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Stevoska S, Behm-Ferstl V, Zott S, Stadler C, Gotterbarm T, Klasan A. Second-Line Antibiotic Agents in Patient-Reported Penicillin or Cephalosporin Allergy Have No Negative Impact on Antibiotic Resistance After Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:242-249.e2. [PMID: 37380142 DOI: 10.1016/j.arth.2023.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND The aim of the present study was to compare causative bacteria and their antibiotic resistance profiles in patients developing a periprosthetic joint infection (PJI) based on preoperative prophylactic antibiotic regimens in primary total hip (THA) and primary total and unicompartmental knee arthroplasty (TKA/UKA). METHODS We reviewed all cases of PJI occurring after primary THA and primary TKA/UKA, between 2011 and 2020 in a tertiary referral hospital. The standard preoperative prophylactic antibiotic for primary joint arthroplasty was cefuroxime and recommended second-line agent was clindamycin. Patients were divided by the replaced joint and analyzed independently. RESULTS In the THA group, culture-positive PJI was detected in 61 of 3,123 (2.0%) cefuroxime-administered cases and 6 of 206 (2.9%) noncefuroxime-administered cases. In the TKA/UKA group, culture positive PJI was identified in 21 of 2,455 (0.9%) cefuroxime-administered cases and in 3 of 211 (1.4%) noncefuroxime administered cases. The most commonly isolated bacteria in both groups were coagulase negative staphylococci (CNS). There were no statistically significant differences of pathogen spectrum depending on the preoperative antibiotic regimen detected. Antibiotic resistance of isolated bacteria was significantly different in 4 of 27 (14.8%) analyzed antibiotics in THA and in 3 of 22 (13.6%) analyzed antibiotics in TKA/UKA. In all cohorts, a high occurrence of oxacillin-resistant CNS (50.0 to 100.0%) and clindamycin-resistant CNS (56.3 to 100.0%) has been observed. CONCLUSION The use of the second-line antibiotic did not influence the pathogen spectrum or antibiotic resistance. However, an alarmingly high proportion of CNS strains was resistant to clindamycin.
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Affiliation(s)
- Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Verena Behm-Ferstl
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Stephanie Zott
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Linz, Austria; Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Antonio Klasan
- Faculty of Medicine, Johannes Kepler University Linz, Linz, Austria; AUVA UKH Steiermark, Graz, Austria
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2
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Azamgarhi T, Warren S, Fouch S, Standing JF, Gerrand C. Prophylactic antibiotics for massive endoprostheses in orthopaedic oncology. Bone Joint J 2023; 105-B:850-856. [PMID: 37524359 DOI: 10.1302/0301-620x.105b8.bjj-2022-1418.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic prophylaxis from 24 hours to five days after endoprosthetic reconstruction for lower limb bone tumours. PARITY is the first randomized controlled trial in orthopaedic oncology and is a huge step forward in understanding antibiotic prophylaxis. However, significant gaps remain, including questions around antibiotic choice, particularly in the UK, where cephalosporins are avoided due to concerns of Clostridioides difficile infection. We present a review of the evidence for antibiotic choice, dosing, and timing, and a brief description of PARITY, its implication for practice, and the remaining gaps in our understanding.
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Affiliation(s)
- Tariq Azamgarhi
- Pharmacy Department, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Simon Warren
- Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Sarah Fouch
- School of Pharmacy and Biomedical Sciences, Portsmouth, UK
| | - Joseph F Standing
- Infection, Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Craig Gerrand
- Division of Orthopaedic Oncology, Royal National Orthopaedic Hospital NHS Trust Sarcoma Unit, London, UK
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3
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Stevoska S, Himmelbauer F, Stiftinger J, Stadler C, Gotterbarm T, Heyse TJ, Klasan A. Significant Difference in Antimicrobial Resistance of Coagulase Negative Periprosthetic Joint Infection in Septic Revision Total Knee Arthroplasty Between Two Major Orthopedic Centers. J Arthroplasty 2022; 37:S306-S312. [PMID: 35210149 DOI: 10.1016/j.arth.2021.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/22/2021] [Accepted: 11/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is recognized as a major public health threat. It occurs naturally; however, an excessive antibiotic use and misuse of antibiotics accelerate the process. Periprosthetic joint infections (PJI) are becoming harder to treat as the efficacy of antibiotics is becoming lower. The aim of this study was to compare the resistance of coagulase-negative staphylococci (CNS) to antibiotics identified after revision TKAs for PJI between two major orthopedic centers. METHODS A review of all revision TKAs, undertaken between 2006 and 2018 in two orthopedic centers, was performed, including all those meeting the consensus criteria for PJI, in which CNS were identified. There were no major differences in surgical approach and tissue sampling between both centers. Thirteen commonly used antibiotics were tested at both centers. RESULTS The 132 strains were analyzed for their resistance to 13 different antibiotics. Staphylococcus epidermidis was identified in 70.5% cultures, followed by Staphylococcus capitis in 8.3% cultures. The comparison of antibiotic resistance between two centers was statistically significant to penicillin (P = .001), oxacillin (P = .011), cefuroxime (P = .044), levofloxacin (P = .006), moxifloxacin (P = .008), tetracycline (P < .001), rifampicin (P < .001) and vancomycin (P < .001). The difference of resistance of CNS was not statistically significant to fosfomycin, clindamycin, teicoplanin, erythromycin and ampicillin. CONCLUSIONS The resistance of CNS to antibiotics differs significantly between two major orthopedic centers that are geographically fairly close. Monitoring of bacteriological analyses in each referral center should be continuously performed. Close monitoring is needed for more efficient antibiotic treatment of and prophylaxis against PJI.
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Affiliation(s)
- Stella Stevoska
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | - Felix Himmelbauer
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | - Julian Stiftinger
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | - Christian Stadler
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | - Tobias Gotterbarm
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
| | | | - Antonio Klasan
- Kepler University Hospital and Johannes Kepler University Linz, Linz, Austria
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4
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Levack AE, Turajane K, Driscoll DA, Yang X, Miller AO, Bostrom MP, Wellman DS, Carli AV. Identifying alternative antibiotics that elute from calcium sulfate beads for treatment of orthopedic infections. J Orthop Res 2022; 40:1143-1153. [PMID: 34191350 PMCID: PMC8716667 DOI: 10.1002/jor.25135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/17/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
There has been increasing interest in the use of a synthetic absorbable calcium sulfate (CaSO4 ) for local antibiotic delivery in orthopaedic infections. The purpose of this study was to quantify elution kinetics of six antibiotics (amikacin, meropenem, fosfomycin, minocycline, cefazolin, and dalbavancin) from a clinically relevant CaSO4 bead model and compare elution and antimicrobial activity to the current clinical gold standards: vancomycin and tobramycin. Antibiotic-loaded synthetic CaSO4 beads were immersed in phosphate buffered saline and incubated at 37°C. Eluent was harvested at eight time points over 28 days. Antibiotic concentrations were measured by high performance liquid chromatography to quantify elution rates. CaSO4 beads demonstrated burst release kinetics. Dalbavancin, cefazolin, and minocycline all demonstrated similar elution profiles to vancomycin. Amikacin and meropenem demonstrated favorable elution profiles and durations of above-minimum inhibitory concentration when compared to tobramycin. Clinical Significance: This study provides important novel data regarding the utility of amikacin, meropenem and dalbavancin as alternative choices to place in CaSO4 carriers when treating orthopaedic infections.
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Affiliation(s)
- Ashley E. Levack
- Orthopaedic Trauma Service, Hospital for Special Surgery; New York, NY, USA,Loyola University Medical Center, Maywood, IL, USA
| | - Kathleen Turajane
- Musculoskeletal Integrity Program, Hospital for Special Surgery; New York, NY, USA
| | - Daniel A. Driscoll
- Orthopaedic Trauma Service, Hospital for Special Surgery; New York, NY, USA
| | - Xu Yang
- Musculoskeletal Integrity Program, Hospital for Special Surgery; New York, NY, USA
| | - Andy O. Miller
- Infectious Diseases, Hospital for Special Surgery; New York, NY, USA
| | - Mathias P. Bostrom
- Musculoskeletal Integrity Program, Hospital for Special Surgery; New York, NY, USA,Adult Reconstruction, Hospital for Special Surgery; New York, NY, USA
| | - David S. Wellman
- Orthopaedic Trauma Service, Hospital for Special Surgery; New York, NY, USA,Westchester Medical Center, Valhalla NY, USA
| | - Alberto V. Carli
- Musculoskeletal Integrity Program, Hospital for Special Surgery; New York, NY, USA,Adult Reconstruction, Hospital for Special Surgery; New York, NY, USA
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Huzum B, Curpan AS, Puha B, Serban DN, Veliceasa B, Necoara RM, Alexa O, Serban IL. Connections between Orthopedic Conditions and Oxidative Stress: Current Perspective and the Possible Relevance of Other Factors, Such as Metabolic Implications, Antibiotic Resistance, and COVID-19. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:439. [PMID: 35334615 PMCID: PMC8951198 DOI: 10.3390/medicina58030439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 12/15/2022]
Abstract
The general opinion in the literature is that these topics remain clearly understudied and underrated, with many unknown aspects and with controversial results in the respective areas of research. Based on the previous experience of our groups regarding such matters investigated separately, here we attempt a short overview upon their links. Thus, we summarize here the current state of knowledge regarding the connections between oxidative stress and: (a) orthopedic conditions; (b) COVID-19. We also present the reciprocal interferences among them. Oxidative stress is, of course, an interesting and continuously growing area, but what exactly is the impact of COVID-19 in orthopedic patients? In the current paper we also approached some theories on how oxidative stress, metabolism involvement, and even antibiotic resistance might be influenced by either orthopedic conditions or COVID-19. These manifestations could be relevant and of great interest in the context of this current global health threat; therefore, we summarize the current knowledge and/or the lack of sufficient evidence to support the interactions between these conditions.
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Affiliation(s)
- Bogdan Huzum
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Alexandrina Stefania Curpan
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University of Iasi, Carol I Avenue, 20A, 700554 Iasi, Romania
| | - Bogdan Puha
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Dragomir Nicolae Serban
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bogdan Veliceasa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Riana Maria Necoara
- Radiology-Imaging Clinic, “Sf. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania;
| | - Ovidiu Alexa
- Department of Orthopaedic and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.H.); (B.P.); (B.V.); (O.A.)
| | - Ionela Lacramioara Serban
- Department of Physiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
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Kurapatti M, Oakley C, Singh V, Aggarwal VK. Antibiotic Therapy in 2-Stage Revision for Periprosthetic Joint Infection: A Systematic Review. JBJS Rev 2022; 10:01874474-202201000-00003. [PMID: 35020709 DOI: 10.2106/jbjs.rvw.21.00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients undergoing total joint arthroplasty (TJA) are at risk for developing periprosthetic joint infection (PJI). To treat PJI, orthopaedic surgeons can perform 1-stage or 2-stage revision arthroplasty. Although 2-stage revision yields superior long-term outcomes, the optimal antibiotic therapy duration and route of administration between stages remain uncertain. In this systematic review, we aimed to identify if variations in antibiotic therapy, duration, and administration during 2-stage hip or knee revision arthroplasty affect PJI eradication rates and surgical outcome measures. METHODS A literature search was performed using the PubMed and Google Scholar databases to identify all original reports from January 2000 to June 2021 involving 2-stage revision arthroplasty to treat PJI. Studies were included if they specified antibiotic duration, an intravenous (IV) route of antibiotic administration, type of antibiotic, and 2-stage revision PJI eradication rate and had a mean or median follow-up of at least 2 years after the second-stage operation. Included studies were classified into 3 groups based on the length of IV antibiotic therapy after prosthesis explantation: prolonged IV antibiotic therapy of 4 to 6 weeks, shortened IV antibiotic therapy of ≤2 weeks, and shortened course of IV antibiotic therapy followed by 6 to 12 weeks of oral antibiotics. RESULTS Nine studies were included. Three studies utilizing a prolonged IV antibiotic therapy had PJI eradication rates of 79% to 96%. Four studies using a shortened IV antibiotic therapy showed PJI eradication rates of 88% to 100%. Finally, 2 studies utilizing a shortened course of IV antibiotic therapy with oral antibiotics had PJI eradication rates of 95% and 97%. There was no significant difference in eradication rates across IV antibiotic duration strategies, despite a diverse array of cultured microorganisms across the studies. CONCLUSIONS Although the numbers are small, this systematic review suggests that prolonged IV antibiotic duration, shortened IV antibiotic duration, and shortened IV antibiotic duration supplemented with oral antibiotics confer similar PJI eradication rates after hip or knee arthroplasty. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mark Kurapatti
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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7
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Levack AE, Turajane K, Yang X, Miller AO, Carli AV, Bostrom MP, Wellman DS. Thermal Stability and in Vitro Elution Kinetics of Alternative Antibiotics in Polymethylmethacrylate (PMMA) Bone Cement. J Bone Joint Surg Am 2021; 103:1694-1704. [PMID: 33857030 DOI: 10.2106/jbjs.20.00011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Amikacin, meropenem, minocycline, and fosfomycin have potential clinical utility for orthopaedic infections; however, their suitability for use in polymethylmethacrylate (PMMA) is poorly understood. The purpose of this study was (1) to quantify the thermal stability of these antibiotics at clinically relevant temperatures and (2) to determine the elution pharmacodynamics of these alternative antibiotics in vitro from PMMA beads of different sizes. METHODS Polymerization temperatures of 10-mm PMMA beads were measured over time to generate a simulated heating curve. Aqueous solutions of tobramycin, amikacin, meropenem, minocycline, and fosfomycin were subjected to the temperature curves, followed by incubation at 37°C. Minimum inhibitory concentrations of each antibiotic were evaluated against Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii. High-dose 4.5-mm, 6-mm, and 10-mm antibiotic-laden PMMA beads (10% antibiotic by weight) were submerged individually in a phosphate-buffered saline solution and incubated at 37°C. Antibiotic elution was determined with use of high-performance liquid chromatography with mass spectrometry. RESULTS Tobramycin, amikacin, and fosfomycin demonstrated thermal stability and maintained antimicrobial activity for 28 days. Minocycline and meropenem lost antimicrobial activity against all 3 organisms after 48 hours and 7 days, respectively. Elution concentrations, rates, and cumulative drug mass for tobramycin, amikacin, and meropenem were orders of magnitude higher than minocycline and fosfomycin at each time point. CONCLUSIONS This study identified notable differences in thermal stability and elution among antibiotics used to treat infections. Amikacin exhibited activity similarly to tobramycin. Meropenem demonstrated favorable elution kinetics and thermal stability in the initial 7-day period. CLINICAL RELEVANCE Amikacin and meropenem show pharmacologic promise as potential acceptable alternatives for local delivery in PMMA for treatment of orthopaedic infections. Further work to establish clinical relevance and utility is needed.
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Affiliation(s)
- Ashley E Levack
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY.,Loyola University Medical Center, Maywood, Illinois
| | - Kathleen Turajane
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Xu Yang
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Andy O Miller
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Alberto V Carli
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - Mathias P Bostrom
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY
| | - David S Wellman
- Orthopaedic Trauma Service (A.E.L. and D.S.W.), Musculoskeletal Integrity Program (K.T., X.Y, A.V.C., and M.P.B.), Infectious Diseases (A.O.M.), and Adult Reconstruction (A.V.C. and M.P.B.), Hospital for Special Surgery, New York, NY.,Westchester Medical Center, Valhalla, New York
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8
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Raeder SB, Sandbakken ET, Nepal A, Løseth K, Bergh K, Witsø E, Otterlei M. Novel Peptides Targeting the β-Clamp Rapidly Kill Planktonic and Biofilm Staphylococcus epidermidis Both in vitro and in vivo. Front Microbiol 2021; 12:631557. [PMID: 33815313 PMCID: PMC8009970 DOI: 10.3389/fmicb.2021.631557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
Antimicrobial resistance is an increasing threat to global health and challenges the way we treat infections. Peptides containing the PCNA interacting motif APIM (APIM-peptides) were recently shown to bind to the bacterial PCNA homolog, the beta (β)-clamp, and to have both antibacterial and anti-mutagenic activities. In this study we explore the antibacterial effects of these peptides on Staphylococcus epidermidis, a bacterial species commonly found in prosthetic joint infections (PJI). Drug-resistant bacterial isolates from PJIs often lead to difficult-to-treat chronic infections. We show that APIM-peptides have a rapid bactericidal effect which when used at sublethal levels also increase the efficacy of gentamicin. In addition, APIM-peptides reduce development and eliminate already existing S. epidermidis biofilm. To study the potential use of APIM-peptides to prevent PJI, we used an in vivo bone graft model in rats where APIM-peptide, gentamicin, or a combination of the two was added to cement. The bone grafts containing cement with the combination was more effective than cement containing only gentamicin, which is the current standard of care. In summary, these results suggest that APIM-peptides can be a promising new drug candidate for anti-infective implant materials to use in the fight against resistant bacteria and chronic PJI.
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Affiliation(s)
- Synnøve Brandt Raeder
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Anala Nepal
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kirsti Løseth
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kåre Bergh
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medical Microbiology, St. Olav University Hospital, Trondheim, Norway
| | - Eivind Witsø
- Department of Orthopaedic Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Marit Otterlei
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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9
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Cole K, Atkins B, Llewelyn M, Paul J. Genomic investigation of clinically significant coagulase-negative staphylococci. J Med Microbiol 2021; 70. [PMID: 33704043 DOI: 10.1099/jmm.0.001337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction. Coagulase-negative staphylococci have been recognized both as emerging pathogens and contaminants of clinical samples. High-resolution genomic investigation may provide insights into their clinical significance.Aims. To review the literature regarding coagulase-negative staphylococcal infection and the utility of genomic methods to aid diagnosis and management, and to identify promising areas for future research.Methodology. We searched Google Scholar with the terms (Staphylococcus) AND (sequencing OR (infection)). We prioritized papers that addressed coagulase-negative staphylococci, genomic analysis, or infection.Results. A number of studies have investigated specimen-related, phenotypic and genetic factors associated with colonization, infection and virulence, but diagnosis remains problematic.Conclusion. Genomic investigation provides insights into the genetic diversity and natural history of colonization and infection. Such information allows the development of new methodologies to identify and compare relatedness and predict antimicrobial resistance. Future clinical studies that employ suitable sampling frames coupled with the application of high-resolution whole-genome sequencing may aid the development of more discriminatory diagnostic approaches to coagulase-staphylococcal infection.
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Affiliation(s)
- Kevin Cole
- Brighton and Sussex Medical School, Brighton, UK.,Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK
| | | | - Martin Llewelyn
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - John Paul
- Public Health England Collaborating Centre, Royal Sussex County Hospital, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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10
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Kuiper JWP, Hogervorst JMA, Herpers BL, Bakker AD, Klein-Nulend J, Nolte PA, Krom BP. The novel endolysin XZ.700 effectively treats MRSA biofilms in two biofilm models without showing toxicity on human bone cells in vitro. BIOFOULING 2021; 37:184-193. [PMID: 33615928 DOI: 10.1080/08927014.2021.1887151] [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] [Received: 09/27/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
In this in vitro study the effect of XZ.700, a new endolysin, on methicillin resistant Staphylococcus aureus (MRSA) biofilms grown on titanium was evaluated. Biofilms of S. aureus USA300 were grown statically and under flow, and treatment with XZ.700 was compared with povidone-iodine (PVP-I) and gentamicin. To evaluate the cytotoxic effects of XZ.700 and derived biofilm lysates, human osteocyte-like cells were exposed to biofilm supernatants, and metabolism and proliferation were quantified. XZ.700 showed a significant, concentration dependent reduction in biofilm viability, compared with carrier controls. Metabolism and proliferation of human osteocyte-like cells were not affected by XZ.700 or lysates, unlike PVP-I and gentamicin lysates which significantly inhibited proliferation. Using time-lapse microscopy, rapid biofilm killing and removal was observed for XZ.700. In comparison, PVP-I and gentamicin showed slower biofilm killing, with no apparent biofilm removal. In conclusion, XZ.700 reduced MRSA biofilms, especially under flow condition, without toxicity for surrounding bone cells.
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Affiliation(s)
- Jesse W P Kuiper
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Jolanda M A Hogervorst
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Bjorn L Herpers
- Department of Medical Microbiology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Astrid D Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Peter A Nolte
- Department of Orthopedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Bastiaan P Krom
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Yu Y, Kong Y, Ye J, Wang A, Si W. Microbiological pattern of prosthetic hip and knee infections: a high-volume, single-centre experience in China. J Med Microbiol 2021; 70. [PMID: 33448922 DOI: 10.1099/jmm.0.001305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Prosthetic joint infection (PJI) is a serious complication after arthroplasty, which results in high morbidity, prolonged treatment and considerable healthcare expenses in the absence of accurate diagnosis. In China, microbiological data on PJIs are still scarce.Hypothesis/Gap Statement. The incidence of PJI is increasing year by year, and the proportion of drug-resistant bacteria infection is nicreasing, which brings severe challenges to the treatment of infection.Aim. This study aimed to identify the pathogens in PJIs, multi-drug resistance, and evaluate the effect of the treatment regimen in patients with PJI.Methodology. A total of 366 consecutive cases of PJI in the hip or knee joint were admitted at the Orthopedic Surgery Center in Zhengzhou, China from January 2012 to December 2018. Infections were confirmed in accordance with the Infectious Diseases Society of America and the Musculoskeletal Infection Society (MSIS) criteria. Concurrently, patient demographic data, incidence and antibiotic resistance were investigated. Statistical differences were analysed using Fisher's exact test or chi-square test.Results. Altogether, 318 PJI cases satisfying the inclusion criteria were enrolled in this study, including 148 with hip PJIs and 170 with knee PJIs. The average age of patients with hip PJIs was lesser than that of patients with knee PJIs (56.4 vs. 68.6 years). Meanwhile, coagulase-negative staphylococcus (CNS, n=81, 25.5 %) was the predominant causative pathogen, followed by Staphylococcus aureus (n=67, 21.1 %). Methicillin-resistant Staphylococcus (MRS) was identified in 28.9 % of PJI patients. In addition, fungus accounted for 4.8 % (n=15), non-tuberculosis mycobacterium accounted for 1.6 % (n=5), polymicrobial pathogens accounted for 21.7 % (n=69), and Gram-negative bacteria accounted for 7.9 % (n=25) of the total infections. The results of antibiotic susceptibility testing showed that gentamicin and clindamycin β-lactam antibiotics were poorly susceptible to Gram-positive isolates, but they were sensitive to rifampicin, linezolid and vancomycin. While antibiotics such as amikacin and imipenem were effective against Gram-negative bacteria, there was a high resistance rate of other pathogens to gentamicin, clindamycin and some quinolone antibacterial drugs. Empirical antibiotic treatment should combine vancomycin and cephalosporin, levofloxacin or clindamycin. When the pathogen is confirmed, the treatment should be individualized.Conclusions. The prevalence of culture-negative PJIs is still very high. Gram-positive bacteria are still the main type of pathogens that cause PJIs. Attention should be paid to the high incidence of MRS, such as MRSA and MR-CNS, among PJI patients. Empirical antibiotic treatment should cover Gram-positive isolates, especially Staphylococcus.
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Affiliation(s)
- Yali Yu
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450000, PR China
| | - Yiyi Kong
- Department of Clinical Laboratory, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450000, PR China
| | - Jing Ye
- Department of Pathology, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450000, PR China
| | - Aiguo Wang
- Department of Joint Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450000, PR China
| | - Wenteng Si
- Department of Joint Surgery, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450000, PR China
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Wouthuyzen-Bakker M, Kheir MM, Moya I, Rondon AJ, Kheir M, Lozano L, Parvizi J, Soriano A. Failure After 2-Stage Exchange Arthroplasty for Treatment of Periprosthetic Joint Infection: The Role of Antibiotics in the Cement Spacer. Clin Infect Dis 2020; 68:2087-2093. [PMID: 30281077 DOI: 10.1093/cid/ciy851] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Failure after a 2-stage exchange surgery for periprosthetic joint infection (PJI) is high. Previous studies demonstrated that positive cultures at reimplantation are associated with failure afterward. The aim of this multicenter study was to define the role of antibiotics in the cement spacer in relation to reimplantation cultures and subsequent failure. METHODS We retrospectively evaluated 2-stage exchange procedures between 2000 and 2015. Culture-negative PJIs, cases in which no cultures were obtained during reimplantation, and cases without data on cement spacers were excluded. RESULTS Three hundred forty-four cases were included. The rate of positive cultures during reimplantation was 9.5% for cement spacers containing a glycopeptide (27/284) (with or without an aminoglycoside) vs 21.7% for those containing monotherapy with an aminoglycoside (13/60) (P = .008), and was mostly attributed by a reduction in coagulase-negative staphylococci (CoNS) (17% vs 2%, P < .001). The failure rate was >2-fold higher at 40.0% (16/40) in cases with positive cultures at reimplantation compared to 15.8% (48/304) for those with negative cultures (P < .001). Overall, a glycopeptide in the cement spacer was not associated with a lower failure rate (18% vs 23%, P = .3), but was associated with lower failure due to CoNS (2.5% vs 13.3%, P < .001). CONCLUSIONS In a 2-stage exchange procedure for PJI, adding a glycopeptide to the cement spacer reduces the rate of positive cultures during reimplantation and is associated with a lower failure rate due to CoNS afterward.
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Affiliation(s)
- Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Michael M Kheir
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ignacio Moya
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Spain
| | - Alexander J Rondon
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Matthew Kheir
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Luis Lozano
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Spain
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Spain
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Słowik R, Kołpa M, Wałaszek M, Różańska A, Jagiencarz-Starzec B, Zieńczuk W, Kawik Ł, Wolak Z, Wójkowska-Mach J. Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093167. [PMID: 32370125 PMCID: PMC7246776 DOI: 10.3390/ijerph17093167] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/16/2020] [Accepted: 04/30/2020] [Indexed: 11/16/2022]
Abstract
Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted in 2012–2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). Results: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. Conclusions: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.
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Affiliation(s)
- Róża Słowik
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
| | - Małgorzata Kołpa
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
- State Higher Vocational School, 33-100 Tarnów, Poland
| | - Marta Wałaszek
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
- State Higher Vocational School, 33-100 Tarnów, Poland
| | - Anna Różańska
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-007 Kraków, Poland;
- Correspondence:
| | - Barbara Jagiencarz-Starzec
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
| | - Witold Zieńczuk
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
| | - Łukasz Kawik
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
| | - Zdzisław Wolak
- St. Luke’s Provincial Hospital, 33-100 Tarnów, Poland; (R.S.); (M.K.); (M.W.); (B.J.-S.); (W.Z.); (Ł.K.); (Z.W.)
- State Higher Vocational School, 33-100 Tarnów, Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Jagiellonian University, Polish Society of Hospital Infections, 31-007 Kraków, Poland;
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van Hengel I, Putra N, Tierolf M, Minneboo M, Fluit A, Fratila-Apachitei L, Apachitei I, Zadpoor A. Biofunctionalization of selective laser melted porous titanium using silver and zinc nanoparticles to prevent infections by antibiotic-resistant bacteria. Acta Biomater 2020; 107:325-337. [PMID: 32145392 DOI: 10.1016/j.actbio.2020.02.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/20/2022]
Abstract
Antibiotic-resistant bacteria are frequently involved in implant-associated infections (IAIs), making the treatment of these infections even more challenging. Therefore, multifunctional implant surfaces that simultaneously possess antibacterial activity and induce osseointegration are highly desired in order to prevent IAIs. The incorporation of multiple inorganic antibacterial agents onto the implant surface may aid in generating synergistic antibacterial behavior against a wide microbial spectrum while reducing the occurrence of bacterial resistance. In this study, porous titanium implants synthesized by selective laser melting (SLM) were biofunctionalized with plasma electrolytic oxidation (PEO) using electrolytes based on Ca/P species as well as silver and zinc nanoparticles in ratios from 0 to 100% that were tightly embedded into the growing titanium oxide layer. After the surface bio-functionalization process, silver and zinc ions were released from the implant surfaces for at least 28 days resulting in antibacterial leaching activity against methicillin-resistant Staphylococcus aureus (MRSA). Furthermore, the biofunctionalized implants generated reactive oxygen species, thereby contributing to antibacterial contact-killing. While implant surfaces containing up to 75% silver and 25% zinc nanoparticles fully eradicated both adherent and planktonic bacteria in vitro as well as in an ex vivo experiment performed using murine femora, solely zinc-bearing surfaces did not. The minimum inhibitory and bactericidal concentrations determined for different combinations of both types of ions confirmed the presence of a strong synergistic antibacterial behavior, which could be exploited to reduce the amount of required silver ions by two orders of magnitude (i.e., 120 folds). At the same time, the zinc bearing surfaces enhanced the metabolic activity of pre-osteoblasts after 3, 7, and 11 days. Altogether, implant biofunctionalization by PEO with silver and zinc nanoparticles is a fruitful strategy for the synthesis of multifunctional surfaces on orthopedic implants and the prevention of IAIs caused by antibiotic-resistant bacteria. STATEMENT OF SIGNIFICANCE: Implant-associated infections are becoming increasingly challenging to treat due to growing antibiotic resistance against antibiotics. Here, we propose an alternative approach where silver and zinc nanoparticles are simultaneously used for the biofunctionalization of rationally designed additively manufactured porous titanium. This combination of porous design and tailored surface treatment allows us to reduce the amount of required silver nanoparticles by two orders of magnitude, fully eradicate antibiotic-resistant bacteria, and enhance the osteogenic behavior of pre-osteoblasts. We demonstrate that the resulting implants display antibacterial activity in vitro and ex vivo against methicillin-resistant Staphylococcus aureus.
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Becker K, Both A, Weißelberg S, Heilmann C, Rohde H. Emergence of coagulase-negative staphylococci. Expert Rev Anti Infect Ther 2020; 18:349-366. [DOI: 10.1080/14787210.2020.1730813] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Karsten Becker
- Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Greifswald, Germany
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Anna Both
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Samira Weißelberg
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
- Interdisciplinary Center for Clinical Research (IZKF), University of Münster, Münster, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yang C, Wang J, Yin Z, Wang Q, Zhang X, Jiang Y, Shen H. A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection. Bone Joint Res 2019. [DOI: 10.1302/2046-3758.811.bjr-2019-0339.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics. Methods A retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)). Results There were 62 and 52 PJI cases treated with the GV and VMA protocols, respectively. Antimicrobial susceptibility testing revealed that 22/78 of all isolates (28.2%) in this series were resistant to gentamicin, whereas there were no vancomycin-, meropenem-, or amphotericin-resistant strains. The overall infection recurrence rates were 17.7% (11/62) and 1.9% (1/52), respectively (p = 0.006). In patients with a negative preoperative culture, there was no infection recurrence reported in the VMA cohort (0/45 (0%) vs 10/54 (18.5%) in the GV cohort; p = 0.002). Multivariate analysis indicated that the VMA protocol correlated with a decreased risk of infection recurrence compared with the GV protocol (p = 0.025). Conclusion The sophisticated VMA protocol for the loading of antibiotics in articulating cement spacers, as part of a two-stage exchange, was associated with a reduced rate of infection recurrence. This proposed protocol appears to be safe and effective, especially in patients with negative culture results prior to the first-stage operation. Cite this article: Bone Joint Res 2019;8:526–534.
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Affiliation(s)
- Chuang Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhifei Yin
- Department of Orthopaedic Surgery, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
| | - Qiaojie Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Jiang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
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Yang C, Wang J, Yin Z, Wang Q, Zhang X, Jiang Y, Shen H. A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection: A retrospective cohort study. Bone Joint Res 2019; 8:526-534. [PMID: 31832172 PMCID: PMC6888737 DOI: 10.1302/2046-3758.811.bjr-2018-0339.r3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of prosthetic joint infection (PJI) remains controversial. The objective of the present study was to investigate the effectiveness of articulating cement spacers loaded with a new combination of antibiotics. METHODS A retrospective cohort study involving 114 PJI cases treated with implantation of an articulating cement spacer between 2005 and 2016 was performed. The treatment outcomes of the conventional protocol (i.e. gentamicin and vancomycin (GV protocol)) were compared with those reported using the sophisticated antibiotic-loading protocol (i.e. vancomycin, meropenem, and amphotericin (VMA protocol)). RESULTS There were 62 and 52 PJI cases treated with the GV and VMA protocols, respectively. Antimicrobial susceptibility testing revealed that 22/78 of all isolates (28.2%) in this series were resistant to gentamicin, whereas there were no vancomycin-, meropenem-, or amphotericin-resistant strains. The overall infection recurrence rates were 17.7% (11/62) and 1.9% (1/52), respectively (p = 0.006). In patients with a negative preoperative culture, there was no infection recurrence reported in the VMA cohort (0/45 (0%) vs 10/54 (18.5%) in the GV cohort; p = 0.002). Multivariate analysis indicated that the VMA protocol correlated with a decreased risk of infection recurrence compared with the GV protocol (p = 0.025). CONCLUSION The sophisticated VMA protocol for the loading of antibiotics in articulating cement spacers, as part of a two-stage exchange, was associated with a reduced rate of infection recurrence. This proposed protocol appears to be safe and effective, especially in patients with negative culture results prior to the first-stage operation.Cite this article: Bone Joint Res 2019;8:526-534.
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Affiliation(s)
- Chuang Yang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jin Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhifei Yin
- Department of Orthopaedic Surgery, Kunshan Traditional Chinese Medicine Hospital, Kunshan, China
| | - Qiaojie Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yao Jiang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- H. Shen;
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Veltman ES, Moojen DJF, van Ogtrop ML, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019; 10:348-355. [PMID: 31750083 PMCID: PMC6854054 DOI: 10.5312/wjo.v10.i10.348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/14/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.
AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.
METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up.
RESULTS Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients.
CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden 2333ZA, Netherlands
| | - Dirk Jan F Moojen
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
| | - Marc L van Ogtrop
- Department of Medical Microbiology, OLVG, Amsterdam 1091AC, Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
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Veltman ES, Moojen DJF, Ogtrop MLV, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i10.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S279-S288. [PMID: 30348572 DOI: 10.1016/j.arth.2018.09.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Significant increase of pathogen detection rate by dry arthroscopic biopsies at suspected low-grade infection following total knee arthroplasty: a prospective observational study. Arch Orthop Trauma Surg 2018; 138:1583-1590. [PMID: 30182141 DOI: 10.1007/s00402-018-3032-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The differentiation between stiff-knee and low-grade periprosthetic joint infection (PJI) is the current diagnostic challenge in total knee (TKA) revision arthroplasty. The aim of this study was to investigate the additional value of dry biopsies, compared to wet biopsies, in patients presenting with knee stiffness following primary TKA. MATERIALS AND METHODS Single center, prospective observational study. Consecutive patients with joint stiffness of unknown origin following primary TKA were enrolled. Patient assessment followed the diagnostic standard algorithm. During diagnostic arthroscopy, synovial fluid (synovial WBC, PMN%) and five dry biopsies (dry) were collected. Then fluid was infused and another five microbiology (wet) and five histological biopsies gathered, all from identical locations. The primary outcome parameter was the difference between the pathogens in wet and dry biopsies. RESULTS 71 patients (61% females, 67 ± 10 years) were eligible. Preoperative blood serology mean CRP (0.7 ± 1.5 mg/dl; p = 0.852), WBC (6.6 ± 1.7 G/l; p = 0.056), and synovial fluid mean WBC (1639 ± 2111; p = 0.602), PMN% (38 ± 28; p = 0.738) did not differ between patients with negative, positive wet or dry biopsies. The histology was in 11% positive (p = 0.058). In 32% at least one pathogen was detected, 48% from wet, 44% from dry biopsies. An inhomogeneous distribution was found. Cutibacterium acnes (100%) was solely found in wet, Micrococcus luteus (75%), Staphylococcus capitis (67%), and Micrococcus lylae (100%) were predominantly found in dry biopsies. Additional dry biopsies increased the pathogen detection rate by 49%. CONCLUSION The addition of dry biopsies to the current standard diagnostic algorithm for PJI increased the pathogen detection rate by 49%.
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Li B, Webster TJ. Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections. J Orthop Res 2018; 36:22-32. [PMID: 28722231 PMCID: PMC5775060 DOI: 10.1002/jor.23656] [Citation(s) in RCA: 368] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/21/2017] [Indexed: 02/04/2023]
Abstract
There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic-resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non-drug approaches to reduce bacteria functions related to orthopedic implant-associated infections. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:22-32, 2018.
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Affiliation(s)
- Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA,Mary Babb Randolph Cancer Center, Morgantown, WV 26506, USA,Correspondence to: Bingyun Li, PhD, Department of Orthopaedics, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9196, USA, Tel: 1-304-293-1075, Fax: 1-304-293-7070, , URL: http://medicine.hsc.wvu.edu/ortho-bli/. Thomas J. Webster, PhD, Department of Chemical Engineering, 313 Snell Engineering Center, 360 Huntington Avenue, Northeastern University, Boston, MA 02115, USA, Tel: 1- 617-373-2989, , URL: http://www.che.neu.edu/people/webster-thomas
| | - Thomas J. Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA,Center of Excellence for Advanced Materials Research, King Abdulaziz University, Jeddah, Saudi Arabia,Correspondence to: Bingyun Li, PhD, Department of Orthopaedics, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9196, USA, Tel: 1-304-293-1075, Fax: 1-304-293-7070, , URL: http://medicine.hsc.wvu.edu/ortho-bli/. Thomas J. Webster, PhD, Department of Chemical Engineering, 313 Snell Engineering Center, 360 Huntington Avenue, Northeastern University, Boston, MA 02115, USA, Tel: 1- 617-373-2989, , URL: http://www.che.neu.edu/people/webster-thomas
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23
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Guren E, Figved W, Frihagen F, Watne LO, Westberg M. Prosthetic joint infection-a devastating complication of hemiarthroplasty for hip fracture. Acta Orthop 2017; 88:383-389. [PMID: 28271919 PMCID: PMC5499328 DOI: 10.1080/17453674.2017.1301009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hemiarthroplasty is the most common treatment in elderly patients with displaced femoral neck fracture. Prosthetic joint infection (PJI) is a feared complication. The infection rate varies in the literature, and there are limited descriptive data available. We investigated the characteristics and outcome of PJI following hemiarthroplasty over a 15-year period. Patients and methods - Patients with PJI were identified among 519 patients treated with hemiarthroplasty for a femoral neck fracture at Oslo University Hospital between 1998 and 2012. We used prospectively registered data from previous studies, and recorded additional data from the patients' charts when needed. Results - Of the 519 patients, we identified 37 patients (6%) with early PJI. 20 of these 37 patients became free of infection. Soft tissue debridement and retention of implant was performed in 35 patients, 15 of whom became free of infection with an intact arthroplasty. The 1-year mortality rate was 15/37. We found an association between 1-year mortality and treatment failure (p = 0.001). Staphylococcus aureus and polymicrobial infection were the most common microbiological findings, each accounting for 14 of the 37 infections. Enterococcus spp. was found in 9 infections, 8 of which were polymicrobial. There was an association between polymicrobial infection and treatment failure, and between polymicrobial infection and 1-year mortality. Interpretation - PJI following hemiarthroplasty due to femoral neck fracture is a devastating complication in the elderly. We found a high rate of polymicrobial PJIs frequently including Enterococcus spp, which is different from what is common in PJI after elective total hip arthroplasty.
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Affiliation(s)
| | - Wender Figved
- Orthopaedic Department, Bærum Hospital, Vestre Viken Hospital Trust
| | - Frede Frihagen
- Division of Orthopaedic Surgery, Oslo University Hospital
| | - Leiv Otto Watne
- Geriatrics Department, Oslo University Hospital, Oslo, Norway
| | - Marianne Westberg
- Division of Orthopaedic Surgery, Oslo University Hospital;,Correspondence:
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24
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One-year incidence of prosthetic joint infection in total hip arthroplasty: a cohort study with linkage of the Danish Hip Arthroplasty Register and Danish Microbiology Databases. Osteoarthritis Cartilage 2017; 25:685-693. [PMID: 27986623 DOI: 10.1016/j.joca.2016.12.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 11/11/2016] [Accepted: 12/06/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the trend of Prosthetic Joint Infections (PJI) following primary total hip arthroplasty (THA) and the antimicrobial resistance of the bacteria causing these infections. MATERIALS AND METHODS We identified a population-based cohort of patients in the Danish Hip Arthroplasty Register (DHR) who had primary THA and received their surgery in Jutland or Funen between 2005 and 2014. We followed the patients until revision, emigration, death, or up to 1-year of follow-up. Data from the DHR were combined with those from microbiology databases, the National Register of Patients, and the Civil Registration System. We estimated the cumulative 1-year incidence of PJI for two 5-year periods; 2005-2009 and 2010-2014. The hazard ratio of PJI as a measure of relative risk after adjusting for multiple risk factors was calculated. RESULTS Of 48,867 primary THAs identified, 1120 underwent revision within 1 year. Of these, 271 were due to PJI. The incidence of PJI was 0.53% (95% confidence interval (CI): 0.44; 0.63) during 2005-2009 and 0.57% (95% CI: 0.49; 0.67) during 2010-2014. The adjusted relative risk was 1.05 (95% CI: 0.82; 1.34) for the 2010-2014 period vs the 2005-2009 period. The most common micro-organisms identified in the 271 PJI were Staphylococcus aureus (36%) and coagulase-negative staphylococci (CoNS) (33%); others commonly identified included Enterobacteriaceae, enterococci, and streptococci. Antimicrobial resistance to beta-lactams and gentamicin did not change during the study period. CONCLUSION The risk of PJI within 1-year after primary THA and the antimicrobial resistance of the most prevalent bacteria remained unchanged during the 2005-2014 study period.
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25
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Saeed K, Dryden M, Bassetti M, Bonnet E, Bouza E, Chan M, Cortes N, Davis JS, Esposito S, Giordano G, Gould I, Hartwright D, Lye D, Marin M, Morgan-Jones R, Lajara-Marco F, Righi E, Romano CL, Segreti J, Unal S, Williams RL, Yalcin AN. Prosthetic joints: shining lights on challenging blind spots. Int J Antimicrob Agents 2017; 49:153-161. [DOI: 10.1016/j.ijantimicag.2016.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/23/2016] [Accepted: 10/01/2016] [Indexed: 12/12/2022]
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26
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Gulcu A, Akman A, Demirkan AF, Yorukoglu AC, Kaleli I, Bir F. Fosfomycin Addition to Poly(D,L-Lactide) Coating Does Not Affect Prophylaxis Efficacy in Rat Implant-Related Infection Model, But That of Gentamicin Does. PLoS One 2016; 11:e0165544. [PMID: 27806071 PMCID: PMC5091905 DOI: 10.1371/journal.pone.0165544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/13/2016] [Indexed: 11/18/2022] Open
Abstract
Gentamicin is the preferred antimicrobial agent used in implant coating for the prevention of implant-related infections (IRI). However, the present heavy local and systemic administration of gentamicin can lead to increased resistance, which has made its future use uncertain, together with related preventive technologies. Fosfomycin is an alternative antimicrobial agent that lacks the cross-resistance presented by other classes of antibiotics. We evaluated the efficacy of prophylaxis of 10% fosfomycin-containing poly(D,L-lactide) (PDL) coated K-wires in a rat IRI model and compared it with uncoated (Control 1), PDL-coated (Control 2), and 10% gentamicin-containing PDL-coated groups with a single layer of coating. Stainless steel K-wires were implanted and methicillin-resistant Staphylococcus aureus (ATCC 43300) suspensions (103 CFU/10 μl) were injected into a cavity in the left tibiae. Thereafter, K-wires were removed and cultured in tryptic soy broth and then 5% sheep blood agar mediums. Sliced sections were removed from the tibiae, stained with hematoxylin-eosin, and semi-quantitatively evaluated with X-rays. The addition of fosfomycin into PDL did not affect the X-ray and histopathological evaluation scores; however, the addition of gentamicin lowered them. The addition of gentamicin showed a protective effect after the 28th day of X-ray evaluations. PDL-only coating provided no protection, while adding fosfomycin to PDL offered a 20% level protection and adding gentamicin offered 80%. Furthermore, there were 103 CFU level growths in the gentamicin-added group, while the other groups had 105. Thus, the addition of fosfomycin to PDL does not affect the efficacy of prophylaxis, but the addition of gentamicin does. We therefore do not advise the use of fosfomycin as a single antimicrobial agent in coating for IRI prophylaxis.
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Affiliation(s)
- Anil Gulcu
- Orthopedics and Traumatology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Alp Akman
- Orthopedics and Traumatology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ahmet Fahir Demirkan
- Orthopedics and Traumatology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ali Cagdas Yorukoglu
- Orthopedics and Traumatology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ilknur Kaleli
- Microbiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ferda Bir
- Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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27
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Langvatn H, Lutro O, Dale H, Schrama JC, Hallan G, Espehaug B, Sjursen H, Engesæter LB. Bacterial and Hematological Findings in Infected Total Hip Arthroplasties in Norway Assessment of 278 Revisions Due to Infection in the Norwegian Arthroplasty Register. Open Orthop J 2015; 9:445-9. [PMID: 26587060 PMCID: PMC4645952 DOI: 10.2174/1874325001509010445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
Our aim was to assess the bacterial findings in infected total hip arthroplasties (THAs) in Norway. We also wanted to investigate the relationship between causal bacteria and hematological findings. Revisions reported to the Norwegian Arthroplasty Register (NAR) due to infection after total hip arthroplasty during the period 1993 through September 2007 were identified. One single observer visited ten representative hospitals where clinical history, preoperative blood samples and the bacterial findings of intraoperative samples were collected. Bacterial growth in two or more samples was found in 278 revisions, and thus included. The following bacteria were identified: Coagulase-negative staphylococci (CoNS) (41%), Staphylococcus aureus (S. aureus) (19%), streptococci (11%), polymicrobial infections (10%), enterococci (9%), Gram-negative bacteria (6%) and others (4%). CoNS were the most common bacteria throughout the period but in the acute postoperative infections (< 3 weeks) S. aureus was the most frequent bacterial finding. We found no change in the distribution of the bacterial groups over time. S. aureus appears correlated with a higher C-reactive protein value (CRP) (mean 140 (95% Confidence interval (CI): 101-180)) than CoNS (mean 42 (CI: 31-53)). S. aureus also correlated with a higher erythrocyte sedimentation rate value (ESR) (mean 67 (CI: 55-79)) than CoNS (mean 47 (CI: 39-54)).
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Affiliation(s)
- Håkon Langvatn
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Olav Lutro
- Department of Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Håvard Dale
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway ; The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | | | - Geir Hallan
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Birgitte Espehaug
- The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway
| | - Haakon Sjursen
- Department of Medicine, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lars B Engesæter
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway ; The Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway ; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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28
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Increasing Resistance of Coagulase-Negative Staphylococci in Total Hip Arthroplasty Infections: 278 THA-Revisions due to Infection Reported to the Norwegian Arthroplasty Register from 1993 to 2007. Adv Orthop 2014; 2014:580359. [PMID: 25371827 PMCID: PMC4209759 DOI: 10.1155/2014/580359] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 11/18/2022] Open
Abstract
We investigated bacterial findings from intraoperative tissue samples taken during revision due to infection after total hip arthroplasty (THA). The aim was to investigate whether the susceptibility patterns changed during the period from 1993 through 2007. Reported revisions due to infection in the Norwegian Arthroplasty Register (NAR) were identified, and 10 representative hospitals in Norway were visited. All relevant information on patients reported to the NAR for a revision due to infection, including bacteriological findings, was collected from the medical records. A total of 278 revision surgeries with bacterial growth in more than 2 samples were identified and included. Differences between three 5-year time periods were tested by the chi-square test for linear trend. The most frequent isolates were coagulase-negative staphylococci (CoNS) (41%, 113/278) and Staphylococcus aureus (19%, 53/278). The proportion of CoNS resistant to the methicillin-group increased from 57% (16/28) in the first period, 1993-1997, to 84% (52/62) in the last period, 2003-2007 (P = 0.003). There was also significant increase in resistance for CoNS to cotrimoxazole, quinolones, clindamycin, and macrolides. All S. aureus isolates were sensitive to both the methicillin-group and the aminoglycosides. For the other bacteria identified no changes in susceptibility patterns were found.
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