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Prosthetic Joint Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Laboratory findings: The presence of inflammation on periprosthetic tissue.Two or more intraoperative tissue samples containing the same organism or one tissue sample containing a virulent is considered definitive evidence.
Daptomycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Anouk E. Muller, Inge C. Gyssens
Several other authors also report clinical success rates in the treatment of periprosthetic joint infection; however, all the studies included a limited number of patients (18–72) and did not compare them with treatment with other antibiotics (Roux et al., 2016; Corona Pérez-Cardona et al., 2012; Perrottet et al., 2015; Lora-Tamayo et al., 2014). Clinical success rates varied from 50–87%. One retrospective study combined the i.v. use of daptomycin with bone cement containing daptomycin after the two-stage revision arthroplasty and included 22 patients with periprosthetic joint infections with methicillin-resistant staphylococci. In the first stage, 10% daptomycin (weight of daptomycin per weight of bone cement) was incorporated into polymethylmethacrylate bone cement, and systemic daptomycin (6 mg/kg) was administered postoperatively for 14 days. In the second stage, 2.5% daptomycin was used in the bone cement. The minimum followup was 2 years or until recurrence of infection. The infecting organisms included MRSA in 10 patients, MRSE in 8 patients, and methicillin-resistant coagulase-negative staphylococci in 4 patients. The mean followup was 33.7 months (range 24–51 months). The treatment success rate was 100%. Only 1 patient developed asymptomatic transient elevation of the CPK level (Kuo et al., 2016).
Infection
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Periprosthetic joint infection (PJI) is a specific type of infection related to joint replacement and a dreadful complication, potentially chronic, with significant clinical relevance for the affected patient, the treating surgeon and the health system. With an incidence of about 1–2% in hip arthroplasty, 2–3% in knee arthroplasty, 1–2% in the shoulder and even 3–5% in the elbow, the economic impact may represent a 5- to 10-fold cost increase compared to a primary arthroplasty. Patient risk factors include obesity, diabetes, rheumatoid arthritis and immunosuppressive treatments. Other risk factors include previous surgery, perioperative infection at a distant site, allogeneic blood transfusion, prolonged operative time and postoperative complications, including hematoma, superficial surgical site infection, wound drainage, and wound dehiscence.
The novel endolysin XZ.700 effectively treats MRSA biofilms in two biofilm models without showing toxicity on human bone cells in vitro
Published in Biofouling, 2021
Jesse W. P Kuiper, Jolanda M. A Hogervorst, Bjorn L. Herpers, Astrid D. Bakker, Jenneke Klein-Nulend, Peter A. Nolte, Bastiaan P. Krom
Periprosthetic joint infection and other biofilm-associated infections, such as infections of mechanical heart valves, vascular endoprostheses and pacemakers, are major complications after surgery, burdening the patient and the hospital with prolonged intravenous antibiotic treatment and multiple surgical procedures (Bozic 2005; Osmon et al. 2013; Rietbergen et al. 2016). The costs of such infections put a strain on the health care system (Brochin et al. 2018). Most of these infections are caused by Staphylococcus spp, with Staphylococcus aureus being a prominent species (Malhas et al. 2015). S. aureus is known to extensively form biofilms, i.e. structured microbial communities embedded in a matrix of polymeric substances (Archer et al. 2011). Bacteria within biofilms are protected against antimicrobial therapy and the host immune system; biofilm formation causes treatment resistance and enhances the development of antibiotic resistant strains (Ricciardi et al. 2018). Surgical therapy for periprosthetic joint infection is focused on macroscopic removal of infected tissue and biofilm, i.e. (partial) exchange of arthroplasty components, rigorous tissue removal, and extensive irrigation with saline. Local antimicrobial therapy, such as irrigation with antibiotics or povidone-iodine (PVP-I) or implantation of antibiotic-releasing material can be used in addition to surgical removal, but currently, no local therapy exists that has been proven sufficiently effective to be implemented in clinical guidelines (Kuiper et al. 2013; Ruder and Springer 2017; Argenson et al. 2019).
Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty
Published in Expert Review of Medical Devices, 2019
Syed S. Ahmed, Fahima Begum, Babar Kayani, Fares S. Haddad
In 2018, approximately 110,000 total hip arthroplasty (THA) procedures were performed across the UK. THA is one of the most successful orthopedic procedures; however, unfortunately 1-2% of the patients develop the devastating complication of periprosthetic joint infection (PJI) [1]. The demand for arthroplasty is going to increase by 400% by 2030. Revisions for loosening and wear are at a decline. This will see PJI’s becoming the leading cause of revision procedures. PJIs are notoriously difficult to manage, resulting in the need for multiple revision procedures and prolonged courses of systemic antibiotics. The impact on the patient’s life is onerous, and involves long periods of immobility, recurrent hospital encounters and related psychological distress. There is also a significant economic burden to the National Health Service, costing at an average of £50,000 for a revision for infection in the UK. Therefore, appropriate recognition and early management are critical to preserve adequate function and prevent morbidity [2].
Optimization of the empirical antibiotic choice during the treatment of acute prosthetic joint infections: a retrospective analysis of 91 patients
Published in Acta Orthopaedica, 2019
Joost H J Van Erp, Adriaan C Heineken, Remco J A Van Wensen, Robin W T M Van Kempen, Johannes G E Hendriks, Marjolijn Wegdam-Blans, Judith M Fonville, M C (Marieke) Van Der Steen
Using electronic medical records, we retrospectively identified eligible patients from the Catharina Hospital in Eindhoven based on Dutch diagnosis treatment codes for irrigation of the knee or hip joint (CoTG 038640 or 038540, respectively). Patients who were diagnosed with a PJI and underwent DAIR are registered under these codes. We included patients who were diagnosed with a PJI and had a DAIR performed between 2012 and 2016. Additional inclusion criteria entailed a joint prosthesis in situ and the suspicion of PJI within 90 days of index surgery or in case of a hematogenous infection within 3 weeks after onset of PJI signs. Furthermore, only patients from whom periprosthetic tissue was obtained during surgery and sent for microbiological analysis were included. Patients with negative cultures were excluded from the analyses. Patients who underwent DAIR between 2014 and 2016 in the Máxima Medical Center, which was collaborating with the same microbiological laboratory, were included following the same criteria.