1
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Veerman K, Goosen J, Spijkers K, Jager N, Heesterbeek P, Telgt D. Prolonged use of linezolid in bone and joint infections: a retrospective analysis of adverse effects. J Antimicrob Chemother 2023; 78:2660-2666. [PMID: 37681570 PMCID: PMC10631826 DOI: 10.1093/jac/dkad276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES Antibiotic treatment for bone and joint infections generally lasts for 6 weeks or longer. Linezolid may be a good option for treating bone and joint infections, but there is an increased risk of potential serious adverse drug events (ADEs) when used for more than 28 days. The aim of this study was to obtain detailed information on the type and time to occurrence of the patient-reported ADEs, the dynamics of haematopoiesis over time, and the reasons for early discontinuation of linezolid when used for an intended maximum duration of 12 weeks. METHODS This single-centre retrospective study was conducted at the Sint Maartenskliniek in The Netherlands. Patients were included if they were planned to use linezolid for more than 28 days. The main reason for discontinuation of linezolid, the ADE according to the Naranjo score, and the time to occurrence of ADEs were analysed. RESULTS Among 78 patients, drug toxicity led to early discontinuation of linezolid in 11 (14%) patients before and nine (12%) after 28 days of therapy. The median treatment duration was 42 days. Gastrointestinal intolerance (42%) and malaise (32%) were the most common ADEs. In 75% of the cases the ADE occurred within 28 days of therapy. Sixty-seven patients were able to continue linezolid beyond 28 days, 87% of whom completed therapy as scheduled. Severe cytopenia, according to the Common Terminology Criteria for Adverse events (CTCA), was observed in four patients and was reversible after discontinuation of linezolid. One patient suffered optic neuropathy related to linezolid use. CONCLUSIONS Linezolid could be considered an alternative option to the current standard of IV glycopeptides for the treatment of bone and joint infection for up to 12 weeks. If patients pass the first 28 days of therapy, the likelihood of successful completion of therapy is high with a low risk of serious ADEs.
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Affiliation(s)
- Karin Veerman
- Department of Internal Medicine, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Jon Goosen
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Karin Spijkers
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Nynke Jager
- Department of Pharmacy, Radboud Institute for Medical Innovation, Nijmegen, The Netherlands
| | - Petra Heesterbeek
- Department Orthopaedic Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Denise Telgt
- Department of Internal Medicine, Sint Maartenskliniek, Nijmegen, The Netherlands
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2
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Simon MJK, Beyersdorff J, Strahl A, Rolvien T, Rüther W, Niemeier A. Diagnostic value of open incisional biopsies in suspected, difficult-to-diagnose periprosthetic hip joint infection prior to revision surgery. Arch Orthop Trauma Surg 2023; 143:1663-1670. [PMID: 35348871 PMCID: PMC9957879 DOI: 10.1007/s00402-022-04402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/20/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Prior to revision of total hip arthroplasty (THA), low-grade chronic periprosthetic joint infection (PJI) is often difficult to diagnose. We aimed to determine the diagnostic accuracy of open incisional tissue biopsy for the prediction of PJI prior to THA revision in cases with culture-negative or dry tap joint aspirates. MATERIALS AND METHODS This retrospective single-center study includes 32 consecutive THA revision cases with high clinical suspicion of low-grade chronic PJI of the hip with culture-negative or dry tap joint aspirates and without systemic signs of infection. Open incisional biopsy (OIB) was performed prior to revision surgery. Periprosthetic tissue samples were analyzed by microbiology and histopathology for PJI. During definitive revision arthroplasty, identical diagnostics were repeated. Results from both procedures were compared and sensitivity, specificity, positive and negative predictive values of OIB for the final diagnosis were calculated. RESULTS Average age at revision was 69.3 ± 13.5 years. The sensitivity of the OIB procedure was 80% (microbiology), 69% (histology) and 82% for combined analyses (microbiology and histology). Specificity of OIB was 80% (microbiology), 94% (histology) and 60% for combined analyses. CONCLUSIONS Open tissue biopsy performed in cases with culture-negative or inconclusive synovial fluid aspirates prior to revision of THA has limited diagnostic accuracy for the prediction of PJI. The procedure does not reliably close the diagnostic gap in a substantial number of cases. In this difficult patient population, risk of an open procedure may outweigh benefits and alternative less invasive methods should be considered for the preoperative diagnosis of PJI.
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Affiliation(s)
- M. J. K. Simon
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany ,Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | - J. Beyersdorff
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - A. Strahl
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - T. Rolvien
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - W. Rüther
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Andreas Niemeier
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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3
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Bettin D, Maurer T, Schlatt F, Bettin S. The scientific publication score - a new tool for summarizing evidence and data quality criteria of biomedical publications. J Bone Jt Infect 2022; 7:269-278. [PMID: 36644591 PMCID: PMC9832303 DOI: 10.5194/jbji-7-269-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
The number of biomedical research articles increases by over 2.5 million publications each year, making it difficult to stay up to date. In this study, we introduce a standardized search and evaluation tool to combat this issue. Employing crowdsourcing, a large database of publications is gathered. Using a standardized data entry format, coined the "scientific publication score" (SPS), specific publication results can be easily aggregated, thereby allowing fast and accurate comparisons for clinical questions. The SPS combines two quality dimensions. The first captures the quality of evidence of the study using the evidence criteria defined by the Centre for Evidence-Based Medicine, Oxford, UK. The second is more fine-grained and considers the magnitude of statistical analyses on individual and specific results. From 2014 to 2019, experts of the European Bone and Joint Infection Society (EBJIS) were asked to enter data of relevant publications about prosthetic joint infection. Data and evidence levels of specific results were averaged, summarized and ranked. A total of 366 publications were divided into two groups: (I) risk factors (e.g., host-related factors, pre- and postoperative issues) with 243 publications and (II) diagnostic methods (e.g., laboratory tests, imaging methods) with 123 publications. After ranking, the highest score for risk factors of prosthetic joint infection were calculated by the SPS for anemia (mean 3.50 ± SD 0.91), malignancy (mean 3.17 ± SD 0.29) and previous alloarthroplasty (mean 3.00 ± SD 0.35). A comparison of the full SPS ranking with the ranking determined at the 2018 International Consensus Meeting (ICM) on Musculoskeletal Infection resulted in a Spearman rank correlation coefficient of 0.48 and a p value of 0.0382. The diagnostic methods ranked highest by the SPS were aspirate leucocyte count (mean 3.15 ± SD 1.21), interleukin 6 (mean 3.14 ± SD 1.07) and aspirate (neutrophils over 80 %) (mean 3.12 ± SD 0.63). The comparison to the ICM ranking yielded a Spearman rank correlation coefficient of 0.91 and a p value of 0.0015. Our pilot study evaluated a new tool for the quality assessment of specific results based on the quality of the source publication. The SPS is suitable for a ranking of specific results by evidence and data quality criteria important for systematic reviews.
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Affiliation(s)
- Dieter Bettin
- Department for General Orthopedics and Tumor Orthopedics, University
Clinic Münster, 48149 Münster, Germany
| | - Thomas Maurer
- Orthopedic Clinic Kantonsspital Baselland Liestal, 4410 Liestal,
Switzerland
| | - Ferdinand Schlatt
- Department of Informatics, Martin Luther University of Halle-Wittenberg,
06120 Halle (Saale), Germany
| | - Simon Bettin
- The University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg,
Germany
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4
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Saltiel G, Meyssonnier V, Kerroumi Y, Heym B, Lidove O, Marmor S, Zeller V. Cutibacterium acnes Prosthetic Joint Infections: Is Rifampicin-Combination Therapy Beneficial? Antibiotics (Basel) 2022; 11:antibiotics11121801. [PMID: 36551458 PMCID: PMC9774273 DOI: 10.3390/antibiotics11121801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
No consensus has been reached on the optimal antibiotic regimen to treat Cutibacterium acnes PJIs (Ca-PJIs). In vitro studies showed excellent rifampicin efficacy against biofilm-associated C. acnes infections, but clinical studies did not confirm the superiority of rifampicin-combined therapy over monotherapy. This prospective cohort study was undertaken to analyze the outcomes of 70 patients who underwent exchange arthroplasty for chronic monomicrobial Ca-PJI and were treated with rifampicin or without between 2004 and 2019. The 37 patients treated from January 2004 to August 2014 were prescribed rifampicin-combination therapy and the 33 treated from September 2014 to December 2019 received monotherapy without rifampicin. The primary endpoint was the 2-year Kaplan-Meier-estimated reinfection-free probability, including relapses and new-pathogen PJIs. The 2-year reinfection-free rate was high and not different for patients who had received rifampicin or not (89.2% vs. 93.8%, respectively; p = 0.524). None of the patients relapsed and six developed new-pathogen PJIs. Our results do not support a benefit of rifampicin-combination therapy for patients who underwent exchange arthroplasty for chronic Ca-PJIs.
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Affiliation(s)
- Grégoire Saltiel
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Laboratoire des Centres de Santé et Hôpitaux d’Île-de-France, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Olivier Lidove
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, 125, rue d’Avron, 75020 Paris, France
- Correspondence: ; Tel.: +33-1-44-64-17-80
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5
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Veerman CM, Goosen JHM, Telgt DSC, Rijnen WHM, Nabuurs MH, Wertheim HFL. Assessment of antimicrobial mismatches in empirical treatment in early PJI after aseptic revision arthroplasty. JAC Antimicrob Resist 2022; 4:dlac124. [PMID: 36506891 PMCID: PMC9728518 DOI: 10.1093/jacamr/dlac124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background In early periprosthetic joint infection (PJI), 'debridement, antibiotics and implant retention' (DAIR) is a widely accepted form of treatment. Empirical antimicrobial treatment is started while culture results of tissue samples taken during debridement are pending. Objectives In this retrospective study we assessed the antimicrobial mismatch rate between empirical treatment and the susceptibility of the causative microorganisms of PJI after aseptic revision arthroplasty. We analysed risk factors for antimicrobial mismatches and the impact of mismatches on the outcome of PJI treatment. Results A total of 119 patients were included in the analysis. In 72% (86/119) of the cases there was an antimicrobial mismatch in empirical treatment. Most of the antimicrobial mismatches were caused by multidrug-resistant (MDR) Staphylococcus spp. (77%, 66/86). In multivariable analysis, polymicrobial PJI was significantly associated with antimicrobial mismatch (OR: 6.89; 95% CI: 2.38-19.53; P < 0.001), and antimicrobial mismatch was significantly associated with reduced success rate of PJI treatment (OR: 0.20; 95% CI: 0.05 ± 0.82; P = 0.026). There was no difference in successful outcome between PJI caused by Gram-negative bacilli (61%) and Gram-positive bacteria (69%, P = 0.516). Conclusions Mismatching empirical antimicrobial treatment after DAIR following aseptic revision arthroplasty was significantly associated with failure of PJI treatment. Polymicrobial PJI is a risk factor for antimicrobial mismatch of the empirical treatment of PJI. Antimicrobial mismatch and delay in targeted treatment should be integrated in the approach to optimize antibiotic treatment to improve clinical outcomes, while minimizing unintended side effects of antimicrobial use (antimicrobial stewardship).
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Affiliation(s)
| | - J H M Goosen
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - D S C Telgt
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, The Netherlands,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W H M Rijnen
- Department of Orthopedics Nijmegen, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M H Nabuurs
- Department of Medical Microbiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - H F L Wertheim
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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6
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Xará-Leite F, Ribau A, Lopes Guerra MD, Abreu MA, Rodrigues-Pinto R. Multidisciplinary Approach to Multiple Multiresistant Agent Infection of Instrumented Spine Surgery: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00029. [PMID: 35081062 DOI: 10.2106/jbjs.cc.21.00472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report the case of a patient with consecutive infections with several multidrug-resistant agents-including carbapenem-resistant strains of Klebsiella pneumoniae among others-from a surgical wound infection after lumbar spine fusion, only successfully treated after the resort to novel antibiotics (ceftazidime-avibactam) in combination therapy. CONCLUSIONS Multidrug resistance has become a major challenge in today's medicine. Care should be taken to avoid their emergence, but when present, a multidisciplinary approach is mandatory to ensure clinically up-to-date treatment choices. Multimodal antibiotic schemes tend to show the most promising results, with which successful infection resolution can still be achieved.
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Affiliation(s)
- Francisco Xará-Leite
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Ana Ribau
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | | | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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7
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On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results. J Pers Med 2021; 11:jpm11101039. [PMID: 34683181 PMCID: PMC8538359 DOI: 10.3390/jpm11101039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023] Open
Abstract
Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).
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8
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Ahari H, Soufiani SP. Smart and Active Food Packaging: Insights in Novel Food Packaging. Front Microbiol 2021; 12:657233. [PMID: 34305829 PMCID: PMC8299788 DOI: 10.3389/fmicb.2021.657233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/05/2021] [Indexed: 12/02/2022] Open
Abstract
The demand for more healthy foods with longer shelf life has been growing. Food packaging as one of the main aspects of food industries plays a vital role in meeting this demand. Integration of nanotechnology with food packaging systems (FPSs) revealed promising promotion in foods’ shelf life by introducing novel FPSs. In this paper, common classification, functionalities, employed nanotechnologies, and the used biomaterials are discussed. According to our survey, FPSs are classified as active food packaging (AFP) and smart food packaging (SFP) systems. The functionality of both systems was manipulated by employing nanotechnologies, such as metal nanoparticles and nanoemulsions, and appropriate biomaterials like synthetic polymers and biomass-derived biomaterials. “Degradability and antibacterial” and “Indicating and scavenging” are the well-known functions for AFP and SFP, respectively. The main purpose is to make a multifunctional FPS to increase foods’ shelf life and produce environmentally friendly and smart packaging without any hazard to human life.
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Affiliation(s)
- Hamed Ahari
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Solmaz P Soufiani
- Department of Food Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
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9
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Le Maréchal M, Cavalli Z, Batailler C, Gonzalez JF, Ferreira A, Lustig S, Ferry T, Courjon J. Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization. BMC Infect Dis 2021; 21:401. [PMID: 33933020 PMCID: PMC8088082 DOI: 10.1186/s12879-021-06075-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases. RESULTS Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90-92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents. CONCLUSIONS Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
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Affiliation(s)
- Marion Le Maréchal
- Centre Hospitalier de Grenoble, Grenoble, France
- Université de Grenoble-Alpes, Grenoble, France
| | - Zoé Cavalli
- Hôpital de Mercy, Centre Hospitalier Régional de Metz-Thionville, Ars-Laquenexy, France
| | | | - Jean-François Gonzalez
- Université Côte d'Azur, Nice, France
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France
| | - André Ferreira
- Société Française de chirurgie de la hanche et du genou, Paris, France
| | | | - Tristan Ferry
- Claude Bernard University Lyon 1, Villeurbanne, France
- CRIOAc Lyon, Lyon, France
| | - Johan Courjon
- Université Côte d'Azur, CHU, INSERM, C3M, Nice, France.
- Infectiologie, Hôpital Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France.
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10
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Poilvache H, Ruiz-Sorribas A, Sakoulas G, Rodriguez-Villalobos H, Cornu O, Van Bambeke F. Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model. Front Med (Lausanne) 2020; 7:527. [PMID: 33043028 PMCID: PMC7527469 DOI: 10.3389/fmed.2020.00527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/27/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Prosthetic joint infections (PJI) are difficult to treat complications of joint arthroplasty. Debridement with implant retention is a common treatment strategy and frequently involves the use of pulsed lavage (PL). However, PL effects on biofilms and antibiotic activity have been scarcely studied in-vitro. We report the effects of PL, vancomycin or flucloxacillin used independently or in combination against Staphylococcus aureus biofilms. Methods: Biofilms of 3 methicillin-susceptible (MSSA) and of 3 methicillin-resistant (MRSA) S. aureus were grown on Ti6Al4V coupons in TGN (TSB + 1%glucose + 2%NaCl). After 24 h, PL was applied to half of the samples (50 mL saline from 5 cm). Samples were either reincubated for 24 h in TGN or TGN + flucloxacillin or vancomycin. Analyses included CFUs counts, biomass assays or fluorescence microscopy. Results: PL transiently reduced bacterial counts by 3-4 Log10 CFU/coupon, but bacterial regrowth to baseline levels was seen after 24 h. At 20 mg/L, flucloxacillin reduced both the CFU counts (3 Log10 CFU/coupon) and biomass (-70%) in one MSSA only, while vancomycin had no effects against MRSA. PL combined with a 24 h reincubation with vancomycin or flucloxacillin at 20 mg/L was synergistic (-5 to 6.5 Log10 CFU/coupon; 81-100% biomass reduction). Fluorescence microscopy confirmed that PL removed most of the biofilm and that subsequent antibiotic treatment partially killed bacteria. Conclusions: While PL only transiently reduces the bacterial load and antibiotics at clinically relevant concentrations show no or limited activity on biofilms, their combination is synergistic against MRSA and MSSA biofilms. These results highlight the need for thorough PL before antibiotic administration in PJI.
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Affiliation(s)
- Hervé Poilvache
- Laboratoire de Neuro-Musculo-Squelettique, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Laboratoire de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.,Orthopaedic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Albert Ruiz-Sorribas
- Laboratoire de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
| | - George Sakoulas
- School of Medicine, University of California, San Diego, San Diego, CA, United States
| | | | - Olivier Cornu
- Laboratoire de Neuro-Musculo-Squelettique, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Orthopaedic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Françoise Van Bambeke
- Laboratoire de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium
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11
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Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, Dietvorst M, van der Zwaard BC. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong) 2020; 27:2309499019860468. [PMID: 31284831 DOI: 10.1177/2309499019860468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current literature occasionally considers septic arthritis in native joints and prosthetic joint infections as equal pathologies. However, significant differences can be identified. The aim of this review of literature is to describe these differences in definitions, pathology, diagnostic workups, treatment strategies, and prognosis.
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Affiliation(s)
- Ramon Lucas Roerdink
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
| | | | | | - Martijn Dietvorst
- 4 Department of Orthopedic Surgery at Máxima Medical Center, The Netherlands
| | - Babette Corine van der Zwaard
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
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12
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Abad L, Josse J, Tasse J, Lustig S, Ferry T, Diot A, Laurent F, Valour F. Antibiofilm and intraosteoblastic activities of rifamycins against Staphylococcus aureus: promising in vitro profile of rifabutin. J Antimicrob Chemother 2020; 75:1466-1473. [DOI: 10.1093/jac/dkaa061] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Background
Targeting biofilm-embedded and intraosteoblastic Staphylococcus aureus, rifampicin gained a pivotal role in bone and joint infection (BJI) treatment. Two other rifamycins, rifabutin and rifapentine, may represent better-tolerated alternatives, but their activity against bacterial reservoirs associated with BJI chronicity has never been evaluated.
Objectives
To evaluate the activities of rifampicin, rifabutin and rifapentine in osteoblast infection models.
Methods
Using three S. aureus isolates, rifamycins were compared regarding: (i) their intracellular activity in ‘acute’ (24 h) and ‘chronic’ (7 days) osteoblast infection models at 0.1× MIC, 1× MIC, 10× MIC and 100× MIC, while impacting infection-induced cytotoxicity (MTT assay), intracellular phenol-soluble modulin (PSM) secretion (RT–PCR), resistance selection and small colony variant (SCV) emergence; and (ii) their minimal biofilm eradication concentration (MBEC) and their MIC to prevent biofilm formation (bMIC).
Results
At 0.1× MIC, only rifabutin significantly reduced intracellular inoculum and PSM secretion. All rifamycins allowed a 50% reduction of intraosteoblastic inoculum at higher concentrations, with no difference between acute and chronic infection models, while reducing infection-induced cytotoxicity and PSM secretion. Dose-dependent emergence of intracellular SCVs was observed for all molecules. No intracellular emergence of resistance was detected. bMICs were equivalent for all molecules, but MBEC90s of rifapentine and rifabutin were 10- to 100-fold lower than those of rifampicin, respectively.
Conclusions
All rifamycins are efficient in reducing the S. aureus intraosteoblastic reservoir while limiting infection-induced cytotoxicity, with a higher activity of rifabutin at low concentrations. All molecules prevent biofilm formation, but only rifapentine and rifabutin consistently reduce formed biofilm-embedded bacteria for all isolates. The activity of rifabutin at lower doses highlights its therapeutic potential.
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Affiliation(s)
- Lélia Abad
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de bactériologie, Institut des Agents Infectieux, French National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Josse
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
| | - Jason Tasse
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
| | - Sébastien Lustig
- Université Claude Bernard Lyon 1, Lyon, France
- Centres de Référence pour la prise en charge des Infections ostéoarticulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Department de chirurgie orthopédique, Hospices Civils de Lyon, Lyon, France
| | - Tristan Ferry
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centres de Référence pour la prise en charge des Infections ostéoarticulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Département maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
| | - Alan Diot
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
| | - Frédéric Laurent
- Laboratoire de bactériologie, Institut des Agents Infectieux, French National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Laboratoire de bactériologie, Institut des Agents Infectieux, French National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
- Centres de Référence pour la prise en charge des Infections ostéoarticulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
| | - Florent Valour
- CIRI – Centre International de Recherche en Infectiologie, Inserm, U1111, Université´ Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Univ Lyon, F-69007 Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
- Centres de Référence pour la prise en charge des Infections ostéoarticulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Lyon, France
- Département maladies infectieuses et tropicales, Hospices Civils de Lyon, Lyon, France
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Wang L, Di Luca M, Tkhilaishvili T, Trampuz A, Gonzalez Moreno M. Synergistic Activity of Fosfomycin, Ciprofloxacin, and Gentamicin Against Escherichia coli and Pseudomonas aeruginosa Biofilms. Front Microbiol 2019; 10:2522. [PMID: 31781056 PMCID: PMC6853019 DOI: 10.3389/fmicb.2019.02522] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/18/2019] [Indexed: 01/18/2023] Open
Abstract
Gram-negative (GN) rods cause about 10% periprosthetic joint infection (PJI) and represent an increasing challenge due to emergence of antimicrobial resistance. Escherichia coli and Pseudomonas aeruginosa are among the most common cause of GN-PJI and ciprofloxacin is the first-line antibiotic. Due to emergence of fluoroquinolone resistance, we evaluated in vitro the activity of fosfomycin, ciprofloxacin, and gentamicin, alone and in combinations, against E. coli and P. aeruginosa biofilms. Conventional microbiological tests and isothermal microcalorimetry were applied to investigate the anti-biofilm activity of the selected antibiotics against standard laboratory strains as well as clinical strains isolated from patients with prosthetic joint associated infections. The biofilm susceptibility to each antibiotic varied widely among strains, while fosfomycin presented a poor anti-biofilm activity against P. aeruginosa. Synergism of two-pair antibiotic combinations was observed against different clinical strains from both species. Highest synergism was found for the fosfomycin/gentamicin combination against the biofilm of E. coli strains (75%), including a gentamicin-resistant but fosfomycin-susceptible strain, whereas the gentamicin/ciprofloxacin combination presented synergism with higher frequency against the biofilm of P. aeruginosa strains (71.4%). A hypothetical bacteriolysis effect of gentamicin could explain why combinations with this antibiotic seem to be particularly effective. Still, the underlying mechanism of the synergistic effect on biofilms is unknown. In conclusion, combinatorial antibiotic application has shown to be more effective against biofilms compared to monotherapy. Further in vivo and clinical studies are essential to define the potential treatment regimen based on our results.
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Affiliation(s)
- Lei Wang
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mariagrazia Di Luca
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Tamta Tkhilaishvili
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mercedes Gonzalez Moreno
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
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