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Mikziński P, Kraus K, Widelski J, Paluch E. Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI). Microorganisms 2024; 12:1198. [PMID: 38930580 DOI: 10.3390/microorganisms12061198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/05/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Biofilm formation is a serious problem that relatively often causes complications in orthopedic surgery. Biofilm-forming pathogens invade implanted foreign bodies and surrounding tissues. Such a condition, if not limited at the appropriate time, often requires reoperation. This can be partially prevented by selecting an appropriate prosthesis material that prevents the development of biofilm. There are many modern techniques available to detect the formed biofilm. By applying them we can identify and visualize biofilm-forming microorganisms. The most common etiological factors associated with biofilms in orthopedics are: Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), and Enterococcus spp., whereas Gram-negative bacilli and Candida spp. also deserve attention. It seems crucial, for therapeutic success, to eradicate the microorganisms able to form biofilm after the implantation of endoprostheses. Planning the effective targeted antimicrobial treatment of postoperative infections requires accurate identification of the microorganism responsible for the complications of the procedure. The modern microbiological testing techniques described in this article show the diagnostic options that can be followed to enable the implementation of effective treatment.
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Affiliation(s)
- Paweł Mikziński
- Faculty of Medicine, Wroclaw Medical University, Wyb. Pasteura 1, 50-376 Wroclaw, Poland
| | - Karolina Kraus
- Faculty of Medicine, Wroclaw Medical University, Wyb. Pasteura 1, 50-376 Wroclaw, Poland
| | - Jarosław Widelski
- Department of Pharmacognosy with Medicinal Plants Garden, Lublin Medical University, 20-093 Lublin, Poland
| | - Emil Paluch
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Tytusa Chalubinskiego 4, 50-376 Wroclaw, Poland
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Kaiser S, Verboket RD, Frank J, Marzi I, Janko M. Effectiveness of combined local therapy with antibiotics and fibrin vs. vacuum-assisted wound therapy in soft tissue infections: a retrospective study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02483-1. [PMID: 38466400 DOI: 10.1007/s00068-024-02483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Soft tissue infections can be severe and life-threatening. Their treatment consists currently in radical surgical wound debridement and combined systemic antimicrobial therapy. Different side effects are possible. Local antibiotic therapy represents a new approach to reduce side effects and improve healing. The aim of this study is to assess the effectiveness of the local sprayed use of antibiotics with fibrin sealing compared with negative pressure wound therapy as an established treatment of soft-tissue infections. METHODS In this retrospective study, patients with soft tissue infections who underwent surgical treatment were analysed. One group consists of patients, who received local fibrin-antibiotic spray (FAS) (n = 62). Patients treated by vacuum-assisted wound therapy (VAWT) as the established treatment were the control group (n = 57). Main outcomes were differences in the success of healing, the duration until healing and the number of needed operations. RESULTS Clinical healing could be achieved for 55 patients (98.21%) in the FAS group vs. 47 patients (92.16%) in the VAWT group (p = 0.19). Time to require this was 10.65 ± 10.38 days in the FAS group and 22.85 ± 14.02 days in the VAWT group (p < 0.001). In the FAS group, patients underwent an average of 1.44 ± 0.72 vs.3.46 ± 1.66 operations in the VAWT group (p < 0.001). CONCLUSION Compared to vacuum-assisted wound therapy in soft tissue infections, local fibrin-antibiotic spray shows faster clinical healing and less needed operations. Leading to shorter hospital stays and more satisfied patients. The combination of sprayed fibrin and antibiotics can be seen as a promising and effective method.
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Affiliation(s)
- S Kaiser
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - R D Verboket
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany.
| | - J Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
| | - M Janko
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Theodor‑Stern‑Kai 7, 60590, Frankfurt am Main, Germany
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3
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Haigh DA, Mistry D, Farooq HZ, Ajdukiewicz KMB. A major pain in the hip - Destruction of the left acetabulum and femoral head secondary to Tuberculosis: A case report and review of the literature. INFECTIOUS MEDICINE 2024; 3:100086. [PMID: 38352920 PMCID: PMC10863318 DOI: 10.1016/j.imj.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/24/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
Abstract
A 68-year-old-gentleman presented with left hip pain, night sweats, fatigue, and weight loss. He had previously experienced pain with white discharge until he underwent an arthroscopic washout and reduction. The left lower limb was shortened and wasted with limited hip movements. He had recently travelled to Zambia, his country of origin. Imaging demonstrated a large mass with chronic erosions of the acetabulum and femoral head. Synovial biopsy grew Mycobacterium tuberculosis, which was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months then 4 months of rifampicin and isoniazid. Whole genome sequencing indicated full sensitivity. Complex reconstructive surgery is scheduled, with a custom femoral head and acetabulum. This case illustrates the importance of considering tuberculosis in patients with erosive joint pathology and a multidisciplinary approach as delayed diagnosis results in high morbidity. Prompt diagnosis using newer modalities such as whole genome sequencing on synovial fluid can enable timely treatment.
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Affiliation(s)
- Dominic A Haigh
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Department of Virology, Manchester University NHS Foundation Trust, M13 9WL Manchester, UK
| | - Dillan Mistry
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
| | - Hamzah Z Farooq
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Department of Virology, Manchester University NHS Foundation Trust, M13 9WL Manchester, UK
| | - Katherine M B Ajdukiewicz
- Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, M8 5RB Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL Manchester, UK
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Baertl S, Renz N, Alt V, Perka C, Kirschbaum S. [Acute postoperative infections after dual head arthroplasty in geriatric patients]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:110-116. [PMID: 37853237 DOI: 10.1007/s00113-023-01376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent a major challenge with a 1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. A therapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be a single-stage stem replacement in combination with implantation of a cup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16-82%). Surgical treatment should always be followed by antibiotic treatment with a total duration of 12 weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.
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Affiliation(s)
- Susanne Baertl
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Nora Renz
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Stephanie Kirschbaum
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Kaushik A, Kest H, Sood M, Steussy BW, Thieman C, Gupta S. Biofilm Producing Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Humans: Clinical Implications and Management. Pathogens 2024; 13:76. [PMID: 38251383 PMCID: PMC10819455 DOI: 10.3390/pathogens13010076] [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: 12/11/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
Since its initial description in the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has developed multiple mechanisms for antimicrobial resistance and evading the immune system, including biofilm production. MRSA is now a widespread pathogen, causing a spectrum of infections ranging from superficial skin issues to severe conditions like osteoarticular infections and endocarditis, leading to high morbidity and mortality. Biofilm production is a key aspect of MRSA's ability to invade, spread, and resist antimicrobial treatments. Environmental factors, such as suboptimal antibiotics, pH, temperature, and tissue oxygen levels, enhance biofilm formation. Biofilms are intricate bacterial structures with dense organisms embedded in polysaccharides, promoting their resilience. The process involves stages of attachment, expansion, maturation, and eventually disassembly or dispersion. MRSA's biofilm formation has a complex molecular foundation, involving genes like icaADBC, fnbA, fnbB, clfA, clfB, atl, agr, sarA, sarZ, sigB, sarX, psm, icaR, and srtA. Recognizing pivotal genes for biofilm formation has led to potential therapeutic strategies targeting elemental and enzymatic properties to combat MRSA biofilms. This review provides a practical approach for healthcare practitioners, addressing biofilm pathogenesis, disease spectrum, and management guidelines, including advances in treatment. Effective management involves appropriate antimicrobial therapy, surgical interventions, foreign body removal, and robust infection control practices to curtail spread within healthcare environments.
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Affiliation(s)
- Ashlesha Kaushik
- Division of Pediatric Infectious Diseases, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
- Master of Science, Healthcare Quality and Safety, Harvard Medical School, Boston, MA 02115, USA
| | - Helen Kest
- Division of Pediatric Infectious Diseases, St. Joseph’s Children’s Hospital, 703 Main Street, Paterson, NJ 07503, USA;
| | - Mangla Sood
- Department of Pediatrics, Indira Gandhi Medical College, Shimla 171006, India;
| | - Bryan W. Steussy
- Division of Microbiology, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
| | - Corey Thieman
- Division of Pharmacology, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
| | - Sandeep Gupta
- Division of Pulmonary and Critical Care, St. Luke’s Regional Medical Center, Unity Point Health, 2720 Stone Park Blvd, Sioux City, IA 51104, USA;
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Schulze M, Nonhoff M, Hasselmann J, Fobker M, Niemann S, Theil C, Gosheger G, Puetzler J. Shock Wave-Activated Silver-Loaded Biopolymer Implant Coating Eliminates Staphylococcus epidermidis on the Surface and in the Surrounding of Implants. Pharmaceutics 2023; 15:2670. [PMID: 38140011 PMCID: PMC10747100 DOI: 10.3390/pharmaceutics15122670] [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: 10/02/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Bacterial biofilms on foreign surfaces are considered a primary cause of implant-related infections, which are challenging to treat. A new implant coating was developed, containing anti-infective silver within a biocompatible polymer carrier substance. In addition to its passive effect on the implant surface, highly concentrated anti-infective silver can be released as needed via the application of high-energy shock waves. This intervention could be applied transcutaneously in a clinical setting without the need for additional surgery. We investigated the inhibition of biofilm formation and the effectiveness of eradication after activation of the coating via shock waves in an in vitro biofilm model using Staphylococcus epidermidis RP62A. This was performed via scanning electron microscopy and quantitative microbiology. Additionally, we examined the cytotoxicity of the new coating on normal human fibroblasts and Saos-2 osteoblast-like cells, depending on the silver concentration. All studies were compared to uncoated titanium surfaces Ti6Al4V and a conventional electroplated silver coating. Cytotoxicity toward normal human fibroblasts and Saos-2 osteoblast-like cells increased with higher silver content but remained tolerable at 6%. Compared to uncoated Ti6Al4V and the electroplated silver coating, the new coating with a silver content of 4% and 6% exhibited a significant reduction in adherent bacteria by a factor of approximately 1000. This was also evident via microscopic examination of the surface morphology of the biofilms. Furthermore, following shock wave activation, no bacteria were detectable on either the implant or in the surrounding fluid after a 24 h period.
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Affiliation(s)
- Martin Schulze
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
| | - Melanie Nonhoff
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
| | - Julian Hasselmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
- Materials Engineering Laboratory, Department of Mechanical Engineering, University of Applied Sciences Muenster, 48565 Steinfurt, Germany
| | - Manfred Fobker
- Central Laboratory, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, Muenster University Hospital, 48149 Münster, Germany
| | - Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
| | - Jan Puetzler
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Münster, Germany
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Sendi P, Lora-Tamayo J, Cortes-Penfield NW, Uçkay I. Early switch from intravenous to oral antibiotic treatment in bone and joint infections. Clin Microbiol Infect 2023; 29:1133-1138. [PMID: 37182643 DOI: 10.1016/j.cmi.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/25/2023] [Accepted: 05/06/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The timing of the switch from intravenous (i.v.) to oral antibiotic therapy for orthopaedic bone and joint infections (BJIs) is debated. In this narrative article, we discuss the evidence for and against an early switch in BJIs. DATA SOURCES We performed a PubMed and internet search investigating the association between the duration of i.v. treatment for BJI and remission of infection among adult orthopaedic patients. CONTENT Among eight randomized controlled trials and multiple retrospective studies, we failed to find any minimal duration of postsurgical i.v. therapy associated with clinical outcomes. We did not find scientific data to support the prolonged use of i.v. therapy or to inform a minimal duration of i.v. THERAPY Growing evidence supports the safety of an early switch to oral medications once the patient is clinically stable. IMPLICATIONS After surgery for BJI, a switch to oral antibiotics within a few days is reasonable in most cases. We recommend making the decision on the time point based on clinical criteria and in an interdisciplinary team at the bedside.
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Affiliation(s)
- Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 'i+12' Hospital 12 de Octubre, Madrid, Spain; CIBER Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Puetzler J, Hasselmann J, Nonhoff M, Fobker M, Niemann S, Theil C, Gosheger G, Schulze M. On-Demand Release of Anti-Infective Silver from a Novel Implant Coating Using High-Energy Focused Shock Waves. Pharmaceutics 2023; 15:2179. [PMID: 37765150 PMCID: PMC10537269 DOI: 10.3390/pharmaceutics15092179] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Implant-related infections are a significant concern in orthopedic surgery. A novel anti-infective implant coating made of bioresorbable polymer with silver nitrate was developed. A controlled release of silver ions into the vicinity of the prosthesis can be triggered on-demand by extracorporeal shock waves to effectively combat all clinically relevant microorganisms. Microscopy techniques were used to examine the effects of shock wave application on coated titanium discs. Cytotoxicity was measured using a fibroblast proliferation assay. The anti-infective effect was assessed by monitoring the growth curves of three bacterial strains and by conventional culture. Microscopic analysis confirmed surface disruption of the coatings, with a complete release of silver in the focus area after shock wave application. Spectrometry detected an increase in silver concentration in the surrounding of the discs that surpassed the minimum inhibitory concentration (MIC) for both S. epidermidis RP62A and E. coli ATCC 25922. The released silver demonstrated an anti-infective effect, significantly inhibiting bacterial growth, especially at 6% and 8% silver concentrations. Cytotoxicity testing showed decreasing fibroblast viability with increasing silver concentration in the coating, with 6% silver maintaining viability above 25%. Compared to a commonly used electroplated silver coating on the market, the new coating demonstrated superior antimicrobial efficacy and lower cytotoxicity.
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Affiliation(s)
- Jan Puetzler
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Julian Hasselmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- Materials Engineering Laboratory, Department of Mechanical Engineering, University of Applied Sciences Muenster, 48565 Steinfurt, Germany
| | - Melanie Nonhoff
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Manfred Fobker
- Central Laboratory, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, Muenster University Hospital, Domagkstraße 10, 48149 Muenster, Germany
| | - Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Martin Schulze
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Gründer L, Bockholt S, Gosheger G, Schulze M, Schwarze J, Pützler J, Moellenbeck B, Theil C. Two-Stage Revision Arthroplasty for Resistant Gram-Positive Periprosthetic Joint Infections Using an Oral Linezolid-Based Antibiotic Regime. Antibiotics (Basel) 2023; 12:1235. [PMID: 37627655 PMCID: PMC10451634 DOI: 10.3390/antibiotics12081235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Increasing antibiotic resistance has been reported as an issue in the systemic treatment of periprosthetic joint infection (PJI). Linezolid offers the advantages of high oral bioavailability and little resistance; however, efficacy in the treatment of PJI varies considerably, and studies reporting consistent surgical treatment are scarce. METHODS This is a retrospective, single-center analysis of two-stage revisions performed between 2008 and 2017. We identified 111 patients who met the inclusion criteria. Oral linezolid was given for 28 days following 14 days of intravenous tailored antibiotics in resistant gram-positive PJI. A total of 64% of the patients had methicillin-resistant coagulase-negative staphylococci. The median follow-up was 43 (interquartile range (IQR) 30-57) months. RESULTS 22% (24/111) of the patients underwent surgery for subsequent infection. The 5-year infection-free survival probability was 77% (95% confidence interval (CI) 69-85). A total of 5% of the patients (6/111) had the same organism at the time of reinfection. The patients with infections caused by other organisms than Coagulase-negative staphylococci tended to have a worse reinfection-free survivorship at five years (70% vs. 81%, p = 0.09). Furthermore, the patients with obesity tended to have reduced reinfection-free survivorship at five years (69% vs. 84%, p = 0.08). Overall, 5% (6/111) of the patients had blood count abnormalities with no treatment discontinuations. CONCLUSION Two-stage revision arthroplasty with systemic oral linezolid treatment for resistant gram-positive PJI results in an infection control of 77% at the mid-term.
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Affiliation(s)
| | | | | | | | | | | | | | - Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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10
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Kejwal MB, Verboket RD, Sommer K, Dust F, Thomas D, Störmann P, Frank J, Henrich D, Marzi I, Janko MC. Local Gentamicin Fixation with Sprayed Fibrin-An In Vivo Animal Study Reveals New Options to Treat Soft Tissue Infections. J Clin Med 2023; 12:jcm12103390. [PMID: 37240497 DOI: 10.3390/jcm12103390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
For acute and chronic soft tissue infections, radical surgical debridement is required and is considered the gold standard, along with its immediate systemic antibiotic therapy. Treatment with local antibiotics and/or antibiotic-containing materials is commonly used as an additional tool in clinical practice. Spraying with fibrin and antibiotics is a newer technique that has been studied for some antibiotics. However, for gentamicin, data are not yet available on absorption, optimal application, antibiotic fate at the site and transfer of antibiotic into the blood. In an animal study involving 29 Sprague Dawley rats, 116 back wounds were sprayed with gentamicin using either gentamicin alone or one of two possible spray combinations of gentamicin and fibrin. Simultaneous application of gentamicin and fibrin via a spray system to soft tissue wounds resulted in significant antibiotic concentration over a long period of time. The technique is easy and cost-effective. The systemic crossover was significantly minimized in our study, which may have led to fewer side effects in patients. These results could lead to an improvement in local antibiotic therapy.
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Affiliation(s)
- Meike B Kejwal
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - René D Verboket
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Katharina Sommer
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Fabian Dust
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Dominique Thomas
- Institute of Clinical Pharmacology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Philipp Störmann
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Dirk Henrich
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Maren C Janko
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
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11
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Rottier W, Seidelman J, Wouthuyzen-Bakker M. Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles. ARTHROPLASTY 2023; 5:10. [PMID: 36864531 PMCID: PMC9979546 DOI: 10.1186/s42836-023-00169-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/16/2023] [Indexed: 03/04/2023] Open
Abstract
The antibiotic treatment of periprosthetic joint infections (PJI) is complicated by the presence of biofilm produced by bacteria on the abiotic surface of the implant. Bacteria within the deeper layers of the biofilm become metabolically less active, resulting in antibiotic tolerance due to several mechanisms. This review describes the basic principles of antibiotic treatment in PJI in relation to the behavior of bacteria within the biofilm. The concept of biofilm-active antibiotics will be explained from an in vitro as well as in vivo perspective. Evidence from clinical studies on biofilm-active antibiotics in PJI will be highlighted, mainly focusing on the role of rifampicin for Gram-positive microorganisms and fluoroquinolones for Gram-negative microorganisms. The optimal treatment duration will be discussed as the timing of switching to oral antibiotic therapy.
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Affiliation(s)
- Wouter Rottier
- grid.4830.f0000 0004 0407 1981Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ the Netherlands
| | - Jessica Seidelman
- grid.26009.3d0000 0004 1936 7961Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27708 USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, 9713 GZ, the Netherlands.
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Toirac B, Aguilera-Correa JJ, Mediero A, Esteban J, Jiménez-Morales A. The Antimicrobial Activity of Micron-Thin Sol-Gel Films Loaded with Linezolid and Cefoxitin for Local Prevention of Orthopedic Prosthesis-Related Infections. Gels 2023; 9:gels9030176. [PMID: 36975625 PMCID: PMC10048042 DOI: 10.3390/gels9030176] [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: 01/30/2023] [Revised: 02/13/2023] [Accepted: 02/21/2023] [Indexed: 03/29/2023] Open
Abstract
Orthopedic prosthesis-related infections (OPRI) are an essential health concern. OPRI prevention is a priority and a preferred option over dealing with poor prognosis and high-cost treatments. Micron-thin sol-gel films have been noted for a continuous and effective local delivery system. This study aimed to perform a comprehensive in vitro evaluation of a novel hybrid organic-inorganic sol-gel coating developed from a mixture of organopolysiloxanes and organophosphite and loaded with different concentrations of linezolid and/or cefoxitin. The kinetics of degradation and antibiotics release from the coatings were measured. The inhibition of biofilm formation of the coatings against Staphylococcus aureus, S. epidermidis, and Escherichia coli strains was studied, as well as the cell viability and proliferation of MC3T3-E1 osteoblasts. The microbiological assays demonstrated that sol-gel coatings inhibited the biofilm formation of the evaluated Staphylococcus species; however, no inhibition of the E. coli strain was achieved. A synergistic effect of the coating loaded with both antibiotics was observed against S. aureus. The cell studies showed that the sol-gels did not compromise cell viability and proliferation. In conclusion, these coatings represent an innovative therapeutic strategy with potential clinical use to prevent staphylococcal OPRI.
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Affiliation(s)
- Beatriz Toirac
- Materials Science and Engineering and Chemical Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain
| | - John Jairo Aguilera-Correa
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Aranzazu Mediero
- Bone and Joint Unit, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Antonia Jiménez-Morales
- Materials Science and Engineering and Chemical Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain
- CIBERINFEC-Consorcio Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas, 28029 Madrid, Spain
- Alvaro Alonso Barba Technological Institute of Chemistry and Materials, Carlos III University of Madrid, 28911 Madrid, Spain
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Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections: An Urgent Need. Trop Med Infect Dis 2023; 8:tropicalmed8020113. [PMID: 36828529 PMCID: PMC9959361 DOI: 10.3390/tropicalmed8020113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC24h/MIC < 400 mg × h/L, between 400 and 600 mg × h/L and >600 mg × h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure.
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Ibrahim MM, Liu Y, Ure K, Hall CW, Mah TF, Abdelbary H. Establishment of a Novel Rat Model of Gram-Negative Periprosthetic Joint Infection Using Cementless Hip Hemiarthroplasty. J Bone Joint Surg Am 2023; 105:42-52. [PMID: 36598474 DOI: 10.2106/jbjs.22.00094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Gram-negative periprosthetic joint infections (GN-PJIs) present unique challenges. Our aim was to establish a clinically representative GN-PJI model that recapitulates biofilm formation in vivo. We also hypothesized that biofilm formation on the implant surface would affect its ability to osseointegrate. METHODS Three-dimensionally-printed medical-grade titanium hip implants were used to replace the femoral heads of male Sprague-Dawley rats. GN-PJI was induced using 2 bioluminescent Pseudomonas aeruginosa strains: a reference strain (PA14-lux) and a mutant biofilm-defective strain (ΔflgK-lux). Infection was monitored in real time using an in vivo imaging system (IVIS) and magnetic resonance imaging (MRI). Bacterial loads were quantified utilizing the viable colony count. Biofilm formation at the bone-implant interface was visualized using field-emission scanning electron microscopy (FE-SEM). Implant stability, as an outcome, was directly assessed by quantifying osseointegration using microcomputed tomography, and indirectly assessed by identifying gait-pattern changes. RESULTS Bioluminescence detected by the IVIS was focused on the hip region and demonstrated localized infection, with greater ability of PA14-lux to persist in the model compared with the ΔflgK-lux strain, which is defective in biofilm formation. This was corroborated by MRI, as PA14-lux induced relatively larger implant-related abscesses. Biofilm formation at the bone-implant interface induced by PA14-lux was visualized using FE-SEM versus defective-biofilm formation by ΔflgK-lux. Quantitatively, the average viable colony count of the sonicated implants, in colony-forming units/mL, was 3.77 × 108 for PA14-lux versus 3.65 × 103 for ΔflgK-lux, with a 95% confidence interval around the difference of 1.45 × 108 to 6.08 × 108 (p = 0.0025). This difference in the ability to persist in the model was reflected significantly on implant osseointegration, with a mean intersection surface of 4.1 × 106 ± 1.99 × 106 μm2 for PA14-lux versus 6.44 × 106 ± 2.53 × 106 μm2 for ΔflgK-lux and 7.08 × 106 ± 1.55 × 106 μm2 for the noninfected control (p = 0.048). CONCLUSIONS To our knowledge, this proposed, novel in vivo biofilm-based model is the most clinically representative for GN-PJI to date, since animals can bear weight on the implant, poor osseointegration was associated with biofilm formation, and localized PJI was assessed by various modalities. CLINICAL RELEVANCE This model will allow for more reliable testing of novel biofilm-targeting therapeutics.
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Affiliation(s)
- Mazen M Ibrahim
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Orthopaedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Yun Liu
- Materials Characterization Core Facility, Centre for Advanced Materials Research (CAMaR), University of Ottawa, Ottawa, Ontario, Canada
| | - Kerstin Ure
- Animal Behavior and Physiology Core, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clayton W Hall
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thien-Fah Mah
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hesham Abdelbary
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
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15
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Hipfl C, Karczewski D, Oronowicz J, Pumberger M, Perka C, Hardt S. Total hip arthroplasty for destructive septic arthritis of the hip using a two-stage protocol without spacer placement. Arch Orthop Trauma Surg 2023; 143:19-28. [PMID: 34097122 PMCID: PMC9886611 DOI: 10.1007/s00402-021-03981-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The optimal treatment of patients with a degenerative joint disease secondary to an active or chronic septic arthritis of the hip is unclear. The aim of the present study was to report on our experience with two-stage total hip arthroplasty (THA) using a contemporary treatment protocol without spacer insertion. MATERIALS AND METHODS Our prospective institutional database was used to identify all patients with degenerative septic arthritis treated with a non-spacer two-stage protocol between 2011 and 2017. Clinical outcomes included interim revision, periprosthetic infection (PJI) and aseptic revision rates. Restoration of leg-length and offset were assessed radiographically. Modified Harris hip score (mHHS) were obtained. Treatment success was defined using the modified Delphi consensus criteria. Mean follow-up was 62 months (13-110). RESULTS A total of 33 patients with a mean age of 60 years (13-85) were included. 55% of the cohort was male and average Charlson Comorbidity Index (CCI) was 3.7 (0-12). 21 patients (64%) had an active/acute infection and 12 patients (36%) were treated for chronic/quiescent septic arthritis. Overall, 11 patients (33%) had treatment failure, including 5 patients who failed to undergo THA, 2 interim re-debridement for persistent infection, and 4 patients who developed PJI after an average of 7 months (0.3-13) following THA. The most common identified pathogen was Staphylococcus aureus (42.4%). No aseptic revision was recorded following THA. Leg-length and offset were successfully restored. Mean mHHS improved from 35.2 points to 73.4 points. CONCLUSION Two-stage THA without spacer placement is a viable treatment option for destructive septic arthritis of the hip, demonstrating comparable rates of infection control and functional outcome. However, definitive resection arthroplasty is not uncommon in these often critically ill patients.
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Affiliation(s)
- Christian Hipfl
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Karczewski
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jakub Oronowicz
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Hardt
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Strategies to Mitigate and Treat Orthopaedic Device-Associated Infections. Antibiotics (Basel) 2022; 11:antibiotics11121822. [PMID: 36551479 PMCID: PMC9774155 DOI: 10.3390/antibiotics11121822] [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: 11/11/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Orthopaedic device implants play a crucial role in restoring functionality to patients suffering from debilitating musculoskeletal diseases or to those who have experienced traumatic injury. However, the surgical implantation of these devices carries a risk of infection, which represents a significant burden for patients and healthcare providers. This review delineates the pathogenesis of orthopaedic implant infections and the challenges that arise due to biofilm formation and the implications for treatment. It focuses on research advancements in the development of next-generation orthopaedic medical devices to mitigate against implant-related infections. Key considerations impacting the development of devices, which must often perform multiple biological and mechanical roles, are delineated. We review technologies designed to exert spatial and temporal control over antimicrobial presentation and the use of antimicrobial surfaces with intrinsic antibacterial activity. A range of measures to control bio-interfacial interactions including approaches that modify implant surface chemistry or topography to reduce the capacity of bacteria to colonise the surface, form biofilms and cause infections at the device interface and surrounding tissues are also reviewed.
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Salar-Vidal L, Aguilera-Correa JJ, Brüggemann H, Achermann Y, Esteban J. Microbiological Characterization of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections. Antibiotics (Basel) 2022; 11:antibiotics11091260. [PMID: 36140039 PMCID: PMC9495218 DOI: 10.3390/antibiotics11091260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Aims: This study aimed to characterize 79 Cutibacterium acnes strains isolated from prosthetic joint infections (PJIs) originated from eight European hospitals. Methods: Isolates were phylotyped according to the single-locus sequence typing (SLST) scheme. We evaluated the ability of the biofilm formation of C. acnes strains isolated from PJIs and 84 isolates recovered from healthy skin. Antibiotic susceptibility testing of planktonic and biofilm cells of PJI isolates and skin isolates was performed. Results: Most of the isolates from PJIs belonged to the SLST class H/phylotype IB (34.2%), followed by class D/phylotype IA1 (21.5%), class A/phylotype IA1 (18.9%), and class K/phylotype II (13.9%). All tested isolates were biofilm producers; no difference in biofilm formation was observed between the healthy skin group and the PJI group of strains. Planktonic and sessile cells of C. acnes remained highly susceptible to a broad spectrum of antibiotics, including beta-lactams, clindamycin, fluoroquinolones, linezolid, rifampin, and vancomycin. The minimal inhibitory concentrations (MICs) for planktonic and biofilm states coincided in most cases. However, the minimal biofilm eradication concentration (MBEC) was high for all antimicrobial drugs tested (>32 mg/L), except for rifampin (2 mg/L). Conclusions: C. acnes strains isolated from healthy skin were able to produce biofilm to the same extent as isolates recovered from PJIs. All C. acnes strains in planktonic and sessile states were susceptible to most antibiotics commonly used for PJI treatment, although rifampin was the only antimicrobial agent able to eradicate C. acnes embedded in biofilm.
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Affiliation(s)
- Llanos Salar-Vidal
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
- Correspondence: ; Tel.: +34-915504900
| | - John Jairo Aguilera-Correa
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
| | | | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich (USZ), 8091 Zurich, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8091 Zurich, Switzerland
- Internal Medicine, Hospital Zollikerberg, 8091 Zurich, Switzerland
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, 28020 Madrid, Spain
- CIBER de EnfermedadesInfecciosas (CIBERINFEC), 28020 Madrid, Spain
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18
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Bright R, Hayles A, Wood J, Palms D, Brown T, Barker D, Vasilev K. Surfaces Containing Sharp Nanostructures Enhance Antibiotic Efficacy. NANO LETTERS 2022; 22:6724-6731. [PMID: 35900125 DOI: 10.1021/acs.nanolett.2c02182] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ever-increasing rate of medical device implantations is met by a proportionately high burden of implant-associated infections. To mitigate this threat, much research has been directed toward the development of antibacterial surface modifications by various means. One recent approach involves surfaces containing sharp nanostructures capable of killing bacteria upon contact. Herein, we report that the mechanical interaction between Staphylococcus aureus and such surface nanostructures leads to a sensitization of the pathogen to the glycopeptide antibiotic vancomycin. We demonstrate that this is due to cell wall damage and impeded bacterial defenses against reactive oxygen species. The results of this study promise to be impactful in the clinic, as a combination of nanostructured antibacterial surfaces and antibiotics commonly used in hospitals may improve antimicrobial therapy strategies, helping clinicians to prevent and treat implant-associated infections using reduced antibiotic concentrations instead of relying on invasive revision surgeries with often poor outcomes.
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Affiliation(s)
- Richard Bright
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Andrew Hayles
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
| | - Jonathan Wood
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
| | - Dennis Palms
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
| | - Toby Brown
- Corin Australia, Pymble 2073, New South Wales, Australia
| | - Dan Barker
- Corin Australia, Pymble 2073, New South Wales, Australia
| | - Krasimir Vasilev
- Academic Unit of STEM, University of South Australia, Mawson Lakes, Adelaide 5095, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park 5042, South Australia, Australia
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Depypere M, Sliepen J, Onsea J, Debaveye Y, Govaert GAM, IJpma FFA, Zimmerli W, Metsemakers WJ. The Microbiological Etiology of Fracture-Related Infection. Front Cell Infect Microbiol 2022; 12:934485. [PMID: 35873162 PMCID: PMC9300981 DOI: 10.3389/fcimb.2022.934485] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Fracture-related infection (FRI) is an important complication related to orthopaedic trauma. Although the scientific interest with respect to the diagnosis and treatment of FRI is increasing, data on the microbiological epidemiology remains limited. Therefore, the primary aim of this study was to evaluate the microbiological epidemiology related to FRI, including the association with clinical symptoms and antimicrobial susceptibility data. The secondary aim was to analyze whether there was a relationship between the time to onset of infection and the microbiological etiology of FRI. Methods FRI patients treated at the University Hospitals of Leuven, Belgium, between January 1st 2015 and November 24th 2019 were evaluated retrospectively. The microbiological etiology and antimicrobial susceptibility data were analyzed. Patients were classified as having an early (<2 weeks after implantation), delayed (2-10 weeks) or late-onset (> 10 weeks) FRI. Results One hundred ninety-one patients with 194 FRIs, most frequently involving the tibia (23.7%) and femur (18.6%), were included. Staphylococcus aureus was the most frequently isolated pathogen, regardless of time to onset (n=61; 31.4%), followed by S. epidermidis (n=50; 25.8%) and non-epidermidis coagulase-negative staphylococci (n=35; 18.0%). Polymicrobial infections (n=49; 25.3%), mainly involving Gram negative bacilli (GNB) (n=32; 65.3%), were less common than monomicrobial infections (n=138; 71.1%). Virulent pathogens in monomicrobial FRIs were more likely to cause pus or purulent discharge (n=45;54.9%; p=0.002) and fistulas (n=21;25.6%; p=0.030). Susceptibility to piperacillin/tazobactam for GNB was 75.9%. Vancomycin covered 100% of Gram positive cocci. Conclusion This study revealed that in early FRIs, polymicrobial infections and infections including Enterobacterales and enterococcal species were more frequent. A time-based FRI classification is not meaningful to estimate the microbiological epidemiology and cannot be used to guide empiric antibiotic therapy. Large multicenter prospective studies are necessary to gain more insight into the added value of (broad) empirical antibiotic therapy.
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Affiliation(s)
- Melissa Depypere
- Department of laboratory medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Jonathan Sliepen
- Department of Trauma Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Jolien Onsea
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Geertje A. M. Govaert
- Department of Trauma Surgery, University of Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
| | - Frank F. A. IJpma
- Department of Trauma Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Werner Zimmerli
- Basel University Medical Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
- *Correspondence: Willem-Jan Metsemakers,
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Kobayashi S, Tagawa S, Ogura T, Kitaoka A, Yasu T. Safety of linezolid, rifampicin, and clindamycin combination therapy in patients with prosthetic joint infection. Drug Discov Ther 2022; 16:142-144. [PMID: 35753771 DOI: 10.5582/ddt.2022.01038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated adverse events in patients with prosthetic joint infections receiving combination therapy with linezolid, rifampicin, and clindamycin for ≥ 7 days. Twenty-two patients were evaluated. The combination therapy was administered for 15.5 (7-29) days at dosages of 1200, 450, and 450-1200 mg/day for linezolid, rifampicin, and clindamycin, respectively. Adverse events (gastrointestinal, eye, and skin disorders; liver damage; myelosuppression; hyponatremia, and others) were recorded. The incidence rates of leukopenia, neutropenia, anemia, thrombocytopenia, and hyponatremia were 36.4%, 31.8%, 40.9%, 18.2%, and 18.2%, respectively. Common Terminology Criteria for Adverse Events version 5.0 Grade 3 neutropenia, anemia, and hyponatremia were observed. The incidence rate of myelosuppression was higher following combination therapy compared with that previously reported following single-drug administration. All patients were discharged after the infection was under control. It is important to monitor these adverse events during combination therapy with the aforementioned agents; these conditions may be relieved by discontinuing linezolid.
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Affiliation(s)
| | - Seiji Tagawa
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Takashi Ogura
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Akira Kitaoka
- Department of Pharmacy, Nissan Tamagawa Hospital, Tokyo, Japan
| | - Takeo Yasu
- Department of Medicinal Therapy Research, Pharmaceutical Education and Research Center, Meiji Pharmaceutical University, Tokyo, Japan
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21
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Janko M, Dust F, Wagner PV, Gurke R, Frank J, Henrich D, Marzi I, Verboket RD. Local Fixation of Colistin With Fibrin Spray: An in vivo Animal Study for the Therapy of Skin and Soft Tissue Infections. Front Surg 2022; 9:749600. [PMID: 35372468 PMCID: PMC8968937 DOI: 10.3389/fsurg.2022.749600] [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: 08/06/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Skin and soft tissue infections (SSTI) are a commonly known entity of diseases associated with difficult treatment procedures. The current gold standard when there is a rapidly progressing infection of soft tissues with a risk of sepsis is radical surgical debridement accompanied by systemic antibiotic therapy. In clinical settings, local antibiotics alone or formulated within carrier material are commonly used alongside this therapy regimen. One possibility of local antibiotic application is the fixation of colistin with fibrin glue spray. It is not yet sufficiently researched how the local antibiotic concentrations remain as high as possible over time. Methods We conducted an animal study including 29 male Wistar rats inducing sterile back sores reaching the muscle fascia. We sprayed only colistin, simultaneously or consecutively, with fibrin glue in different groups in order to measure the tissue concentration of the antibiotic applied locally. Results After liquid chromatography and quadrupole mass spectrometry analysis, it could be demonstrated that in comparison to the colistin group, tissue concentrations of colistin stayed significantly higher in the wound tissue when it was fixed with fibrin glue. This was observed in both groups, the simultaneous as well as in the consecutively fibrin glue sprayed groups after colistin application. Conclusion The fixation of colistin with the fibrin-glue-spray technique as a carrier for local antibiotic therapy is an easy and inexpensive method and shows promising potential for the treatment of SSTI.
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Affiliation(s)
- Maren Janko
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
- *Correspondence: Maren Janko
| | - Fabian Dust
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
| | - Pia Viktoria Wagner
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
| | - Robert Gurke
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt, Germany
- Pharmazentrumfrankfurt/ZAFES, Department of Clinical Pharmacology, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Johannes Frank
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
| | - Dirk Henrich
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
| | - René Danilo Verboket
- Department of Trauma-, Hand and Reconstructive Surgery, Hospital of the Goethe-University, Goethe-University, Frankfurt, Germany
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Gatti M, Barnini S, Guarracino F, Parisio EM, Spinicci M, Viaggi B, D’Arienzo S, Forni S, Galano A, Gemmi F. Orthopaedic Implant-Associated Staphylococcal Infections: A Critical Reappraisal of Unmet Clinical Needs Associated with the Implementation of the Best Antibiotic Choice. Antibiotics (Basel) 2022; 11:antibiotics11030406. [PMID: 35326869 PMCID: PMC8944676 DOI: 10.3390/antibiotics11030406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/24/2022] Open
Abstract
Infections associated with orthopaedic implants represent a major health concern characterized by a remarkable incidence of morbidity and mortality. The wide variety of clinical scenarios encountered in the heterogeneous world of infections associated with orthopaedic implants makes the implementation of an optimal and standardized antimicrobial treatment challenging. Antibiotic bone penetration, anti-biofilm activity, long-term safety, and drug choice/dosage regimens favouring outpatient management (i.e., long-acting or oral agents) play a major role in regards to the chronic evolution of these infections. The aim of this multidisciplinary opinion article is to summarize evidence supporting the use of the different anti-staphylococcal agents in terms of microbiological and pharmacological optimization according to bone penetration, anti-biofilm activity, long-term safety, and feasibility for outpatient regimens, and to provide a useful guide for clinicians in the management of patients affected by staphylococcal infections associated with orthopaedic implants Novel long-acting lipoglycopeptides, and particularly dalbavancin, alone or in combination with rifampicin, could represent the best antibiotic choice according to real-world evidence and pharmacokinetic/pharmacodynamic properties. The implementation of a multidisciplinary taskforce and close cooperation between microbiologists and clinicians is crucial for providing the best care in this scenario.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy;
- SSD Clinical Pharmacology, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simona Barnini
- Bacteriology Unit, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy;
| | - Eva Maria Parisio
- UOSD Microbiologia Arezzo PO San Donato, Azienda Usl Toscana Sud Est, 52100 Arezzo, Italy;
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy;
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Bruno Viaggi
- Neurointensive Care Unit, Department of Anesthesiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Sara D’Arienzo
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
| | - Silvia Forni
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
| | - Angelo Galano
- SOD Microbiologia e Virologia, Careggi University Hospital, 50134 Florence, Italy;
| | - Fabrizio Gemmi
- Agenzia Regionale di Sanità della Toscana, 50141 Florence, Italy; (S.D.); (S.F.)
- Correspondence:
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Mertens B, Van Daele R, Depypere M, Lagrou K, Debaveye Y, Wauters J, Nijs S, Metsemakers WJ, Spriet I. Isavuconazole in the Treatment of Aspergillus fumigatus Fracture-Related Infection: Case Report and Literature Review. Antibiotics (Basel) 2022; 11:antibiotics11030344. [PMID: 35326807 PMCID: PMC8944859 DOI: 10.3390/antibiotics11030344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Aspergillus fracture-related infection (FRI) is a rare, but severe complication in trauma surgery. The optimal antifungal treatment for Aspergillus osteomyelitis, including FRI, has not been established yet, as only cases have been documented and data on bone penetration of antifungal drugs are scarce. We describe a patient with Aspergillus fumigatus FRI of the tibia who was treated with isavuconazole after developing liver function disturbances during voriconazole therapy. Isavuconazole, the active moiety formed after hydrolysis of the prodrug isavuconazonium sulfate by plasma esterases, was administered in a maintenance dose of 200 mg q24 h, followed by 150 mg q24 h. The patient completed a six-month antifungal treatment course. Although fracture union was not achieved during six months of follow-up after therapy cessation, no confirmatory signs of FRI were observed. Additionally, two literature searches were conducted to review available data on antifungal treatment of Aspergillus osteomyelitis and bone penetration of antifungals. One hundred and eight cases of Aspergillus osteomyelitis, including six (5.6%) FRI cases, were identified. Voriconazole and (lipid formulations of) amphotericin B were the most commonly used antifungals. In three (2.8%) cases isavuconazole was prescribed as salvage therapy. Data on antifungal bone penetration were reported for itraconazole, voriconazole, amphotericin B, anidulafungin and 5-fluorocytosin. Isavuconazole might be a promising alternative for the treatment of Aspergillus osteomyelitis. However, standardized case documentation is needed to evaluate the efficacy of isavuconazole and other antifungals in the treatment of Aspergillus osteomyelitis, including FRI.
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Affiliation(s)
- Beatrijs Mertens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, Belgium; (R.V.D.); (I.S.)
- Pharmacy Department, University Hospitals Leuven, B-3000 Leuven, Belgium
- Correspondence: ; Tel.: +32-16-34-69-57
| | - Ruth Van Daele
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, Belgium; (R.V.D.); (I.S.)
- Pharmacy Department, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Melissa Depypere
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, Belgium; (M.D.); (K.L.); (J.W.)
| | - Katrien Lagrou
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, Belgium; (M.D.); (K.L.); (J.W.)
- Belgian National Reference Center for Mycosis, University Hospitals Leuven, B-3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, B-3000 Leuven, Belgium
| | - Yves Debaveye
- Department of Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium;
- Intensive Care Unit, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Joost Wauters
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, B-3000 Leuven, Belgium; (M.D.); (K.L.); (J.W.)
- Medical Intensive Care Unit, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Stefaan Nijs
- Department of Development and Regeneration, KU Leuven, B-3000 Leuven, Belgium; (S.N.); (W.-J.M.)
- Department of Trauma Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Development and Regeneration, KU Leuven, B-3000 Leuven, Belgium; (S.N.); (W.-J.M.)
- Department of Trauma Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, B-3000 Leuven, Belgium; (R.V.D.); (I.S.)
- Pharmacy Department, University Hospitals Leuven, B-3000 Leuven, Belgium
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Feihl S, Querbach C, Hapfelmeier A, Busch DH, von Eisenhart-Rothe R, Gebhardt F, Pohlig F, Mühlhofer HML. Effect of an Intensified Antibiotic Stewardship Program at an Orthopedic Surgery Department. Surg Infect (Larchmt) 2021; 23:105-112. [PMID: 34762545 DOI: 10.1089/sur.2021.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Institutional programs such as antibiotic stewardship (ABS) programs offer possibilities to monitor and modify antibiotic usage with the aim of reducing antibiotic resistance. In orthopedic units that treat peri-prosthetic joint infections (PJIs), ABS programs are still rare, however, there is extensive use of high-risk antibiotic agents and an increased risk for the occurrence of Clostridium difficile infections (CDIs). Patients and Methods: An ABS program was implemented at the Department of Orthopedic Surgery at a university hospital. Quarterly antibiotic consumption was measured in defined daily doses (DDDs) per 100 patient-days (PDs) at 10 quarters before the intervention and seven quarters after the intervention. The effect of the new antibiotic policy on drug use rates was evaluated using an interrupted time-series analysis. Estimated changes over time in the incidence of CDIs (cases per 1,000 PDs) were analyzed. Results: A remarkable percentual reduction in second-generation cephalosporin use of 83% (p < 0.001; pre-intervention level, 81.486 DDDs/100 patient-days; post-intervention level, 13.751 DDDs/100 PDs) and clindamycin administration of 78% (p < 0.001; pre-intervention level, 18.982 DDDs/100 PDs; post-intervention level, 4.216 DDDs/100 PDs) was observed after implementation of ABS interventions. Total antibiotic use declined by 25% (p < 0.001; pre-intervention level, 129.078 DDDs/100 PDs; post-intervention level, 96.826 DDDs/100 PDs). Conclusions: This research assessed the positive impact of an intensified ABS program at an orthopedic department specializing in PJIs. Antibiotic stewardship program interventions encourage the reduction of total antibiotic usage and especially high-risk antibiotic agents, associated with the development of antimicrobial resistance.
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Affiliation(s)
- Susanne Feihl
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Christiane Querbach
- Pharmacy Department, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Alexander Hapfelmeier
- Institute of Medical Informatics, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Friedemann Gebhardt
- Institute for Medical Microbiology, Immunology and Hygiene, Statistics, Epidemiology, Technical University Munich, School of Medicine, Munich, Germany
| | - Florian Pohlig
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
| | - Heinrich M L Mühlhofer
- Department of Orthopedic Surgery, University Hospital Klinikum rechts der Isar, Technical University Munich, School of Medicine, Munich, Germany
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Dadi NCT, Radochová B, Vargová J, Bujdáková H. Impact of Healthcare-Associated Infections Connected to Medical Devices-An Update. Microorganisms 2021; 9:2332. [PMID: 34835457 PMCID: PMC8618630 DOI: 10.3390/microorganisms9112332] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 01/12/2023] Open
Abstract
Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.
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Affiliation(s)
| | - Barbora Radochová
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
| | | | - Helena Bujdáková
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 84215 Bratislava, Slovakia; (N.C.T.D.); (J.V.)
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26
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Li L, Wang Y, Liu K, Yang L, Zhang B, Luo Q, Luo R, Wang Y. Nanoparticles-stacked superhydrophilic coating supported synergistic antimicrobial ability for enhanced wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 132:112535. [DOI: 10.1016/j.msec.2021.112535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
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Garcia D, Gilmore A, Berns E, Spake C, Dockery DM, Vishwanath N, Glasser J, Antoci V, Daniels A, Born CT. Silver carboxylate and titanium dioxide-polydimethylsiloxane coating decreases adherence of multi-drug resistant Serratia marcescens on spinal implant materials. Spine Deform 2021; 9:1493-1500. [PMID: 34173223 DOI: 10.1007/s43390-021-00380-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/19/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The opportunistic multi-drug resistant nosocomial gram negative bacilli Serratia marcescens (S. marcescens) is a rising contributor to spinal implant infections (Iguchi et al., Genome Biol Evol 6:2096-2110, 2014; Teresa et al., J Clin Microbiol 55:2334-2347; Dante et al., J Clin Microbiol 54:120-126). This study investigates the most effective matrix ratio of an antibiotic-independent, silver carboxylate-doped titanium dioxide (TiO2)-polydimethylsiloxane (PDMS) coating in preventing adherence of multidrug resistant pathogen S. marcescens to spinal implant materials. METHODS This project examined an antibiotic-independent, silver carboxylate-doped titanium dioxide (TiO2)-polydimethylsiloxane (PDMS) coating on three common spinal implant materials, polyetheretherketone (PEEK), stainless steel (SS), and titanium (Ti), which previously were found to be prone to bacterial adhesion (Garcia et al., Spine Deform 8:351-359). After generation of dose response curves to find the optimal silver carboxylate concentration, 95% TiO2-5% PDMS was combined with 10× silver carboxylate and compared to 100% silver carboxylate and uncoated implants. Implants were imaged using scanning electron microscopy and confocal laser scanning microscopy to detect adherent S. marcescens. RESULTS Ninety-five percent TiO2-5% PDMS and 10× silver carboxylate coating decreased adherence of S. marcescens on PEEK by 99.61% (p = 0.001), on titanium by 98.77% (p = 0.001), and on stainless steel by 88.10% (p = 0.001) after 24 h. The average decrease in bacterial adherence was 95.49% compared to uncoated implants. CONCLUSION A coating composition comprised of 95% TiO2-5% PDMS matrix and 10× silver carboxylate most effectively decreases adherence of S. marcescens on spinal implants. These results suggest that the application of a non-antibiotic, bactericidal coating prior to spinal surgery may prevent the adherence and proliferation of MDR S. marcescens and decrease the incidence of spinal SSI.
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Affiliation(s)
- Dioscaris Garcia
- Department of Orthopaedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA.
| | - Andrea Gilmore
- Brown University, Providence, RI, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Ellis Berns
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Carole Spake
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Dominique M Dockery
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Neel Vishwanath
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Jillian Glasser
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Valentin Antoci
- Department of Orthopaedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
| | - Alan Daniels
- Department of Orthopaedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Christopher T Born
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University, Providence, RI, USA
- Department of Orthopaedic Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, RI, USA
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28
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Bright R, Hayles A, Fernandes D, Visalakshan RM, Ninan N, Palms D, Burzava A, Barker D, Brown T, Vasilev K. In Vitro Bactericidal Efficacy of Nanostructured Ti6Al4V Surfaces is Bacterial Load Dependent. ACS APPLIED MATERIALS & INTERFACES 2021; 13:38007-38017. [PMID: 34374279 DOI: 10.1021/acsami.1c06919] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for medical implants globally has increased significantly due to an aging population amongst other reasons. Despite the overall increase in the survivorship of Ti6Al4V implants, implant infection rates are increasing due to factors such as diabetes, obesity, and bacterial resistance to antibiotics. Two commonly found bacteria implicated in implant infections are Staphylococcus aureus and Pseudomonas aeruginosa. Based on prior work that showed nanostructured surfaces might have potential in passively killing these bacterial species, we developed a hierarchical, hydrothermally etched, nanostructured titanium surface. To evaluate the antibacterial efficacy of this surface, etched and as-received surfaces were inoculated with S. aureus or P. aeruginosa at concentrations ranging from 102 to 109 colony-forming units per disc. Live/dead staining revealed there was a 60% decrease in viability for S. aureus and greater than a 98% decrease for P. aeruginosa on etched surfaces at the lowest inoculum of 102 CFU/disc, when compared to the control surface. Bactericidal efficiency decreased with increasing bacterial concentrations in a stepwise manner, with decreases in bacterial viability noted for S. aureus above 105 CFU/disc and above 106 CFU/disc for P. aeruginosa. Surprisingly, biofilm depth analysis revealed a decrease in bacterial viability in the 2 μm layer furthest from the nanostructured surface. The nanostructured Ti6Al4V surface developed here holds the potential to reduce the rate of implant infections.
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Affiliation(s)
- Richard Bright
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Andrew Hayles
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Daniel Fernandes
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Rahul M Visalakshan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Neethu Ninan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dennis Palms
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Anouck Burzava
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dan Barker
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Toby Brown
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Krasimir Vasilev
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
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Hipfl C, Carganico T, Leopold V, Perka C, Müller M, Hardt S. Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency. J Arthroplasty 2021; 36:2575-2585. [PMID: 33750632 DOI: 10.1016/j.arth.2021.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary two-stage exchange for periprosthetic hip infection without spacer insertion. METHODS We reviewed 141 infected THAs with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection, and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. RESULTS Thirty-four patients (24%) had treatment failure, including 13 reinfections, 16 interim redebridements for persistent infection, 2 antibiotic suppressive therapies, and 3 prosthetic joint infection-related deaths. Aseptic rerevision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leg-length and offset were restored to preoperative measures. Mean modified Harris hip scores significantly improved from 35 points to 67 points. CONCLUSION A nonspacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good midterm survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.
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Affiliation(s)
- Christian Hipfl
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Teresa Carganico
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Vincent Leopold
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Carsten Perka
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Michael Müller
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Sebastian Hardt
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
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30
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Vilchez HH, Escudero-Sanchez R, Fernandez-Sampedro M, Murillo O, Auñón Á, Rodríguez-Pardo D, Jover-Sáenz A, del Toro MD, Rico A, Falgueras L, Praena-Segovia J, Guío L, Iribarren JA, Lora-Tamayo J, Benito N, Morata L, Ramirez A, Riera M. Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10050475. [PMID: 33919103 PMCID: PMC8143127 DOI: 10.3390/antibiotics10050475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.
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Affiliation(s)
- Helem H. Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-653419331
| | - Rosa Escudero-Sanchez
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Cantabria, Spain;
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Álvaro Auñón
- Bone and Joint Infection Unit, Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Alfredo Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena CSIC, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Alicia Rico
- Infectious Diseases Unit and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Luis Falgueras
- Infectious Diseases Department, Corporació Sanitària Parc Taulí, 08208 Barcelona, Spain;
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, 41013 Sevilla, Spain;
| | - Laura Guío
- Infectious Diseases Department, Hospital Universitario Cruces, 48903 Vizcaya, Spain;
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, Instituto BioDonostia, 20014 San Sebastián, Spain;
| | - Jaime Lora-Tamayo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre “i + 12”, 28041 Madrid, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Antonio Ramirez
- Microbiologic Department, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
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Leung YKS, Ledergerber B, Eberhard N, Mestres CA, Rancic Z, Zimmermann A, Zbinden R, Brugger SD, Zinkernagel AS, Hasse B. Open wounds and rifampicin therapy are associated with rifampicin resistance among staphylococcal vascular graft/endograft infections. JAC Antimicrob Resist 2021; 3:dlab041. [PMID: 34223108 PMCID: PMC8209986 DOI: 10.1093/jacamr/dlab041] [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: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Optimal timing for rifampicin combination therapy in patients with staphylococcal vascular graft/endograft infection (S-VGEI) is unknown. Experts recommend adding rifampicin after lowering bacterial load by surgery and wound closure. Objectives To assess predictors of rifampicin resistance among staphylococci isolated from patients in the Vascular Graft Infection Cohort Study. Methods We included prospective patients with S-VGEI diagnosis from 1 January 2002 to 30 June 2020. We retrospectively assessed determinants of rifampicin resistance using exact logistic regression and described survival with Kaplan–Meier curves. Results We analysed 513 Staphylococcus spp. among 143 predominantly male (82%) patients with a median age of 68 years (IQR 60–75). Thereof, 82 (57%) received a rifampicin combination therapy and 61 (43%) received an antimicrobial therapy without rifampicin. Among 82 patients with rifampicin, 26/26 patients with any rifampicin resistance had open wounds with a strong association of rifampicin resistance with rifampicin treatment while having open wounds (OR 37, 95% CI 6.1 to ∞). Among 75 patients with a rifampicin combination therapy and rifampicin-susceptible staphylococci at S-VGEI diagnosis, 12/12 patients with a secondary rifampicin-resistant isolate had an open wound (OR 14, 95% CI 2.1 to ∞). Conclusions Rifampicin should be started after wound closure due to increased risk of rifampicin resistance observed while having open wounds or second-look surgeries among patients with S-VGEI.
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Affiliation(s)
- Yau Kei Stefan Leung
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Nadia Eberhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Carlos A Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Zoran Rancic
- Clinic for Vascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Alexander Zimmermann
- Clinic for Vascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28, Zurich, Switzerland
| | - Silvio D Brugger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
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O' Sullivan C, O' Neill L, O' Leary ND, O' Gara JP, Crean AM, Ryan KB. Osteointegration, antimicrobial and antibiofilm activity of orthopaedic titanium surfaces coated with silver and strontium-doped hydroxyapatite using a novel blasting process. Drug Deliv Transl Res 2021; 11:702-716. [PMID: 33713316 DOI: 10.1007/s13346-021-00946-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 01/18/2023]
Abstract
Poor integration of orthopaedic devices with the host tissue owing to aseptic loosening and device-associated infections are two of the leading causes of implant failure, which represents a significant problem for both patients and the healthcare system. Novel strategies have focused on silver to combat antimicrobial infections as an alternative to drug therapeutics. In this study, we investigated the impact of increasing the % substitution (12% wt) of silver and strontium in hydroxyapatite (HA) coatings to enhance antimicrobial properties and stimulate osteoblasts, respectively. Additionally, we prepared a binary substituted coating containing both silver and strontium (AgSrA) at 12% wt as a comparison. All coatings were deposited using a novel blasting process, CoBlast, onto biomedical grade titanium (V). Surface physicochemical properties, cytocompatibility and antimicrobial functionality were determined. The anticolonising properties of the coatings were screened using Staphylococcus aureus ATCC 1448, and thereafter, the AgA coating was evaluated using clinically relevant strains. Strontium-doped surfaces demonstrated enhanced osteoblast viability; however, a lower inhibition of biofilm formation was observed compared with the other surfaces. A co-substituted AgSrA surface did not show enhanced osteoblast or anticolonising properties compared with the SrA and AgA surfaces, respectively. Due to its superior anticolonising performance in preliminary studies, AgA was chosen for further studies. The AgA coated surfaces demonstrated good antibacterial activity (eluted and immobilised ion) against methicillin-resistant S. aureus followed by methicillin-sensitive Staphylococcus aureus clinical isolates; however, the AgA surface displayed poor impact against Staphylococcus epidermidis. In conclusion, herein, we demonstrate that HA can be substituted with a range of ions to augment the properties of HA coatings on orthopaedic devices, which offer promising potential to combat orthopaedic device-associated infections and enhance device performance.
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Affiliation(s)
- Caroline O' Sullivan
- Department of Process, Energy and Transport Engineering, Munster Technological University, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland
| | - Liam O' Neill
- TheraDep, Questum Innovation Centre, Co. Tipperary, Ireland
| | - Niall D O' Leary
- Department of Microbiology and Environmental Research Institute, University College Cork, Cork, Ireland
| | - James P O' Gara
- School of Natural Sciences, National University of Ireland, Galway, Ireland
| | - Abina M Crean
- School of Pharmacy, University College Cork, Cork, Ireland.,SSPC Centre for Pharmaceutical Research, School of Pharmacy, University College Cork, Cork, Ireland
| | - Katie B Ryan
- School of Pharmacy, University College Cork, Cork, Ireland. .,SSPC Centre for Pharmaceutical Research, School of Pharmacy, University College Cork, Cork, Ireland.
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Karau MJ, Schmidt-Malan SM, Albano M, Mandrekar JN, Rivera CG, Osmon DR, Oravec CP, Berry DJ, Abdel MP, Patel R. Novel Use of Rifabutin and Rifapentine to Treat Methicillin-Resistant Staphylococcus aureus in a Rat Model of Foreign Body Osteomyelitis. J Infect Dis 2021; 222:1498-1504. [PMID: 32914837 DOI: 10.1093/infdis/jiaa401] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/05/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Owing to patient intolerance or drug interactions, alternative agents to rifampin are needed for management of staphylococcal periprosthetic joint infection. In the current study, we evaluated rifabutin, rifapentine and rifampin, with and without vancomycin, in a rat model of foreign body osteomyelitis. METHODS Proximal tibiae were inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and a Kirschner wire (K-wire) implanted in each. After 4 weeks of infection, rifampin, rifabutin, or rifapentine were administered, alone or with vancomycin. Tibiae and K-wires were cultured, and medians were reported as log10 colony-forming units (CFUs) per gram of bone or log10 CFUs per K-wire, respectively. RESULTS Rifampin, rifabutin or rifapentine administered with vancomycin yielded less MRSA from bones (0.10, 3.02, and 0.10 log10 CFUs/g, respectively) than did no treatment (4.36 log10 CFUs/g) or vancomycin alone (4.64 log10 CFUs/g) (both P ≤ .02). The K-wires of animals receiving no treatment or vancomycin monotherapy recovered medians of 1.76 and 2.91 log10 CFUs/g per K-wire, respectively. In contrast, rifampin, rifabutin and rifapentine administered with vancomycin yielded medians of 0.1 log10 CFUs per K-wire, respectively. Rifampin resistance was detected in a single animal in the rifampin monotherapy group. CONCLUSIONS Rifabutin or rifapentine with vancomycin were as active as rifampin with vancomycin against MRSA in rat foreign body osteomyelitis, suggesting that rifabutin and/or rifapentine may be alternatives to rifampin in the clinical management of staphylococcal periprosthetic joint infections.
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Affiliation(s)
- Melissa J Karau
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA
| | - Suzannah M Schmidt-Malan
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA
| | - Mariana Albano
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA
| | | | | | - Douglas R Osmon
- Division of Infectious Diseases, Rochester, Minnesota, USA.,Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daniel J Berry
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA.,Department of Pharmacy, Rochester, Minnesota, USA
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Abstract
Biofilms are widely involved in human lives, such as in medical infection, environmental remediation, and industrial processes. However, the control of the biofilm has still been a challenge because of its strong drug resistance. Here, we designed and synthesized an amphipathic antimicrobial peptide (Ac-DKDHDHDQDKDLDVDFDFDADK-NH2 (KKd-11)) that was composed of d-amino acids (DAAs). KKd-11 was found to self-assemble into a hydrogel with an improved long-term antimicrobial ability and a better antiprotease activity as compared to the hydrogel formed by Ac-LKLHLHLQLKLLLVLFLFLALK-NH2 (KK-11). Our results indicated that KKd-11 was not only able to inhibit the formation of biofilms but also could effectively damage preformed mature biofilms and kill the bacteria within the biofilms. Besides, cell viability assays indicated that the KKd-11 peptide had very good biocompatibility. We think d-peptide hydrogels may have great potential in the treatment of biofilm-induced infections.
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Affiliation(s)
- Zhen Guo
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yujiao Wang
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tingyuan Tan
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuwen Ji
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jun Hu
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China
| | - Yi Zhang
- Key Laboratory of Interfacial Physics and Technology, Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800, China.,Zhangjiang Lab, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China
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Li P, Gao Z, Tan Z, Xiao J, Wei L, Chen Y. New developments in anti-biofilm intervention towards effective management of orthopedic device related infections (ODRI's). BIOFOULING 2021; 37:1-35. [PMID: 33618584 DOI: 10.1080/08927014.2020.1869725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
Orthopedic device related infections (ODRI's) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The involvement of antibiotic resistant pathogens as the etiological agent further worsens the overall clinical picture, pressing on the need to look into alternative treatment strategies. The present review highlightes the microbiological challenges associated with treatment of ODRI's due to biofilm formation on the implant surface. Further, it details the newer anti-infective modalities that work either by preventing biofilm formation and/or through effective disruption of the mature biofilms formed on the medical implant. The study, therefore aims to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.
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Affiliation(s)
- Ping Li
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Zhenwu Gao
- Department of Orthopedics, Shanxi Bethune Hospital, Taiyuan City, China
| | - Zhenwei Tan
- Department of Orthopedics, Western Theater Air Force Hospital of PLA, Chengdu, China
| | - Jun Xiao
- Department of Orthopedics, Ya'an People's Hospital, Yaan City, China
| | - Li Wei
- Nursing Department, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
| | - Yirui Chen
- Department of Orthopedics, Three Gorges Hospital Affiliated to Chongqing University, Chongqing, China
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Cerioli M, Batailler C, Conrad A, Roux S, Perpoint T, Becker A, Triffault-Fillit C, Lustig S, Fessy MH, Laurent F, Valour F, Chidiac C, Ferry T. Pseudomonas aeruginosa Implant-Associated Bone and Joint Infections: Experience in a Regional Reference Center in France. Front Med (Lausanne) 2020; 7:513242. [PMID: 33195289 PMCID: PMC7649271 DOI: 10.3389/fmed.2020.513242] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 09/22/2020] [Indexed: 11/18/2022] Open
Abstract
Background:P. aeruginosa implant-associated bone and joint infections (BJI) is considered to be one of the most difficult to treat BJI. The data focusing specifically on this pathogen are sparse, and it seems difficult to extrapolate the results obtained with Enterobacteriaceae. Methods: We performed a retrospective observation study of all P. aeruginosa implant-associated BJI diagnosed at our institution from 2011 to 2018. We defined failure as any type of relapse, including persistence of the same P. aeruginosa, superinfection by another organism(s) or any other cause of relapse such as the need for a subsequent surgery. Nonparametric statistical methods were used to compare the study groups and Kaplan-Meier curves and multivariate Cox analysis and were used to detect determinants associated with treatment failure. Results: A total of 90 patients (62% men, median age 60 years IQR 47–72) including 30 (33%) prosthetic-joint infections and 60 (66%) other implant-associated BJIs were studied. Most of them were acute (62%). During the prolonged follow-up, (median 20 months; IQR 9–37), 23 patients (26%) experienced treatment failure. Optimal surgical treatment (DAIR for acute forms, explantation, 1-stage or 2-stage exchange for others) was significantly associated with a higher success rate in the univariate analysis (p = 0.003). Sixty-four (71%) patients received effective initial treatment against P. aeruginosa administered and 81 of them (90%) did for at least 3 weeks: both these parameters correlated with a higher success rate. In the multivariate Cox-analysis optimal surgical treatment, IV effective treatment of at least 3 weeks and treatment with ciprofloxacin for at least 3 months proved to be independently associated to a better outcome in patients with P. aeruginosa implant-associated BJI. Conclusion:P. aeruginosa implant-associated BJI is one of the most difficult-to-treat BJI, with a strong impact on the prognosis of the surgical strategy. An effective initial IV antibiotic treatment for at least 3 weeks seems to be required, followed by oral ciprofloxacin for a total duration of 3 months.
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Affiliation(s)
| | - Cécile Batailler
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Anne Conrad
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Sandrine Roux
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Thomas Perpoint
- Hospices Civils de Lyon, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Agathe Becker
- Hospices Civils de Lyon, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Claire Triffault-Fillit
- Hospices Civils de Lyon, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Sebastien Lustig
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Michel-Henri Fessy
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Frederic Laurent
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Florent Valour
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Christian Chidiac
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
| | - Tristan Ferry
- Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Centre Interrégional de Référence des Infections Ostéo-articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France.,Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France
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Brügger J, Saner S, Nötzli HP. A Treatment Pathway Variation for Chronic Prosthesis-Associated Infections. JB JS Open Access 2020; 5:e20.00042. [PMID: 33163843 PMCID: PMC7556364 DOI: 10.2106/jbjs.oa.20.00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Periprosthetic joint infections (PJIs) are relatively rare but are on the rise because of the increasing total number of implantations performed. Treatment of PJI remains individualized and involves both surgical and medical treatment, with variations depending on the time of implantation, the duration and severity of the infection, tissue damage, and the underlying microorganism. In this case series study, we investigated clinical and functional outcomes of a variation of the Liestal algorithm in patients with PJI following total hip arthroplasty. METHODS This study included 32 patients (33 cases) who were treated for chronic PJI with 2-stage exchange using a cement spacer during the period of 2003 to 2014. In contrast to other treatment pathways, antibiotic therapy was targeted to the causative microorganism as early as possible despite the presence of a cement spacer. Second-look surgery was performed 4 days after removal of the primary implant and a 4-week antibiotic-free window was interposed before definitive reimplantation. Thereafter, antibiotic treatment continued for approximately 6 weeks. All patients were followed for a minimum of 2 years. Parameters investigated were the duration of infection-free survival, functional outcome, and epidemiological data. RESULTS At 2 years of follow-up and at the most recent follow-up (on average, 7 years after reimplantation), 100% of the patients were free of signs of infection, and the mean Harris hip score (HHS) was 89 at the latest follow-up. CONCLUSIONS A meticulously performed 2-stage exchange for PJI with early targeted antibiotic treatment, second-look surgery, an antibiotic-free window before reimplantation, and antibiotic treatment post-reimplantation of medium duration is associated with excellent infection-related and good functional outcome after ≥2 years of follow-up even in cases of chronic PJI. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jan Brügger
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Simon Saner
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
| | - Hubert P. Nötzli
- Department of Internal Medicine, Sonnenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Benkabouche M, Racloz G, Spechbach H, Lipsky BA, Gaspoz JM, Uçkay I. Four versus six weeks of antibiotic therapy for osteoarticular infections after implant removal: a randomized trial. J Antimicrob Chemother 2020; 74:2394-2399. [PMID: 31106353 DOI: 10.1093/jac/dkz202] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/26/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The optimal duration of antibiotic therapy for treating orthopaedic implant infections after surgical drainage and complete implant removal is unknown. METHODS This was a single-centre, unblinded, prospective trial randomizing (1:1) eligible patients to either 4 or 6 weeks of systemic, pathogen-targeted antibiotic therapy. Clinical trial registration number: ClinicalTrials.gov (NCT0362209). RESULTS We analysed 123 eligible patients (62 in the 4 week antibiotic arm and 61 in the 6 week arm) in the ITT analysis. The patients' median age was 64 years, 75 (61%) were men and 38 (31%) were immunocompromised. The most common types of infection treated included: two-stage exchange procedure for prosthetic joint infection (n = 38); orthopaedic plate infection (44) and infected nail implants (11). The median duration of post-explant intravenous antibiotic therapy was 4 days. Overall, 120 episodes (98%) were cured microbiologically and 116 (94%) clinically after a median follow-up period of 2.2 years. During follow-up, four patients had a clinical recurrence with a pathogen other than the initial causative agent. We noted recurrence of clinical infection in four patients in the 4 week arm and three patients in the 6 week arm (4/62 versus 3/61; χ2 test; P = 0.74); in all cases, this occurred at around 2 months following the end of antibiotic treatment. CONCLUSIONS We found no statistically significant difference in the rates of clinical or microbiological remission between patients randomized to only 4 compared with 6 weeks of systemic antibiotic therapy after removal of an infected osteoarticular implant.
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Affiliation(s)
- Mohamed Benkabouche
- Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Guillaume Racloz
- Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Orthopaedic Service of Surgery, Pourtales Hospital, Neuchâtel, Switzerland
| | - Hervé Spechbach
- Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin A Lipsky
- Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Michel Gaspoz
- Department of Community Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ilker Uçkay
- Orthopaedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,Infectiology, Balgrist University Hospital and Faculty of Medicine, Zurich, Switzerland
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Szewczyk A, Skwira A, Konopacka A, Sądej R, Walker G, Prokopowicz M. Mesoporous silica pellets as bifunctional bone drug delivery system for cefazolin. Int J Pharm 2020; 588:119718. [PMID: 32750441 DOI: 10.1016/j.ijpharm.2020.119718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022]
Abstract
For decades, bone drug delivery systems dedicated for osteomyelitis treatment have been investigated as bifunctional materials that exhibit prolonged drug release and mineralization potential. Herein, composite-type pellets based on cefazolin-loaded amino-modified mesoporous silica SBA-15 and microwave-assisted hydroxyapatite were investigated as potential bone drug delivery system in vitro. Pellets were obtained by granulation, extrusion and spheronization methods in laboratory scale and studied in terms of physical properties, drug release, mineralization potential, antimicrobial activity and cytotoxicity towards human osteoblasts. The obtained pellets were characterized for hardness and friability which indicated the pellets durability during further investigations. Prolonged (5-day) release of cefazolin from pellets was observed. The pellets exhibited mineralization potential in simulated body fluid, i.e., a continuous layer of bone-like apatite was formed on the surface of pellets after 28 days of incubation. An antimicrobial assay of pellets revealed an antibacterial effect against Staphylococcus aureus strain during 6 days. No cytotoxic effects of pellets towards human osteoblasts were observed. The obtained results proved that proposed pellets appear to have potential applications as bone drug delivery systems.
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Affiliation(s)
- Adrian Szewczyk
- Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland
| | - Adrianna Skwira
- Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland
| | - Agnieszka Konopacka
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland
| | - Rafał Sądej
- Department of Molecular Enzymology and Oncology, Intercollegiate Faculty of Biotechnology, University of Gdańsk and Medical University of Gdańsk, 80-210 Gdańsk, Poland
| | - Gavin Walker
- Bernal Institute and Department of Chemical Science, University of Limerick, Limerick, Ireland
| | - Magdalena Prokopowicz
- Department of Physical Chemistry, Faculty of Pharmacy, Medical University of Gdańsk, Hallera 107, 80-416 Gdańsk, Poland.
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Declercq P, Neyt J, Depypere M, Goris S, Van Wijngaerden E, Verhaegen J, Wauters J, Spriet I. Preoperative joint aspiration culture results and causative pathogens in total hip and knee prosthesis infections: mind the gap. Acta Clin Belg 2020; 75:284-292. [PMID: 31057053 DOI: 10.1080/17843286.2019.1611718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In prosthetic joint infections (PJIs), there is no consensus about the utility of the preoperative joint aspiration culture to guide antimicrobial treatment. The main objective of this retrospective study was to investigate the value of these preoperative samples to narrow immediate postoperative empirical antimicrobial treatment in patients with a knee or hip PJI. METHODS Adult patients admitted for an exchange procedure between June 2007 and July 2016 for whom a preoperative joint aspiration within 6 months prior to the procedure was available and with an antibiotic-free interval before sampling, were eligible. Per PJI, taking both preoperative joint aspiration and intraoperative deep samples into account, causative pathogen(s) were assessed by the current Infectious Diseases Society of America (IDSA) guidelines. Per PJI, agreement of preoperative joint aspiration cultures corresponding to the causative pathogen(s) was investigated both on species and on Gram/fungi level. RESULTS From the 85 PJIs, on species level, the total agreement was found in 58 (68%) PJIs. On Gram/fungi level, when preoperative joint aspiration cultures yielded exclusively Gram-positive microorganisms (n = 61), a 100% predictive value for Gram positive causing pathogens was attained. Insufficient predictive value was observed in PJIs with preoperative joint aspiration yielding Gram-negative microorganisms (n = 4), a fungus (n = 1) or with sterile results (n = 19). CONCLUSION In the immediate postoperative setting, the treating team might consider a broad spectrum empirical antibiotic regime, guided by the local epidemiology and susceptibility, which can be narrowed to Gram-positive coverage if preoperative joint aspiration cultures yield exclusively Gram-positive microorganisms.
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Affiliation(s)
- Peter Declercq
- Pharmacy Dpt. and Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jeroen Neyt
- Department of Orthopedic Surgery, Head Division Septic Orthopedic and Trauma Surgery, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University Hospitals Leuven, Leuven, Belgium
| | - Stefanie Goris
- Pharmacy Dpt. and Department of Pharmaceutical and Pharmacological Sciences, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of General Internal Medicine, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Jan Verhaegen
- Department of Microbiology and Immunology, Laboratory of Clinical Bacteriology and Mycology, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of General Internal Medicine, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Dpt. and Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Theil C, Schmidt-Braekling T, Gosheger G, Schwarze J, Dieckmann R, Schneider KN, Möllenbeck B. Clinical use of linezolid in periprosthetic joint infections - a systematic review. J Bone Jt Infect 2020; 6:7-16. [PMID: 32983842 PMCID: PMC7517662 DOI: 10.5194/jbji-6-7-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/20/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: The most common causative organism in periprosthetic joint
infections (PJIs) is Gram-positive bacteria that are increasingly drug
resistant. In these cases the use of linezolid may be warranted. However,
there are conflicting reports regarding its role in antibiotic treatment of
PJIs. The aim of this review is to gather and analyze clinical results and
treatment details on linezolid in patients with PJIs.
Methods: In August 2019, a comprehensive literature search using MEDLINE
(Pubmed and Ovid) and Cochrane Library was performed. A total of 504 records
were screened, and a total of 16 studies including 372 patients treated with
linezolid for a PJI were included in this review based on the PRISMA
criteria and after quality analysis using the MINOR score and Newcastle–Ottawa
scale, as well as assessing level of evidence. Pooling analysis as well as
descriptive analysis was performed.
Results: Based on the results from the studies included, infection control
was achieved in 80 % (range 30 %–100 %) of patients after a mean follow-up
period of 25 (range 2–66) months. The mean duration of treatment was 58 d
intravenous and orally at a median dose of 600 mg bis in die (b.i.d.)
(range 400–900 b.i.d.). A combination therapy with rifampicin was used in
53 % of patients. MRSA (methicillin-resistant Staphylococcus aureus) infections were present in
29 % and resistant CoNS (coagulase-negative Staphylococcus) in 46 %. Adverse effects
occurred in 33 % of cases, mostly anemia, thrombocytopenia and
gastrointestinal complaints leading to treatment discontinuation in 9 %.
However, great heterogeneity was found with respect to surgical treatment,
diagnosis of infection and indication for linezolid.
Discussion: Linezolid is an appropriate option for treatment of resistant
Gram-positive organisms in PJIs. Most commonly 600 mg b.i.d. is used, and a
combination with rifampicin appears feasible although one must consider
individual increases in doses in these cases. However, adverse effects are
common and there are limited data for long-term use and optimal antibiotic
combinations or individual doses.
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Affiliation(s)
- Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Burkhard Möllenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Landersdorfer CB, Kinzig M, Höhl R, Kempf P, Nation RL, Sörgel F. Physiologically Based Population Pharmacokinetic Modeling Approach for Ciprofloxacin in Bone of Patients Undergoing Orthopedic Surgery. ACS Pharmacol Transl Sci 2020; 3:444-454. [PMID: 32566910 DOI: 10.1021/acsptsci.0c00045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Indexed: 01/22/2023]
Abstract
Ciprofloxacin is highly active against bacteria that commonly cause bone infections. However, the time-course of ciprofloxacin in bone has not been characterized using population pharmacokinetic modeling. Thirty-nine patients received a 1-h infusion of 400 mg of ciprofloxacin before orthopedic surgery. Blood and bone samples were collected at 0.5 to 20 h following the start of the infusion. Bone samples were separated into cortical and cancellous bone and pulverized under liquid nitrogen using a cryogenic mill. Ciprofloxacin in plasma, and cortical and cancellous bone was quantified by liquid chromatography-tandem mass spectrometry. A physiologically based pharmacokinetic modeling approach was utilized to describe the concentration-time profiles in plasma and bone. Ciprofloxacin concentrations ranged from 0.176 to 5.98 mg/L (median, 1.67; density, 1.99 g/cm3) in cortical, and 0.224 to 14.6 mg/L (median, 1.22; 1.92 g/cm3) in cancellous bone. The average observed cortical bone/plasma concentration ratio was 0.67 at 0.5 to 2 h (n = 7) and 5.1 at 13 to 20 h (n = 9). For cancellous bone the respective average ratios were 0.77 and 4.4. The population PK model included a central (blood) compartment, two peripheral tissue compartments, and compartments for the organic and inorganic (hydroxyapatite) matrix in cortical and cancellous bone. The population mean ciprofloxacin clearance was 20.7 L/h. The estimated partition coefficients of the organic bone matrix were 3.39 for cortical and 5.11 for cancellous bone. Ciprofloxacin achieved higher concentrations in bone than plasma. Slow redistribution from bone to plasma may have been due to binding to the inorganic bone matrix. The developed model presents a step toward optimized antibiotic dosing in osteomyelitis.
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Affiliation(s)
- Cornelia B Landersdorfer
- IBMP-Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg, 90562, Germany.,Centre for Medicine Use and Safety, and Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, 3052, Australia
| | - Martina Kinzig
- IBMP-Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg, 90562, Germany
| | - Rainer Höhl
- Institute for Clinical Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical Private University, Nürnberg Hospital, Nürnberg, 90419, Germany
| | - Peter Kempf
- Department of Surgery, Municipal Hospital, Rüsselsheim, 65428, Germany
| | - Roger L Nation
- Centre for Medicine Use and Safety, and Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, 3052, Australia
| | - Fritz Sörgel
- IBMP-Institute for Biomedical and Pharmaceutical Research, Nürnberg-Heroldsberg, 90562, Germany.,Department of Pharmacology, University of Duisburg-Essen, Essen, 47057, Germany
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Xiao X, Zhao W, Liang J, Sauer K, Libera M. Self-defensive antimicrobial biomaterial surfaces. Colloids Surf B Biointerfaces 2020; 192:110989. [PMID: 32361372 PMCID: PMC7308212 DOI: 10.1016/j.colsurfb.2020.110989] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 01/16/2023]
Abstract
Self-defensive biomaterial surfaces are being developed in order to mitigate infection associated with tissue-contacting biomedical devices. Such infection occurs when microbes colonize the surface of a device and proliferate into a recalcitrant biofilm. A key intervention point centers on preventing the initial colonization. Incorporating antimicrobials within a surface coating can be very effective, but the traditional means of antimicrobial delivery by continuous elution can often be counterproductive. If there is no infection, continuous elution creates conditions that promote the development of resistant microbes throughout the patient. In contrast, a self-defensive coating releases antimicrobial only when and only where there is a microbial challenge to the surface. Otherwise, the antimicrobial remains sequestered within the coating and does not contribute to the development of resistance. A self-defensive surface requires a local trigger that signals the microbial challenge. Three such triggers have been identified as: (1) local pH lowering; (2) local enzyme release; and (3) direct microbial-surface contact. This short review highlights the need for self-defensive surfaces in the general context of the device-infection problem and then reviews key biomaterials developments associated with each of these three triggering mechanisms.
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Affiliation(s)
- Xixi Xiao
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Wenhan Zhao
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Jing Liang
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Karin Sauer
- Binghamton Biofilm Research Center (BBRC), Binghamton University Binghamton, NY USA
| | - Matthew Libera
- Department of Chemical Engineering and Materials Science, Stevens Institute of Technology, Hoboken, NJ, USA.
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Wang X, Fang L, Wang S, Chen Y, Ma H, Zhao H, Xie Z. Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases. BMC Musculoskelet Disord 2020; 21:215. [PMID: 32264852 PMCID: PMC7140329 DOI: 10.1186/s12891-020-03214-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim was to investigate the clinical efficacy and complications of antibiotic treatment regimens for patients with bone infection. METHODS We retrospectively analysed patients with bone infection admitted to our hospital between March 2013 and October 2018. After surgical debridement was performed, the patients were divided into three groups: IV group (intravenous antibiotics for 2 weeks); oral group (intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); and rifampicin group (intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared among the three groups. RESULTS A total of 902 patients were enrolled. The infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, and 47 miscellaneous sites, as well as 23 multiple-site infections. After at least 6 months of follow-up, 148 (16.4%) patients had an infection recurrence. The recurrence rate of the IV group was 17.9%, which was not significantly higher than the recurrence rates of the oral group (10.1%) and rifampicin group (10.5%), P = 0.051. The incidence of abnormal alanine aminotransferase (ALT) levels in the IV group was 15.1%, which was lower than that in the oral group (18.0%) and rifampicin group (27.4%), P = 0.026. The rates of proteinuria in the three groups were 3.2, 4.5, and 9.3%, respectively, P = 0.020. CONCLUSIONS After debridement of bone infection, short-term antibiotic treatment regimens might offer similar rates of infection eradication while avoiding the risk of renal and hepatic damage associated with prolonged antibiotic use. THE LEVEL OF CLINICAL RELEVANCE Stage III.
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Affiliation(s)
- Xiaohua Wang
- Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Gaotanyan No. 30, Chongqing, 400038, People's Republic of China
| | - Li Fang
- Department of Kidney, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Shulin Wang
- Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Gaotanyan No. 30, Chongqing, 400038, People's Republic of China
| | - Yueqi Chen
- Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Gaotanyan No. 30, Chongqing, 400038, People's Republic of China
| | - Huan Ma
- Department of Pharmacy, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Hongwen Zhao
- Department of Kidney, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.
| | - Zhao Xie
- Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Gaotanyan No. 30, Chongqing, 400038, People's Republic of China.
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Mühlhofer HML, Feihl S, Suren C, Banke IJ, Pohlig F, von Eisenhart-Rothe R. Implantatassoziierte Gelenkinfektionen. DER ORTHOPADE 2020; 49:277-286. [DOI: 10.1007/s00132-020-03877-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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46
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Depypere M, Kuehl R, Metsemakers WJ, Senneville E, McNally MA, Obremskey WT, Zimmerli W, Atkins BL, Trampuz A. Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group. J Orthop Trauma 2020; 34:30-41. [PMID: 31567902 PMCID: PMC6903362 DOI: 10.1097/bot.0000000000001626] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
Fracture-related infection (FRI) is a major complication in musculoskeletal trauma and one of the leading causes of morbidity. Standardization of general treatment strategies for FRI has been poor. One of the reasons is the heterogeneity in this patient population, including various anatomical locations, multiple fracture patterns, different degrees of soft-tissue injury, and different patient conditions. This variability makes treatment complex and hard to standardize. As these infections are biofilm-related, surgery remains the cornerstone of treatment, and this entails multiple key aspects (eg, fracture fixation, tissue sampling, debridement, and soft-tissue management). Another important aspect, which is sometimes less familiar to the orthopaedic trauma surgeon, is systemic antimicrobial therapy. The aim of this article is to summarize the available evidence and provide recommendations for systemic antimicrobial therapy with respect to FRI, based on the most recent literature combined with expert opinion. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
| | | | - Eric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital, University of Lille, Lille, France
| | - Martin A. McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - William T. Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Werner Zimmerli
- Kantonsspital Baselland, Interdisciplinary Unit for Orthopedic Infections, Liestal, Switzerland; and
| | - Bridget L. Atkins
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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47
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Abstract
Infection can be a devastating complication of surgically inserted prosthetic implants and intramedullary rods, plates and pins. About 2 million implants were inserted in the United States in 2004, and, despite appropriate perioperative antibiotics, approximately 5% of internal fixation devices became infected. Infection rates in fractures that pierce the skin can be as high as 22.7%. Complications of infection include excessive antibiotic use, implant removal, reoperation, and potential amputation. Infections caused by colonized prosthetic implants are often difficult to predict, diagnose, and treat, because they form biofilms. This article explores the approach to infected implants.
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Affiliation(s)
- Dena El-Sayed
- Internal Medicine Clinic, Infectious Diseases Clinic, Ventura County Medical Center, Ventura, CA, USA
| | - Aksone Nouvong
- Department of Surgery, Division of Vascular Surgery, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 526, Los Angeles, CA 90095, USA.
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48
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Yang J, Qiu L, Huang Y, Chen Y, Rao S, Ruan W, Zhao G, Ye L. [The inhibition of accessory gene regulator C specific binding peptides on biofilm formation of Staphylococcus epidermidis on the surface of polyvinyl chloride in vitro]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:349-355. [PMID: 30874395 DOI: 10.7507/1002-1892.201806110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effect of accessory gene regulator C (agr C) specific binding peptides (named N1) on the biofilm formation of Staphylococcus epidermidis on the surface of polyvinyl chloride (PVC) materials in vitro. Methods Firstly, the two strains (ATCC35984, ATCC12228) were cultured with N1 at concentrations of 100, 200, 400, 800, and 1 600 μg/mL, respectively. The control group was cultured with agrC specific binding unrelated peptides (named N0) at the same concentrations and the absorbance ( A) value was measured after 24 hours to determine the optimal bacteriostatic concentration of N1. The two strains were cultured with N1 and N0 of the optimal concentration, respectively. The A values were measured at 6, 12, 18, 24, 30, and 48 hours to observe the effect of N1 on the biofilm formation ability of Staphylococcus epidermidis. On this basis, the surface structure of the biofilm on the surface of PVC material was observed by scanning electron microscopy after 6, 12, 18, 24, and 30 hours of incubation with PVC material sheet. The thickness of the biofilm was observed by laser confocal microscopy after 6, 12, 18, and 24 hours of incubation with ATCC35984 strain. Results The optimal bacteriostatic concentration of N1 was 800 μg/mL. ATCC 12228 strain did not form obvious biofilm after being cultured with N1 and N0. When ATCC35984 strain was cultured with N1 and N0 for 12 hours, the difference in biofilm formation ability between groups N1 and N0 was statistically significant ( P<0.05), but there was no significant difference at 6, 18, 24, 30, and 48 hours ( P>0.05). Scanning electron microscopy examination showed that mature biofilm structure was observed in ATCC35984 strain and was not observed in ATCC12228 strain. Laser confocal microscopy observation showed that the number of bacteria in the group N1 was significantly lower than that in the group N0 at 12 hours, and the most of bacteria were dead bacteria. There was no significant difference in the number of bacteria at 6, 18, and 24 hours, and the most of them were live bacteria. The biofilm thickness of group N1 was significantly lower than that of group N0 at 12 and 18 hours ( P<0.05). Conclusion The intensity of N1 inhibiting the formation of Staphylococcus epidermidis biofilm is dose-dependent. During the aggregation period, N1 can inhibit the biofilm formation by hindering the bacterial growth and aggregation. The inhibition effect on mature biofilm is not obvious.
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Affiliation(s)
- Jichen Yang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Liangting Qiu
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Yunchao Huang
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Ya Chen
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Sunyin Rao
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Wenpeng Ruan
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118, P.R.China
| | - Lianhua Ye
- Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Tumor Hospital of Yunnan Province, Kunming Yunnan, 650118,
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49
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van Vugt TAG, Arts JJ, Geurts JAP. Antibiotic-Loaded Polymethylmethacrylate Beads and Spacers in Treatment of Orthopedic Infections and the Role of Biofilm Formation. Front Microbiol 2019; 10:1626. [PMID: 31402901 PMCID: PMC6671866 DOI: 10.3389/fmicb.2019.01626] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Polymethylmethacrylate (PMMA) also referred as (acrylic) bone cement is a non-degradable biomaterial that has been used in clinical orthopedic practice for several decades. PMMA can be used in a plain formulation, but is often used in an antibiotic-loaded formulation in (primary and revision) arthroplasty and in treatment of orthopedic infections as prosthetic joint infections (PJI) and chronic osteomyelitis. In treatment of PJIs antibiotic-loaded PMMA is often used as a carrier material for local antibiotic delivery in addition to treatment with systemic antibiotics. In this case, the antibiotic-loaded PMMA is often used as a spacer or as a bead chain. Since the introduction of PMMA as an antibiotic carrier there is a tremendous amount of scientific and clinical papers published, which studied numerous different aspects of antibiotic-loaded PMMA. This paper will review the research regarding basic principles of antibiotic-loaded PMMA as mechanism of action, antibiotic-release capacities, choice of antibiotics and influences on mechanical properties of PMMA. Subsequently, concerns regarding the application of antibiotic-loaded PMMA, biofilm formation, antibiotic resistance and local or systemic toxicity will be discussed. In addition to these subjects, the role of antibiotic loaded PMMA in clinical treatment of PJIs and chronic osteomyelitis is discussed in the final part of this paper.
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Affiliation(s)
- Tom A G van Vugt
- Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Jacobus J Arts
- Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
| | - Jan A P Geurts
- Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands
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50
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Management of Chronically Infected Total Knee Arthroplasty With Severe Bone Loss Using Static Spacers With Intramedullary Rods. J Arthroplasty 2019; 34:1462-1469. [PMID: 31023514 DOI: 10.1016/j.arth.2019.03.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Two-stage revision with static antibiotic spacers is the preferred treatment for chronically infected total knee arthroplasty (TKA) associated with severe bone loss. Intramedullary rods to reinforce static spacers have been described. On those, however, bacterial colonization may occur and hamper infection control. This study reports the microbiological findings on the spacer rods and the treatment outcome among these patients. METHODS We reviewed 97 infected TKA with extensive bone loss treated with antibiotic-loaded cement spacers reinforced with intramedullary rods. Mean interim period with the spacer in situ was 9 weeks (range: 6-24 weeks). Intraoperative cultures and sonicated spacer rods were analyzed. Mean follow-up after TKA reimplantation was 41 months (range: 27-56 months). Treatment success was defined using the modified Delphi consensus criteria. RESULTS Twenty-two patients (23%) had treatment failure, including 3 reinfections caused by the same organism, 9 reinfections caused by a different organism, 9 patients required interim spacer exchange, and 1 patient died in the early postoperative course. Sonication cultures of the spacer rods were positive in 2 cases (2%), and none of them failed. Host and limb status was significantly worse in patients who sustained reinfection. At the latest follow-up, all patients had a TKA in place, and 2 patients received chronic antibiotic suppression. CONCLUSION Two-stage revision with the use of intramedullary rods is a safe and efficient treatment for chronically infected TKA with severe bone loss. Most reinfections grew different organisms compared with initial infection. Compromised hosts and extremities may be subjected to chronic antibiotic suppression.
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