scholarly journals Sonication fluid culture of antibiotic-loaded bone cement spacer has high accuracy to confirm eradication of infection before reimplantation of new prostheses

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qingyu Zhang ◽  
Baocong Ding ◽  
Jinglin Wu ◽  
Jun Dong ◽  
Fanxiao Liu
Keyword(s):  
Tissue Culture ◽  
Bone Cement ◽  
Positive Culture ◽  
High Accuracy ◽  
Cement Spacer ◽  
Culture Result ◽  
Two Stage ◽  
Eradication Of Infection ◽  
Sensitivity Specificity ◽  
Fluid Culture

Abstract Background Sonication fluid culture of antibiotic-loaded bone cement spacer has been used to predict reinfection of two-stage revision, but its value remains disputable. This study aims to evaluate the association between the culture result of the sonicated spacer and the status of patients with periprosthetic joint infection receiving two-stage revision. Materials and methods A comprehensive electronic literature search was performed through four databases including PubMed, Embase/Ovid, and EBSCO, and the Cochrane Library to retrieve studies in which sonication fluid culture of the antibiotic spacer was conducted before reimplantation. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated to assess the association between the culture result of sonicated spacer and prognosis of the two-stage revision. Results Eleven eligible studies comprising 603 artificial joints with PJI (134 suffering a clinical failure of two-stage revision) were included in the quantitative analysis. The pooled incidences of positive culture of sonicated spacer and intraoperative tissue were 0.14 (95% confidence interval [CI] 0.08–0.21) and 0.14 (95% CI 0.08–0.20), respectively. A positive culture of sonicated antibiotic-loaded bone cement spacer illustrated moderate sensitivity (0.31, 95% CI 0.13–0.58) but high specificity (0.94, 95% CI 0.86–0.98) for the diagnosis of therapeutic failure of two-stage revision; the pooled DOR was 7.67 (95% CI, 3.63–16.22). Meanwhile, the pooled sensitivity, specificity, and DOR of intraoperative tissue culture during the two-stage revision to predict therapeutic failure were 0.32 (95% CI, 0.20–0.47), 0.96 (95% CI, 0.92–0.98), and 10.62 (95% CI, 4.90–23.01), respectively. Conclusions Sonication fluid culture of antibiotic-loaded bone cement spacer revealed high accuracy for confirming eradication of infection before reimplantation of new prostheses and therefore could be used as a supplement for assessing therapeutic effect for PJI. However, both sonication fluid culture and intraoperative tissue culture from antibiotic-loaded bone cement spacer showed restricted yield for the prediction of a septic failure after the two-stage revision of PJI. Large-scale, prospective studies are still needed to testify current findings.

scholarly journals Infected nonunion proximal humerus fracture: two-stage oncologic approach solution with reverse total shoulder reconstruction

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Khairul Nizam Siron ◽  
Goh Kian Liang ◽  
Mohd Ariff Sharifuddin ◽  
Ed Simor Khan Mor Japar Khan ◽  
Mohd Shahidan Nor Rahin ◽  
...  
Keyword(s):  
Proximal Humerus ◽  
Wide Resection ◽  
Cement Spacer ◽  
Two Stage ◽  
Infected Nonunion ◽  
Non Union ◽  
Eradication Of Infection ◽  
Staged Approach ◽  
Reverse Shoulder Replacement ◽  
Reverse Total Shoulder

Introduction: Infected non-union of proximal humerus after fixation is devastating consequence and remains challenging. Methods: The staged oncologic approach consists of wide resection and reconstruction ensures remissions of the infection. Results: We report a case of two-stage oncologic approach in a patient with infected non-union proximal humerus after fixation. In the first stage we have performed a wide resection and antibiotic cement spacer insertion. After complete eradication of infection, subsequent reconstruction of the shoulder using reverse shoulder replacement with modular humeral stem had been performed on purpose of restoring the acceptable joint functions. Conclusions: Reconstruction of the infected non-union of the proximal humerus is a challenging task, costly procedure that requires the use of the sophisticated limb reconstruction system. Staged approach incorporating the use oncologic wide resection to eradicate the infection with subsequent bony reconstruction ensure the optimum restoration of upper limb functions.

Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement

2001 ◽  
Vol 72 (6) ◽  
pp. 591-594 ◽  
Author(s):  
Bruno Magnan ◽  
Dario Regis ◽  
Roberto Biscaglia ◽  
Pietro Bartolozzi
Keyword(s):  
Bone Cement ◽  
Cement Spacer ◽  
Acrylic Bone Cement ◽  
Two Stage ◽  
Total Replacement ◽  
Antibiotics Use

Antibiotic Distribution in a Bone Cement Spacer Model

2007 ◽  
Vol 17 (4) ◽  
pp. 218-223 ◽  
Author(s):  
K. Shiramizu ◽  
V. Lovric ◽  
A.M.D. Leung ◽  
W.R. Walsh
Keyword(s):  
Liquid Phase ◽  
Bone Cement ◽  
Cross Sections ◽  
High Dose ◽  
Cement Spacer ◽  
Traditional Technique ◽  
Low Viscosity ◽  
Significant Difference ◽  
Group A ◽  
Medium Viscosity

Purpose To mix high dose antibiotic powder to the bone cement more easily, Hanssen et al reported mixing the antibiotics with the cement during its liquid phase but made no comments about the relevance of cement viscosity and antibiotic distribution. The purpose of this study was to investigate the effect of the cement mixing technique and cement viscosity on the antibiotics distribution in a cement spacer model. Methods Thirty cylindrical models from three groups were examined. Group A was made by mixing the antibiotics with medium viscosity cement prior to adding the liquid monomer (traditional technique). Group B was made by mixing the antibiotics with medium viscosity cement during its liquid phase (Hanssen's technique). Group C was made by traditional technique with low viscosity cement. In all groups 2 g of tetracycline was used. Three 0.1 mm thick cross sections from each spacer model were examined under the fluorescent microscope. The fluorescent spots of tetracycline were calculated automatically in pixels. To evaluate the distribution of the antibiotics in the spacer model, we selected the cross section with the highest number of pixels and the one with the lowest number of pixels from each of the three cross sections and calculated the difference between them. The distribution disequilibrium was compared between group A and B, A and C. Results No significant difference was observed in either comparison. Conclusion The Hanssen's mixing technique can be used when using high dose antibiotics, and either medium or low viscosity cement could be used in terms of antibiotic distribution.

COMPARATIVE STUDY OF BACTERIAL IDENTIFICATION BY COLORECTAL TISSUE CULTURE AND FLUID CULTURE AFTER COLONOSCOPIC WASHING

2006 ◽  
Vol 18 (2) ◽  
pp. 114-121 ◽  
Author(s):  
Hiroaki Suda ◽  
Takaaki Tamayama ◽  
Sumio Fujinuma ◽  
Yoshihiro Sakai
Keyword(s):  
Tissue Culture ◽  
Comparative Study ◽  
Bacterial Identification ◽  
Colorectal Tissue ◽  
Fluid Culture

scholarly journals Knee Arthrodesis Outcomes After Infected Total Knee Arthroplasty and Failure of Two-stage Revision With an Antibiotic Cement Spacer

2018 ◽  
Vol 2 (1) ◽  
pp. e077 ◽  
Author(s):  
Matthew Robinson ◽  
Hristo I. Piponov ◽  
Andrew Ormseth ◽  
Cory W. Helder ◽  
Brian Schwartz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Two Stage ◽  
Antibiotic Cement ◽  
Infected Total Knee Arthroplasty ◽  
Total Knee

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p < 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p < 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

scholarly journals Two-stage carcinogenesis with rat embryo cells in tissue culture

1977 ◽  
Vol 35 (6) ◽  
pp. 722-729 ◽  
Author(s):  
C Lasne ◽  
A Gentil ◽  
I Chouroulinkov
Keyword(s):  
Tissue Culture ◽  
Rat Embryo ◽  
Two Stage ◽  
Embryo Cells
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