host immune defenses will be discussed. These new observations in the field may shed light on the early protection conferred upon entry into the joint space ultimately leading to the establishment of a mature biofilm. Additionally, standards of clinical diagnosis as well as current measures of prevention and treatment will be briefly discussed.
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Affiliation(s)
- Amelia Staats
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
- Department of Microbiology, The Ohio State University, Columbus, Ohio, USA
| | - Daniel Li
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Anne C. Sullivan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
| | - Paul Stoodley
- Department of Microbial Infection and Immunity, The Ohio State University, Columbus, Ohio, USA
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, USA
- National Centre for Advanced Tribology at Southampton and National Biofilm Innovation Centre, Mechanical Engineering, University of Southampton, Southampton, UK
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19
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Fatima N, Bjarnsholt T, Bay L. Dynamics of skin microbiota in shoulder surgery infections. APMIS 2021; 129:665-674. [PMID: 34587324 DOI: 10.1111/apm.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/25/2021] [Indexed: 01/10/2023]
Abstract
Post-surgical infections arise due to various contributing factors. Most important is the presence of potential pathogenic microorganisms in the skin complemented by the patient´s health status. Cutibacterium acnes is commonly present in the pilosebaceous glands and hair follicle funnels in human skin. After surgical intervention, these highly prevalent, slow-growing bacteria can be found in the deeper tissues and in proximity of implants. C. acnes is frequently implicated in post-surgical infections, often resulting in the need for revision surgery. This review summarizes the current understanding of microbial dynamics in shoulder surgical infections. In particular, we shed light on the contribution of C. acnes to post-surgical shoulder infections as well as their colonization and immune-modulatory potential. Despite being persistently found in post-surgical tissues, C. acnes is often underestimated as a causative organism due to its slow growth and the inefficient detection methods. We discuss the role of the skin environment constituted by microbial composition and host cellular status in influencing C. acnes recolonization potential. Future mapping of the individual skin microbiome in shoulder surgery patients using advanced molecular methods would be a useful approach for determining the risk of post-operative infections.
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Affiliation(s)
- Naireen Fatima
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - Lene Bay
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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20
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Taggar R, Singh S, Bhalla V, Bhattacharyya MS, Sahoo DK. Deciphering the Antibacterial Role of Peptide From Bacillus subtilis subsp. spizizenii Ba49 Against Staphylococcus aureus. Front Microbiol 2021; 12:708712. [PMID: 34489898 PMCID: PMC8417246 DOI: 10.3389/fmicb.2021.708712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/23/2021] [Indexed: 02/04/2023] Open
Abstract
An increase in antibiotic resistance has led to escalating the need for the development of alternate therapy. Antimicrobial peptides (AMPs) are at the forefront of replacing conventional antibiotics, showing slower development of drug resistance, antibiofilm activity, and the ability to modulate the host immune response. The ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens that jeopardize most conventional antibiotics are known to be involved in severe respiratory tract, bloodstream, urinary tract, soft tissue, and skin infections. Among them, S. aureus is an insidious microbe and developed resistance against conventional antibiotics. In the present study, an AMP (named as peptide-Ba49) isolated from Bacillus subtilis subsp. spizizenii strain from Allium cepa (the common onion) exhibited strong antibacterial efficacy against S. aureus ATCC 25923. The mode of action of this peptide-Ba49 on S. aureus was deciphered through various sensitive probes, i.e., DiSC3 (5) and H2DCFDA, suggesting the peptide-Ba49 to be acting upon through change in membrane potential and by triggering the production of reactive oxygen species (ROS). This induced disruption of the cell membrane was further supported by morphological studies using scanning electron microscopy (SEM). Investigations on a possible post-antibiotic effect (PAE) of peptide-Ba49 showed prolonged PAE against S. aureus. Furthermore, the peptide-Ba49 prevented the formation of S. aureus biofilm at low concentration and showed its potential to degrade the mature biofilm of S. aureus. The peptide-Ba49 also exhibited intracellular killing potential against S. aureus ATCC 25923 in the macrophage cells, and moreover, peptide-Ba49 was found to bolster the fibroblast cell migration in the scratch assay at low concentration, exhibiting a wound healing efficacy of this peptide. These studies demonstrated that peptide-Ba49 isolated from the strain B. subtilis subsp. spizizenii could be a therapeutic candidate to combat the pathogenic S. aureus infections.
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Affiliation(s)
- Ramita Taggar
- CSIR-Institute of Microbial Technology, Sector 39A, Chandigarh, India
| | - Sanpreet Singh
- CSIR-Institute of Microbial Technology, Sector 39A, Chandigarh, India
| | - Vijayender Bhalla
- CSIR-Institute of Microbial Technology, Sector 39A, Chandigarh, India
| | | | - Debendra K Sahoo
- CSIR-Institute of Microbial Technology, Sector 39A, Chandigarh, India.,Academy of Scientific and Innovative Research, New Delhi, India
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21
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Van Belkum A, Gros MF, Ferry T, Lustig S, Laurent F, Durand G, Jay C, Rochas O, Ginocchio CC. Novel strategies to diagnose prosthetic or native bone and joint infections. Expert Rev Anti Infect Ther 2021; 20:391-405. [PMID: 34384319 DOI: 10.1080/14787210.2021.1967745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed. AREAS COVERED We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available. EXPERT OPINION Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.
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Affiliation(s)
- Alex Van Belkum
- bioMérieux, Open Innovation and Partnerships, 3 Route De Port Michaud, La Balme Les Grottes, France
| | | | - Tristan Ferry
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre Interrégional De Référence Pour La Prise En Charge Des Infections Ostéo-articulaires Complexes (Crioac Lyon), Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | - Sebastien Lustig
- Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Service De Chirurgie Orthopédique, Hôpital De La Croix-Rousse, Lyon, France
| | - Frédéric Laurent
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | | | - Corinne Jay
- bioMérieux, BioFire Development Emea, Grenoble, France
| | - Olivier Rochas
- Corporate Business Development, bioMérieux, Marcy-l'Étoile, France
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22
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Gamie Z, Karthikappallil D, Gamie E, Stamiris S, Kenanidis E, Tsiridis E. Molecular sequencing technologies in the diagnosis and management of prosthetic joint infections. Expert Rev Mol Diagn 2021; 22:603-624. [PMID: 33641572 DOI: 10.1080/14737159.2021.1894929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Prosthetic joint infections (PJIs) can be challenging to eradicate and have high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been linked to a greater rate of reoperation. AREAS COVERED There has been increasing investigation of the use of next-generation sequencing (NGS) technology such as metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction (PCR) has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJIs when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further toward routine clinical practice. EXPERT OPINION Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJIs are diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
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Affiliation(s)
- Zakareya Gamie
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK; Genomic Medicine - St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE; King's College London, Strand, London
| | - Dileep Karthikappallil
- Department of Trauma and Orthopedics, East Cheshire NHS Trust, Macclesfield District General Hospital, Victoria Road, Macclesfield, Cheshire, SK10 3BL, UK
| | - Emane Gamie
- School of Molecular and Cellular Biology, Faculty of Biological Sciences and Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK; MBiol, BSc Biological Sciences, University of Leeds Alumni, UK
| | - Stavros Stamiris
- Academic Orthopedic Department, Papageorgiou General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-A.U.Th., Aristotle University Medical School, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopedic Department, Papageorgiou General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-A.U.Th., Aristotle University Medical School, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Department, Papageorgiou General Hospital, Thessaloniki, Greece; CORE-Center for Orthopedic Research at CIRI-A.U.Th., Aristotle University Medical School, Thessaloniki, Greece
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23
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Casado-Castillo F, Kobayashi T, Sekar P, Streit J, Molano De Pena I. Prosthetic hip infection due to Salmonella enterica serovar Enteritidis. IDCases 2021; 25:e01170. [PMID: 34094868 PMCID: PMC8167264 DOI: 10.1016/j.idcr.2021.e01170] [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: 01/29/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/06/2022] Open
Abstract
Prosthetic joint infection (PJI) due to Salmonella spp. is uncommon, with an estimated prevalence of <0.3 % of all PJI. Salmonella enterica serovar Enteritidis and Salmonella enterica serovar Typhimurium are the most common isolates causing PJI. Risk factors include malignancy, hemoglobinopathies, diabetes mellitus, HIV/AIDS, alcohol dependency and immunosuppressed state. PJI due to Salmonella spp. can occur without significant preceding gastrointestinal symptoms of infection.
Prosthetic joint infection (PJI) is a serious complication of prosthetic joint implantation with a prevalence of about 1–2 % of all prosthetic joint surgeries. While Staphylococcus spp. are the most common organisms isolated, Salmonella spp. are a rare cause of PJI (estimated prevalence < 0.3 %). We present a case of a 62-year-old patient with a history of previous joint trauma complicated by osteonecrosis, infection and chronic alcohol abuse with late hematogenous prosthetic hip infection due to Salmonella enterica serovar Enteritidis. PJI due to Salmonella spp. should be considered in the differential diagnosis when a patient has risk factors such as malignancy, hemoglobinopathies, diabetes mellitus, human immunodeficiency virus/acquired immunodeficiency syndrome, alcohol dependency or immunosuppressed state, even without significant preceding gastrointestinal symptoms. Our patient had a few of these risk factors and required surgical debridement in addition to antimicrobials for treatment of his PJI.
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Affiliation(s)
- Fernando Casado-Castillo
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
| | - Takaaki Kobayashi
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
| | - Poorani Sekar
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
| | - Judy Streit
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
| | - Ilonka Molano De Pena
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Hospitals and Clinics, United States
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24
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Löwik CAM, Parvizi J, Jutte PC, Zijlstra WP, Knobben BAS, Xu C, Goswami K, Belden KA, Sousa R, Carvalho A, Martínez-Pastor JC, Soriano A, Wouthuyzen-Bakker M. Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty. Clin Infect Dis 2021; 71:630-636. [PMID: 31504331 DOI: 10.1093/cid/ciz867] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. METHODS We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. RESULTS We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1-2 was 42% (95/226), the rate for Week 3-4 was 38% (143/378), the rate for Week 5-6 was 29% (29/100), and the rate for Week 7-12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. CONCLUSIONS DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.
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Affiliation(s)
- Claudia A M Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Chi Xu
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan Carlos Martínez-Pastor
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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van Hengel IAJ, Tierolf MWAM, Fratila-Apachitei LE, Apachitei I, Zadpoor AA. Antibacterial Titanium Implants Biofunctionalized by Plasma Electrolytic Oxidation with Silver, Zinc, and Copper: A Systematic Review. Int J Mol Sci 2021; 22:3800. [PMID: 33917615 PMCID: PMC8038786 DOI: 10.3390/ijms22073800] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
Patients receiving orthopedic implants are at risk of implant-associated infections (IAI). A growing number of antibiotic-resistant bacteria threaten to hamper the treatment of IAI. The focus has, therefore, shifted towards the development of implants with intrinsic antibacterial activity to prevent the occurrence of infection. The use of Ag, Cu, and Zn has gained momentum as these elements display strong antibacterial behavior and target a wide spectrum of bacteria. In order to incorporate these elements into the surface of titanium-based bone implants, plasma electrolytic oxidation (PEO) has been widely investigated as a single-step process that can biofunctionalize these (highly porous) implant surfaces. Here, we present a systematic review of the studies published between 2009 until 2020 on the biomaterial properties, antibacterial behavior, and biocompatibility of titanium implants biofunctionalized by PEO using Ag, Cu, and Zn. We observed that 100% of surfaces bearing Ag (Ag-surfaces), 93% of surfaces bearing Cu (Cu-surfaces), 73% of surfaces bearing Zn (Zn-surfaces), and 100% of surfaces combining Ag, Cu, and Zn resulted in a significant (i.e., >50%) reduction of bacterial load, while 13% of Ag-surfaces, 10% of Cu-surfaces, and none of Zn or combined Ag, Cu, and Zn surfaces reported cytotoxicity against osteoblasts, stem cells, and immune cells. A majority of the studies investigated the antibacterial activity against S. aureus. Important areas for future research include the biofunctionalization of additively manufactured porous implants and surfaces combining Ag, Cu, and Zn. Furthermore, the antibacterial activity of such implants should be determined in assays focused on prevention, rather than the treatment of IAIs. These implants should be tested using appropriate in vivo bone infection models capable of assessing whether titanium implants biofunctionalized by PEO with Ag, Cu, and Zn can contribute to protect patients against IAI.
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Affiliation(s)
- Ingmar A. J. van Hengel
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands; (M.W.A.M.T.); (L.E.F.-A.); (I.A.); (A.A.Z.)
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26
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Meinshausen AK, Herbster M, Zwahr C, Soldera M, Müller A, Halle T, Lasagni AF, Bertrand J. Aspect ratio of nano/microstructures determines Staphylococcus aureus adhesion on PET and titanium surfaces. J Appl Microbiol 2021; 131:1498-1514. [PMID: 33565669 DOI: 10.1111/jam.15033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/26/2021] [Accepted: 02/06/2021] [Indexed: 01/09/2023]
Abstract
AIMS Joint infections cause premature implant failure. The avoidance of bacterial colonization of implant materials by modification of the material surface is therefore the focus of current research. In this in vitro study the complex interaction of periodic structures on PET and titanium surfaces on the adhesion of Staphylococcus aureus is analysed. METHODS AND RESULTS Using direct laser interference patterning as well as roll-to-roll hot embossing methods, structured periodic textures of different spatial distance were produced on surfaces and S. aureus were cultured for 24 h on these. The amount of adhering bacteria was quantified using fluorescence microscopy and the local adhesion behaviour was investigated using scanning electron microscopy. For PET structures, minimal bacterial adhesion was identified for an aspect ratio of about 0·02. On titanium structures, S. aureus adhesion was significantly decreased for profile heights of < 200 nm. Our results show a significantly decreased bacterial adhesion for structures with an aspect ratio range of 0·02 to 0·05. CONCLUSIONS We show that structuring on surfaces can decrease the amount of S. aureus on titanium and PET as common implant materials. SIGNIFICANCE AND IMPACT OF THE STUDY The study highlights the immense potential of applying specific structures to implant materials to prevent implant colonization with pathogen bacteria.
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Affiliation(s)
- A-K Meinshausen
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - M Herbster
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Institute of Materials and Joining Technology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - C Zwahr
- Chair of Large Area Laser Based Surface Structuring, Technische Universität Dresden, Dresden, Germany
| | - M Soldera
- Chair of Large Area Laser Based Surface Structuring, Technische Universität Dresden, Dresden, Germany
| | - A Müller
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - T Halle
- Institute of Materials and Joining Technology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - A F Lasagni
- Chair of Large Area Laser Based Surface Structuring, Technische Universität Dresden, Dresden, Germany.,Fraunhofer Institute for Material and Beam Technology IWS, Dresden, Germany
| | - J Bertrand
- Department of Orthopedic Surgery, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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27
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Rupp M, Kerschbaum M, Freigang V, Bärtl S, Baumann F, Trampuz A, Alt V. [PJI-TNM as new classification system for periprosthetic joint infections : An evaluation of 20 cases]. DER ORTHOPADE 2021; 50:198-206. [PMID: 32533215 PMCID: PMC8222041 DOI: 10.1007/s00132-020-03933-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current classifications for periprosthetic joint infections (PJIs) often lack a detailed description of the overall underlying situation of a patient. The PJI-TNM classification uses the principles of the TNM classification from oncology for the description of critical parameters in PJIs: affected joint, type of implant and implant stability, soft tissue conditions, maturity of biofilm formation, causative microorganism, comorbidities of the patient and recurrence of infection. The aim of the current work is to evaluate the feasibility of this new PJI-TNM classification in clinical practice. METHODS The PJI-TNM classification was used in 20 patients with hip, knee and shoulder PJIs. Based on a retrospective chart review, the respective parameters T (tissue and implants), N (non-eukaryotic cells and fungi), M (morbidity) and r (reinfection) were classified for each case. RESULTS All 20 cases (12 male, 8 female, average age 72.2 (40-88 years)) with 13 hip, 6 knee and 1 shoulder PJIs were to be classified with the new TNM-PJI classification system. There was a considerable heterogeneity among the cases: 12 protheses were fixed (T0), 6 were loosened (T1) and 2 were associated with a soft tissue defect (T2). Biofilm formation was considered immature in 7 cases (N0). Out of the PJIs, 13 were considered to be associated with mature biofilm formation. Out of the patients, 9 were systemically not or only mildly compromised (M0), 7 patients moderately (M1) and 3 patients (M2) severely compromised. One patient refused surgical treatment (M3a). Recurrent infections (r) were diagnosed in three cases. CONCLUSIONS The principles of the TNM classification from oncology can also be used for the classification of PJIs. Despite the limited number of cases in this study, a considerable heterogeneity of the evaluated PJIs is shown, which is a phenomenon that is also known from clinical practice. This heterogeneity can be adequately addressed by this new classification, which might be beneficial in decision-making in the future.
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Affiliation(s)
- Markus Rupp
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Maximilian Kerschbaum
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Viola Freigang
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Susanne Bärtl
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Florian Baumann
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
| | - Andrej Trampuz
- Charité - Universitätsmedizin Berlin und Center for Musculoskeletal Surgery (CMSC), Berlin, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg (UKR), Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
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28
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Nurmohamed FRHA, van Dijk B, Veltman ES, Hoekstra M, Rentenaar RJ, Weinans HH, Vogely HC, van der Wal BCH. One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty - a retrospective cohort study. J Bone Jt Infect 2021; 6:91-97. [PMID: 34084696 PMCID: PMC8129908 DOI: 10.5194/jbji-6-91-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. Materials and methods: All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) ( < 10 ) with no use of antibiotic therapy. Results: Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty ( n = 51 ) and after prior PJI-related revision arthroplasty ( n = 16 ) were 69 % and 56 %, respectively ( p = 0.38 ). The successful infection control rates of a DAIR procedure after an early acute infection ( n = 35 ) and after a hematogenous infection ( n = 16 ) following primary arthroplasty were both 69 % ( p = 1.00 ). Conclusion: In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.
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Affiliation(s)
| | - Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewout S Veltman
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marrit Hoekstra
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob J Rentenaar
- Department of Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
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29
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Manoharadas S, Altaf M, Alrefaei AF, Devasia RM, Badjah Hadj AYM, Abuhasil MSA. Concerted dispersion of Staphylococcus aureus biofilm by bacteriophage and 'green synthesized' silver nanoparticles. RSC Adv 2021; 11:1420-1429. [PMID: 35424119 PMCID: PMC8693614 DOI: 10.1039/d0ra09725j] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Staphylococcal biofilms predominantly cause persistent nosocomial infections. The widespread antibiotic resistance followed by its ability to form biofilm in biological and inert surfaces often contributes to major complications in patients and veterinary animals. Strategic importance of bacteriophage therapy against critical staphylococcal infections had been predicted ever since the advent of antibiotic resistant staphylococcal strains. The significance of metal nanoparticles in quenching biofilm associated bacteria was previously reported. In this study, we demonstrate a concerted action of ‘green synthesized’ silver nanoparticles and bacteriophages in removing pre-formed Staphylococcus aureus biofilms from an inert glass surface in a time dependent manner. Our results demonstrate, for the first time, the rapid co-operative dispersion of the bacterial biofilm. In addition, the synergistic activity of the nanoparticles and bacteriophages causes the loss of viability of the biofilm entrapped bacterial cells thus preventing establishment of a new infection and subsequent colonization. This work further opens up a platform for the combinational therapeutic approach with a variety of nanoparticles and bacteriophages against mono or poly bacterial biofilm in environmental, industrial or clinical settings. Formation of biofilm by Staphylococcus aureus ‘Rumba’ on untreated glass surface and a concerted disruption of the biofilm by silver nanoparticle and phage ϕ44AHJD.![]()
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Affiliation(s)
- Salim Manoharadas
- King Saud University, Department of Botany and Microbiology, Central Laboratory RM 55A College of Science Building 5, P.O. Box. 2454 Riyadh 11451 Saudi Arabia +966-14699665 +966-114689170
| | - Mohammad Altaf
- King Saud University, Department of Botany and Microbiology, Central Laboratory RM 55A College of Science Building 5, P.O. Box. 2454 Riyadh 11451 Saudi Arabia +966-14699665 +966-114689170.,King Saud University, Department of Chemistry, College of Science P.O. Box. 2454 Riyadh 11451 Saudi Arabia
| | - Abdulwahed Fahad Alrefaei
- King Saud University, Department of Zoology, College of Science P.O. Box. 2454 Riyadh 11451 Saudi Arabia
| | | | - Ahmed Yacine M Badjah Hadj
- King Saud University, Department of Chemistry, College of Science P.O. Box. 2454 Riyadh 11451 Saudi Arabia
| | - Mohammed Saeed Ali Abuhasil
- King Saud University, Department of Food Science and Nutrition, College of Agriculture and Food Science P.O. Box. 2454 Riyadh 11451 Saudi Arabia
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30
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Lehner B, Omlor GW, Schwarze M. [Periprosthetic joint infections : Latest developments, strategies and treatment algorithms]. DER ORTHOPADE 2020; 49:648-659. [PMID: 32642942 DOI: 10.1007/s00132-020-03950-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to their multidimensional consequences, periprosthetic joint infections are a serious complication in arthroplasty. There are disagreements in the literature regarding their classification. At the same time, a consequence for the practical procedure cannot always be derived. THERAPEUTIC PROCEDURES In addition to debridement with antibiotics and implant retention, there are options for a one or two-stage change in the therapeutic procedure. Although the preservation of implants is only possible in the case of acute infections with a short duration of symptoms, prosthesis changes are indicated with a longer symptom duration. For both procedures, there are interinstitutional deviating indication criteria, weighing pros and cons. Both have specific problems, such as, in particular, the duration of the antibiotics course, the question of anchoring the prosthesis and, in the case of a two-stage procedure, the shape of the spacer.
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Affiliation(s)
- B Lehner
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - G-W Omlor
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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31
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Prosthetic joint infections: diagnosis, management, and complications of the two-stage replacement arthroplasty. Skeletal Radiol 2020; 49:847-859. [PMID: 32040604 DOI: 10.1007/s00256-020-03389-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Despite improved strategies to prevent prosthetic joint infection, as the total number of joint replacements increases, so does the absolute number of infections. Radiography serves as the first-line imaging modality for the assessment of a suspected prosthetic joint infection. Additionally, serial radiographs acquired after a surgery to eradicate a prosthetic joint infection are an important clinical tool. Prosthetic joint infections are often treated with a 2-stage replacement arthroplasty utilizing a prosthesis with antibiotic-loaded acrylic cement. While complications are uncommon with this procedure, imaging may demonstrate periprosthetic fractures, as well as spacer migration, joint dislocation, and spacer fracture. We describe the classification of prosthetic joint infections, the clinical and imaging diagnosis, and treatment strategies. Familiarity with the hardware utilized in the management of the prosthetic joint infection, and its potential complications is fundamental to accurate imaging interpretation.
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Pham TT, Lazarevic V, Gaia N, Girard M, Cherkaoui A, Suva D, Schrenzel J. Second Periprosthetic Joint Infection Caused by Streptococcus dysgalactiae: How Genomic Sequencing Can Help Defining the Best Therapeutic Strategy. Front Med (Lausanne) 2020; 7:53. [PMID: 32154259 PMCID: PMC7046550 DOI: 10.3389/fmed.2020.00053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/04/2020] [Indexed: 12/04/2022] Open
Abstract
Primary and revision arthroplasties are increasing worldwide, as are periprosthetic joint infections (PJI). The management of PJI requires surgery, the strategy of which is dictated by the acute or chronic nature of the infection, with an exchange of the implant in the event of a chronic PJI or in the case of recurrence with the same pathogen. We report the case of a 63-year-old man with two episodes of Streptococcus dysgalactiae subsp. equisimilis PJI within 9 months. Based on clinical suspicion of an haematogenous PJI, the patient was treated by DAIR (debridement, antibiotics, implant retention), while genomic sequencing revealed two different strains, confirming our hypothesis that no additional surgery was needed. Hence, we report a case where genomic analysis was decisive for the decision of the best therapeutic strategy.
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Affiliation(s)
- Truong-Thanh Pham
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Division of Orthopedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Vladimir Lazarevic
- Genomic Research Laboratory, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Gaia
- Genomic Research Laboratory, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - Myriam Girard
- Genomic Research Laboratory, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - Abdessalam Cherkaoui
- Bacteriology Laboratory, Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
| | - Domizio Suva
- Division of Orthopedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland.,Genomic Research Laboratory, Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Geneva, Geneva University Hospitals, Geneva, Switzerland.,Bacteriology Laboratory, Department of Diagnostic, Geneva University Hospitals, Geneva, Switzerland
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33
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Affiliation(s)
- Siddartha Simha
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | | | - J Michael Wiater
- Department of Orthopaedics, Beaumont Health System, Royal Oak, Michigan
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Tan J, Wang J, Yang C, Zhu C, Guo G, Tang J, Shen H. Antimicrobial characteristics of Berberine against prosthetic joint infection-related Staphylococcus aureus of different multi-locus sequence types. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:218. [PMID: 31419978 PMCID: PMC6697971 DOI: 10.1186/s12906-019-2558-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Staphylococcal aureus (S. aureus) has become the leading causative pathogen of Prosthetic Joint Infection (PJI), which is the most devastating complication after arthroplasty surgeries. Due to the biofilm formation ability and emergence of multiple-drugs resistance strains of S. aureus, it has become an urgency to find new anti-staphylococcal agents to establish effective prophylaxis and treatment strategy for PJI. Extracted from a traditional Chinese herb, berberine is proved active in inhibiting S. aureus, while whether it exerts the same effect on PJI-related S. aureus remains unknown. This study aims to investigate the antimicrobial activity of berbrine against clinical derived PJI-related S. aureus and whether its inhibiting efficacy is associated with subtypes of S. aureus. METHODS Eighteen PJI-associated S. aureus were collected and their Multi-locus Sequence Types (MLST) and susceptibility to berberine both in planktonic and biofilm form were investigated. Additionally, one S. aureus strain (ST1792) was selected from the group and its transcriptomic profiling in berberine incubation was performed. The statistical analyses were conducted using Student's t-test with SPSS 24.0(SPSS, IBM, USA). The data were expressed as the means ± standard deviation. Values of p < 0.05 were considered statistically significant. RESULTS It was found out that the Minimum Inhibitory Concentration values of PJI-related S. aureus varied in a broad range (from 64 to 512 μg/ml) among different MLST subtypes and the bacteria were able to regain growth after 24 h in berberine of MIC value or higher concentrations. In addition, sub-inhibitory concentrations of berberine surprisingly enhanced biofilm formation in some S. aureus strains. CONCLUSION Traditional medicine is utilised by a large number of individuals, which provides abundant resources for modern medical science. In our study, berberine was found bactericidal against PJI related S. aureus, however, its antibacterial property was impacted by the MLST subtypes of the bacteria, both in planktonic and biofilm growth forms.
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Graf AC, Leonard A, Schäuble M, Rieckmann LM, Hoyer J, Maass S, Lalk M, Becher D, Pané-Farré J, Riedel K. Virulence Factors Produced by Staphylococcus aureus Biofilms Have a Moonlighting Function Contributing to Biofilm Integrity. Mol Cell Proteomics 2019; 18:1036-1053. [PMID: 30850421 PMCID: PMC6553939 DOI: 10.1074/mcp.ra118.001120] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/19/2019] [Indexed: 12/11/2022] Open
Abstract
Staphylococcus aureus is the causative agent of various biofilm-associated infections in humans causing major healthcare problems worldwide. This type of infection is inherently difficult to treat because of a reduced metabolic activity of biofilm-embedded cells and the protective nature of a surrounding extracellular matrix (ECM). However, little is known about S. aureus biofilm physiology and the proteinaceous composition of the ECM. Thus, we cultivated S. aureus biofilms in a flow system and comprehensively profiled intracellular and extracellular (ECM and flow-through (FT)) biofilm proteomes, as well as the extracellular metabolome compared with planktonic cultures. Our analyses revealed the expression of many pathogenicity factors within S. aureus biofilms as indicated by a high abundance of capsule biosynthesis proteins along with various secreted virulence factors, including hemolysins, leukotoxins, and lipases as a part of the ECM. The activity of ECM virulence factors was confirmed in a hemolysis assay and a Galleria mellonella pathogenicity model. In addition, we uncovered a so far unacknowledged moonlighting function of secreted virulence factors and ribosomal proteins trapped in the ECM: namely their contribution to biofilm integrity. Mechanistically, it was revealed that this stabilizing effect is mediated by the strong positive charge of alkaline virulence factors and ribosomal proteins in an acidic ECM environment, which is caused by the release of fermentation products like formate, lactate, and acetate because of oxygen limitation in biofilms. The strong positive charge of these proteins most likely mediates electrostatic interactions with anionic cell surface components, eDNA, and anionic metabolites. In consequence, this leads to strong cell aggregation and biofilm stabilization. Collectively, our study identified a new molecular mechanism during S. aureus biofilm formation and thus significantly widens the understanding of biofilm-associated S. aureus infections - an essential prerequisite for the development of novel antimicrobial therapies.
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Affiliation(s)
- Alexander C Graf
- From the ‡Institute of Microbiology, Department of Microbial Physiology and Molecular Biology
| | - Anne Leonard
- §Institute of Biochemistry, Department of Cellular Biochemistry and Metabolomics
| | - Manuel Schäuble
- From the ‡Institute of Microbiology, Department of Microbial Physiology and Molecular Biology
| | - Lisa M Rieckmann
- From the ‡Institute of Microbiology, Department of Microbial Physiology and Molecular Biology
| | - Juliane Hoyer
- ¶Institute of Microbiology, Department of Microbial Proteomics; University of Greifswald, Germany
| | - Sandra Maass
- ¶Institute of Microbiology, Department of Microbial Proteomics; University of Greifswald, Germany
| | - Michael Lalk
- §Institute of Biochemistry, Department of Cellular Biochemistry and Metabolomics
| | - Dörte Becher
- ¶Institute of Microbiology, Department of Microbial Proteomics; University of Greifswald, Germany
| | - Jan Pané-Farré
- From the ‡Institute of Microbiology, Department of Microbial Physiology and Molecular Biology
| | - Katharina Riedel
- From the ‡Institute of Microbiology, Department of Microbial Physiology and Molecular Biology;
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36
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Löwik CAM, Zijlstra WP, Knobben BAS, Ploegmakers JJW, Dijkstra B, de Vries AJ, Kampinga GA, Mithoe G, Al Moujahid A, Jutte PC, Wouthuyzen-Bakker M. Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients. PLoS One 2019; 14:e0215035. [PMID: 30958847 PMCID: PMC6453483 DOI: 10.1371/journal.pone.0215035] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023] Open
Abstract
Background Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category. Methods We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2. Results A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018). Conclusions Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.
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Affiliation(s)
- Claudia A. M. Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Bas A. S. Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Joris J. W. Ploegmakers
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Baukje Dijkstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Astrid J. de Vries
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Greetje A. Kampinga
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Glen Mithoe
- Department of Medical Microbiology, Certe Medical Diagnostics and Advice, Groningen, the Netherlands
| | - Aziz Al Moujahid
- Center for Infectious Diseases Friesland, Izore, Leeuwarden, the Netherlands
| | - Paul C. Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Contrasting the Clinical Presentation and Prevalence of Septic, Reactive, and Crystal Arthritis in Patients With Hematologic and Solid Malignancies. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Peel TN. Studying Biofilm and Clinical Issues in Orthopedics. Front Microbiol 2019; 10:359. [PMID: 30863390 PMCID: PMC6399144 DOI: 10.3389/fmicb.2019.00359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022] Open
Abstract
The association between biofilm-forming microorganisms and prosthetic joint infection influences all aspect of management including approaches to diagnosis, management and prevention. This article will provide an overview of new anti-biofilm strategies for management of prosthetic joint infection.
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Affiliation(s)
- Trisha N Peel
- Department of Infectious Diseases, Monash University, Melbourne, VIC, Australia.,Alfred Health, Melbourne, VIC, Australia
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39
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Noori N, Myerson C, Charlton T, Thordarson D. Is Antibiotic Prophylaxis Necessary Before Dental Procedures in Patients Post Total Ankle Arthroplasty? Foot Ankle Int 2019; 40:237-241. [PMID: 30406674 DOI: 10.1177/1071100718809454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The need for dental antibiotic prophylaxis after orthopedic surgery remains unclear. Current recommendations are based on patients with total hip and total knee arthroplasties. We investigated available evidence regarding the need for dental antibiotic prophylaxis in patients post foot and ankle surgery, specifically total ankle arthroplasty. Additionally, we examined the microbiology behind the risk of transient bacteremia from dental procedures and whether this leads to an increased risk for postoperative infection in foot and ankle surgery. METHODS: We performed a MEDLINE literature review of English articles between 1980 and 2018 on patients with prosthetic joints undergoing dental work, and studies evaluating hematogenous prosthetic joint infection (PJI) and dental antibiotic prophylaxis. We additionally included articles on PJI post total ankle arthroplasty, as well as committee guidelines. RESULTS: There is no literature at present that evaluates transient bacteremia with dental procedures in patients following foot and ankle surgery. The data on this topic are isolated to PJI rates in the context of hip and total knee arthroplasty. This is of particular interest as rates of total ankle arthroplasty PJI have been reported to be 2- to 4-fold higher than in hip and total knee arthroplasty. CONCLUSION: The concern for postoperative infection due to transient bacteremia without dental antibiotic prophylaxis can be extrapolated to patients undergoing foot and ankle surgeries. Some data suggest that oral cavity bacteria can seed a prosthetic joint, though no clear relationship has been demonstrated. Similar risk factors have been identified between hip and knee PJI and total ankle arthroplasty. In light of the absence of scrutiny of and guidelines on this topic in foot and ankle surgery, it may be advisable to apply similar principles to decision-making in patients after foot and ankle surgery. LEVEL OF EVIDENCE: Level III, systematic review.
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Affiliation(s)
| | - Charles Myerson
- 2 Tulane University School of Medicine, New Orleans, LA, USA
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40
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Impact of surface contamination of implants with saliva during placement in augmented bone defects in sheep calvaria. Br J Oral Maxillofac Surg 2019; 57:41-46. [DOI: 10.1016/j.bjoms.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 11/30/2018] [Indexed: 01/01/2023]
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41
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Li ZL, Hou YF, Zhang BQ, Chen YF, Wang Q, Wang K, Chen ZY, Li XW, Lin JH. Identifying Common Pathogens in Periprosthetic Joint Infection and Testing Drug-resistance Rate for Different Antibiotics: A Prospective, Single Center Study in Beijing. Orthop Surg 2018; 10:235-240. [PMID: 30152610 DOI: 10.1111/os.12394] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/05/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The aim of this study is to identify the common microorganisms causing PJI as well as the drug-resistant spectrum for each microorganism, to help orthopaedic surgeons to choose appropriate antibiotics. METHOD One hundred and sixty patients who suffered from failure of primary or revision total hip or knee arthroplasty for different reasons were prospectively recruited. These patients underwent revision or re-revision total hip or knee arthroplasty in our institution between August 2013 to August 2016. The details of patients' medical history and comprehensive physical examination, as well as demographic data were recorded precisely. Routine blood test results, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) levels, and synovial leukocyte counts were collected. Additionally, aspiration was conducted during surgery to avoid pollution unless when PJI was strongly suspected, in which case, joint puncture and aspiration were conducted before surgery. Intraoperatively, the implant-surrounding tissue and the prosthesis were collected under aseptic conditions. Postoperatively, the prosthesis, implant-surrounding tissue and synovium were sent to the laboratory immediately. The sonicate extraction (the prosthesis was sent for ultrasound sonication first), implant surrounding tissue and synovium were sent for microbiologic culture, and the implant-surrounding tissue was also sent for pathological examination. The isolated bacteria strains and drug-resistance rates for each pathogen for different antibiotics were presented. RESULTS There were 59 PJI cases in the infectious group and 101 cases in the non-infectious group (PJI is diagnosed according to the diagnosing criteria from the Workgroup of the Musculoskeletal Infection Society). Of 69 strains of pathogens isolated, Gram-positive bacterium is the most common pathogenic bacteria causing PJI (60, 86.96%). Staphylococcus epidermidis and Staphylococcus aureus played an important role as well, followed by Gram-negative bacteria (8, 11.59%) and fungus (1, 1.45%). Penicillin (78.57%), erythromycin (66.67%) and clindamycin (44.74%) showed high antibiotic resistance rate. In addition, the second-generation cephalosporin, usually as the prophylactic antibiotic, resistance rate was high (20%) as well. Fortunately, no vancomycin-resistant bacteria were discovered in the current study. CONCLUSION This study provides some information on the most common pathogens in our institution and the selection of antibiotics in the perioperative period in northern China. Cefuroxime and clindamycin might not be appropriate for use as prophylactic antibiotics in revision total knee or hip arthroplasty. Vancomycin is ideal for empiric antibiotic use in suspected PJI cases because of the low drug-resistance rate.
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Affiliation(s)
- Zhang-Lai Li
- Department of Orthopedics, Fuzhou Second Hospital of Xiamen University, Fuzhou, China.,Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Yun-Fei Hou
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Bao-Qing Zhang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China.,Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Yi-Fan Chen
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Kai Wang
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Zhao-Yu Chen
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Xiao-Wei Li
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Jian-Hao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
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Al Thaher Y, Yang L, Jones SA, Perni S, Prokopovich P. LbL-assembled gentamicin delivery system for PMMA bone cements to prolong antimicrobial activity. PLoS One 2018; 13:e0207753. [PMID: 30543660 PMCID: PMC6292632 DOI: 10.1371/journal.pone.0207753] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Antibiotic-loaded poly(methyl methacrylate) bone cements (ALBCs) are widely used in total joint replacement (TJR), for local delivery of antibiotics to provide prophylaxis against prosthetic joint infections (PJI). One of the shortcomings of the current generation of ALBCs is that the antibiotic release profile is characterized by a burst over the first few hours followed by a sharp decrease in rate for the following several days (often below minimum inhibitory concentration (MIC)), and, finally, exhaustion (after, typically, ~ 20 d). This profile means that the ALBCs provide only short-term antimicrobial action against bacterial strains involved PJI. RATIONALE The purpose of the present study was to develop an improved antibiotic delivery system for an ALBC. This system involved using a layer-by-layer technique to load the antibiotic (gentamicin sulphate) (GEN) on silica nanoparticles, which are then blended with the powder of the cement. Then, the powder was mixed with the liquid of the cement (NP-GEN cement). For controls, two GEN-loaded brands were used (Cemex Genta and Palacos R+G). Gentamicin release and a host of other relevant properties were determined for all the cements studied. RESULTS Compared to control cement specimens, improved GEN release, longer antimicrobial activity (against clinically-relevant bacterial strains), and comparable setting time, cytocompatibility, compressive strength (both prior to and after aging in PBS at 37 oC for 30 d), 4-point bend strength and modulus, fracture toughness, and PBS uptake. CONCLUSIONS NP-GEN cement may have a role in preventing or treating PJI.
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Affiliation(s)
- Yazan Al Thaher
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Lirong Yang
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Steve A. Jones
- University Hospital Llandough, Cardiff & Vale University Health Board, Vale of Glamorgan, Wales, United Kingdom
| | - Stefano Perni
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, United Kingdom
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Manandhar S, Singh A, Varma A, Pandey S, Shrivastava N. Biofilm Producing Clinical Staphylococcus aureus Isolates Augmented Prevalence of Antibiotic Resistant Cases in Tertiary Care Hospitals of Nepal. Front Microbiol 2018; 9:2749. [PMID: 30538678 PMCID: PMC6277500 DOI: 10.3389/fmicb.2018.02749] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022] Open
Abstract
Staphylococcus aureus, a notorious human pathogen, is a major cause of the community as well as healthcare associated infections. It can cause a diversity of recalcitrant infections mainly due to the acquisition of resistance to multiple drugs, its diverse range of virulence factors, and the ability to produce biofilm in indwelling medical devices. Such biofilm associated chronic infections often lead to increase in morbidity and mortality posing a high socio-economic burden, especially in developing countries. Since biofilm formation and antibiotic resistance function dependent on each other, detection of biofilm expression in clinical isolates would be advantageous in treatment decision. In this premise, we attempt to investigate the biofilm formation and its association with antibiotic resistance in clinical isolates from the patients visiting tertiary health care hospitals in Nepal. Bacterial cells isolated from clinical samples identified as S. aureus were examined for in-vitro biofilm production using both phenotypic and genotypic assays. The S. aureus isolates were also examined for susceptibility patterns of clinically relevant antibiotics as well as inducible clindamycin resistance using standard microbiological techniques and D-test, respectively. Among 161 S. aureus isolates, 131 (81.4%) were methicillin resistant S. aureus (MRSA) and 30 (18.6%) were methicillin sensitive S. aureus (MSSA) strains. Although a majority of MRSA strains (69.6%) showed inducible clindamycin resistance, almost all isolates (97% and 94%) were sensitive toward chloramphenicol and tetracycline, respectively. Detection of in vitro production of biofilm revealed the association of biofilm with methicillin as well as inducible clindamycin resistance among the clinical S. aureus isolates.
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Affiliation(s)
- Sarita Manandhar
- Tri-Chandra Multiple College, Tribhuvan University, Kathmandu, Nepal.,Amity Institute of Microbial Technology, Amity University, Noida, India
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Ajit Varma
- Amity Institute of Microbial Technology, Amity University, Noida, India
| | - Shanti Pandey
- The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Neeraj Shrivastava
- Amity Institute of Microbial Technology, Amity University, Noida, India.,Institute of Biotechnology, Zhejiang University, Hangzhou, China
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44
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Sebastian S, Malhotra R, Dhawan B. Prosthetic Joint Infection: A Major Threat to Successful Total Joint Arthroplasty. Indian J Med Microbiol 2018; 36:475-487. [DOI: 10.4103/ijmm.ijmm_19_11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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45
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Chang CY, Chien WC, Chung CH, Tsao CH, Lin FH, Chang FY, Shang ST, Wang YC. Protective effect of N-acetylcysteine in prosthetic joint infection: A nationwide population-based cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:225-233. [PMID: 30253996 DOI: 10.1016/j.jmii.2018.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE This nationwide population-based retrospective cohort study evaluated the protective effect of N-acetylcysteine against prosthetic joint infection after hip or knee joint replacement. METHODS Patients receiving N-acetylcysteine after hip or knee joint replacement between 2000 and 2015 were identified from the Taiwan National Health Insurance Research Database. Each patient receiving N-acetylcysteine was matched to four controls based on age, sex, and index year. All subjects were followed-up from the index date to December 31, 2015. The Cox proportional hazards regression model was used to assess the risk of prosthetic joint infection. RESULTS A total of 1478 patients were included in the study group, and 5912 matched subjects not receiving N-acetylcysteine were included in the control group. After adjusting for age, sex, insured premium, comorbidities, and immunosuppressive agent use, no significant difference in the risk of prosthetic joint infection was found between the two groups. A higher N-acetylcysteine dose (>360 cumulative defined daily dose) significantly decreased the risk of prosthetic joint infection (adjusted hazard ratio = 0.891; 95% confidence interval = 0.599-0.989; p = 0.042). The protective effect of N-acetylcysteine was observed only in the group of prosthetic joint infection within 5 years (adjusted hazard ratio = 0.801; 95% confidence interval = 0.581-0.980; p = 0.040). CONCLUSIONS High cumulative dose of N-acetylcysteine (>360 cumulative defined daily dose) can effectively reduce the risk of prosthetic joint infection in patients undergoing knee or hip joint replacement surgery within 5 years.
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Affiliation(s)
- Chan-Yuan Chang
- Department of Medicine, Hualien-Armed Forces General Hospital, Hualien County, Taiwan; Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan; Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei City, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Shih-Ta Shang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan; Department of Internal Medicine, Armed Forces Taoyuan General Hospital, Taoyuan City, Taiwan.
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan.
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Lesens O, Ferry T, Forestier E, Botelho-Nevers E, Pavese P, Piet E, Pereira B, Montbarbon E, Boyer B, Lustig S, Descamps S. Should we expand the indications for the DAIR (debridement, antibiotic therapy, and implant retention) procedure for Staphylococcus aureus prosthetic joint infections? A multicenter retrospective study. Eur J Clin Microbiol Infect Dis 2018; 37:1949-1956. [PMID: 30083889 DOI: 10.1007/s10096-018-3330-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
To evaluate factors associated with failure in patients treated with DAIR (debridement, antibiotic therapy, and implant retention) for Staphylococcus aureus prosthetic joint infections (PJIs). We retrospectively analyzed consecutive patients with stable PJI due to S. aureus treated with DAIR at six hospitals between 2010 and 2014. Cox proportional hazards regression was used to study factors associated with treatment failure at 2 years. Of 154 eligible patients, 137 were included (mean age 73 ± 13 years; male 56%). The estimated success rate according to the Kaplan-Meier method was 76.2 [95% CI 68-83] at 2 years of follow-up. In multivariate analysis, longer duration of treatment (hazard ratio (HR) 0.78 [0.69-0.88]; p < 0.001) and combination therapy including rifampin (HR 0.08 [0.018-0.36]; p = 0.001) were independently associated with success, whereas active smoking was independently associated with failure (HR 3.6 [1.09-11.84]; p = 0.036). When the analysis was restricted to patients with early infection onset (< 3 months), early acute infection was also predictive of a better prognosis (HR 0.25 [0.09-0.7]; p = 0.009). Failure was not associated with time from prosthesis insertion to debridement, nor with duration of symptoms > 3 weeks and type of prosthesis (hip or knee). These results remained unchanged when the 14 patients under immunosuppressive therapy were removed from analysis. These data suggest that DAIR can be performed even if infection and symptoms are delayed but reserved to patients who are able to follow rifampin-based combination therapy for a prolonged duration that should not be different for hip and knee PJI.
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Affiliation(s)
- O Lesens
- Service des Maladies Infectieuses et Tropicales, Hôpital Gabriel Montpied, CRIOAc, CHU, Clermont-Ferrand, France.
- Laboratoire Microorganismes: Génome Environnement (LMGE) UMR 6023, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - T Ferry
- Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - E Forestier
- Service de Maladies Infectieuses, CH Métropole Savoie, Chambéry, France
| | - E Botelho-Nevers
- Service d'Infectiologie, CIC1408-Inserm, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint Etienne, 42055, Saint-Etienne, France
| | - P Pavese
- Service de Maladies Infectieuses, CHU Grenoble Alpes, Grenoble, France
| | - E Piet
- Service d'Infectiologie, CH Annecy Genevois, 74000, Annecy, France
| | - B Pereira
- CHU Clermont-Ferrand, DRCI-Biostatistique, Clermont-Ferrand, France
| | - E Montbarbon
- Service d'Orthopédie-Traumatologie, CH Metropole Savoie, Chambéry, France
| | - B Boyer
- Service Orthopédie, CRIOAc Saint-Etienne, Hôpital Nord-CHU Saint-Etienne, Saint-Etienne, France
| | - S Lustig
- Hospices Civils de Lyon, CRIOAc Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - S Descamps
- Université Clermont- Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Institut de Chimie de Clermont-Ferrand (ICCF), UMR 6296, 24, avenue Blaise-Pascal, 63178, Aubiere, France
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Löwik CAM, Jutte PC, Tornero E, Ploegmakers JJW, Knobben BAS, de Vries AJ, Zijlstra WP, Dijkstra B, Soriano A, Wouthuyzen-Bakker M. Predicting Failure in Early Acute Prosthetic Joint Infection Treated With Debridement, Antibiotics, and Implant Retention: External Validation of the KLIC Score. J Arthroplasty 2018; 33:2582-2587. [PMID: 29691168 DOI: 10.1016/j.arth.2018.03.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/16/2018] [Accepted: 03/17/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Debridement, antibiotics, and implant retention (DAIR) is a widely used treatment modality for early acute prosthetic joint infection (PJI). A preoperative risk score was previously designed for predicting DAIR failure, consisting of chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein >115 mg/L (KLIC). The aim of this study was to validate the KLIC score in an external cohort. METHODS We retrospectively evaluated patients with early acute PJI treated with DAIR between 2006 and 2016 in 3 Dutch hospitals. Early acute PJI was defined as <21 days of symptoms and DAIR performed within 90 days after index surgery. Failure was defined as the need for (1) second DAIR, (2) implant removal, (3) suppressive antimicrobial treatment, or (4) infection-related death within 60 days after debridement. RESULTS A total of 386 patients were included. Failure occurred in 148 patients (38.3%). Patients with KLIC scores of ≤2, 2.5-3.5, 4-5, 5.5-6.5, and ≥7 had failure rates of 27.9%, 37.1%, 49.3%, 54.5%, and 85.7%, respectively (P < .001). The receiver-operating characteristic curve showed an area under the curve of 0.64 (95% confidence interval 0.59-0.69). A KLIC score higher than 6 points showed a specificity of 97.9%. CONCLUSION The KLIC score is a relatively good preoperative risk score for DAIR failure in patients with early acute PJI and appears to be most useful in clinical practice for patients with low or high KLIC scores.
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Affiliation(s)
- Claudia A M Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eduard Tornero
- Department of Orthopaedic Surgery, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Joris J W Ploegmakers
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Astrid J de Vries
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Baukje Dijkstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Manandhar S, Singh A, Varma A, Pandey S, Shrivastava N. Biofilm Producing Clinical Staphylococcus aureus Isolates Augmented Prevalence of Antibiotic Resistant Cases in Tertiary Care Hospitals of Nepal. Front Microbiol 2018. [PMID: 30538678 DOI: 10.3389/fmicb.2018.02749/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Staphylococcus aureus, a notorious human pathogen, is a major cause of the community as well as healthcare associated infections. It can cause a diversity of recalcitrant infections mainly due to the acquisition of resistance to multiple drugs, its diverse range of virulence factors, and the ability to produce biofilm in indwelling medical devices. Such biofilm associated chronic infections often lead to increase in morbidity and mortality posing a high socio-economic burden, especially in developing countries. Since biofilm formation and antibiotic resistance function dependent on each other, detection of biofilm expression in clinical isolates would be advantageous in treatment decision. In this premise, we attempt to investigate the biofilm formation and its association with antibiotic resistance in clinical isolates from the patients visiting tertiary health care hospitals in Nepal. Bacterial cells isolated from clinical samples identified as S. aureus were examined for in-vitro biofilm production using both phenotypic and genotypic assays. The S. aureus isolates were also examined for susceptibility patterns of clinically relevant antibiotics as well as inducible clindamycin resistance using standard microbiological techniques and D-test, respectively. Among 161 S. aureus isolates, 131 (81.4%) were methicillin resistant S. aureus (MRSA) and 30 (18.6%) were methicillin sensitive S. aureus (MSSA) strains. Although a majority of MRSA strains (69.6%) showed inducible clindamycin resistance, almost all isolates (97% and 94%) were sensitive toward chloramphenicol and tetracycline, respectively. Detection of in vitro production of biofilm revealed the association of biofilm with methicillin as well as inducible clindamycin resistance among the clinical S. aureus isolates.
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Affiliation(s)
- Sarita Manandhar
- Tri-Chandra Multiple College, Tribhuvan University, Kathmandu, Nepal
- Amity Institute of Microbial Technology, Amity University, Noida, India
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Ajit Varma
- Amity Institute of Microbial Technology, Amity University, Noida, India
| | - Shanti Pandey
- The University of Southern Mississippi, Hattiesburg, MS, United States
| | - Neeraj Shrivastava
- Amity Institute of Microbial Technology, Amity University, Noida, India
- Institute of Biotechnology, Zhejiang University, Hangzhou, China
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Koçak Tufan Z, Güner HR, Yılmaz G, Özşahin A, Bozkurt M, Taşyaran MA. Empirical therapy and teicoplanin use in periprosthetic joint infections. Turk J Med Sci 2017; 47:1947-1949. [PMID: 29306261 DOI: 10.3906/sag-1604-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Effects of Bacterial Contamination on Dental Implants During Surgery: A Systematic Review. IMPLANT DENT 2017; 26:778-789. [PMID: 28945673 DOI: 10.1097/id.0000000000000660] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Contamination during surgery negatively influences the prognosis of orthopaedic implants; however, it has not been proven whether contamination influences the success of dental implant treatment. The aim of the systematic review was to investigate if there exists evidence in the literature whether contamination of dental implants during surgery affects osseointegration and clinical success. MATERIALS AND METHODS Four data bases were used for the literature search. Primary studies and reviews regarding both clinical and preclinical research were eligible. Rating of the summarized quality of the evidence was performed. RESULTS Five preclinical studies were included. Because of the estimated high risk of bias in all included studies and extensive differences in study design between the included studies, meta-analysis was not performed and no reliable aggregated data could be extracted. CONCLUSIONS It is suggested that the scientific evidence with regard to the current topic is insufficient. Further controlled studies are warranted.
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