Efficacy of Colistin-Loaded Cement Spacer in Carbapenem-Resistant Klebsiella pneumoniae Experimental Prosthetic Joint Infection

Antimicrobial resistance in Gram-negative bacteria, particularly Enterobacteriaceae, has become a leading cause of morbidity and mortality and a serious public health concern. Gram-negative bacteria carrying extended-spectrum beta-lactamase (ESBL) enzymes now represent a significant proportion of all bacteria isolated from different countries worldwide. Furthermore, the increasing number of isolates carrying carbapenemases in recent years includes multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria. Here, we describe what, to our knowledge, is the first case of a patient with a prosthetic joint infection from carbapenemase-resistant Klebsiella pneumoniae (CRKP) successfully treated with ceftazidime-avibactam in Italy.

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Draft Genome Sequence of a Multidrug-Resistant Klebsiella pneumoniae Isolate from a Prosthetic Joint Infection

Microbiology Resource Announcements ◽

10.1128/mra.00148-21 ◽

2021 ◽

Vol 10 (13) ◽

Author(s):

Hosoon Choi ◽

Chetan Jinadatha ◽

Piyali Chatterjee ◽

Munok Hwang ◽

Dhammika H. Navarathna

Keyword(s):

Klebsiella Pneumoniae ◽

Genome Sequence ◽

Prosthetic Joint Infection ◽

Antibiotic Susceptibility ◽

Joint Infection ◽

Draft Genome ◽

Multidrug Resistant ◽

Draft Genome Sequence ◽

Content Type ◽

Prosthetic Joint

ABSTRACT Extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae strain 9120005127 was isolated from a wound infection. We describe the draft genome sequence and antibiotic susceptibility of this strain.

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Open Periprosthetic Knee Fracture: A Case Report and Review of the Literature

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320939547 ◽

2020 ◽

Vol 11 ◽

pp. 215145932093954

Author(s):

Katelyn Ragland ◽

Steven M. Cherney ◽

Jeffrey B. Stambough ◽

Simon C. Mears

Keyword(s):

Soft Tissue ◽

Prosthetic Joint Infection ◽

Motor Vehicle ◽

Tissue Injury ◽

Joint Infection ◽

Soft Tissue Injury ◽

High Energy ◽

Periprosthetic Fractures ◽

Cement Spacer ◽

Prosthetic Joint

Introduction: With the increase in knee and hip implants, these periprosthetic fractures will become more common especially as the population ages. Open periprosthetic fractures are rare and severe injuries and are more likely to be seen in high-energy injuries. They present challenges to the treating physician due to soft tissue damage, contamination of the existing implants, and the effects of polytrauma in the geriatric patient. Methods: . Results A 72-year-old woman was involved in a motor vehicle collision with multiple injuries including an open periprosthetic tibia and femur fracture. This was treated with initial washout and removal of loose tibial component with placement of a cement spacer. The knee was treated with staged revision using a protocol like that used after prosthetic joint infection. After complete soft tissue healing, the patient underwent successful revision with a megaprosthesis. The literature on open periprosthetic fractures is reviewed. Discussion and Conclusion: Open periprosthetic fractures present multiple challenges to the orthopedic surgeon. In the presences of poly trauma and soft tissue injury, we present an approach using staged surgery like that used for prosthetic joint infection.

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A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection

Bone and Joint Research ◽

10.1302/2046-3758.811.bjr-2018-0339.r3 ◽

2019 ◽

Vol 8 (11) ◽

pp. 526-534 ◽

Cited By ~ 5

Author(s):

Chuang Yang ◽

Jin Wang ◽

Zhifei Yin ◽

Qiaojie Wang ◽

Xianlong Zhang ◽

...

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

New Combination ◽

Cement Spacer ◽

Recurrence Rates ◽

Prosthetic Joint ◽

Optimal Protocol ◽

Resistant Strains ◽

Reduced Rate ◽

Infection Recurrence

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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A sophisticated antibiotic-loading protocol in articulating cement spacers for the treatment of prosthetic joint infection

Bone and Joint Research ◽

10.1302/2046-3758.811.bjr-2019-0339.r3 ◽

2019 ◽

Vol 8 (11) ◽

pp. 526-534

Author(s):

Chuang Yang ◽

Jin Wang ◽

Zhifei Yin ◽

Qiaojie Wang ◽

Xianlong Zhang ◽

...

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

New Combination ◽

Cement Spacer ◽

Recurrence Rates ◽

Prosthetic Joint ◽

Optimal Protocol ◽

Resistant Strains ◽

Reduced Rate ◽

Infection Recurrence

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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