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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 PMCID: PMC11205407 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; (P.M.); (K.K.)
| | - Karolina Kraus
- Faculty of Medicine, Wroclaw Medical University, Wyb. Pasteura 1, 50-376 Wroclaw, Poland; (P.M.); (K.K.)
| | - 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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Davis JS, Dewar D, Manning L. Prosthetic joint infection diagnosis in an age of changing clinical patterns of infection and new technologies. Med J Aust 2024; 220:225-228. [PMID: 38351733 DOI: 10.5694/mja2.52228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Joshua S Davis
- University of Newcastle, Newcastle, NSW
- Hunter Medical Research Institute, Newcastle, NSW
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Rahardja R, Zhu M, Davis JS, Manning L, Metcalf S, Young SW. Success of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infection Following Primary Total Knee Arthroplasty: Results from a Prospective Multicenter Study of 189 Cases. J Arthroplasty 2023:S0883-5403(23)00370-4. [PMID: 37084921 DOI: 10.1016/j.arth.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND This study aimed to identify the success rate of debridement, antibiotics, and implant retention (DAIR) for prosthetic joint infection (PJI) in a large prospective cohort of patients undergoing total knee arthroplasty (TKA). The ability for different PJI classification systems to predict success was assessed. METHODS Prospective data recorded in the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) study was analyzed. 189 newly diagnosed knee PJIs were managed with DAIR between July 2014 and December 2017. Patients were prospectively followed up for 2 years. A strict definition of success was used, requiring the patient being alive with documented absence of infection, no ongoing antibiotics and the index prosthesis in place. Success was compared against the Coventry (early PJI = ≤1 month), International Consensus Meeting (early = ≤90 days), Auckland (early = <1 year), and Tsukayama (early = ≤1 month, hematogenous = >1 month with <7 days symptoms, chronic = >1 month with >7 days symptoms) classifications. RESULTS DAIR success was 45% (85/189) and was highest in early PJIs defined according to the Coventry (adjusted odds ratio [aOdds Ratio (OR)] = 3.9, P=0.01), the ICM (aOR = 3.1, p=0.01), and the Auckland classifications (aOR = 2.6, P=0.01). Success was lower in both hematogenous (aOR = 0.4, P=0.03) and chronic infections (aOR = 0.1, P=0.003). CONCLUSION Time since primary TKA is an important predictor of DAIR success. Success was highest in infections occurring <1 month of the primary TKA and progressively decreased as time since the primary TKA increased.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Mark Zhu
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joshua S Davis
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Laurens Manning
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia
| | - Sarah Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Differing Microorganism Profile in Early and Late Prosthetic Joint Infections Following Primary Total Knee Arthroplasty - Implications for Empiric Antibiotic Treatment. J Arthroplasty 2022; 37:1858-1864.e1. [PMID: 35460813 DOI: 10.1016/j.arth.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/19/2022] [Accepted: 04/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is the leading cause of revision following total knee arthroplasty (TKA). Prior to microorganism identification, the choice of the correct empiric antibiotics is critical to treatment success. This study aims to 1) compare the microorganism and resistance profile in early and late PJIs; 2) recommend appropriate empiric antibiotics. METHODS A multicentre retrospective review was performed over a 15-year period. First episode PJIs were classified by both the Tsukayama Classification and Auckland Classification. For each PJI case, the causative organism and antibiotic sensitivity were recorded. RESULTS Of eligible patients, 232 culture-positive PJI cases were included. Using either classification system, early PJIs (<4 weeks or <1 year since primary) were significantly more likely to be resistant and polymicrobial. The predominant organisms were coagulase-negative Staphylococci in early PJIs while Staphylococcus aureus was the most common in late PJIs. The distribution of gram-negative cases was higher in early Class-A than late Class-C PJIs (25% versus 6%, P = .004). Vancomycin provided significantly superior coverage when compared to Flucloxacillin for early infections, and addition of a gram-negative agent achieved coverage over 90% using both classification systems. CONCLUSION Based on the microbiological pattern in Tsukayama criteria, Vancomycin with the consideration of Gram-negative agent should be considered for Class-A infections given the high proportion of resistant and polymicrobial cases. For Class-C infections, Cephazolin or Flucloxacillin is likely sufficient. We recommend antibiotics to be withheld in Class-B infections until cultures and sensitivities are known.
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Casenaz A, Piroth L, Labattut L, Sixt T, Magallon A, Guilloteau A, Neuwirth C, Amoureux L. Epidemiology and antibiotic resistance of prosthetic joint infections according to time of occurrence, a 10-year study. J Infect 2022; 85:492-498. [PMID: 35933039 DOI: 10.1016/j.jinf.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To describe the microorganisms responsible for prosthetic joint infections (PJIs) and their antimicrobial susceptibilities, and to propose appropriate empirical antimicrobial treatments (EATs) according to time of occurrence METHODS: : This 10-year retrospective study presents the bacterial etiology of 282 consecutive PJIs in a French hospital according to time of occurrence (adapted from Zimmerli's classification: early, <3 months; delayed, 3-12 months; late acute, >12 months with hematogenous seeding or contiguous spread; late chronic, >12 months without hematogenous seeding). The expected efficacy of various EATs was analyzed for each PJI. RESULTS Staphylococci were the most commonly found bacteria (S. aureus (44.3%), coagulase-negative staphylococci (25.2%) with 15.2% and 49.3% methicillin resistance respectively), followed by Gram-negative bacilli (GNB) (17.7%) and streptococci (14.9%). The distribution of species varied between categories, but antibiotics targeting GNBs were required in all categories. Imipenem-vancomycin was the most effective combination (99.3%) but should be reserved for patients with suspected resistant GNB. Cefotaxime-vancomycin was less effective in early/delayed and late PJIs (91.1% and 86.1% respectively), due to resistant GNB and polymicrobial infections. Piperacillin/tazobactam-vancomycin appeared to be appropriate in all situations (>96% efficacy). CONCLUSION Proposing universal recommendations remains challenging, but a good understanding of the local epidemiology is important for optimizing EATs.
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Affiliation(s)
- Alice Casenaz
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France
| | - Lionel Piroth
- Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France; INSERM, CIC1432, Clinical Epidemiology unit; Dijon Bourgogne University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical trials unit, Dijon, France
| | - Ludovic Labattut
- Department of Orthopaedic Surgery, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Thibault Sixt
- Infectious Diseases Department, Dijon Bourgogne University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France
| | - Arnaud Magallon
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France
| | - Adrien Guilloteau
- Methodological Support Unit, Dijon University Hospital, CHU Dijon, 14 rue Paul Gaffarel, 21079, Dijon, Cedex, France
| | - Catherine Neuwirth
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France
| | - Lucie Amoureux
- Department of Bacteriology, Dijon Bourgogne University Hospital, BP 37013, 21070, Dijon Cedex, France; UMR/CNRS 6249 Chrono-environnement, University of Bourgogne-Franche-Comté, Besançon, France.
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