Does Antibiotic-Loaded Bone Cement Trigger Widespread Antibiotic Resistance Affecting Prosthetic Joint Infection Treatment?

2022 ◽  
pp. 701-706
Author(s):  
Christof Berberich
Keyword(s):  
Antibiotic Resistance ◽  
Bone Cement ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Infection Treatment

scholarly journals Antimicrobial-Loaded Bone Cement Does Not Negatively Influence Sonicate Fluid Culture Positivity for Diagnosis of Prosthetic Joint Infection

2016 ◽  
Vol 54 (6) ◽  
pp. 1656-1659 ◽  
Author(s):  
Kyung-Hwa Park ◽  
Kerryl E. Greenwood-Quaintance ◽  
Arlen D. Hanssen ◽  
Matthew P. Abdel ◽  
Robin Patel
Keyword(s):  
Bone Cement ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Culture Positivity ◽  
Prosthetic Joint ◽  
Fluid Culture

We compared culture results to investigate the influence of antimicrobial-loaded cement on sonicate fluid culture positivity for the diagnosis of prosthetic joint infection. Fifty-four subjects were assessed. The sensitivities of sonicate fluid culture were 77.8% (14 of 18) in subjects with an antimicrobial-loaded cemented prosthesis and 58.3% (21 of 36) in subjects with an antimicrobial-free prosthesis.

Specific microbiology issues relating to prosthetic joint infection

2018 ◽  
pp. 41-50
Author(s):  
Umraz Khan ◽  
Graeme Perks ◽  
Rhidian Morgan-Jones ◽  
Peter James ◽  
Colin Esler ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Therapy ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antibiotic Use ◽  
Stopping Rules ◽  
Two Stage ◽  
Infected Case ◽  
Prosthetic Joint ◽  
Resistance Approach

This chapter discusses specific microbiology issues relating to prosthetic joint infection (PJI) and includes discussion on antibiotic prophylaxis (including elective joint replacement in the uninfected case), choice of ‘prophylaxis/treatment’ in the infected, or presumed, infected case, a suggested framework for a safe practice, antibiotic use in PJI in the age of resistance, background on rising antibiotic resistance, approach to one- and two-stage surgical management, outpatient antibiotic therapy and when to use it, monitoring/stopping rules, the particular problems of Pseudomonas and Candida in PJI, and myths and facts about what ‘immunosuppression’ actually means in practice (including MRSA), and a conclusion.

Factors influencing the cost of prosthetic joint infection treatment

2013 ◽  
Vol 85 (3) ◽  
pp. 213-219 ◽  
Author(s):  
T.N. Peel ◽  
A.C. Cheng ◽  
Y.P. Lorenzo ◽  
D.C.M. Kong ◽  
K.L. Buising ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Factors Influencing ◽  
Prosthetic Joint ◽  
Infection Treatment ◽  
The Cost

Successful Clinical Use of Daptomycin-Impregnated Bone Cement in Two-Stage Revision Hip Surgery for Prosthetic Joint Infection

2013 ◽  
Vol 47 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Nicholas J Cortes ◽  
John M Lloyd ◽  
Leszek Koziol ◽  
Lawrence O'Hara
Keyword(s):  
Bone Cement ◽  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Past History ◽  
Joint Infection ◽  
Pmma Bone Cement ◽  
Prosthetic Joint ◽  
History Of

OBJECTIVE To describe the safe and successful use of daptomycin-impregnated polymethyl methacrylate (PMMA) bone cement in the treatment of a case of recurrent prosthetic joint infection in a patient with multiple antibiotic allergies and past colonization with multiply antibiotic-resistant organisms. CASE SUMMARY A 79-year-old female had a history of chronic recurrent left prosthetic hip infection. The patient had confirmed allergies to multiple antibiotics and a past history of colonization with methicillin-resistant Staphylococcus aureus. At first-stage revision surgery, the infected prosthesis was removed and samples were sent for microbiologic culture. A spacer device was fashioned, with incorporation of daptomycin and gentamicin into the PMMA bone cement at a concentration of 5% w/w for each antibiotic. Systemic daptomycin and gentamicin were administered postoperatively for 14 days. Propionibacterium acnes was isolated from deep-tissue specimens. The patient made excellent postoperative progress and was discharged after 2 weeks. Second-stage revision surgery was performed at 6 months, with no signs of persistent infection. She remained well, pain free, and mobilizing independently 2 years later. DISCUSSION Daptomycin, a cyclic lipopeptide antibiotic, is approved for systemic treatment of endocarditis and skin and soft tissue infections. In vitro data demonstrate acceptable drug elution from and tensile strength of daptomycin-impregnated PMMA bone cement; however, clinical data are lacking. In our patient's case, the cement formulation was well tolerated, with no adverse effects detected, and demonstrated adequate mechanical strength in vivo. Infection with P. acnes, an unusual pathogen, was successfully treated. Further clinical studies are required to assess the efficacy of daptomycin-impregnated cement in infection with more typical pathogens, such as S. aureus. CONCLUSIONS Daptomycin impregnation of PMMA bone cement may be an option in cases in which patient or pathogen factors preclude use of routinely incorporated agents.

scholarly journals IN VITRO TESTING OF GENTAMICIN-VANCOMYCIN LOADED BONE CEMENT TO PREVENT PROSTHETIC JOINT INFECTION

2005 ◽  
Vol 149 (1) ◽  
pp. 153-158 ◽  
Author(s):  
Jiri Gallo ◽  
Milan Kolar ◽  
Anthony V. Florschutz ◽  
Radek Novotny ◽  
Roman Pantucek ◽  
...  
Keyword(s):  
Bone Cement ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
In Vitro Testing ◽  
Prosthetic Joint

scholarly journals Risk assessment of antibiotic resistance development by antibiotic-loaded bone cements: is it a clinical concern?

2019 ◽  
Vol 4 (10) ◽  
pp. 576-584 ◽  
Author(s):  
Christof Berberich ◽  
Pablo Sanz-Ruiz
Keyword(s):  
Antibiotic Resistance ◽  
Bone Cement ◽  
Selection Process ◽  
Joint Infection ◽  
Bacterial Biofilm ◽  
Resistant Bacteria ◽  
Local Antibiotics ◽  
Resistance Development ◽  
Prosthetic Joint ◽  
Drug Concentrations

Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaedic procedures involving the implantation of large prosthesis systems is considered mandatory. A strategy based on the rationale that local antibiotics released from bone cement or other carriers establish a second antibacterial frontline in and around the prosthesis is considered complementary to the administration of systemic antibiotics. Although less common as a consequence of the initially very high drug concentrations of local antibiotics in the tissues, a selection process of previous high resistance bacteria may occur, leading to antibiotic resistance. The use of antibiotic combinations in bone cement is generally accepted to improve antibiotic efficacy and minimizes the treatment failure risk due to antibiotic resistance. This is important in septic revisions and/or in patients at particularly high risk of infection. On an individual basis, the benefit of a lower infection probability with combined systemic and local antibiotic application should outweigh the risk of the selection of more resistant bacteria. Each prevented infection means that a complex and extended antibiotic therapy with risk of resistance development over time has been avoided. On an epidemiological level there is no clinical evidence that the routine use of bone cement impregnated with appropriate bactericidal antibiotics promotes the widespread development of antibiotic resistance and thereby puts the successful treatment of a prosthetic joint infection at higher risk. Cite this article: EFORT Open Rev 2019;4:576-584. DOI: 10.1302/2058-5241.4.180104

scholarly journals Prosthetic Joint Infection Microorganism Pattern and Risk Factor Profile: A Single Center Study

2020 ◽  
Vol 1 (1) ◽  
pp. 28-35
Author(s):  
Fahreza Hilmy ◽  
Yoshi Pratama Djaja ◽  
Anggaditya Putra ◽  
Jamot Silitonga ◽  
Ludwig Andribert Pontoh
Keyword(s):  
Antibiotic Resistance ◽  
Risk Factor ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Frailty Index ◽  
Causative Microorganism ◽  
Prosthetic Joint ◽  
Duration Of Surgery ◽  
Resistance Patterns ◽  
Antibiotic Resistance Patterns

Introduction: Prosthetic joint infection (PJI) is a serious complication especially following arthroplasty surgeries. The outcome of these cases is affected by the pattern of infection, causative microorganism, and antibiotic resistance. This study was aimed to evaluate the prevalence of PJI, distribution of causative microorganism, antibiotic resistance, and risk factor profiling.Methods: A retrospective review was performed by arthroplasty registry evaluation from 2008-2018, followed by a medical record review and patient interview. Distribution of causative microorganisms, antibiotic resistance patterns, and the onset of infection was extracted. Risk factor evaluation was performed by assessing preoperative (age, body mass index (BMI), frailty index) and perioperative parameters (duration of surgery, number of previous surgeries, the interval between those surgeries). Results: Seventeen patients were diagnosed with PJI (13 hip and 4 knees), with a prevalence of 1.56% and 1.77% respectively. The most common causative organism was Staphylococcus aureus and Escherichia coli with multiple antibiotic resistance patterns. These infections mostly occurred in patients with the age of 40-60 years, BMI 30kg/m2, and pre-operative frailty index of 4. The perioperative risk factor was the duration of surgery for more than 3 hours, have undergone more than 3 surgeries with an average surgical interval of 2 months.Conclusions: The prevalence of PJI in this series was 1.56% in hip and 1.77% in the knee. The risk factor profile showed that most cases have high BMI, prolonged duration of surgery, and a high number of previous surgeries within a short interval. 

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