1
|
Duployez C, Millière L, Senneville E, Piantoni L, Migaud H, Wallet F, Loïez C. Evolution of antibiotic susceptibility profiles of staphylococci from osteoarticular infections: A 10-year retrospective study. Orthop Traumatol Surg Res 2023; 109:103512. [PMID: 36528264 DOI: 10.1016/j.otsr.2022.103512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/12/2022] [Accepted: 10/17/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Knowledge of the antibiotic susceptibility profiles of the bacteria responsible for osteoarticular infections is crucial for choosing the appropriate empirical antibiotic regimen. Wide use of broad spectrum antibiotics in these infections may have lead to selection of resistant bacteria. The aim of our study was to answer to these questions: (1) Did the bacterial pathogens isolated from osteoarticular infections (OAIs) and their antibiotic susceptibility profile change over the 10-year period in our University Hospital, particularly for Staphylococcus aureus and Coagulase negative staphylococci? (2) Are the antibiotics used for post-operative antibiotic therapy still effective against staphylococci involved in OAIs? (3) Are the antibiotics used for documented therapy still effective against staphylococci involved in OAIs? HYPOTHESIS We hypothetise that bacterial epidemiology and antibiotic resistance rates have changed little thanks to a reasoned prescription of antibiotics in our Center. MATERIALS AND METHODS We performed a retrospective study describing the antibiotic susceptibility profile of bacteria isolated from osteoarticular infections over 10years in our University Hospital, with a focus on the Staphylococcus genus. RESULTS A total of 3474 staphylococci were included (2373 coagulase negative staphylococci and 1101 S. aureus), 34.8% (1207/3469) of which were resistant to methicillin. Antibiotic susceptibility profiles remained quite stable between 2010 and 2019, except for rifampicin (14.1% (45/318) versus 5.7% (23/401), p=0.0001) and fluoroquinolones (35.3% (109/309) versus 20.3% (81/399), p=0.000008) for which resistance rates significantly decreased even among methicillin-resistant strains. DISCUSSION In spite of wide use of antibiotics in orthopaedic units, overall resistance rates did not increase over the last 10years. The prescription of these molecules in combination regimens guided by the antibiotic susceptibility patterns performed on reliable samples and on the basis of multidisciplinary discussions may explain these results. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Claire Duployez
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France; University Hospital of Lille, 59037 Lille, France.
| | - Laurine Millière
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Eric Senneville
- University Hospital of Lille, 59037 Lille, France; Infectious Diseases Department, Gustave Dron Hospital, Rue du Président Coty, 59200 Tourcoing, France
| | - Luc Piantoni
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Henri Migaud
- Orthopaedic Department, Lille University Hospital, Hôpital Salengro, Rue Emile Laine, 59037 Lille, France
| | - Frédéric Wallet
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| | - Caroline Loïez
- Centre de Biologie-Pathologie, Institute of Microbiology, Lille University Hospital, Rue du Pr. Jules Leclercq, 59037 Lille, France
| |
Collapse
|
2
|
Mimram L, Magréault S, Kerroumi Y, Salmon D, Kably B, Marmor S, Jannot AS, Jullien V, Zeller V. What clindamycin dose should be administered by continuous infusion during combination therapy with rifampicin? A prospective population pharmacokinetics study. J Antimicrob Chemother 2023; 78:2943-2949. [PMID: 37883695 DOI: 10.1093/jac/dkad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Despite its important drug-drug interaction, combined clindamycin/rifampicin therapy may achieve effective plasma clindamycin concentrations, provided clindamycin is administered by continuous infusion. However, the precise clindamycin dose remains unknown. OBJECTIVES This study was undertaken to determine the daily clindamycin dose to be administered by continuous infusion in combination with rifampicin to achieve effective plasma clindamycin concentrations. PATIENTS AND METHODS Two plasma clindamycin concentrations were determined prospectively for 124 patients with bone-and-joint infections treated with continuously infused clindamycin. Twenty patients received clindamycin monotherapy, 19 clindamycin combined with rifampicin and 85 received clindamycin successively without and with rifampicin. A population pharmacokinetic model was developed using NONMEM 7.5. Monte Carlo simulations were run to determine which regimens obtained clindamycin concentrations of at least 3 mg/L. RESULTS A linear one-compartment model with first-order elimination accurately described the data. Clindamycin distribution volume was not estimated. Mean clindamycin clearances with rifampicin and without, respectively, were 33.6 and 10.9 L/h, with 12.8% interindividual variability. The lowest daily clindamycin dose achieving plasma concentrations of at least 3 mg/L in >90% of the patients, when combined with rifampicin, was 4200 mg/24 h. CONCLUSIONS Our results support continuous infusion of 4200 mg of clindamycin/24 h, in combination with rifampicin. This high-dose regimen requires therapeutic drug monitoring-guided dose adaptation.
Collapse
Affiliation(s)
- Léo Mimram
- Unité Fonctionelle de Pharmacologie, GHU Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris (APHP), Université Sorbonne Paris Nord, Bondy, France
| | - Sophie Magréault
- Unité Fonctionelle de Pharmacologie, GHU Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris (APHP), Université Sorbonne Paris Nord, Bondy, France
- IAME UMR 1137, Inserm and Sorbonne Paris Nord University, Team Biostatistic Modeling, Clinical Investigation and Pharmacometrics in Infectious Diseases, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Dominique Salmon
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Benjamin Kably
- Service de Pharmacologie DMU BioPhyGen, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Anne-Sophie Jannot
- Service d'Informatique Médicale, Biostatistiques et Santé Publique, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Vincent Jullien
- Unité Fonctionelle de Pharmacologie, GHU Paris Seine Saint-Denis, Assistance Publique-Hôpitaux de Paris (APHP), Université Sorbonne Paris Nord, Bondy, France
- IAME UMR 1137, Inserm and Sorbonne Paris Nord University, Team Biostatistic Modeling, Clinical Investigation and Pharmacometrics in Infectious Diseases, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes (CRIOAc), Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| |
Collapse
|
3
|
Tomoyama A, Kobayashi N, Choe H, Ike H, Yukizawa Y, Higashihira S, Takagawa S, Kumagai K, Inaba Y. A Comparison of the Minimum Inhibitory Concentration of Antibiotics in Staphylococcus Species Isolated From Orthopedic and Respiratory Medicine Infections. Cureus 2023; 15:e49535. [PMID: 38156162 PMCID: PMC10753157 DOI: 10.7759/cureus.49535] [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] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Antibiotic susceptibility is very important for the successful treatment of orthopedic infections, particularly for implant-related infections. While the minimum inhibitory concentrations (MICs) of Staphylococcus species were well investigated for the isolates from the respiratory tract, investigations for orthopedic pathogens are very limited. We investigated the antibiotic MIC values of Staphylococcus species isolated from orthopedic infections and compared them with those of respiratory medicine isolates used as a control. METHODS The MICs of vancomycin (VCM), arbekacin (ABK), teicoplanin (TEIC), linezolid (LZD), and rifampicin (RFP) of a total of consecutive 259 (89 orthopedic and 170 respiratory) Staphylococcus speciesisolated in our laboratory from January 2013 to July 2016 were retrospectively reviewed. Differences between the MICs of each antibiotic in orthopedic and respiratory samples were determined. RESULTS The number of methicillin-sensitive Staphylococcus aureus (MSSA) with a VCM MIC of <0.5 μg/mL among respiratory isolates was significantly higher than that among orthopedic isolates, while those with a MIC of 2 μg/mL were significantly lower (P = 0.0078). The proportion of methicillin-resistant coagulase-negative staphylococci (MRCNS) isolates with a VCM MIC of 2 μg/mL was significantly higher in orthopedic samples than that of methicillin-resistant Staphylococcus aureus (MRSA) (P < 0.001) in respiratory isolates. The proportion of MRCNS orthopedic isolates with an RFP MIC of >2 μg/mL was significantly higher (P = 0.0058) than that of other orthopedic staphylococci. CONCLUSIONS The VCM MICs of Staphylococcus species from orthopedic infections were higher than those of respiratory samples, particularly MRCNS from implant-related samples.
Collapse
Affiliation(s)
- Akito Tomoyama
- Department of Laboratory Medicine, Yokohama City University Hospital, Yokohama, JPN
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, JPN
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, JPN
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shota Higashihira
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Shu Takagawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, JPN
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, JPN
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, JPN
| |
Collapse
|
4
|
Reinecke P, Morovic P, Niemann M, Renz N, Perka C, Trampuz A, Meller S. Adverse Events Associated with Prolonged Antibiotic Therapy for Periprosthetic Joint Infections-A Prospective Study with a Special Focus on Rifampin. Antibiotics (Basel) 2023; 12:1560. [PMID: 37998762 PMCID: PMC10668752 DOI: 10.3390/antibiotics12111560] [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: 10/03/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/25/2023] Open
Abstract
Periprosthetic Joint Infection (PJI) is a significant contributor to patient morbidity and mortality, and it can be addressed through a range of surgical interventions coupled with antibiotic therapies. Following surgical intervention(s), prolonged administration of oral antibiotics is recommended to cure PJI. There is a lack of reports on the adverse events (AEs) associated with oral antibiotics, particularly rifampin. This investigation sought to elucidate the occurrence of antibiotic-related AEs after an initial regimen of intravenous antibiotic administration, supplemented by an extended course of oral antibiotics. A prospective study of patients diagnosed with PJI of the hip, knee, or shoulder who underwent single-stage exchange arthroplasty (SSE) (10%), two-stage exchange arthroplasty (TSE) (81%), or debridement, antibiotics, and implant retention (DAIR) (6%) was performed. The primary outcome of interest was the detection of AEs, the secondary outcome the detection of a correlation between rifampin use and the incidence of AEs, and the tertiary outcome was whether oral antibiotic treatment needed to be adjusted or discontinued due to AEs. In addition, subjective tolerability was monitored throughout the study. A total of 336 events were identified for 73 out of 80 patients. The most frequently used antibiotics were rifampin and co-trimoxazole. Most AEs occurred in the gastrointestinal tract (46%). The most frequent AEs were nausea, inappetence, diarrhea, and skin rash. In 6% of cases, the AEs led to antibiotic discontinuation, and in 29% of cases, a dose adjustment of the oral therapy occurred, mainly with amoxicillin or co-trimoxazole. The majority of patients (55%) rated the subjective tolerability as good. In conclusion, AEs during antibiotic treatment for PJI are common. They mainly affect the gastrointestinal tract. Rifampin use might be a reason for the higher incidence of AEs compared to non-rifampin antibiotic treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sebastian Meller
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Center for Musculoskeletal Surgery (CMSC), Augustenburger Platz 1, 13353 Berlin, Germany; (P.R.); (P.M.); (M.N.); (N.R.); (C.P.); (A.T.)
| |
Collapse
|
5
|
Magréault S, Charbit J, Berkane N, Jaureguy F, Carbonnelle E, Cosson E, Jullien V, Bihan H. Usefulness of Therapeutic Drug Monitoring to Manage Clindamycin-Rifampicin Interaction in a Patient with Diabetic Foot Osteomyelitis. Ther Drug Monit 2023; 45:703-706. [PMID: 37559218 DOI: 10.1097/ftd.0000000000001123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
- Sophie Magréault
- Department of Pharmacology, AP-HP, Jean Verdier Hospital, Sorbonne Paris Nord and Sorbonne Paris Cité University, IAME, Bobigny, France
| | - Judith Charbit
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Sorbonne Paris Cité University, Bobigny, France
| | - Narimane Berkane
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Sorbonne Paris Cité University, Bobigny, France
| | - Françoise Jaureguy
- Department of Clinical Microbiology, AP-HP, Avicenne Hospital, Sorbonne Paris Nord and Sorbonne Paris Cité University, IAME, Bobigny, France; and
| | - Etienne Carbonnelle
- Department of Clinical Microbiology, AP-HP, Avicenne Hospital, Sorbonne Paris Nord and Sorbonne Paris Cité University, IAME, Bobigny, France; and
| | - Emmanuel Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Sorbonne Paris Cité University, Bobigny, France
| | - Vincent Jullien
- Department of Pharmacology, AP-HP, Jean Verdier Hospital, Sorbonne Paris Nord University, Bobigny, France
| | - Hélène Bihan
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, AP-HP, Avicenne Hospital, Sorbonne Paris Cité University, Bobigny, France
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Wouthuyzen-Bakker M, Scheper H. Rifampicin in periprosthetic joint infections: where do we stand and where are we headed? Expert Rev Anti Infect Ther 2023:1-7. [PMID: 37141111 DOI: 10.1080/14787210.2023.2211263] [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: 05/05/2023]
Abstract
INTRODUCTION A periprosthetic joint infection (PJI) is a major complication of arthroplasty. Treatment of PJI consists of surgical debridement with or without the exchange of the implant and long-term antimicrobial treatment. Rifampicin is regarded as one of the cornerstones of antimicrobial treatment for staphylococcal PJI, but the exact role of rifampicin for PJI in different clinical scenarios remains to be elucidated. AREAS COVERED In this perspective article, an overview is provided of in vitro, in vivo and clinical studies that were the basis of the current guidelines and recommendations for rifampicin use in daily practice for PJI. Controversial issues on indication, dosing, timing, duration and antibiotic drug interactions will be addressed. Finally, the most urgent clinical questions on rifampicin use that need answering in the nearby future will be formulated. EXPERT OPINION Many inquiries remain concerning the exact indications and clinical use of rifampicin in PJI. Randomized controlled trials are needed to answer these questions.
Collapse
Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of medical microbiology and infection prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk Scheper
- Department of infectious diseases, Leiden University Medical Center, University of Leiden, Leiden, The Netherlands
| |
Collapse
|
8
|
Khairullah AR, Sudjarwo SA, Effendi MH, Ramandinianto SC, Gelolodo MA, Widodo A, Riwu KHP, Kurniawati DA. Review of pork and pork products as a source for transmission of methicillin-resistant Staphylococcus aureus. INTERNATIONAL JOURNAL OF ONE HEALTH 2022. [DOI: 10.14202/ijoh.2022.167-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterium that can cause infection in animals and humans. Recently, MRSA from food-producing or farm animals has been identified as livestock-associated MRSA (LA-MRSA). The spread of LA-MRSA is particularly found in pork and pork products because LA-MRSA has been widely known to infect pigs. The most common type of LA-MRSA identified in pork and pork products is the clonal complex LA-MRSA 398 (LA-MRSA CC398). The MRSA strains on the surface of pork carcasses can be spread during the handling and processing of pork and pork products through human hands, cutting tools, and any surface that comes into direct contact with pork. Food infection is the main risk of MRSA in pork and pork products consumed by humans. Antibiotics to treat food infection cases due to MRSA infection include vancomycin and tigecycline. The spread of MRSA in pork and pork products is preventable by appropriately cooking and cooling the pork and pork products at temperatures above 60°C and below 5°C, respectively. It is also necessary to take other preventive measures, such as having a clean meat processing area and disinfecting the equipment used for processing pork and pork products. This review aimed to explain epidemiology, transmission, risk factors, diagnosis, public health consequences, treatment of food poisoning, and preventing the spread of MRSA in pork and pork products.
Collapse
Affiliation(s)
- Aswin Rafif Khairullah
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sri Agus Sudjarwo
- Department of Veterinary Pharmacology, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Mustofa Helmi Effendi
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Sancaka Cashyer Ramandinianto
- Master Program in Veterinary Disease and Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Maria Aega Gelolodo
- Department of Animal Infectious Diseases and Veterinary Public Health, Faculty of Medicine and Veterinary Medicine, Universitas Nusa Cendana, Kupang, Indonesia
| | - Agus Widodo
- Doctoral Program in Veterinary Science, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | - Dyah Ayu Kurniawati
- Master Program in Veterinary Disease and Public Health, Faculty of Veterinary Medicine, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
9
|
Aguilera-Correa JJ, Gisbert-Garzarán M, Mediero A, Fernández-Aceñero MJ, de-Pablo-Velasco D, Lozano D, Esteban J, Vallet-Regí M. Antibiotic delivery from bone-targeted mesoporous silica nanoparticles for the treatment of osteomyelitis caused by methicillin-resistant Staphylococcus aureus. Acta Biomater 2022; 154:608-625. [PMID: 36341887 DOI: 10.1016/j.actbio.2022.10.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 12/14/2022]
Abstract
Osteomyelitis is a hard-to-treat infection of the bone and bone marrow that is mainly caused by Staphylococcus aureus, with an increasing incidence of methicillin-resistant S. aureus (MRSA). Owing to the aggressiveness of these bacteria in colonizing and destroying the bone, systemic antibiotic treatments fail to eradicate the infection. Instead, it normally entails surgery to remove the dead or infected bone. In this work, we report bone-targeted mesoporous silica nanoparticles for the treatment of osteomyelitis. The nanoparticles have been engineered with a functional gelatine/colistin coating able to hamper premature release from the mesopores while effectively disaggregating the bacterial biofilm. Because antibiotic resistance is a global emergency, we have designed two sets of identical nanoparticles, carrying each of them a clinically relevant antibiotic, that have demonstrated to have synergistic effect. The bone-targeted nanoparticles have been thoroughly evaluated in vitro and in vivo, obtaining a notable reduction of the amount of bacteria in the bone in just 24 h after only one dose, and paving the way for localized, nanoparticle-mediated treatment of MRSA-caused osteomyelitis. STATEMENT OF SIGNIFICANCE: In this work, we propose the use of bone-targeted mesoporous silica nanoparticles to address S. aureus-caused osteomyelitis that render synergistic therapeutic effect via multidrug delivery. Because the bacterial biofilm is responsible for an aggressive surgical approach and prolonged antibiotic treatment, the nanoparticles have been functionalized with a functional coating able to both disaggregate the biofilm, hamper premature antibiotic release and protect the intact bone. These engineered nanoparticles are able to effectively target bone tissue both in vitro and in vivo, showing high biocompatibility and elevated antibacterial effect.
Collapse
Affiliation(s)
- J J Aguilera-Correa
- Departamento de Química en Ciencias Farmacéuticas, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre i+12, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - M Gisbert-Garzarán
- Departamento de Química en Ciencias Farmacéuticas, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre i+12, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - A Mediero
- Bone and Joint Unit, IIS- Fundación Jimenez Diaz, UAM, Avenida Reyes Católicos, 2 28037 Madrid, Spain
| | | | | | - D Lozano
- Departamento de Química en Ciencias Farmacéuticas, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre i+12, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - J Esteban
- CIBER de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain; Clinical Microbiology Department, IIS-Fundación Jiménez Diaz, UAM, Avenida Reyes Católicos, 2 28037 Madrid, Spain.
| | - M Vallet-Regí
- Departamento de Química en Ciencias Farmacéuticas, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital 12 de Octubre i+12, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain.
| |
Collapse
|
10
|
Mian HM, Lyons JG, Perrin J, Froehle AW, Krishnamurthy AB. A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. ARTHROPLASTY 2022; 4:31. [PMID: 36045436 PMCID: PMC9434893 DOI: 10.1186/s42836-022-00136-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection remains a significant challenge for arthroplasty surgeons globally. Over the last few decades, there has been much advancement in terms of treatment and diagnosis, however, the fight rages on. As management of periprosthetic joint infections continues to evolve, it is critical to reflect back on current debridement practices to establish common ground as well as identify areas for future research and improvement. BODY: In order to understand the debridement techniques of periprosthetic joint infections, one must also understand how to diagnose a periprosthetic joint infection. Multiple definitions have been elucidated over the years with no single consensus established but rather sets of criteria. Once a diagnosis has been established the decision of debridement method becomes whether to proceed with single vs two-stage revision based on the probability of infection as well as individual patient factors. After much study, two-stage revision has emerged as the gold standard in the management of periprosthetic infections but single-stage remains prominent with further and further research. CONCLUSION Despite decades of data, there is no single treatment algorithm for periprosthetic joint infections and subsequent debridement technique. Our review touches on the goals of debridement while providing a perspective as to diagnosis and the particulars of how intraoperative factors such as intraarticular irrigation can play pivotal roles in infection eradication. By providing a perspective on current debridement practices, we hope to encourage future study and debate on how to address periprosthetic joint infections best.
Collapse
Affiliation(s)
- Humza M Mian
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA.
| | - Joseph G Lyons
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
| | - Joshua Perrin
- Wright State University Boonshoft School of Medicine, Wright State Physicians Bldg, 725 University Blvd., Dayton, OH, 45435, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
- School of Nursing, Kinesiology and Health, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA
| | - Anil B Krishnamurthy
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, 30 E. Apple St. Suite #2200, Dayton, OH, 45409, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Ways to Improve Insights into Clindamycin Pharmacology and Pharmacokinetics Tailored to Practice. Antibiotics (Basel) 2022; 11:antibiotics11050701. [PMID: 35625345 PMCID: PMC9137603 DOI: 10.3390/antibiotics11050701] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 02/07/2023] Open
Abstract
Given the increase in bacterial resistance and the decrease in the development of new antibiotics, the appropriate use of old antimicrobials has become even more compulsory. Clindamycin is a lincosamide antibiotic approved for adults and children as a drug of choice for systemic treatment of staphylococcal, streptococcal, and gram-positive anaerobic bacterial infections. Because of its profile and high bioavailability, it is commonly used as part of an oral multimodal alternative for prolonged parenteral antibiotic regimens, e.g., to treat bone and joint or prosthesis-related infections. Clindamycin is also frequently used for (surgical) prophylaxis in the event of beta-lactam allergy. Special populations (pediatrics, pregnant women) have altered cytochrome P450 (CYP)3A4 activity. As clindamycin is metabolized by the CYP3A4/5 enzymes to bioactive N-demethyl and sulfoxide metabolites, knowledge of the potential relevance of the drug’s metabolites and disposition in special populations is of interest. Furthermore, drug–drug interactions derived from CYP3A4 inducers and inhibitors, and the data on the impact of the disease state on the CYP system, are still limited. This narrative review provides a detailed survey of the currently available literature on pharmacology and pharmacokinetics and identifies knowledge gaps (special patient population, drug–drug, and drug–disease interactions) to describe a research strategy for precision medicine.
Collapse
|
13
|
Wald-Dickler N, Holtom PD, Phillips MC, Centor RM, Lee RA, Baden R, Spellberg B. Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review. Am J Med 2022; 135:369-379.e1. [PMID: 34715060 PMCID: PMC8901545 DOI: 10.1016/j.amjmed.2021.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/03/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND We sought to determine if controlled, prospective clinical data validate the long-standing belief that intravenous (IV) antibiotic therapy is required for the full duration of treatment for 3 invasive bacterial infections: osteomyelitis, bacteremia, and infective endocarditis. METHODS We performed a systematic review of published, prospective, controlled trials that compared IV-only to oral stepdown regimens in the treatment of these diseases. Using the PubMed database, we identified 7 relevant randomized controlled trials (RCTs) of osteomyelitis, 9 of bacteremia, 1 including both osteomyelitis and bacteremia, and 3 of endocarditis, as well as one quasi-experimental endocarditis study. Study results were synthesized via forest plots and funnel charts (for risk of study bias), using RevMan 5.4.1 and Meta-Essentials freeware, respectively. RESULTS The 21 studies demonstrated either no difference in clinical efficacy, or superiority of oral versus IV-only antimicrobial therapy, including for mortality; in no study was IV-only treatment superior in efficacy. The frequency of catheter-related adverse events and duration of inpatient hospitalization were both greater in IV-only groups. DISCUSSION Numerous prospective, controlled investigations demonstrate that oral antibiotics are at least as effective, safer, and lead to shorter hospitalizations than IV-only therapy; no contrary data were identified. Treatment guidelines should be modified to indicate that oral therapy is appropriate for reasonably selected patients with osteomyelitis, bacteremia, and endocarditis.
Collapse
Affiliation(s)
- Noah Wald-Dickler
- Los Angeles County + University of Southern California Medical Center, Los Angeles; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul D Holtom
- Los Angeles County + University of Southern California Medical Center, Los Angeles; Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Matthew C Phillips
- Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Robert M Centor
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham; Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Ala
| | - Rachael A Lee
- Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham; Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Ala
| | - Rachel Baden
- Los Angeles County + University of Southern California Medical Center, Los Angeles
| | - Brad Spellberg
- Los Angeles County + University of Southern California Medical Center, Los Angeles.
| |
Collapse
|
14
|
Totten KMC, Patel R. Phage Activity against Planktonic and Biofilm Staphylococcus aureus Periprosthetic Joint Infection Isolates. Antimicrob Agents Chemother 2022; 66:e0187921. [PMID: 34662191 PMCID: PMC8765226 DOI: 10.1128/aac.01879-21] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023] Open
Abstract
We recently reported the successful treatment of a case of periprosthetic joint infection (PJI) with phage. Phage activity against bacteria causing PJI has not been systematically evaluated. Here, we examined the in vitro activity of seven phages against 122 clinical isolates of Staphylococcus aureus recovered between April 1999 and February 2018 from subjects with PJI. Phages were assessed against planktonic and biofilm phenotypes. Activity of individual phages was demonstrated against up to 73% of bacterial isolates in the planktonic state and up to 100% of biofilms formed by isolates that were planktonically phage susceptible. Susceptibility to phage was not correlated with small-colony-variant phenotype for planktonic or biofilm bacteria; correlation between antibiotic susceptibility and planktonic phage susceptibility and between biofilm phage susceptibility and strength of biofilm formation were noted under select conditions. These results demonstrate that phages can infect S. aureus causing PJI in both planktonic and biofilm phenotypes, and thus are worthy of investigation as an alternative or addition to antibiotics in this setting.
Collapse
Affiliation(s)
- Katherine M. C. Totten
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Pietsch M, Hochegger M, Djahani O, Hofmann S, Mlaker G, Eder-Halbedl M, Hofstätter T. A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees. Knee Surg Sports Traumatol Arthrosc 2021; 29:3186-3194. [PMID: 32556435 DOI: 10.1007/s00167-020-06106-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients. METHODS A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1 years (range 2.0-9.9 years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2 weeks intravenously and orally for 4 weeks. TKA implantation was performed 6 weeks after the first stage. RESULTS The infection was eradicated without recurrence in all patients. The functional results were significantly improved, and pain was significantly reduced after spacer and TKA implantation. The mean amount of knee flexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation. CONCLUSION The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was effective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the final follow-up. No intra- or postoperative complications occurred.
Collapse
Affiliation(s)
- M Pietsch
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
| | - M Hochegger
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - O Djahani
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - S Hofmann
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - G Mlaker
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - M Eder-Halbedl
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - Th Hofstätter
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| |
Collapse
|
16
|
Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection: What Predicts Success or Failure? J Arthroplasty 2021; 36:3562-3569. [PMID: 34116912 DOI: 10.1016/j.arth.2021.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/17/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Debridement, antibiotics and implant retention (DAIR) is the treatment of choice for acute postoperative and acute hematogenous periprosthetic joint infection (PJI). There is limited literature on predictive prognostic factors for DAIR. We aim to report the outcomes of DAIR and investigate the predictive prognostic factors. METHODS We retrospectively reviewed 106 DAIRs. Failure was defined as requiring removal of TKA implants. Predictive factors that may influence success of DAIR treatment such as age, gender, body mass index, ethnicity, American Society of Anesthesiologists score, comorbidities, preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein, symptom duration, time between total knee arthroplasty and DAIR, cultures, rifampicin use, polyethylene liner change, and antibiotic duration were analyzed. RESULTS The success rate of DAIR was 69.8% (74/106 patients). For successes, mean time from DAIR-to-mortality was longer than failures (61.6 ± 42.7 vs 9.75 ± 9.60 months, P = .0150). Methicillin-susceptible Staphylococcus aureus PJI (odds ratio [OR] 3.64, confidence interval [CI] 1.30-10.2, P = .0140) was a significant predictor for failure of DAIR. Higher preoperative ESR correlated to failure (OR 1.02, CI 1.01-1.04, P = .008). In successes, mean ESR was 75.4 (66.1-84.6), whereas mean ESR in failures was 116 (88.3-143) (P = .011). An ESR > 107.5 predicted failure with a sensitivity of 51.5 and specificity of 85.2. ESR > 107.5 correlated to failure (OR 6.60, CI 2.29-19.0, P < .001). Repeat DAIRs were strongly correlated to failure (OR 5.27, CI 1.99-13.9, P < .01). CONCLUSION DAIR failure is associated with earlier time to mortality. Repeat DAIRs, elevated ESR > 107.5, and S aureus PJI are associated with treatment failure and 2-stage revision is recommended.
Collapse
|
17
|
Schildkraut JA, Zweijpfenning SMH, Nap M, He K, Dacheva E, Overbeek J, Tostmann A, Wertheim HFL, Hoefsloot W, van Ingen J. The epidemiology of nontuberculous mycobacterial pulmonary disease in the Netherlands. ERJ Open Res 2021; 7:00207-2021. [PMID: 34262970 PMCID: PMC8273392 DOI: 10.1183/23120541.00207-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/05/2022] Open
Abstract
Background Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens of humans. Because NTM pulmonary disease (PD) is not a notifiable disease in Europe, the epidemiology of NTM-PD is not well known. However, the prevalence of NTM-PD is thought to be increasing, particularly in countries where tuberculosis rates have decreased. Here we aim to determine the prevalence of NTM-PD in the Netherlands. Methods Annual prevalence estimates of NTM-PD in the Netherlands (2012-2019) were derived from four separate databases, including two drug dispensing databases, an ICD-10 code database and a hospitalisation database. Databases covered a fraction of the Dutch population and were extrapolated. In addition, annual NTM-PD prevalence was also estimated by means of a pulmonologist survey. Results The estimated annual prevalence of NTM-PD using databases is between 2.3 and 5.9 patients per 100 000 inhabitants. Prevalence estimates derived from the drug dispensing databases, the hospitalisation database and the claims database were 2.3, 5.9, 3.5 and 4.5 per 100 000 inhabitants, respectively. The annual prevalence estimated in the pulmonologist survey was between 6.2 and 9.9 per 100 000 inhabitants. The annual prevalence remained stable over the included period. Conclusion The estimated annual prevalence of NTM-PD using databases was between 2.3 and 5.9 patients per 100 000 inhabitants. Due to the possible presence of tuberculosis patients and low coverage in one dispensing database, we believe an annual prevalence of between 2.3 and 4.5 patients per 100 000 inhabitants is more probable, which still renders NTM-PD a serious health threat. This estimate is lower than the estimate from the pulmonologist survey, indicating physicians likely overestimate prevalence.
Collapse
Affiliation(s)
- Jodie Anne Schildkraut
- Dept of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Martijn Nap
- IQVIA Analytics Solutions, Amsterdam, the Netherlands
| | - Kun He
- IQVIA Analytics Solutions, Amsterdam, the Netherlands
| | - Elena Dacheva
- IQVIA Analytics Solutions, Amsterdam, the Netherlands
| | - Jetty Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Alma Tostmann
- Dept of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Dept of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wouter Hoefsloot
- Dept of Pulmonary Diseases, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jakko van Ingen
- Dept of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
18
|
Beldman M, Löwik C, Soriano A, Albiach L, Zijlstra WP, Knobben BAS, Jutte P, Sousa R, Carvalho A, Goswami K, Parvizi J, Belden KA, Wouthuyzen-Bakker M. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis 2021; 73:1634-1641. [PMID: 33970214 PMCID: PMC8563307 DOI: 10.1093/cid/ciab426] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Rifampin is generally advised in the treatment of acute staphylococcal periprosthetic joint infections (PJI). However, if, when, and how to use rifampin remains a matter of debate. We evaluated the outcome of patients treated with and without rifampin, and analyzed the influence of timing, dose and co-antibiotic. Methods Acute staphylococcal PJIs treated with surgical debridement between 1999 and 2017, and a minimal follow-up of 1 year were evaluated. Treatment failure was defined as the need for any further surgical procedure related to infection, PJI-related death or the need for suppressive antimicrobial treatment. Results A total of 669 patients were analyzed. Treatment failure was 32.2% (131/407) in patients treated with rifampin and 54.2% (142/262) in whom rifampin was withheld (P < .001). The most prominent effect of rifampin was observed in knees (treatment failure 28.6% versus 63.9%, respectively, P < .001). The use of rifampin was an independent predictor of treatment success in the multi-variate analysis (OR 0.30, 95% CI 0.20 – 0.45). In the rifampin group, the use of a co-antibiotic other than a fluoroquinolone or clindamycin (OR 10.1, 95% CI 5.65 – 18.2) and the start of rifampin within 5 days after surgical debridement (OR 1.96, 95% CI 1.08 – 3.65) were predictors of treatment failure. The dosing of rifampin had no effect on outcome. Conclusions Our data supports the use of rifampin in acute staphylococcal PJIs treated with surgical debridement, particularly in knees. Immediate start of rifampin after surgical debridement should probably be discouraged, but requires further investigation.
Collapse
Affiliation(s)
- Mark Beldman
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Claudia Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Laila Albiach
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Paul Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
19
|
Sharma N, Chhillar AK, Dahiya S, Punia A, Choudhary P, Gulia P, Behl A, Dangi M. Chemotherapeutic Strategies for Combating Staphylococcus aureus Infections. Mini Rev Med Chem 2021; 22:26-42. [PMID: 33797362 DOI: 10.2174/1389557521666210402150325] [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] [Received: 10/09/2020] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022]
Abstract
Staphylococcus aureus is a prominent human pathogen that causes nosocomial and community acquired infections. The accelerating emergence and prevalence of staphylococcal infections have grotesque health consequences which are mostly due to its anomalous capability to acquire drug resistance and scarcity of novel classes of antibacterials. Many combating therapies are centered on primary targets of S. aureus which are cell envelope, ribosomes and nucleic acids. This review describes various chemotherapeutic strategies for combating S. aureus infections which includes monotherapy, combination drug therapy, phage endolysin therapy, lysostaphins and antibacterial drones. Monotherapy has dwindled in due course of time but combination therapy, endolysin therapy, lysostaphin and antibacterial drones are emerging alternatives which efficiently conquer the shortcomings of monotherapy. Combinations of more than one antibiotic agents or combination of adjuvant with antibiotics provide a synergistic approach to combat infections causing pathogenic strains. Phage endolysin therapy and lysostaphin are also presents as possible alternatives to conventional antibiotic therapies. Antibacterial Drones goes a step further by specifically targeting the virulence genes in bacteria giving them a certain advantage over existing antibacterial strategies. But the challenge remains on the better understanding of these strategies for executing and implementing them in health sector. In this day and age, most of the S. aureus strains are resistant to ample number of antibiotics, so there is an urgent need to overcome such multidrug resistant strains for the welfare of our community.
Collapse
Affiliation(s)
| | | | | | - Aruna Punia
- Centre for Biotechnology, MDU, Rohtak 124001. India
| | | | - Prity Gulia
- Centre for Biotechnology, MDU, Rohtak 124001. India
| | | | - Mehak Dangi
- Centre for Bioinformatics, MDU, Rohtak 124001. India
| |
Collapse
|
20
|
Zhang CF, He L, Fang XY, Huang ZD, Bai GC, Li WB, Zhang WM. Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection. Orthop Surg 2020; 12:463-470. [PMID: 32159296 PMCID: PMC7189032 DOI: 10.1111/os.12641] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To report on our clinical outcomes and on the experience of managing acute periprosthetic joint infection (PJI) with debridement, antibiotics, and implant retention (DAIR). Methods We performed a retrospective review of all patients who were diagnosed with acute PJI after primary hip or knee replacement surgeries and who were managed with DAIR in our prospective joint replacement registry from 2008 to 2019. The diagnosis of PJI was made according to the 2011 Musculoskeletal Infection Society (MSIS) criteria. The symptom onset duration, inflammatory marker levels (i.e. C‐reactive protein [CRP], erythrocyte sedimentation rate [ESR], white cell count [WBC], and synovial WBC count), functional scores including the Knee Society Score (KSS), the KSS functional score and the Harris Hip Score (HHS), bacteriology, and surgical outcomes of the patients were tracked and recorded. A paired sample of joint fluid and tissues was also sent for a metagenomic next‐generation sequencing (mNGS) test. A paired‐samples t‐test was used to compare the differences in the inflammatory markers and functional scores before and after surgery. Results A total of 24 patients with 7 infections after hip replacements and 17 infections after knee replacements were included. A total of 21 patients exhibited early postoperative infections, and 3 exhibited late acute hematogenous infections. During a mean follow‐up time of 29.2 ± 15.1 months, 22 patients were successfully treated, whereas 2 patients were unsuccessfully treated and required repeated DAIR. The overall success rate of DAIR was 91.7%. For staphylococcal infections, DAIR had a 100% success rate. Five patients who presented with symptoms between 4 and 8 weeks also achieved a 100% success rate. At the last follow‐up, the mean CRP level decreased from 52.6 ± 34.0 to 5.4 ± 3.5 (P < 0.001), and the mean ESR level decreased from 72.3 ± 34.3 to 20.2 ± 12.1 (P < 0.001). The mean KSS score increased from 44.8 ± 12.2 to 81.4 ± 9.2 (P < 0.001), and the mean KSS functional score increased from 38.1 ± 3.5 to 73.9 ± 23.0 (P < 0.001), and the mean HHS score increased from 34.4 ± 6.9 to 84.1 ± 15.1 (P < 0.001). The overall pathogen identification rate was 91.7% (22/24 cases). The success rates for Staphylococcus, Streptococcus, and the other pathogens were 100% (9/9 cases), 71.4% (5/7 cases), and 100% (6/6 cases), respectively. Conclusion Debridement, antibiotics, and implant retention has a high success rate for the treatment of acute PJI and may be performed in selected patients whose symptoms have been sustained for over 4 weeks. A high rate of success for staphylococcal infections was reported with the use of DAIR.
Collapse
Affiliation(s)
- Chao-Fan Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Long He
- Department of Hand Surgery, The Second Hospital of Fuzhou Affiliated to Xiamen University, Fuzhou, China
| | - Xin-Yu Fang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-da Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guo-Chang Bai
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
21
|
Grecka K, Kuś PM, Okińczyc P, Worobo RW, Walkusz J, Szweda P. The Anti-Staphylococcal Potential of Ethanolic Polish Propolis Extracts. Molecules 2019; 24:molecules24091732. [PMID: 31058881 PMCID: PMC6540221 DOI: 10.3390/molecules24091732] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 01/24/2023] Open
Abstract
The principal objective of this study was to determine the anti-staphylococcal potential of ethanol extracts of propolis (EEPs). A total of 20 samples of propolis collected from apiaries located in different regions of Poland were used in the study. The two-fold broth microdilution method revealed some important differences in the antimicrobial activity of investigated EEPs. Up to the concentration of 4096 µg/mL no activity was observed against Gram-negative bacteria (E. coli and P. aeruginosa). Staphylococci exhibited much higher susceptibility. The highest efficiency observed for EEP12 and EEP20 (MIC values ranged between 32 and 256 µg/mL). However, the achievement of bactericidal effect usually required higher concentrations. In the case of clinical isolates of S. aureus MBC values for EEP12 and EEP20 ranged from 512 to 1024 µg/mL. The HPLC analysis revealed that these two products contained a higher concentration of flavonoids (flavonols, flavones, and flavanones) compared to other investigated EEPs. In checkerboard test, a synergistic anti-staphylococcal effect was observed for the action of EEP20 in combination with amikacin, kanamycin, gentamycin, tetracycline, and fusidic acid (all these antibiotics inhibit protein synthesis). Moreover, the investigated EEPs effectively eradicated staphylococcal biofilm. The obtained results clearly confirm the high anti-staphylococcal potential of propolis harvested in Polish apiaries.
Collapse
Affiliation(s)
- Katarzyna Grecka
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, ul. G. Narutowicza 11/12, 80-233 Gdańsk, Poland.
| | - Piotr M Kuś
- Department of Pharmacognosy and Herbal Medicines, Wrocław Medical University, ul. Borowska 211a, 50-556 Wrocław, Poland.
| | - Piotr Okińczyc
- Department of Pharmacognosy and Herbal Medicines, Wrocław Medical University, ul. Borowska 211a, 50-556 Wrocław, Poland.
| | - Randy W Worobo
- Department of Food Science, Cornell University, Ithaca, NY 14853, USA.
| | - Justyna Walkusz
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, ul. G. Narutowicza 11/12, 80-233 Gdańsk, Poland.
| | - Piotr Szweda
- Department of Pharmaceutical Technology and Biochemistry, Faculty of Chemistry, Gdańsk University of Technology, ul. G. Narutowicza 11/12, 80-233 Gdańsk, Poland.
| |
Collapse
|
22
|
Argenson JN, Arndt M, Babis G, Battenberg A, Budhiparama N, Catani F, Chen F, de Beaubien B, Ebied A, Esposito S, Ferry C, Flores H, Giorgini A, Hansen E, Hernugrahanto KD, Hyonmin C, Kim TK, Koh IJ, Komnos G, Lausmann C, Loloi J, Lora-Tamayo J, Lumban-Gaol I, Mahyudin F, Mancheno-Losa M, Marculescu C, Marei S, Martin KE, Meshram P, Paprosky WG, Poultsides L, Saxena A, Schwechter E, Shah J, Shohat N, Sierra RJ, Soriano A, Stefánsdóttir A, Suleiman LI, Taylor A, Triantafyllopoulos GK, Utomo DN, Warren D, Whiteside L, Wouthuyzen-Bakker M, Yombi J, Zmistowski B. Hip and Knee Section, Treatment, Debridement and Retention of Implant: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S399-S419. [PMID: 30348550 DOI: 10.1016/j.arth.2018.09.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Key Words
- acute periprosthetic joint infection (PJI)
- antibiotic combination
- antibiotic duration
- antibiotic therapy
- antibiotic treatment
- biofilm
- chronic obstructive pulmonary disease (COPD)), and C-reactive protein (CRP) >115 mg/L (C), rheumatoid arthritis (R), indication prosthesis (I), male (M), exchange of mobile components (E), age > 80 years (80) (CRIME80) scores
- chronic renal failure (K), liver cirrhosis (L), index surgery (I), cemented prosthesis (C), and C-reactive protein (CRP) >115 mg/L (KLIC) score
- contraindications
- debridement antibiotics and retention of the prosthesis
- debridement, antibiotics, implant retention (DAIR)
- emergency management
- exchange of modular components
- failed debridement, antibiotics, implant retention (DAIR) management
- fluoroquinolone
- gram-negative acute periprosthetic joint infection (PJI)
- indications
- infection recurrence
- intra-articular antibiotic infusion
- irrigation
- irrigation and debridement
- irrigation solution
- length of antibiotics
- megaprosthesis
- methicillin-resistant Staphylococcus aureus (MRSA)
- pathogen identification
- patient optimization
- periprosthetic joint infection (PJI) recurrence
- povidone-iodine
- rifampicin
- risk stratification
- surgical factors
- surgical intervention
- surgical outcome
- surgical outcomes
- surgical site infection (SSI) recurrence
- surgical timing
- treatment failure
- treatment success
- two-stage exchange arthroplasty
- unicompartmental knee arthroplasty debridement, antibiotics, implant retention (DAIR)
Collapse
|
23
|
Role of Rifampin against Staphylococcal Biofilm Infections In Vitro, in Animal Models, and in Orthopedic-Device-Related Infections. Antimicrob Agents Chemother 2019; 63:AAC.01746-18. [PMID: 30455229 DOI: 10.1128/aac.01746-18] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rifampin has been used as an agent in combination therapy in orthopedic device-related infections (ODRI) for almost three decades. The aim of this review is to provide data regarding the role of rifampin against biofilm infection in vitro, in animal models, and in clinical ODRI. Available data are gathered in order to present the rational use of rifampin combinations in patients with periprosthetic joint infection (PJI). The role of rifampin is well defined in patients with PJI and is indicated in those who fulfill the Infectious Diseases Society of America criteria for debridement and implant retention or one-stage exchange. It should be used with care because of the danger of rapid emergence of resistance. Potential drug interactions should be considered.
Collapse
|
24
|
Ho KK, Conley AC, Kennis RA, Hathcock TL, Boothe DM, White AG. Minimum inhibitory concentration and killing properties of rifampicin against canine Staphylococcus pseudintermedius isolates from dogs in the southeast USA. Vet Dermatol 2018; 29:302. [PMID: 29845664 DOI: 10.1111/vde.12653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 02/28/2024]
Abstract
BACKGROUND Meticillin-resistant (MR) staphylococcal pyoderma in dogs has led to increased use of alternate antibiotics such as rifampicin (RFP). However, little information exists regarding its pharmacodynamics in MR Staphylococcus pseudintermedius. HYPOTHESIS/OBJECTIVES To determine the minimum inhibitory concentration (MIC) and killing properties of RFP for canine Staphylococcus pseudintermedius isolates. METHODS The MIC of RFP was determined using the ETEST® for 50 meticillin-susceptible (MS) and 50 MR S. pseudintermedius isolates collected from dogs. From these isolates, two MS isolates (RFP MIC of 0.003 and 0.008 μg/mL, respectively) and two MR isolates (RFP MIC of 0.003 and 0.012 μg/mL, respectively) were subjected to time-kill studies. Mueller-Hinton broth was supplemented with RFP at 0, 0.5, 1, 2, 4, 8, 16 and 32 times the MIC for 0, 2, 4, 10, 16 and 24 h. The number of viable colony forming units in each sample was determined using a commercial luciferase assay kit. RESULTS The MIC50 and MIC90 were the same for MS and MR isolates, at 0.004 μg/mL and 0.008 μg/mL, respectively. Rifampicin kill curves were not indicative of concentration-dependency, suggesting time-dependent activity. Two isolates (MS 0.003 and 0.008 μg/mL) exhibited bacteriostatic activity, whereas two others (MR 0.003 and 0.012 μg/mL) exhibited bactericidal activity. CONCLUSIONS AND CLINICAL IMPORTANCE This study demonstrated that MS and MR S. pseudintermedius isolates were equally susceptible to rifampicin and that dosing intervals should be designed for time-dependent efficacy. These data can support pharmacokinetic studies of RFP in dogs with susceptible infections caused by S. pseudintermedius.
Collapse
Affiliation(s)
- Karen K Ho
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| | - Austin C Conley
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
| | - Robert A Kennis
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| | - Terri L Hathcock
- Department of Pathobiology, College of Veterinary Medicine, Auburn University, 264 Greene Hall, Auburn, AL, 36849, USA
| | - Dawn M Boothe
- Department of Anatomy, Physiology, and Pharmacology, College of Veterinary Medicine, Auburn University, 109 Greene Hall, Auburn, AL, 36849, USA
| | - Amelia G White
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, 1220 Wire Road, Auburn, AL, 36849, USA
| |
Collapse
|