Current Concepts on the Application, Pharmacokinetics and Complications of Antibiotic-Loaded Cement Spacers in the Treatment of Prosthetic Joint Infections

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.

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Diagnostics in prosthetic joint infections

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dku248 ◽

2014 ◽

Vol 69 (suppl 1) ◽

pp. i11-i19 ◽

Cited By ~ 14

Author(s):

K. Saeed

Keyword(s):

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

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

Scientific Reports ◽

10.1038/s41598-020-79225-x ◽

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.

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

Antibiotics ◽

10.3390/antibiotics10010018 ◽

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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Rare case of Ureaplasma parvum septic arthritis in an immunocompetent patient

BMJ Case Reports ◽

10.1136/bcr-2020-236396 ◽

2020 ◽

Vol 13 (9) ◽

pp. e236396

Author(s):

Abuzar Ali Asif ◽

Moni Roy ◽

Sharjeel Ahmad

Keyword(s):

Septic Arthritis ◽

Rare Case ◽

Immunocompetent Patient ◽

Next Generation ◽

Ureaplasma Parvum ◽

Urogenital Infections ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Diagnostic Modalities

Mycoplasmatacea family comprises two genera: Mycoplasma and Ureaplasma. Ureaplasma parvum (previously known as U. urealyticum biovar 1) commonly colonises the urogenital tract in humans. Although Ureaplasma species have well-established pathogenicity in urogenital infections, its involvement in septic arthritis has been limited to prosthetic joint infections and immunocompromised individuals. We present a rare case of native right knee infection due to U. parvum identified using next-generation sequencing of microbial cell-free DNA testing and confirmed with PCR assays. This rare case of Ureaplasma septic arthritis was diagnosed using newer next-generation DNA sequencing diagnostic modalities and a literature review of prior cases, antibiotic coverage and antimicrobial resistance is incorporated as part of the discussion.

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