scholarly journals 75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections

2015 ◽  
Vol 86 (4) ◽  
pp. 457-462 ◽  
Author(s):  
Anna Holmberg ◽  
Valdís Gudrún Thórhallsdóttir ◽  
Otto Robertsson ◽  
Annette W-Dahl ◽  
Anna Stefánsdóttir
Keyword(s):  
Success Rate ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Tibial Insert ◽  
Open Debridement

Addressing prosthetic joint infections via gentamicin-eluting UHMWPE spacer

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 151-157
Author(s):  
Dmitry Gil ◽  
Ali E. Atici ◽  
Rachel L. Connolly ◽  
Shannon Hugard ◽  
Sergey Shuvaev ◽  
...  
Keyword(s):  
Bone Cement ◽  
The Novel ◽  
Wear Properties ◽  
Compression Moulding ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Drug Elution ◽  
Prosthetic Joint Infections ◽  
Tibial Insert

Aims We propose a state-of-the-art temporary spacer, consisting of a cobalt-chrome (CoCr) femoral component and a gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial insert, which can provide therapeutic delivery of gentamicin, while retaining excellent mechanical properties. The proposed implant is designed to replace conventional spacers made from bone cement. Methods Gentamicin-loaded UHMWPE was prepared using phase-separated compression moulding, and its drug elution kinetics, antibacterial, mechanical, and wear properties were compared with those of conventional gentamicin-loaded bone cement. Results Gentamicin-loaded UHMWPE tibial components not only eradicated planktonic Staphylococcus aureus, but also prevented colonization of both femoral and tibial components. The proposed spacer possesses far superior mechanical and wear properties when compared with conventional bone cement spacers. Conclusion The proposed gentamicin-eluting UHMWPE spacer can provide antibacterial efficacy comparable with currently used bone cement spacers, while overcoming their drawbacks. The novel spacer proposed here has the potential to drastically reduce complications associated with currently used bone cement spacers and substantially improve patients’ quality of life during the treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):151–157.

scholarly journals Outcome of Acute Prosthetic Joint Infections Due to Gram-Negative Bacilli Treated with Open Debridement and Retention of the Prosthesis

2009 ◽  
Vol 53 (11) ◽  
pp. 4772-4777 ◽  
Author(s):  
Juan C. Martínez-Pastor ◽  
Ernesto Muñoz-Mahamud ◽  
Félix Vilchez ◽  
Sebastián García-Ramiro ◽  
Guillem Bori ◽  
...  
Keyword(s):  
Regression Model ◽  
Cox Regression ◽  
Oral Antibiotic ◽  
Cox Regression Model ◽  
Gram Negative ◽  
Joint Infections ◽  
Kaplan Meier ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Open Debridement

ABSTRACT The aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJIs) due to gram-negative bacilli (GNB) treated without implant removal. Patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, comorbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy, and outcome were recorded. Classification and regression tree analysis, the Kaplan-Meier survival method, and the Cox regression model were applied. Forty-seven patients were included. The mean age was 70.7 years, and there were 15 hip prostheses and 32 knee prostheses. The median number of days from the time of arthroplasty was 20. The most frequent pathogens were members of the Enterobacteriaceae family in 41 cases and Pseudomonas spp. in 20 cases. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin. The median durations of intravenous and oral antibiotic treatment were 14 and 64 days, respectively. A total of 35 (74.5%) patients were in remission after a median follow-up of 463 days (interquartile range, 344 to 704) days. By use of the Kaplan-Meier survival curve, a C-reactive protein (CRP) concentration of ≤15 mg/dl (P = 0.03) and receipt of a fluoroquinolone, when all GNB isolated were susceptible (P = 0.0009), were associated with a better outcome. By use of a Cox regression model, a CRP concentration of ≤15 mg/dl (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.05 to 12.5; P = 0.043) and receipt of a fluoroquinolone (OR, 9.09; 95% CI, 1.96 to 50; P = 0.005) were independently associated with better outcomes. Open debridement without removal of the implant had a success rate of 74.5%, and the factors associated with good prognosis were a CRP concentration at the time of diagnosis ≤15 mg/dl and treatment with a fluoroquinolone.

scholarly journals Genomic Analysis of Cutibacterium acnes Strains Isolated from Prosthetic Joint Infections

2021 ◽  
Vol 9 (7) ◽  
pp. 1500
Author(s):  
Llanos Salar-Vidal ◽  
Yvonne Achermann ◽  
John-Jairo Aguilera-Correa ◽  
Anja Poehlein ◽  
Jaime Esteban ◽  
...  
Keyword(s):  
Normal Skin ◽  
Genomic Analysis ◽  
Healthy Skin ◽  
Common Cause ◽  
Good Outcome ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Cutibacterium Acnes ◽  
Clinical Conditions

Cutibacterium acnes is a common cause of prosthetic joint infections (PJIs). The C. acnes population can be divided into six main phylotypes (IA1, IA2, IB, IC, II and III) that are associated with different clinical conditions and normal skin. A single-locus sequence typing (SLST) scheme can distinguish ten main SLST types: A-E (all IA1), F (IA2), G (IC), H (IB), K (II), L (III). We genome-sequenced and compared 16 strains of C. acnes isolated from healthy skin (n = 4) and PJIs (n = 12), including six PJI cases with a good outcome (four shoulder PJIs, one hip PJI, one knee PJI) and six with infection relapse (three shoulder PJIs, three hip PJIs). The sequenced strains belonged to four different phylotypes (IA1, IA2, IB and II) and seven different SLST types. All five type IB strains (all SLST type H1) were PJI isolates (three hip PJIs, two shoulder PJIs), and four of these caused infection relapse (three hip PJIs, one shoulder PJI). Isolates from PJI cases with a good outcome belonged to three different phylotypes (IA, IB, II). Interestingly, four strains (three strains from PJI cases with good outcome and one strain from healthy skin) contained a linear plasmid; these strains belonged to different SLST types (A1, C1, F4, H1) and were isolated in three different hospitals. This study suggests that type IB strains have the potential to cause infection relapse, in particular regarding hip PJIs. Moreover, our study revealed that strains belonging to the same SLST type can differ in their accessory genome in different geographic locations, indicative of microevolution.

scholarly journals Presence of the neonatal Staphylococcus capitis outbreak clone (NRCS-A) in prosthetic joint infections

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Staffan Tevell ◽  
Sharmin Baig ◽  
Bengt Hellmark ◽  
Patricia Martins Simoes ◽  
Thierry Wirth ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Coagulase Negative Staphylococcus ◽  
Nasal Carrier ◽  
Joint Infections ◽  
Staphylococcus Capitis ◽  
Prosthetic Joint ◽  
Strain Collection ◽  
Prosthetic Joint Infections

AbstractStaphylococcus capitis is a coagulase-negative staphylococcus that has been described primarily as causing bloodstream infections in neonatal intensive care units (NICUs), but has also recently been described in prosthetic joint infections (PJIs). The multidrug-resistant S. capitis subsp. urealyticus clone NRCS-A, comprising three sublineages, is prevalent in NICUs across the world, but its impact on other patient groups such as those suffering from PJIs or among adults planned for arthroplasty is unknown. Genome sequencing and subsequent analysis were performed on a Swedish collection of PJI isolates (n = 21), nasal commensals from patients planned to undergo arthroplasty (n = 20), NICU blood isolates (n = 9), operating theatre air isolates (n = 4), and reference strains (n = 2), in conjunction with an international strain collection (n = 248). The NRCS-A Outbreak sublineage containing the composite type V SCCmec-SCCcad/ars/cop element was present in PJIs across three Swedish hospitals. However, it was not found among nasal carrier strains, where the less virulent S. capitis subsp. capitis was most prevalent. The presence of the NRCS-A Outbreak clone in adult patients with PJIs demonstrates that dissemination occurs beyond NICUs. As this clone has several properties which facilitate invasive infections in patients with medical implants or immunosuppression, such as biofilm forming ability and multidrug resistance including heterogeneous glycopeptide-intermediate susceptibility, further research is needed to understand the reservoirs and distribution of this hospital-associated pathogen.

scholarly journals Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Alba Rivera ◽  
Alba Sánchez ◽  
Sonia Luque ◽  
Isabel Mur ◽  
Lluís Puig ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Bacterial Contamination ◽  
Antimicrobial Prophylaxis ◽  
Coagulase Negative Staphylococci ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Total Knee ◽  
Surgical Antimicrobial Prophylaxis ◽  
Almost All

Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined.

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