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Wang W, Liu H, Guo Z, Hu Z, Wang K, Leng Y, Yuan C, Li Z, Ge X. Various Antibacterial Strategies Utilizing Titanium Dioxide Nanotubes Prepared via Electrochemical Anodization Biofabrication Method. Biomimetics (Basel) 2024; 9:408. [PMID: 39056849 PMCID: PMC11274689 DOI: 10.3390/biomimetics9070408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Currently, titanium and its alloys have emerged as the predominant metallic biomaterials for orthopedic implants. Nonetheless, the relatively high post-operative infection rate (2-5%) exacerbates patient discomfort and imposes significant economic costs on society. Hence, urgent measures are needed to enhance the antibacterial properties of titanium and titanium alloy implants. The titanium dioxide nanotube array (TNTA) is gaining increasing attention due to its topographical and photocatalytic antibacterial properties. Moreover, the pores within TNTA serve as excellent carriers for chemical ion doping and drug loading. The fabrication of TNTA on the surface of titanium and its alloys can be achieved through various methods. Studies have demonstrated that the electrochemical anodization method offers numerous significant advantages, such as simplicity, cost-effectiveness, and controllability. This review presents the development process of the electrochemical anodization method and its applications in synthesizing TNTA. Additionally, this article systematically discusses topographical, chemical, drug delivery, and combined antibacterial strategies. It is widely acknowledged that implants should possess a range of favorable biological characteristics. Clearly, addressing multiple needs with a single antibacterial strategy is challenging. Hence, this review proposes systematic research into combined antibacterial strategies to further mitigate post-operative infection risks and enhance implant success rates in the future.
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Affiliation(s)
- Wuzhi Wang
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin 300354, China
| | - Hanpeng Liu
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300072, China
| | - Zilin Guo
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin 300354, China
| | - Zijun Hu
- School of Mechanical Engineering, Hebei University of Technology, Tianjin 300401, China
| | - Kefeng Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu 610064, China
| | - Yujia Leng
- School of Precision Instrument and Opto-Electronics Engineering, Tianjin University, Tianjin 300072, China
| | - Caideng Yuan
- School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Zhaoyang Li
- Tianjin Key Laboratory of Composite and Functional Materials, School of Materials Science and Engineering, Tianjin University, Tianjin 300072, China
| | - Xiang Ge
- Key Laboratory of Mechanism Theory and Equipment Design of Ministry of Education, School of Mechanical Engineering, Tianjin University, Tianjin 300354, China
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Pfang B, Villegas García MA, Blanco García A, Auñón Rubio Á, Esteban J, García Cañete J. Risk Factors for Therapeutic Failure and One-Year Mortality in Patients with Intramedullary Nail-Associated Infection after Trochanteric and Subtrochanteric Hip Fracture Repair. Antibiotics (Basel) 2024; 13:463. [PMID: 38786191 PMCID: PMC11118869 DOI: 10.3390/antibiotics13050463] [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: 04/02/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
Despite the implications of trochanteric and subtrochanteric intramedullary (IM) nail infection for patients with hip fracture, little is known about risk factors for therapeutic failure and mortality in this population. We performed a retrospective observational analysis including patients diagnosed with trochanteric and subtrochanteric IM nail infection at a Spanish academic hospital during a 10-year period, with a minimum follow-up of 22 months. Of 4044 trochanteric and subtrochanteric IM nail implants, we identified 35 cases of infection during the study period (0.87%), 17 of which were chronic infections. Patients with therapeutic failure (n = 10) presented a higher average Charlson Comorbidity Index (CCI) (5.40 vs. 4.21, p 0.015, CI 0.26-2.13) and higher rates of polymicrobial (OR 5.70, p 0.033, CI 1.14-28.33) and multidrug-resistant (OR 7.00, p 0.027, CI 1.24-39.57) infections. Upon multivariate analysis, polymicrobial infection and the presence of multidrug-resistant pathogens were identified as independent risk factors for therapeutic failure. Implant retention was associated with an increased risk of failure in chronic infection and was found to be an independent risk factor for overall one-year mortality in the multivariate analysis. Our study highlights the importance of broad-spectrum empirical antibiotics as initial treatment of trochanteric and subtrochanteric IM nail-associated infection while awaiting microbiological results. It also provides initial evidence for the importance of implant removal in chronic IM-nail infection.
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Affiliation(s)
- Bernadette Pfang
- Unidad de Innovación Clínica y Organizativa, Red Quirónsalud 4H, 28040 Madrid, Spain
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
| | | | - Antonio Blanco García
- Emergency Department, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Álvaro Auñón Rubio
- CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
- Orthopedic Surgery and Traumatology Department, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Jaime Esteban
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
| | - Joaquín García Cañete
- Industrial Engineering Politecnic, University of Castilla-La Mancha, 13071 Ciudad Real, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, 28029 Madrid, Spain
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3
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Oliveira PR, Leonhardt MC, Panico CT, Silva JB, Carvalho VC, Kojima KE, Silva JS, Lima ALL. Infection after intramedullary nailing of femoral and tibial diaphyseal fractures. Injury 2023; 54 Suppl 6:110821. [PMID: 38143135 DOI: 10.1016/j.injury.2023.05.052] [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: 10/21/2022] [Revised: 04/20/2023] [Accepted: 05/13/2023] [Indexed: 12/26/2023]
Abstract
PURPOSE Management of fracture-related infection (FRI) after intramedullary fixation (IF) is a challenge. The aim of the present study is to describe a series of 26 patients with FRI after IF and to evaluate factors possibly related to the outcome. METHODS Baseline variables were obtained at the time of IF: age, sex, body mass index, affected bone, open fracture, substance abuse, use of an external fixator, type of nail, reaming, soft-tissue reconstruction and surveillance culture result. After diagnosis of the infection, information was obtained about the time interval between IF and diagnosis and classification according to both the Willeneger and Roth and Makridis systems. Treatment modalities were grouped and analysed according to: use of antimicrobials, surgical debridement, nail removal or retention and spacer use. Cultures of bone or deep soft tissues were performed. Patients were followed up for 12 months, and outcomes (remission, relapse, death and loss of follow-up) were evaluated, as well as fracture consolidation. RESULTS Remission was observed in 42.3% of patients. There was no significant association between any baseline variable and outcome. There was a significant association between Makridis stage 2 classification and recurrence or death. Treatment strategy was not significantly associated with outcome, and 65.4% of cases had positive culture results, with Enterobacter cloacae as the predominant agent. Consolidation was observed in 81.8% of patients and was not significantly related to the outcome. CONCLUSION There was a significant association between Makridis classification and the outcome. Consolidation rate was not associated with the outcome regarding the treatment of the infection.
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Affiliation(s)
- Priscila R Oliveira
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - Marcos C Leonhardt
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Caroline T Panico
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Julia B Silva
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Vladimir C Carvalho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Kodi E Kojima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Jorge S Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Ana Lucia L Lima
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Flores-Balado Á, Castresana Méndez C, Herrero González A, Mesón Gutierrez R, de Las Casas Cámara G, Vila Cordero B, Arcos J, Pfang B, Martín-Ríos MD. Using artificial intelligence to reduce orthopedic surgical site infection surveillance workload: Algorithm design, validation, and implementation in 4 Spanish hospitals. Am J Infect Control 2023; 51:1225-1229. [PMID: 37100291 DOI: 10.1016/j.ajic.2023.04.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Surgical site infection (SSI) surveillance is a labor-intensive endeavor. We present the design and validation of an algorithm for SSI detection after hip replacement surgery, and a report of its successful implementation in 4 public hospitals in Madrid, Spain. METHODS We designed a multivariable algorithm, AI-HPRO, using natural language processing (NLP) and extreme gradient boosting to screen for SSI in patients undergoing hip replacement surgery. The development and validation cohorts included data from 19,661 health care episodes from 4 hospitals in Madrid, Spain. RESULTS Positive microbiological cultures, the text variable "infection", and prescription of clindamycin were strong markers of SSI. Statistical analysis of the final model indicated high sensitivity (99.18%) and specificity (91.01%) with an F1-score of 0.32, AUC of 0.989, accuracy of 91.27%, and negative predictive value of 99.98%. DISCUSSION Implementation of the AI-HPRO algorithm reduced the surveillance time from 975 person/hours to 63.5 person/hours and permitted an 88.95% reduction in the total volume of clinical records to be reviewed manually. The model presents a higher negative predictive value (99.98%) than algorithms relying on NLP alone (94%) or NLP and logistic regression (97%). CONCLUSIONS This is the first report of an algorithm combining NLP and extreme gradient-boosting to permit accurate, real-time orthopedic SSI surveillance.
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Affiliation(s)
- Álvaro Flores-Balado
- Infection Control Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | | | | | - Beatriz Vila Cordero
- Infection Control Department, Rey Juan Carlos University Hospital, Móstoles, Comunidad de Madrid, Spain
| | - Javier Arcos
- Fundación Jiménez Díaz University Hospital, Madrid, Spain; UICO (Clinical and Organizational Innovation Unit), Quironsalud 4-H Network, Madrid, Spain
| | - Bernadette Pfang
- UICO (Clinical and Organizational Innovation Unit), Quironsalud 4-H Network, Madrid, Spain
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Abbas S, Yasmin A, Maqbool N, Shah AA, Fariq A. Insights into the microbiological and virulence characteristics of bacteria in orthopaedic implant infections: A study from Pakistan. PLoS One 2023; 18:e0292956. [PMID: 37847701 PMCID: PMC10581495 DOI: 10.1371/journal.pone.0292956] [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: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
The exponential increase in the prevalence of multidrug resistant bacteria has resulted in limiting surgical treatment options globally, potentially causing biofilm-related complications, implant failure, and severe consequences. This study aims to isolate and characterize bacteria from post-surgical orthopaedic implant infections and screening for multiple antibiotic resistance. A cross-sectional study was conducted, involving isolation of forty-four dominant pathogenic bacterial isolates from 16 infected implant samples from across Islamabad and Rawalpindi. Out of forty-four, 38% cocci and 61% bacilli were obtained. Approximately 90% of isolates showed multiple antibiotic resistance (MAR) index of more than 0.2. Eleven strains were identified via 16S rRNA gene sequencing as Pseudomonas aeruginosa, Bacillus spp., Planococcus chinensis, Staphylococcus, Escherichia coli and Enterobacter cloacae. The bacterial strain E. coli MB641 showed sensitivity to Polymyxin only, and was resistant to all other antibiotics used. Maximum biofilm forming ability 0.532 ± 0.06, 0.55 ± 0.01 and 0.557 ± 0.07 was observed in Pseudomonas aeruginosa MB663, Pseudomonas aeruginosa MB664 and Bacillus spp. MB647 respectively after 24 hours of incubation. EPS production of bacterial strains was assessed, the polysaccharides and protein content of EPS were found to be in the range of 11-32 μg/ml and 2-10 μg/ml, respectively. Fourier transform infrared spectroscopic analysis of EPS showed the presence of carbohydrates, proteins, alkyl halides, and nucleic acids. X-ray diffraction analysis revealed crystalline structure of EPS extracted from biofilm forming bacteria. These findings suggest a high prevalence of antibiotic-resistant bacteria in orthopaedic implant-associated surgeries, highlighting the urgent need for ongoing monitoring and microorganism testing in infected implants.
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Affiliation(s)
- Sidra Abbas
- Microbiology and Biotechnology Research laboratory, Department of Biotechnology, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Azra Yasmin
- Microbiology and Biotechnology Research laboratory, Department of Biotechnology, Fatima Jinnah Women University, Rawalpindi, Pakistan
| | - Nouman Maqbool
- Department of Orthopaedic Surgery, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Asim Ali Shah
- Microbiology Laboratory, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Anila Fariq
- Microbiology and Biotechnology Research laboratory, Department of Biotechnology, Fatima Jinnah Women University, Rawalpindi, Pakistan
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Lilleøre JG, Jørgensen AR, Knudsen MB, Hanberg P, Öbrink-Hansen K, Tøstesen SK, Søballe K, Stilling M, Bue M. Steady-State Piperacillin Concentrations in the Proximity of an Orthopedic Implant: A Microdialysis Porcine Study. Antibiotics (Basel) 2023; 12:antibiotics12030615. [PMID: 36978481 PMCID: PMC10045023 DOI: 10.3390/antibiotics12030615] [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: 02/24/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Implant-associated osteomyelitis is one of the most feared complications following orthopedic surgery. Although the risk is low, sufficient antibiotic protection of the implant surface is important. The aim of this study was to assess steady-state piperacillin concentrations in the proximity of an orthopedic implant. Time above the minimal inhibitory concentration (fT>MIC) was evaluated for MIC of 8 (low target) and 16 μg/mL (high target). Six female pigs received an intravenous bolus infusion of 4 g/0.5 g piperacillin/tazobactam over 30 min every 6 h. Steady state was assumed achieved in the third dosing interval (12-18 h). Microdialysis catheters were placed in a cannulated screw in the proximal tibial cancellous bone, in cancellous bone next to the screw, and in cancellous bone on the contralateral tibia. Dialysates were collected from time 12 to 18 h and plasma samples were collected as reference. For the low piperacillin target (8 µg/mL), comparable mean fT>MIC across all the investigated compartments (mean range: 54-74%) was found. For the high target (16 µg/mL), fT>MIC was shorter inside the cannulated screw (mean: 16%) than in the cancellous bone next to the screw and plasma (mean range: 49-54%), and similar between the two cancellous bone compartments. To reach more aggressive piperacillin fT>MIC targets in relation to the implant, alternative dosing regimens such as continuous infusion may be considered.
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Affiliation(s)
- Johanne Gade Lilleøre
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Andrea René Jørgensen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Martin Bruun Knudsen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Pelle Hanberg
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Kristina Öbrink-Hansen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, 7400 Herning, Denmark
| | - Sara Kousgaard Tøstesen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Mats Bue
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Aarhus Denmark Microdialysis Research Group (ADMIRE), Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Orthopedic Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark
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7
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Martín-García M, Aguilera-Correa JJ, Arenas MÁ, García-Diego IM, Conde A, de Damborenea JJ, Esteban J. Differences in In Vitro Bacterial Adherence between Ti6Al4V and CoCrMo Alloys. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1505. [PMID: 36837133 PMCID: PMC9959577 DOI: 10.3390/ma16041505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Prosthetic joint infection is an uncommon entity, but it supposes high costs, both from the economic side to the health systems and from the emotional side of the patient. The evaluation of the bacterial adherence to different materials frequently involved in joint prostheses allows us to better understand the mechanisms underlying this and provide information for the future development of prevention strategies. This study evaluated the bacterial adherence of four different species (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa) on Ti6Al4V and CoCrMo. The topography, surface contact angles, and linear average roughness were measured in the samples from both alloys. The interaction with the surface of both alloys was significantly different, with the CoCrMo showing an aggregating effect on all the species, with additional anti-adherent activity in the case of Pseudomonas aeruginosa. The viability also changes, with a significant decrease (p < 0.05) in the CoCrMo alloy. In the case of S. epidermidis, the viability in the supernatant from the samples was different, too, with a decrease in the colony-forming units in the Ti6Al4V, which could be related to cation release from the surface. Beyond adhesion is a multifactorial and complex process, and considering that topography and wettability were similar, the chemical composition could play a main role in the different properties observed.
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Affiliation(s)
- Marta Martín-García
- Department of Clinical Microbiology, University Hospital Fundación Jiménez Díaz, IIS-FJD, 28040 Madrid, Spain
| | - John Jairo Aguilera-Correa
- Department of Clinical Microbiology, University Hospital Fundación Jiménez Díaz, IIS-FJD, 28040 Madrid, Spain
- CIBERINFEC—CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Ángeles Arenas
- CIBERINFEC—CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research (CENIM-CSIC), 28040 Madrid, Spain
| | - Ignacio M. García-Diego
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research (CENIM-CSIC), 28040 Madrid, Spain
| | - Ana Conde
- CIBERINFEC—CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research (CENIM-CSIC), 28040 Madrid, Spain
| | - Juan José de Damborenea
- CIBERINFEC—CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Surface Engineering Corrosion and Durability, National Centre for Metallurgical Research (CENIM-CSIC), 28040 Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, University Hospital Fundación Jiménez Díaz, IIS-FJD, 28040 Madrid, Spain
- CIBERINFEC—CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Giannitsioti E, Salles M, Mavrogenis A, Rodriguez-Pardo D, Los-Arcos I, Ribera A, Ariza J, del Toro M, Nguyen S, Senneville E, Bonnet E, Chan M, Pasticci M, Petersdorf S, Benito N, O' Connell N, Blanco García A, Skaliczki G, Tattevin P, Kocak Tufan Z, Pantazis N, Megaloikonomos P, Papagelopoulos P, Soriano A, Papadopoulos A, the ESGIAI collaborators study group. Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study. J Bone Jt Infect 2022; 7:279-288. [PMID: 36644590 PMCID: PMC9832304 DOI: 10.5194/jbji-7-279-2022] [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] [Received: 05/17/2022] [Accepted: 11/19/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients ( n = 57 ) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli ( n = 16 ), Pseudomonas aeruginosa ( n = 14 ; XDR 50 %), Klebsiella spp. ( n = 7 ), Enterobacter spp. ( n = 9 ), Acinetobacter spp. ( n = 5 ), Proteus mirabilis ( n = 3 ), Serratia marcescens ( n = 2 ) and Stenotrophomonas maltophilia ( n = 1 ). The prevalence of ESBL (extended-spectrum β -lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients ( n = 37 ; 64.9 %) were treated with a combination including carbapenems ( n = 32 ) and colistin ( n = 11 ) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) ( p = 0.008 ). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age > 60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540-9.752; p = 0.004 ) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144-6.963; p = 0.024 ). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.
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Affiliation(s)
- Efthymia Giannitsioti
- Fourth Department of Internal Medicine, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mauro José Salles
- Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Andreas Mavrogenis
- First Department of Orthopaedics, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dolors Rodriguez-Pardo
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ibai Los-Arcos
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alba Ribera
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Javier Ariza
- Department of Infectious Diseases, Hospital Universitari Bellvitge, Barcelona, Spain
| | - María Dolores del Toro
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla, Seville, Spain
| | - Sophie Nguyen
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Eric Senneville
- Infectious Diseases Department, Gustave Dron Hospital, Tourcoing, France
| | - Eric Bonnet
- Department of Infectious Diseases, Clinique Pasteur, Toulouse, France
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Sabine Petersdorf
- Institute for Medical Laboratory Diagnostics, Helios University Clinic Wuppertal, Wuppertal, Germany
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuala O' Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Antonio Blanco García
- Bone and Joint Infection Unit, Department of Emergency Medicine, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Gábor Skaliczki
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Zeliha Kocak Tufan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Nikolaos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis D. Megaloikonomos
- First Department of Orthopaedics, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Papagelopoulos
- First Department of Orthopaedics, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alejandro Soriano
- Department of Infectious Diseases, Hospital Clínic, Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Antonios Papadopoulos
- Fourth Department of Internal Medicine, University General Hospital Attikon, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Macias-Valcayo A, Aguilera-Correa JJ, Broncano A, Parron R, Auñon A, Garcia-Cañete J, Blanco A, Esteban J. Comparative In Vitro Study of Biofilm Formation and Antimicrobial Susceptibility in Gram-Negative Bacilli Isolated from Prosthetic Joint Infections. Microbiol Spectr 2022; 10:e0085122. [PMID: 35876589 PMCID: PMC9430931 DOI: 10.1128/spectrum.00851-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Prosthetic joint infections (PJIs) are typically caused by microorganisms that grow in biofilms. Traditional antimicrobial susceptibility tests are based on the study of planktonic bacteria that might lead to missing the biofilm behavior and to a treatment failure. This study was designed to analyze the antimicrobial susceptibility of clinical Gram-negative bacilli (GNB) isolates from PJIs in planktonic and sessile states and the possible relationship between antimicrobial resistance and biofilm formation. A total of 46 clinical isolates from patients with PJIs (mainly hip and knee prostheses) plus three GNB ATCC isolates were studied. The Minimal Inhibitory Concentration (MIC), minimal bactericidal concentration (MBC), minimal biofilm inhibitory concentration (MBIC), and minimal biofilm eradication concentration (MBEC) were assessed using a previously published methodology. Almost all of the GNB clinical isolates tested were biofilm forming. Pseudomonas aeruginosa was the largest biofilm-forming species. A comparison of MBIC90 versus MIC90 shows an increase higher than 1- to -2-fold dilutions in most antimicrobials studied, and MBEC90 was significantly higher than MIC90, becoming resistant to all the antimicrobial drugs tested. Higher biofilm production values were obtained in antibiotic-susceptible Escherichia coli in comparison to their resistant counterparts. However, regarding the relationships between antimicrobial resistance and biofilm formation, our analysis showed that each strain differed. A high antimicrobial resistance rate was found among the GNB studied. Moreover, almost all bacterial isolates were in vitro biofilm formers. Although there was no significant association between biofilm and antibiotic resistance, multidrug-resistant isolates were found to be greater biofilm formers than non-multidrug-resistant isolates. IMPORTANCE This study is the first one to analyze a high number of isolates of Gram-negative bacilli that are the cause of prosthetic joint infection. The analysis includes biofilm development and antimicrobial susceptibility testing of both planktonic and sessile bacteria. The obtained results support the clinical knowledge about the treatment of these bacteria when biofilms are involved.
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Affiliation(s)
- Alicia Macias-Valcayo
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - John-Jairo Aguilera-Correa
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Antonio Broncano
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Raul Parron
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Madrid, Spain
| | - Alvaro Auñon
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Orthopaedic Surgery, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Blanco
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
- Department of Internal Medicine-Emergencies, Fundación Jiménez Díaz, Madrid, Spain
| | - Jaime Esteban
- Department of Clinical Microbiology, Instituto de Investigación Sanitaria (IIS)-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Centre for Biomedical Research Network in Infectious Diseases (CIBERINFEC), CIBER de Enfermedades Infecciosas, Madrid, Spain
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10
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Wang N, Ma Y, Shi H, Song Y, Guo S, Yang S. Mg-, Zn-, and Fe-Based Alloys With Antibacterial Properties as Orthopedic Implant Materials. Front Bioeng Biotechnol 2022; 10:888084. [PMID: 35677296 PMCID: PMC9168471 DOI: 10.3389/fbioe.2022.888084] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Implant-associated infection (IAI) is one of the major challenges in orthopedic surgery. The development of implants with inherent antibacterial properties is an effective strategy to resolve this issue. In recent years, biodegradable alloy materials have received considerable attention because of their superior comprehensive performance in the field of orthopedic implants. Studies on biodegradable alloy orthopedic implants with antibacterial properties have gradually increased. This review summarizes the recent advances in biodegradable magnesium- (Mg-), iron- (Fe-), and zinc- (Zn-) based alloys with antibacterial properties as orthopedic implant materials. The antibacterial mechanisms of these alloy materials are also outlined, thus providing more basis and insights on the design and application of biodegradable alloys with antibacterial properties as orthopedic implants.
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Affiliation(s)
- Ning Wang
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yutong Ma
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Huixin Shi
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yiping Song
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shu Guo
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Shu Guo, ; Shude Yang,
| | - Shude Yang
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
- Liaoning Provincial Key Laboratory of Oral Diseases, School of Stomatology and Department of Oral Pathology, School of Stomatology, China Medical University, Shenyang, China
- *Correspondence: Shu Guo, ; Shude Yang,
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11
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Mudenur C, Boruah P, Kumar A, Katiyar V. Prodigiosin-Loaded Poly(lactic acid) to Combat the Biofilm-Associated Infections. ACS APPLIED BIO MATERIALS 2022; 5:2143-2151. [PMID: 35467829 DOI: 10.1021/acsabm.1c01187] [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: 11/29/2022]
Abstract
Poly(lactic acid) (PLA) is an emerging biobased implant material. Despite its biocompatibility and the aseptic procedures followed during orthopedic surgery, bacterial infection remains an obstacle to implementing PLA-based implants. To tackle this issue, prodigiosin-incorporated PLA has been developed, which possesses improved hydrophobicity with a contact angle of 111 ± 1.5°. The degradation temperature of the prodigiosin is 215 °C, which is more than the melting temperature of PLA, which supports the processability and sterilization of the PLA-based implants without any toxic gases. Further, prodigiosin improves the transparency of PLA and acts as a nucleation site. The spherulite density increases three times compared to that of neat PLA. The inherent methoxy group of prodigiosin is an active site responsible for the inhibition of bacterial attack and biofilm formation. The in vitro study on biofilm formation shows excellent inhibition activity against implant-associated pathogens such as Klebsiella aerogenes and Staphylococcus aureus.
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Affiliation(s)
- Chethana Mudenur
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Pankaj Boruah
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Amit Kumar
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
| | - Vimal Katiyar
- Department of Chemical Engineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India
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12
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Davido B, Noussair L, El Sayed F, Jaffal K, Le Liepvre H, Marmouset D, Bauer T, Herrmann JL, Rottman M, Cremieux AC, Saleh-Mghir A. Hip joint infections caused by multidrug-resistant Enterobacterales among patients with spinal cord injury: experience of a reference center in the Greater Paris area. Open Forum Infect Dis 2022; 9:ofac209. [PMID: 35783683 PMCID: PMC9246273 DOI: 10.1093/ofid/ofac209] [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: 02/18/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
We aimed to describe the management and treatment of hip joint infections caused by multidrug-resistant Enterobacterales among patients with spinal cord injury (SCI).
Methods
We included all hip joint infections associated with grade IV decubitus ulcers caused by Extended-Spectrum Beta-Lactamase producing Enterobacterales (ESBL-PE) and Carbapenemase-Producing Enterobacterales (CPE) treated in a reference center for bone and joint infections (BJIs) over 9 years in a retrospective study.
Results
Seventeen SCI patients with ischial pressure ulcers breaching the hip capsule (mean age 52 ± 15 years) were analyzed. In 16 patients, paraplegia was secondary to trauma and one was secondary to multiple sclerosis. Infections were mostly polymicrobial (n=15; 88.2%), notably caused by Klebsiella pneumoniae (n=10) and S. aureus (n=10). The carbapenemases identified were exclusively OXA-48-type (n=3) including 2 isolates co-expressed with ESBL-PE within the same bacterial host.
Multidrug-resistant Enterobacterales were commonly resistant to fluoroquinolones (n=12; 70.6%). Most therapies were based on carbapenems (n=10) and combination therapies (n=13). Median duration of treatment was 45 (6-60) days. Of 17 cases of hip joint infections, 94.1% (n=16) benefited from a femoral head and neck resection.
Infection control was initially achieved in 58.8% (n=10) of cases and up to 88.2% after revision surgeries, after a median follow-up of 3 (1-36) months.
Conclusion
Hip infections among SCI patients caused by multidrug-resistant Enterobacterales are often polymicrobial and fluoroquinolones-resistant infections caused by K. pneumoniae and S. aureus, highlighting the need for expert centers with pluridisciplinary meetings associating experienced surgeons, clinical microbiologists and infectious disease specialists.
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Affiliation(s)
- B. Davido
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
- UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - L. Noussair
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
| | - F. El Sayed
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - K. Jaffal
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
| | - H. Le Liepvre
- Medecine Physique et reeducation, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
| | - D. Marmouset
- Service d’Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - T. Bauer
- Service d’Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - JL. Herrmann
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
- UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - M. Rottman
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
- UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - AC. Cremieux
- Service de Maladies Infectieuses, Université Paris Nord, Hôpital Saint-Louis, AP-HP, Paris, France
- UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - A. Saleh-Mghir
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond Poincaré, AP-HP, Garches, France
- UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
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13
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Sun Y, Yang Y, Jiang W, Bai H, Liu H, Wang J. In Vivo Antibacterial Efficacy of Nanopatterns on Titanium Implant Surface: A Systematic Review of the Literature. Antibiotics (Basel) 2021; 10:antibiotics10121524. [PMID: 34943736 PMCID: PMC8698789 DOI: 10.3390/antibiotics10121524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/04/2021] [Accepted: 12/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Bionic surface nanopatterns of titanium (Ti) materials have excellent antibacterial effects in vitro for infection prevention. To date, there is a lack of knowledge about the in vivo bactericidal outcomes of the nanostructures on the Ti implant surfaces. Methods: A systematic review was performed using the PubMed, Embase, and Cochrane databases to better understand surface nanoscale patterns’ in vivo antibacterial efficacy. The inclusion criteria were preclinical studies (in vivo) reporting the antibacterial activity of nanopatterns on Ti implant surface. Ex vivo studies, studies not evaluating the antibacterial activity of nanopatterns or surfaces not modified with nanopatterns were excluded. Results: A total of five peer-reviewed articles met the inclusion criteria. The included studies suggest that the in vivo antibacterial efficacy of the nanopatterns on Ti implants’ surfaces seems poor. Conclusions: Given the small number of literature results, the variability in experimental designs, and the lack of reporting across studies, concluding the in vivo antibacterial effectiveness of nanopatterns on Ti substrates’ surfaces remains a big challenge. Surface coatings using metallic or antibiotic elements are still practical approaches for this purpose. High-quality preclinical data are still needed to investigate the in vivo antibacterial effects of the nanopatterns on the implant surface.
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Affiliation(s)
- Yang Sun
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Yang Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
- Engineering Research Centre of Molecular Diagnosis and Cell Treatment for Metabolic Bone Disease, The Second Hospital of Jilin University, Changchun 130041, China
| | - Weibo Jiang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Haotian Bai
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
| | - Jincheng Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, China; (Y.S.); (Y.Y.); (W.J.); (H.B.); (H.L.)
- Correspondence:
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14
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Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, Lawrence C, Bauer T, Herrmann JL, De Truchis P, Noussair L, Cremieux AC. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrob Agents 2021; 59:106497. [PMID: 34906675 DOI: 10.1016/j.ijantimicag.2021.106497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022]
Abstract
Antibiotic treatment of native osteomyelitis caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a challenge. Limited epidemiological and outcome data are available. This retrospective cohort study included osteomyelitis patients with ESBL-PE infections treated in a reference centre for bone and joint infections (BJIs) between 2011-2019. Twenty-nine patients with native BJI (mean age, 44.4 ± 15.7 years) were analysed. Fifteen cases were paraplegic patients with ischial pressure sores breaching the hip capsule. Other cases included eight other hip infections, four tibial infections and two foot infections. Infections were mostly polymicrobial (n = 23; 79.3%), including Staphylococcus aureus (n = 13; 8 methicillin-resistant). Klebsiella pneumoniae (n = 13) was the most frequent ESBL-producing species identified, followed by Escherichia coli (n = 10), including 3 E. coli/K. pneumoniae co-infections, and Enterobacter spp. (n = 9). ESBL-PE were rarely susceptible to fluoroquinolones (n = 4; 13.8%). Most therapies were based on carbapenems (n = 22) and combination therapies (n = 19). The median duration of treatment was 41 (5-60) days. Primary control of the infection was achieved in 62.1% (18/29) of cases and up to 86.2% after second look surgeries, after a median follow-up of 6 (1-36) months. Infection with ESBL-producing K. pneumoniae was associated with failure (P = 0.001), whereas age, infection location, prior colonisation and antimicrobial therapy were not found to be predictors of outcome. ESBL-PE native BJIs are often polymicrobial and fluoroquinolone-resistant infections caused by K. pneumoniae, highlighting the need for expert centres with pluridisciplinary meetings with experienced surgeons.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France.
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - M Rottman
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - K Jaffal
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - P De Truchis
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A C Cremieux
- Service de Maladies Infectieuses, Université Paris Nord, Hôpital Saint-Louis, AP-HP, Paris, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
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15
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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: 42] [Impact Index Per Article: 14.0] [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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16
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Esteban J, Vallet-Regí M, Aguilera-Correa JJ. Antibiotics- and Heavy Metals-Based Titanium Alloy Surface Modifications for Local Prosthetic Joint Infections. Antibiotics (Basel) 2021; 10:1270. [PMID: 34680850 PMCID: PMC8532710 DOI: 10.3390/antibiotics10101270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/04/2023] Open
Abstract
Prosthetic joint infection (PJI) is the second most common cause of arthroplasty failure. Though infrequent, it is one of the most devastating complications since it is associated with great personal cost for the patient and a high economic burden for health systems. Due to the high number of patients that will eventually receive a prosthesis, PJI incidence is increasing exponentially. As these infections are provoked by microorganisms, mainly bacteria, and as such can develop a biofilm, which is in turn resistant to both antibiotics and the immune system, prevention is the ideal approach. However, conventional preventative strategies seem to have reached their limit. Novel prevention strategies fall within two broad categories: (1) antibiotic- and (2) heavy metal-based surface modifications of titanium alloy prostheses. This review examines research on the most relevant titanium alloy surface modifications that use antibiotics to locally prevent primary PJI.
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Affiliation(s)
- Jaime Esteban
- Clinical Microbiology Department, Jiménez Díaz Foundation Health Research Institute, Autonomous University of Madrid, Av. Reyes Católicos 2, 28040 Madrid, Spain
- Networking Research Centre on Infectious Diseases (CIBER-ID), 28029 Madrid, Spain
| | - María Vallet-Regí
- Department of Chemistry in Pharmaceutical Sciences, Research Institute Hospital 12 de Octubre (i+12), School of Pharmacy, Complutense University of Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
- Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
| | - John J Aguilera-Correa
- Networking Research Centre on Infectious Diseases (CIBER-ID), 28029 Madrid, Spain
- Department of Chemistry in Pharmaceutical Sciences, Research Institute Hospital 12 de Octubre (i+12), School of Pharmacy, Complutense University of Madrid, Pza. Ramón y Cajal s/n, 28040 Madrid, Spain
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17
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Esteban J, Gómez-Barrena E. An update about molecular biology techniques to detect orthopaedic implant-related infections. EFORT Open Rev 2021; 6:93-100. [PMID: 33828851 PMCID: PMC8022009 DOI: 10.1302/2058-5241.6.200118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Despite different criteria to diagnose a prosthetic joint infection (PJI), aetiological diagnosis of the causing microorganism remains essential to guide treatment.Molecular-biology-based PJI diagnosis is progressing (faster, higher specificity) in different techniques, from the experimental laboratory into clinical use.Multiplex polymerase chain reaction techniques (custom-made or commercial) provide satisfactory results in clinical series of cases, with specificity close to 100% and sensitivity over 70-80%.Next-generation metagenomics may increase sensitivity while maintaining high specificity.Molecular biology techniques may represent, in the next five years, a significant transformation of the currently available microbiological diagnosis in PJI. Cite this article: EFORT Open Rev 2021;6:93-100. DOI: 10.1302/2058-5241.6.200118.
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Affiliation(s)
- Jaime Esteban
- Servicio de Microbiología Clínica, Hospital Universitario Fundación Jiménez Díaz-IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Gómez-Barrena
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz-IdiPaz, Universidad Autónoma de Madrid, Madrid, Spain
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18
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Liu J, Liu J, Attarilar S, Wang C, Tamaddon M, Yang C, Xie K, Yao J, Wang L, Liu C, Tang Y. Nano-Modified Titanium Implant Materials: A Way Toward Improved Antibacterial Properties. Front Bioeng Biotechnol 2020; 8:576969. [PMID: 33330415 PMCID: PMC7719827 DOI: 10.3389/fbioe.2020.576969] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/22/2020] [Indexed: 01/01/2023] Open
Abstract
Titanium and its alloys have superb biocompatibility, low elastic modulus, and favorable corrosion resistance. These exceptional properties lead to its wide use as a medical implant material. Titanium itself does not have antibacterial properties, so bacteria can gather and adhere to its surface resulting in infection issues. The infection is among the main reasons for implant failure in orthopedic surgeries. Nano-modification, as one of the good options, has the potential to induce different degrees of antibacterial effect on the surface of implant materials. At the same time, the nano-modification procedure and the produced nanostructures should not adversely affect the osteogenic activity, and it should simultaneously lead to favorable antibacterial properties on the surface of the implant. This article scrutinizes and deals with the surface nano-modification of titanium implant materials from three aspects: nanostructures formation procedures, nanomaterials loading, and nano-morphology. In this regard, the research progress on the antibacterial properties of various surface nano-modification of titanium implant materials and the related procedures are introduced, and the new trends will be discussed in order to improve the related materials and methods.
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Affiliation(s)
- Jianqiao Liu
- Department of Orthopaedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
- Youjiang Medical University for Nationalities, Baise, China
| | - Jia Liu
- Department of Orthopaedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Shokouh Attarilar
- Department of Pediatric Orthopaedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chong Wang
- College of Mechanical Engineering, Dongguan University of Technology, Dongguan, China
| | - Maryam Tamaddon
- Institute of Orthopaedic and Musculoskeletal Science, Division of Surgery & Orthopaedic Science, University College London, The Royal National National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Chengliang Yang
- Department of Orthopaedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Kegong Xie
- Department of Orthopaedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Jinguang Yao
- Youjiang Medical University for Nationalities, Baise, China
| | - Liqiang Wang
- State Key Laboratory of Metal Matrix Composites, School of Materials Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chaozong Liu
- Institute of Orthopaedic and Musculoskeletal Science, Division of Surgery & Orthopaedic Science, University College London, The Royal National National Orthopaedic Hospital, Stanmore, United Kingdom
| | - Yujin Tang
- Department of Orthopaedics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
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19
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Wang L, Tkhilaishvili T, Bernal Andres B, Trampuz A, Gonzalez Moreno M. Bacteriophage-antibiotic combinations against ciprofloxacin/ceftriaxone-resistant Escherichia coli in vitro and in an experimental Galleria mellonella model. Int J Antimicrob Agents 2020; 56:106200. [PMID: 33075514 DOI: 10.1016/j.ijantimicag.2020.106200] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/07/2020] [Accepted: 10/11/2020] [Indexed: 02/08/2023]
Abstract
Escherichia coli is the most common cause of Gram-negative prosthetic joint infections (PJIs) and ciprofloxacin is the first-line antibiofilm antibiotic. Due to the emergence of fluoroquinolone resistance, management of E. coli PJIs has become challenging and is associated with high treatment failure rates. We evaluated the efficacy of a newly isolated bacteriophage ɸWL-3 as a therapeutic agent in combination with ciprofloxacin, fosfomycin, gentamicin, meropenem or ceftriaxone against biofilm of a ciprofloxacin/ceftriaxone-resistant E. coli strain and the ATCC 25922 reference strain. ɸWL-3 was first characterised in terms of virion morphology, absorption rate, burst size and killing kinetics against both E. coli strains. The tested antibiotics presented high inhibitory concentrations (ranging from 16 to >1024 μg/mL) when tested alone against biofilms. Co-administration of ɸWL-3 with antibiotics improved the antibiotic efficacy against biofilm, especially after staggered exposure, reducing the minimum biofilm bactericidal concentration (MBBC) up to 512 times. The in vivo antimicrobial activity of ɸWL-3/fosfomycin combination against both E. coli strains was assessed in a Galleria mellonella invertebrate infection model. Treatment of infected larvae after lethal doses of E. coli resulted in enhanced survival rates when combinatorial therapy with ɸWL-3/fosfomycin was applied on E. coli ATCC 25922-infected larvae compared with monotherapy, but not for EC1-infected larvae, which we speculated could be due to higher release of endotoxins in a shorter period in EC1-infected larvae exposed to ɸWL-3. Our study provides new insights into the use of bacteriophages and antibiotics in the treatment of biofilm-associated infections caused by antibiotic-resistant bacteria.
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Affiliation(s)
- Lei Wang
- Centre for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Tamta Tkhilaishvili
- Centre for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Beatriz Bernal Andres
- Centre for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Andrej Trampuz
- BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin; Augustenburger Platz 1 (Südstraße 2), 13353 Berlin, Germany
| | - Mercedes Gonzalez Moreno
- BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin; Augustenburger Platz 1 (Südstraße 2), 13353 Berlin, Germany.
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20
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Chen J, Hu G, Li T, Chen Y, Gao M, Li Q, Hao L, Jia Y, Wang L, Wang Y. Fusion peptide engineered "statically-versatile" titanium implant simultaneously enhancing anti-infection, vascularization and osseointegration. Biomaterials 2020; 264:120446. [PMID: 33069134 DOI: 10.1016/j.biomaterials.2020.120446] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022]
Abstract
Although antimicrobial titanium implants can prevent biomaterial-associated infection (BAI) in orthopedics, they display cytotoxicity and delayed osseointegration. Therefore, versatile implants are desirable for simultaneously inhibiting BAI and promoting osseointegration, especially "statically-versatile" ones with nonessential external stimulations for facilitating applications. Herein, we develop a "statically-versatile" titanium implant by immobilizing an innovative fusion peptide (FP) containing HHC36 antimicrobial sequence and QK angiogenic sequence via sodium borohydride reduction promoted Cu(I)-catalyzed azide-alkyne cycloaddition (CuAAC-SB), which shows higher immobilization efficiency than traditional CuAAC with sodium ascorbate reduction (CuAAC-SA). The FP-engineered implant exhibits over 96.8% antimicrobial activity against four types of clinical bacteria (S. aureus, E. coli, P. aeruginosa and methicillin-resistant S. aureus), being stronger than that modified with mixed peptides. This can be mechanistically attributed to the larger bacterial accessible surface area of HHC36 sequence. Notably, the implant can simultaneously enhance cellular proliferation, up-regulate expressions of angiogenesis-related genes/proteins (VEGF and VEGFR-2) of HUVECs and osteogenesis-related genes/proteins (ALP, COL-1, RUNX-2, OPN and OCN) of hBMSCs. In vivo assay with infection and non-infection bone-defect model reveals that the FP-engineered implant can kill 99.63% of S. aureus, and simultaneously promote vascularization and osseointegration. It is believed that this study presents an excellent strategy for developing "statically-versatile" orthopedic implants.
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Affiliation(s)
- Junjian Chen
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, 510006, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510006, China
| | - Guansong Hu
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, 510006, China; School of Biomedical Science and Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Tianjie Li
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, 510006, China
| | - Yunhua Chen
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, 510006, China
| | - Meng Gao
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, 510006, China; School of Biomedical Science and Engineering, South China University of Technology, Guangzhou, 510006, China
| | - Qingtao Li
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, 510006, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510006, China
| | - Lijing Hao
- School of Biomedical Science and Engineering, South China University of Technology, Guangzhou, 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, 510006, China
| | - Yongguang Jia
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, 510006, China
| | - Lin Wang
- Key Laboratory of Biomedical Engineering of Guangdong Province, South China University of Technology, Guangzhou, 510006, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510006, China.
| | - Yingjun Wang
- National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, 510006, China; School of Biomedical Science and Engineering, South China University of Technology, Guangzhou, 510006, China.
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21
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Biological activity and antimicrobial property of Cu/a-C:H nanocomposites and nanolayered coatings on titanium substrates. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 119:111513. [PMID: 33321606 DOI: 10.1016/j.msec.2020.111513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
Infection associated with titanium based implants remains the most serious problem in implant surgery hence it is important to find optimal strategies to prevent infections. In the present study, we investigated the surface properties, antibacterial activity and biocompatibility of nanocomposite coatings based on an amorphous hydrocarbon (a-C:H) film containing copper nanoparticles (CuNPs) deposited on Ti discs via a gas aggregation cluster source. Three different Cu/a-C:H coatings with approximately the same amount of embedded CuNPs with and without barrier a-C:H layer were fabricated. The obtained results revealed that different structures of the produced coatings have significantly different release rates of Cu ions from the coatings into the aqueous media. This subsequently influences the antibacterial efficiency and osteoblast cell viability of the treated coatings. Coatings with the highest number of CuNPs resulted in excellent antibacterial activity exhibiting approximately 4 log reduction of E.coli and S.aureus after 24 h incubation. The cytotoxicity study revealed that after 7 day cell seeding, even the coating with the highest Cu at.% (4 at.%) showed a cell viability of ̴90%. Consequently, the coating, formed with a properly tailored number of CuNPs and a-C:H barrier thickness offer a strong antibacterial effect without any harm to osteoblast cells.
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22
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Davido B, Noussair L, Saleh-Mghir A, Salomon E, Bouchand F, Matt M, Lawrence C, Bauer T, Herrmann JL, Perronne C, Gaillard JL, Rottman M, Dinh A. Case series of carbapenemase-producing Enterobacteriaceae osteomyelitis: Feel it in your bones. J Glob Antimicrob Resist 2020; 23:74-78. [PMID: 32882450 DOI: 10.1016/j.jgar.2020.08.007] [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] [Received: 05/18/2020] [Revised: 07/20/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Limited data have been reported regarding osteomyelitis due to carbapenemase-producing Enterobacteriaceae (CPE), including co-infections with extended-spectrum β-lactamase (ESBL)-producing micro-organisms. METHODS We conducted a retrospective study in a reference centre for bone and joint infections from 2011 to 2019 among patients infected with CPE. RESULTS Nine patients (mean age 46.8 ± 16.6 years), including three with infected implants, were identified. Infections were mostly polymicrobial (n = 8/9), including Staphylococcus aureus (n = 6/9). CPE were mainly OXA-48-type, associated with ESBL-producing Enterobacteriaceae (n = 8/9), of which 5/9 isolates were Klebsiella pneumoniae. Control of the infection was achieved in seven cases. CONCLUSIONS CPE osteomyelitides are essentially polymicrobial and fluoroquinolone-resistant infections, highlighting the need for efficient surgery with implant removal.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France.
| | - L Noussair
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - M Matt
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - C Perronne
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
| | - J L Gaillard
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Ambroise Paré, AP-HP, Boulogne-Billancourt, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - M Rottman
- Laboratoire de Microbiologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny le Bx, France
| | - A Dinh
- Service des Maladies Infectieuses, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, Garches, France
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23
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Pall E, Roman A. Lactoferrin Functionalized Biomaterials: Tools for Prevention of Implant-Associated Infections. Antibiotics (Basel) 2020; 9:E522. [PMID: 32824241 PMCID: PMC7459815 DOI: 10.3390/antibiotics9080522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022] Open
Abstract
Tissue engineering is one of the most important biotechnologies in the biomedical field. It requires the application of the principles of scientific engineering in order to design and build natural or synthetic biomaterials feasible for the maintenance of tissues and organs. Depending on the specific applications, the selection of the proper material remains a significant clinical concern. Implant-associated infection is one of the most severe complications in orthopedic implant surgeries. The treatment of these infections is difficult because the surface of the implant serves not only as a substrate for the formation of the biofilm, but also for the selection of multidrug-resistant bacterial strains. Therefore, a promising new approach for prevention of implant-related infection involves development of new implantable, non-antibiotic-based biomaterials. This review provides a brief overview of antimicrobial peptide-based biomaterials-especially those coated with lactoferrin.
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Affiliation(s)
- Emoke Pall
- Life Science Institute, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca 400372, Romania
| | - Alexandra Roman
- Department of Periodontology, Faculty of Dental Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca 400012, Romania;
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24
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Thukkaram M, Vaidulych M, Kylián O, Hanuš J, Rigole P, Aliakbarshirazi S, Asadian M, Nikiforov A, Van Tongel A, Biederman H, Coenye T, Du Laing G, Morent R, De Wilde L, Verbeken K, De Geyter N. Investigation of Ag/a-C:H Nanocomposite Coatings on Titanium for Orthopedic Applications. ACS APPLIED MATERIALS & INTERFACES 2020; 12:23655-23666. [PMID: 32374146 DOI: 10.1021/acsami.9b23237] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
One of the leading causes of failure for any bone implant is implant-associated infections. The implant-bone interface is in fact the crucial site of infection where both the microorganisms and cells compete to populate the newly introduced implant surface. Most of the work dealing with this issue has focused on the design of implant coatings capable of preventing infection while ignoring cell proliferation or vice versa. The present study is therefore focused on investigating the antibacterial and biological properties of nanocomposite coatings based on an amorphous hydrocarbon (a-C:H) matrix containing silver nanoparticles (AgNPs). a-C:H coatings with varying silver concentrations were generated directly on medical grade titanium substrates using a combination of a gas aggregation source (GAS) and a plasma-enhanced chemical vapor deposition (PE-CVD) process. The obtained results revealed that the surface silver content increased from 1.3 at % to 5.3 at % by increasing the used DC magnetron current in the GAS from 200 to 500 mA. The in vitro antibacterial assays revealed that the nanocomposites with the highest number of silver content exhibited excellent antibacterial activities resulting in a 6-log reduction of Escherichia coli and a 4-log reduction of Staphylococcus aureus after 24 h of incubation. An MTT assay, fluorescence live/dead staining, and SEM microscopy observations of MC3T3 cells seeded on the uncoated and coated Ti substrates also showed that increasing the amount of AgNPs in the nanocomposites had no notable impact on their cytocompatibility, while improved cell proliferation was especially observed for the nanocomposites possessing a low amount of AgNPs. These controllable Ag/a-C:H nanocomposites on Ti substrates, which simultaneously provide an excellent antibacterial performance and good biocompatibility, could thus have promising applications in orthopedics and other biomedical implants.
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Affiliation(s)
- Monica Thukkaram
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Mykhailo Vaidulych
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Ondřej Kylián
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Jan Hanuš
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Petra Rigole
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Sheida Aliakbarshirazi
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Mahtab Asadian
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Anton Nikiforov
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Alexander Van Tongel
- Orthopaedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Hynek Biederman
- Department of Macromolecular Physics, Faculty of Mathematics and Physics, Charles University, Prague 116 36, Czech Republic
| | - Tom Coenye
- Laboratory of Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Ghent University, Ghent 9000, Belgium
| | - Gijs Du Laing
- Department of Green Chemistry and Technology, Faculty of Bioscience Engineering, Ghent University, Ghent 9000, Belgium
| | - Rino Morent
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Lieven De Wilde
- Orthopaedic Surgery and Traumatology, Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Ghent 9000, Belgium
| | - Kim Verbeken
- Department of Materials, Textiles, and Chemical Engineering, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
| | - Nathalie De Geyter
- Research Unit Plasma Technology (RUPT), Department of Applied Physics, Faculty of Engineering & Architecture, Ghent University, Ghent 9000, Belgium
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25
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Aguilera-Correa JJ, Garcia-Casas A, Mediero A, Romera D, Mulero F, Cuevas-López I, Jiménez-Morales A, Esteban J. A New Antibiotic-Loaded Sol-Gel Can Prevent Bacterial Prosthetic Joint Infection: From in vitro Studies to an in vivo Model. Front Microbiol 2020; 10:2935. [PMID: 32010069 PMCID: PMC6978913 DOI: 10.3389/fmicb.2019.02935] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate the effect of a moxifloxacin-loaded organic-inorganic sol-gel with different antibiotic concentration in the in vitro biofilm development and treatment against Staphylococcus aureus, S. epidermidis, and Escherichia coli, cytotoxicity and cell proliferation of MC3T3-E1 osteoblasts; and its efficacy in preventing the prosthetic joint infection (PJI) caused by clinical strains of S. aureus and E. coli using an in vivo murine model. Three bacterial strains, S. epidermidis ATCC 35984, S. aureus 15981, and, E. coli ATCC 25922, were used for microbiological studies. Biofilm formation was induced using tryptic-soy supplemented with glucose for 24 h, and then, adhered and planktonic bacteria were estimated using drop plate method and absorbance, respectively. A 24-h-mature biofilm of each species growth in a 96-well plate was treated for 24 h using a MBECTM biofilm Incubator lid with pegs coated with the different types of sol-gel, after incubation, biofilm viability was estimated using alamrBlue. MC3T3-E1 cellular cytotoxicity and proliferation were evaluated using CytoTox 96 Non-Radioactive Cytotoxicity Assay and alamarBlue, respectively. The microbiological studies showed that sol-gel coatings inhibited the biofilm development and treated to a mature biofilm of three evaluated bacterial species. The cell studies showed that the sol-gel both with and without moxifloxacin were non-cytotoxic and that cell proliferation was inversely proportional to the antibiotic concentration containing by sol-gel. In the in vivo study, mice weight increased over time, except in the E. coli-infected group without coating. The most frequent symptoms associated with infection were limping and piloerection; these symptoms were more frequent in infected groups with non-coated implants than infected groups with coated implants. The response of moxifloxacin-loaded sol-gel to infection was either total or completely absent. No differences in bone mineral density were observed between groups with coated and non-coated implants and macrophage presence lightly increased in the bone grown directly in contact with the antibiotic-loaded sol-gel. In conclusion, moxifloxacin-loaded sol-gel coating is capable of preventing PJI caused by both Gram-positive and Gram-negative species.
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Affiliation(s)
| | - Amaya Garcia-Casas
- Department of Materials Science and Engineering, University Carlos III of Madrid, Madrid, Spain
| | - Aranzazu Mediero
- Bone and Joint Research Unit, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - David Romera
- Clinical Microbiology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Francisca Mulero
- Molecular Imaging Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Irene Cuevas-López
- Experimental Surgery and Animal Research Service, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Antonia Jiménez-Morales
- Department of Materials Science and Engineering, University Carlos III of Madrid, Madrid, Spain
- Álvaro Alonso Barba Technological Institute of Chemistry and Materials, Carlos III University of Madrid, Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
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26
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Liao C, Li Y, Tjong SC. Visible-Light Active Titanium Dioxide Nanomaterials with Bactericidal Properties. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E124. [PMID: 31936581 PMCID: PMC7022691 DOI: 10.3390/nano10010124] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 12/16/2022]
Abstract
This article provides an overview of current research into the development, synthesis, photocatalytic bacterial activity, biocompatibility and cytotoxic properties of various visible-light active titanium dioxide (TiO2) nanoparticles (NPs) and their nanocomposites. To achieve antibacterial inactivation under visible light, TiO2 NPs are doped with metal and non-metal elements, modified with carbonaceous nanomaterials, and coupled with other metal oxide semiconductors. Transition metals introduce a localized d-electron state just below the conduction band of TiO2 NPs, thereby narrowing the bandgap and causing a red shift of the optical absorption edge into the visible region. Silver nanoparticles of doped TiO2 NPs experience surface plasmon resonance under visible light excitation, leading to the injection of hot electrons into the conduction band of TiO2 NPs to generate reactive oxygen species (ROS) for bacterial killing. The modification of TiO2 NPs with carbon nanotubes and graphene sheets also achieve the efficient creation of ROS under visible light irradiation. Furthermore, titanium-based alloy implants in orthopedics with enhanced antibacterial activity and biocompatibility can be achieved by forming a surface layer of Ag-doped titania nanotubes. By incorporating TiO2 NPs and Cu-doped TiO2 NPs into chitosan or the textile matrix, the resulting polymer nanocomposites exhibit excellent antimicrobial properties that can have applications as fruit/food wrapping films, self-cleaning fabrics, medical scaffolds and wound dressings. Considering the possible use of visible-light active TiO2 nanomaterials for various applications, their toxicity impact on the environment and public health is also addressed.
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Affiliation(s)
- Chengzhu Liao
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Yuchao Li
- Department of Materials Science and Engineering, Liaocheng University, Liaocheng 252000, China;
| | - Sie Chin Tjong
- Department of Physics, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong 999077, China
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27
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Complications in Total Joint Arthroplasties. J Clin Med 2019; 8:jcm8111891. [PMID: 31698808 PMCID: PMC6912594 DOI: 10.3390/jcm8111891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 01/16/2023] Open
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28
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Macias-Valcayo A, Pfang BG, Auñón A, Esteban J. Pharmacotherapy options and drug development in managing periprosthetic joint infections in the elderly. Expert Opin Pharmacother 2019; 20:1109-1121. [PMID: 30983431 DOI: 10.1080/14656566.2019.1602118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Prosthetic joint infections are an increasingly important problem among patients undergoing arthroplasty procedures, and are associated with significant morbidity, reduced quality of life, substantial healthcare costs, and even mortality. Arthroplasties are performed with increasing frequency in elderly patients, who present specific problems. AREAS COVERED Surgical therapy is clearly influenced by the clinical status of the patient, which in some case can contraindicate surgery. Antibiotic selection is also affected by comorbidities and underlying diseases, which in some cases reduce therapeutic options. The authors review this together with the changes in pharmacokinetics and pharmacodynamics in the elderly population and the prospects for future research on prevention and treatment. EXPERT OPINION The management of PJI in the elderly makes multidisciplinary teams even more mandatory than in other patients, because the complexity of these patients. A frequent scenario is that in which surgery is contraindicated with long-term suppressive treatment as the only available option. Treating physicians must consider the presence of multiple comorbidities, interactions with other treatments and secondary effects when choosing antibiotic treatment. An in-depth knowledge of the alterations in pharmacokinetics and pharmacodynamics in elderly patients is key for a proper treatment selection.
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Affiliation(s)
- Alicia Macias-Valcayo
- a Department of Clinical Microbiology , IIS-Fundación Jiménez Díaz , Madrid , Spain.,b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain
| | - Bernadette G Pfang
- b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain.,c Department of Internal Medicine , IIS-Fundación Jiménez Díaz , Madrid , Spain
| | - Alvaro Auñón
- b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain.,d Department of Traumatology and Orthopaedic Surgery , IIS-Fundación Jiménez Díaz , Madrid , Spain
| | - Jaime Esteban
- a Department of Clinical Microbiology , IIS-Fundación Jiménez Díaz , Madrid , Spain.,b Bone and Joint Infection Unit , Fundación Jiménez Díaz University Hospital , Madrid , Spain
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