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Anwar FN, Roca AM, Khosla I, Medakkar SS, Loya AC, Federico VP, Massel DH, Sayari AJ, Lopez GD, Singh K. Antibiotic use in spine surgery: A narrative review based in principles of antibiotic stewardship. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100278. [PMID: 37965567 PMCID: PMC10641566 DOI: 10.1016/j.xnsj.2023.100278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/09/2023] [Indexed: 11/16/2023]
Abstract
Background A growing emphasis on antibiotic stewardship has led to extensive literature regarding antibiotic use in spine surgery for surgical prophylaxis and the treatment of spinal infections. Purpose This article aims to review principles of antibiotic stewardship, evidence-based guidelines for surgical prophylaxis and ways to optimize antibiotics use in the treatment of spinal infections. Methods A narrative review of several society guidelines and spine surgery literature was conducted. Results Antibiotic stewardship in spine surgery requires multidisciplinary investment and consistent evaluation of antibiotic use for drug selection, dose, duration, drug-route, and de-escalation. Developing effective surgical prophylaxis regimens is a key strategy in reducing the burden of antibiotic resistance. For treatment of primary spinal infection, the diagnostic work-up is vital in tailoring effective antibiotic therapy. The future of antibiotics in spine surgery will be highly influenced by improving surgical technique and evidence regarding the role of bacteria in the pathogenesis of degenerative spinal pathology. Conclusions Incorporating evidence-based guidelines into regular practice will serve to limit the development of resistance while preventing morbidity from spinal infection. Further research should be conducted to provide more evidence for surgical site infection prevention and treatment of spinal infections.
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Affiliation(s)
- Fatima N. Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Andrea M. Roca
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Ishan Khosla
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Srinath S. Medakkar
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Alexandra C. Loya
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Vincent P. Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Dustin H. Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Arash J. Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Gregory D. Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States
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Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use. J Clin Med 2022; 11:jcm11123481. [PMID: 35743551 PMCID: PMC9224689 DOI: 10.3390/jcm11123481] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens. VO can be devastating, as infection can result in pathogenic biofilms on instrumentation that is dangerous to remove. New techniques, such as kyphoplasty and novel vertebroplasty methods, could amplify the potential of ABC in spine surgery. However, caution should be exercised when using ABC as there is some evidence of toxicity to patients and surgeons, antibiotic allergies, bone cement structural impairment, and possible development of antibiotic resistance. The purpose of this article is to describe the basic science of antibiotic cement utilization and review its usage in spine surgery.
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Maale GE, Eager JJ, Mohammadi DK, Calderon FA. Elution Profiles of Synthetic CaSO 4 Hemihydrate Beads Loaded with Vancomycin and Tobramycin. Eur J Drug Metab Pharmacokinet 2021; 45:547-555. [PMID: 32328932 PMCID: PMC7359161 DOI: 10.1007/s13318-020-00622-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Backgrounds and Objectives The use of local antibiotic delivery vehicles is common in the management of biofilm-related infections as they provide high concentrations of local antibiotics while simultaneously avoiding complications from systemic toxicity. We present a 100% pure synthetic calcium sulfate hemi-hydrate mixed with 240 mg tobramycin and 500 mg vancomycin per 10 cc mixture for use in revision surgeries of periprosthetic joint infections (PJIs). The purified carrier demonstrates bioabsorbablity, promotion of bone growth, a physiologically favorable pH, and hydrophilicity. These unique properties may alleviate persistent postoperative wound drainage seen in patients with PJI. Our questions consist of two parts: (1) does the novel calcium sulfate carrier provide therapeutic concentrations of antibiotic locally that can kill biofilm related infections? (2) Are serum concentrations of antibiotic significant to cause concern for systemic toxicity? Methods To address these questions, we assayed the elution of antibiotic concentrations obtained from surgical drains and serum among 50 patients in the first 5 postoperative days. Results The elution of vancomycin and tobramycin was greatest on day 1 compared with those concentrations obtained on days 2, 3, 4, and 5; serum concentrations were largely undetectable. Our findings demonstrate that this calcium sulfate preparation provides therapeutic delivery of vancomycin and tobramycin locally at log 2–3 above the minimum inhibitory concentration (MIC), while avoiding toxic serum concentrations. Conclusions When used in one-stage revision arthroplasties, the bioabsorbable, purified carrier delivers high concentrations of antibiotic while avoiding systemic toxicity.
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Affiliation(s)
- Gerhard E Maale
- Orthopaedic Oncology, Dallas Fort Worth Sarcoma Group, 4708 Alliance Blvd Ste 710., Plano, TX, 75093, USA.
| | - John J Eager
- University of Texas Medical School At Houston, 6431 Fannin Street, Box 20708, Houston, TX, 77225, USA
| | - Daniel K Mohammadi
- Orthopaedic Oncology, Dallas Fort Worth Sarcoma Group, 4708 Alliance Blvd Ste 710., Plano, TX, 75093, USA
| | - Flavio A Calderon
- Orthopaedic Oncology, Dallas Fort Worth Sarcoma Group, 4708 Alliance Blvd Ste 710., Plano, TX, 75093, USA
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The Role of Poly(Methyl Methacrylate) in Management of Bone Loss and Infection in Revision Total Knee Arthroplasty: A Review. J Funct Biomater 2020; 11:jfb11020025. [PMID: 32290191 PMCID: PMC7353497 DOI: 10.3390/jfb11020025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
Abstract
Poly(methyl methacrylate) (PMMA) is widely used in joint arthroplasty to secure an implant to the host bone. Complications including fracture, bone loss and infection might cause failure of total knee arthroplasty (TKA), resulting in the need for revision total knee arthroplasty (rTKA). The goals of this paper are: (1) to identify the most common complications, outside of sepsis, arising from the application of PMMA following rTKA, (2) to discuss the current applications and drawbacks of employing PMMA in managing bone loss, (3) to review the role of PMMA in addressing bone infection following complications in rTKA. Papers published between 1970 to 2018 have been considered through searching in Springer, Google Scholar, IEEE Xplore, Engineering village, PubMed and weblinks. This review considers the use of PMMA as both a bone void filler and as a spacer material in two-stage revision. To manage bone loss, PMMA is widely used to fill peripheral bone defects whose depth is less than 5 mm and covers less than 50% of the bone surface. Treatment of bone infections with PMMA is mainly for two-stage rTKA where antibiotic-loaded PMMA is inserted as a spacer. This review also shows that using antibiotic-loaded PMMA might cause complications such as toxicity to surrounding tissue, incomplete antibiotic agent release from the PMMA, roughness and bacterial colonization on the surface of PMMA. Although PMMA is the only commercial bone cement used in rTKA, there are concerns associated with using PMMA following rTKA. More research and clinical studies are needed to address these complications.
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Nagay B, Goiato M, da Silva E, Andreotti A, Bitencourt S, Duque C, dos Santos P, dos Santos D. Effect of photopolymerized glaze application on bacterial adhesion on ocular acrylic resin surfaces submitted to accelerated ageing. Lett Appl Microbiol 2018; 68:120-127. [DOI: 10.1111/lam.13094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/09/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Affiliation(s)
- B.E. Nagay
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - M.C. Goiato
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - E.V.F. da Silva
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - A.M. Andreotti
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - S.B. Bitencourt
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - C. Duque
- Department of Pediatric Dentistry and Public Health; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - P.H. dos Santos
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
| | - D.M. dos Santos
- Department of Dental Materials and Prosthodontics; Aracatuba Dental School; São Paulo State University (UNESP); Aracatuba São Paulo Brazil
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Evaluation of Sterilisation Techniques for Regenerative Medicine Scaffolds Fabricated with Polyurethane Nonbiodegradable and Bioabsorbable Nanocomposite Materials. Int J Biomater 2018; 2018:6565783. [PMID: 30405715 PMCID: PMC6192142 DOI: 10.1155/2018/6565783] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/18/2018] [Accepted: 08/09/2018] [Indexed: 12/31/2022] Open
Abstract
An effective sterilisation technique that maintains structure integrity, mechanical properties, and biocompatibility is essential for the translation of new biomaterials to the clinical setting. We aimed to establish an effective sterilisation technique for a biodegradable (POSS-PCL) and nonbiodegradable (POSS-PCU) nanocomposite scaffold that maintains stem cell biocompatibility. Scaffolds were sterilised using 70% ethanol, ultraviolet radiation, bleach, antibiotic/antimycotic, ethylene oxide, gamma irradiation, argon plasma, or autoclaving. Samples were immersed in tryptone soya broth and thioglycollate medium and inspected for signs of microbial growth. Scaffold surface and mechanical and molecular weight properties were investigated. AlamarBlue viability assay of adipose derived stem cells (ADSC) seeded on scaffolds was performed to investigate metabolic activity. Confocal imaging of rhodamine phalloidin and DAPI stained ADSCs was performed to evaluate morphology. Ethylene oxide, gamma irradiation, argon plasma, autoclaving, 70% ethanol, and bleach were effective in sterilising the scaffolds. Autoclaving, gamma irradiation, and ethylene oxide led to a significant change in the molecular weight distribution of POSS-PCL and gamma irradiation and ethylene oxide to that of POSS-PCU (p<0.05). UV, ethanol, gamma irradiation, and ethylene oxide caused significant changes in the mechanical properties of POSS-PCL (p<0.05). Argon was associated with significantly higher surface wettability and ADSC metabolic activity (p<0.05). In this study, argon plasma was an effective sterilisation technique for both nonbiodegradable and biodegradable nanocomposite scaffolds. Argon plasma should be further investigated as a potential sterilisation technique for medical devices.
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Pezzotti G. Raman spectroscopy of biomedical polyethylenes. Acta Biomater 2017; 55:28-99. [PMID: 28359859 DOI: 10.1016/j.actbio.2017.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022]
Abstract
With the development of three-dimensional Raman algorithms for local mapping of oxidation and plastic strain, and the ability to resolve molecular orientation patterns with microscopic spatial resolution, there is an opportunity to re-examine many of the foundations on which our understanding of biomedical grade ultra-high molecular weight polyethylenes (UHMWPEs) are based. By implementing polarized Raman spectroscopy into an automatized tool with an improved precision in non-destructively resolving Euler angles, oxidation levels, and microscopic strain, we become capable to make accurate and traceable measurements of the in vitro and in vivo tribological responses of a variety of commercially available UHMWPE bearings for artificial hip and knee joints. In this paper, we first review the foundations and the main algorithms for Raman analyses of oxidation and strain of biomedical polyethylene. Then, we critically re-examine a large body of Raman data previously collected on different polyethylene joint components after in vitro testing or in vivo service, in order to shed new light on an area of particular importance to joint orthopedics: the microscopic nature of UHMWPE surface degradation in the human body. A complex scenario of physical chemistry appears from the Raman analyses, which highlights the importance of molecular-scale phenomena besides mere microstructural changes. The availability of the Raman microscopic probe for visualizing oxidation patterns unveiled striking findings related to the chemical contribution to wear degradation: chain-breaking and subsequent formation of carboxylic acid sites preferentially occur in correspondence of third-phase regions, and they are triggered by emission of dehydroxylated oxygen from ceramic oxide counterparts. These findings profoundly differ from more popular (and simplistic) notions of mechanistic tribology adopted in analyzing joint simulator data. Statement of Significance This review was dedicated to the theoretical and experimental evaluation of the commercially available biomedical polyethylene samples by Raman spectroscopy with regard to their molecular textures, oxidative patterns, and plastic strain at the microscopic level in the three dimensions of the Euclidean space. The main achievements could be listed, as follow: (i) visualization of molecular patterns at the surface of UHMWPE bearings operating against metallic components; (ii) differentiation between wear and creep deformation in retrievals; (iii) non-destructive mapping of oxidative patterns; and, (iv) the clarification of chemical interactions between oxide/non-oxide ceramic heads and advanced UHMWPE liners.
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Affiliation(s)
- Giuseppe Pezzotti
- Ceramic Physics Laboratory, Kyoto Institute of Technology, Sakyo-ku, Matsugasaki, 606-8585 Kyoto, Japan; Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, 160-0023 Tokyo, Japan; The Center for Advanced Medical Engineering and Informatics, Osaka University, Yamadaoka, Suita, 565-0871 Osaka, Japan; Department of Molecular Cell Physiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kawaramachi dori, 602-0841 Kyoto, Japan.
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Gilman AB, Piskarev MS, Kuznetsov AA, Ozerin AN. Modification of ultrahigh-molecular-weight polyethylene by low-temperature plasma (review). HIGH ENERGY CHEMISTRY 2017. [DOI: 10.1134/s0018143917020059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Banche G, Allizond V, Bracco P, Bistolfi A, Boffano M, Cimino A, Brach del Prever EM, Cuffini AM. Interplay between surface properties of standard, vitamin E blended and oxidised ultra high molecular weight polyethylene used in total joint replacement and adhesion of Staphylococcus aureus and Escherichia coli. Bone Joint J 2014; 96-B:497-501. [PMID: 24692617 DOI: 10.1302/0301-620x.96b4.32895] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have assessed the different adhesive properties of some of the most common bacteria associated with periprosthetic joint infection on various types of ultra high molecular Weight Polyethylene (UHMWPE). Quantitative in vitro analysis of the adhesion of biofilm producing strains of Staphylococcus aureus and Escherichia coli to physically and chemically characterised standard UHMWPE (PE), vitamin E blended UHMWPE (VE-PE) and oxidised UHMWPE (OX-PE) was performed using a sonication protocol. A significant decreased bacterial adhesion was registered for both strains on VE-PE, in comparison with that observed on PE, within 48 hours of observation (S. aureus p = 0.024 and E. coli p = 0.008). Since Vitamin E reduces bacterial adhesive ability, VE-stabilised UHMWPE could be valuable in joint replacement by presenting excellent mechanical properties, while reducing bacterial adhesiveness.
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Affiliation(s)
- G Banche
- University of Torino, Department of Public Health and Pediatrics, Via Santena 9, 10126 Turin, Italy
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Photocatalytic antibacterial activity of TiO2–SiO2 thin films: The effect of composition on cell adhesion and antibacterial activity. J Photochem Photobiol A Chem 2014. [DOI: 10.1016/j.jphotochem.2014.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Rochford E, Poulsson A, Salavarrieta Varela J, Lezuo P, Richards R, Moriarty T. Bacterial adhesion to orthopaedic implant materials and a novel oxygen plasma modified PEEK surface. Colloids Surf B Biointerfaces 2014; 113:213-22. [DOI: 10.1016/j.colsurfb.2013.09.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/23/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
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Rochford E, Richards R, Moriarty T. Influence of material on the development of device-associated infections. Clin Microbiol Infect 2012; 18:1162-7. [DOI: 10.1111/j.1469-0691.2012.04002.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Gómez-Barrena E, Esteban J, Medel F, Molina-Manso D, Ortiz-Pérez A, Cordero-Ampuero J, Puértolas JA. Bacterial adherence to separated modular components in joint prosthesis: a clinical study. J Orthop Res 2012; 30:1634-9. [PMID: 22467526 DOI: 10.1002/jor.22114] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 03/13/2012] [Indexed: 02/04/2023]
Abstract
Bacterial adherence on total joint replacement implants may lead to biofilm formation and implant-related osteoarticular infection. It is unclear if different biomaterials in the prosthetic components are more prone to facilitate this bacterial adherence, although ultrahigh molecular weight polyethylene (UHMWPE) component exchange in modular systems has been clinically utilized in the early management of these infections. To clarify if the amount of clinically adhered microorganisms was related to the material or the component, we investigated retrieved implants from infected joint replacements. Thirty-two patients were revised after confirmed implant-related infection through positive cultures. Eighty-seven total joint components (hip and knee) were obtained and separately sonicated following a previously published protocol. Cultures were quantified, and detected colony forming units (CFU) were adjusted according to the component surface and compared based on the component material and location. Variable adherence of bacteria to chrome cobalt alloys, UHMWPE, hydroxyapatite coated components, and titanium alloys. The commonest isolated organisms were Staphylococcus epidermidis (23 of 87 components) and Staphylococcus aureus (10 of 87). Twelve components did not show any microorganism adhered despite location in an infected joint, with positive cultures in other components. A mixed linear model adjusted for random effects (the random effect being the infected patient) obtained convergence for the CFU/mm(2) variable, but could not confirm a significantly higher adherence to a particular component or to a particular biomaterial. Therefore, the bacterial adherence primarily depends on the infective microorganism and the response of each individual patient, rather than materials or components.
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Affiliation(s)
- Enrique Gómez-Barrena
- Department of Orthopaedic Surgery, IdiPaz-Hospital La Paz, Autónoma University of Madrid, Madrid, Spain.
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Gatineau M, El-Warrak AO, Bolliger C, Mourez M, Berthiaume F. Effects of sterilization with hydrogen peroxide gas plasma, ethylene oxide, and steam on bioadhesive properties of nylon and polyethylene lines used for stabilization of canine stifle joints. Am J Vet Res 2012; 73:1665-9. [PMID: 23013195 DOI: 10.2460/ajvr.73.10.1665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare effects of sterilization with hydrogen peroxide gas plasma (HPGP), ethylene oxide, and steam on bioadhesive properties of nylon and polyethylene lines used for stabilization of canine stifle joints. SAMPLE Samples of a 36.3-kg test nylon leader line, 57.8-kg test nylon fishing line, and 2-mm ultrahigh-molecular weight polyethylene (UHMWPE) were used. PROCEDURES In this in vitro study, samples of nylon leader line, fishing line, and UHMWPE sterilized by use of HPGP, ethylene oxide, and steam or unsterilized samples were used. Bacterial adherence on unsterilized and sterilized samples was tested with Staphylococcus epidermidis and Escherichia coli. Five samples were examined for each line type and sterilization condition, and final colony counts were obtained. RESULTS Bacterial adherence was significantly affected by method of sterilization for all 3 line types. For most of the samples, bacterial adherence was similar or lower when HPGP sterilization was used, compared with results for sterilization via ethylene oxide and steam, respectively. Bacterial adherence was significantly higher for UHMWPE, compared with adherence for the nylon line, regardless of the sterilization method used. Bacterial adherence was higher for nylon fishing line than for nylon leader line for S epidermidis after ethylene oxide sterilization and for E coli after HPGP and ethylene oxide sterilization. CONCLUSIONS AND CLINICAL RELEVANCE Effects of HPGP sterilization on bioadhesive properties of nylon and polyethylene lines compared favorably with those for ethylene oxide and steam sterilization. Also, nylon line may be a more suitable material than UHMWPE for suture prostheses on the basis of bacterial adherence properties.
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Affiliation(s)
- Matthieu Gatineau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, St-Hyacinthe, QC J2S 2M2, Canada
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Del Prado G, Terriza A, Ortiz-Pérez A, Molina-Manso D, Mahillo I, Yubero F, Puértolas JA, Manrubia-Cobo M, Gómez Barrena E, Esteban J. DLC coatings for UHMWPE: Relationship between bacterial adherence and surface properties. J Biomed Mater Res A 2012; 100:2813-20. [DOI: 10.1002/jbm.a.34220] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 03/25/2012] [Accepted: 04/04/2012] [Indexed: 01/25/2023]
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16
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Banche G, Bracco P, Bistolfi A, Allizond V, Boffano M, Costa L, Cimino A, Cuffini AM, Del Prever EMB. Vitamin E blended UHMWPE may have the potential to reduce bacterial adhesive ability. J Orthop Res 2011; 29:1662-7. [PMID: 21520260 DOI: 10.1002/jor.21432] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 03/21/2011] [Indexed: 02/04/2023]
Abstract
Biomaterial-associated infection (BAI), a clinical problem resulting in septic failure of joint replacement implants, is initiated by bacterial adhesion, often by Staphylococcus epidermidis. Ultra high molecular weight polyethylene (UHMWPE) is a material of choice for joint replacement; reducing the adhesion of S. epidermidis to the polymer could be a means to decrease infection. We examined the adhesion of two ATCC and one clinical strain of S. epidermidis to standard polyethylene (PE), vitamin E blended UHMWPE (VE-PE), and oxidized UHMWPE (OX-PE) after different incubation times: a significant (p < 0.01) decrease in the adhered staphylococci on VE-PE and a significantly higher incidence of the dislodged biofilm bacteria on OX-PE was observed compared with that registered on PE. With attenuated total reflectance (ATR)-FTIR spectroscopy before and after suspension in bacterial medium for 48 h, new absorptions were observed mainly in OX-PE, indicating adsorption of protein-like substances on the polymer surface. We hypothesized that the different hydrophilicity of the surfaces with different chemical characteristics influenced protein adsorption and bacterial adhesion. These results may have clinical implications concerning the prevention of septic loosening: the VE-PE could have the potential to reduce S. epidermidis adhesive ability if the preliminary data observed in these selected strains is further confirmed, as diversity among clinical strains is well known.
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Affiliation(s)
- Giuliana Banche
- Department of Public Health and Microbiology, University of Turin, Via Santena 9, 10126 Turin, Italy
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Bistolfi A, Massazza G, Verné E, Massè A, Deledda D, Ferraris S, Miola M, Galetto F, Crova M. Antibiotic-loaded cement in orthopedic surgery: a review. ISRN ORTHOPEDICS 2011; 2011:290851. [PMID: 24977058 PMCID: PMC4063209 DOI: 10.5402/2011/290851] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 05/27/2011] [Indexed: 01/05/2023]
Abstract
Infections in orthopaedic surgery are a serious issue. Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, many issues are still unclear or controversial: bacterial adhesion and antibiotic resistance, modification of mechanical properties which follows the addition of the antibiotic, factors influencing the release of the antibiotic from the cement and the role of the surface, the method for mixing the cement and the antibiotic, the choice and the effectiveness of the antibiotic, the combination of two or more antibiotics, and the toxicity. This review discusses all these topics, focusing on properties, merits, and defects of the antibiotic loaded cement. The final objective is to provide the orthopaedic surgeons clear and concise information for the correct choice of cement in their clinical practice.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopedics and Traumatology, AO CTO Hospital, Turin, Italy ; c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Torino, Italy
| | - Giuseppe Massazza
- Department of Orthopedics and Traumatology, AO CTO Hospital, Turin, Italy ; c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Torino, Italy ; University of the Studies of Turin, Turin, Italy
| | - Enrica Verné
- Materials Science and Chemical Engineering Department, Polytechnic of Turin, C.so Duca degli Abruzzi, 24-10129 Turin, Italy
| | - Alessandro Massè
- University of the Studies of Turin, Turin, Italy ; Department of Clinical and Biological Sciences, c/o S. Luigi Hospital, Regione Gonzole, 10-10043 Orbassano, Italy
| | - Davide Deledda
- c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Torino, Italy ; University of the Studies of Turin, Turin, Italy
| | - Sara Ferraris
- Materials Science and Chemical Engineering Department, Polytechnic of Turin, C.so Duca degli Abruzzi, 24-10129 Turin, Italy
| | - Marta Miola
- Materials Science and Chemical Engineering Department, Polytechnic of Turin, C.so Duca degli Abruzzi, 24-10129 Turin, Italy
| | - Fabrizio Galetto
- Department of Orthopedics and Traumatology, AO CTO Hospital, Turin, Italy ; c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Torino, Italy
| | - Maurizio Crova
- Department of Orthopedics and Traumatology, AO CTO Hospital, Turin, Italy ; c/o AO CTO/M. Adelaide, Via Zuretti 29, 10126 Torino, Italy ; University of the Studies of Turin, Turin, Italy
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18
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Gómez-Barrena E, Esteban J, Molina-Manso D, Adames H, Martínez-Morlanes MJ, Terriza A, Yubero F, Puértolas JA. Bacterial adherence on UHMWPE with vitamin E: an in vitro study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:1701-1706. [PMID: 21574013 DOI: 10.1007/s10856-011-4340-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/07/2011] [Indexed: 05/30/2023]
Abstract
Orthopaedic materials may improve its capacity to resist bacterial adherence, and subsequent infection. Our aim was to test the bacterial adherence to alpha-tocopherol (frequently named vitamin E, VE) doped or blended UHMWPE with S. aureus and S. epidermidis, compared to virgin material. Collection strains and clinical strains isolated from patients with orthopaedic infections were used, with the biofilm-developing ability as a covariable. While collection strains showed significantly less adherence to VE-UHMWPE, some clinical strains failed to confirm this effect, leading to the conclusion that VE doped or blended UHMWPE affects the adherence of some S. epidermidis and S. aureus strains, independently of the concentration in use, but the results showed important intraspecies differences and cannot be generalized.
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Affiliation(s)
- E Gómez-Barrena
- Department of Orthopaedic Surgery, Hospital La Paz, Madrid, Spain.
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19
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Sterilization of exopolysaccharides produced by deep-sea bacteria: impact on their stability and degradation. Mar Drugs 2011; 9:224-241. [PMID: 21566796 PMCID: PMC3093254 DOI: 10.3390/md9020224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 01/21/2011] [Accepted: 02/07/2011] [Indexed: 11/16/2022] Open
Abstract
Polysaccharides are highly heat-sensitive macromolecules, so high temperature treatments are greatly destructive and cause considerable damage, such as a great decrease in both viscosity and molecular weight of the polymer. The technical feasibility of the production of exopolysaccharides by deep-sea bacteria Vibrio diabolicus and Alteromonas infernus was previously demonstrated using a bioproduct manufacturing process. The objective of this study was to determine which sterilization method, other than heat sterilization, was the most appropriate for these marine exopolysaccharides and was in accordance with bioprocess engineering requirements. Chemical sterilization using low-temperature ethylene oxide and a mixture of ionized gases (plasmas) was compared to the sterilization methods using gamma and beta radiations. The changes to both the physical and chemical properties of the sterilized exopolysaccharides were analyzed. The use of ethylene oxide can be recommended for the sterilization of polysaccharides as a weak effect on both rheological and structural properties was observed. This low-temperature gas sterilizing process is very efficient, giving a good Sterility Assurance Level (SAL), and is also well suited to large-scale compound manufacturing in the pharmaceutical industry.
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20
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Molina-Manso D, Gómez-Barrena E, Esteban J, Adames H, Martínez MJ, Cordero J, Fernández-Roblas R, Puértolas JA. Bacterial adherence on UHMWPE doped with Vitamin E: anin vitrostudy. ACTA ACUST UNITED AC 2010. [DOI: 10.1088/1742-6596/252/1/012014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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