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Cometta S, Hutmacher DW, Chai L. In vitro models for studying implant-associated biofilms - A review from the perspective of bioengineering 3D microenvironments. Biomaterials 2024; 309:122578. [PMID: 38692146 DOI: 10.1016/j.biomaterials.2024.122578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/01/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
Biofilm research has grown exponentially over the last decades, arguably due to their contribution to hospital acquired infections when they form on foreign body surfaces such as catheters and implants. Yet, translation of the knowledge acquired in the laboratory to the clinic has been slow and/or often it is not attempted by research teams to walk the talk of what is defined as 'bench to bedside'. We therefore reviewed the biofilm literature to better understand this gap. Our search revealed substantial development with respect to adapting surfaces and media used in models to mimic the clinical settings, however many of the in vitro models were too simplistic, often discounting the composition and properties of the host microenvironment and overlooking the biofilm-implant-host interactions. Failure to capture the physiological growth conditions of biofilms in vivo results in major differences between lab-grown- and clinically-relevant biofilms, particularly with respect to phenotypic profiles, virulence, and antimicrobial resistance, and they essentially impede bench-to-bedside translatability. In this review, we describe the complexity of the biological processes at the biofilm-implant-host interfaces, discuss the prerequisite for the development and characterization of biofilm models that better mimic the clinical scenario, and propose an interdisciplinary outlook of how to bioengineer biofilms in vitro by converging tissue engineering concepts and tools.
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Affiliation(s)
- Silvia Cometta
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia.
| | - Dietmar W Hutmacher
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; Faculty of Engineering, School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000, Australia; Australian Research Council Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Liraz Chai
- Max Planck Queensland Centre, Queensland University of Technology, Brisbane, QLD 4000, Australia; The Hebrew University of Jerusalem, Institute of Chemistry, Jerusalem, 91904, Israel; The Harvey M. Krueger Family Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 9190401, Israel.
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Dai T, Ma C, Zhang F, Wang H, Ma Z, Wang H, Wen Y, Chen L. The Efficacy and Safety of an Intra-articular Dual-Acting Antibacterial Agent (TNP-2092) for Implant Infection-Associated Methicillin-Resistant Staphylococcus aureus. J Infect Dis 2024; 229:1658-1668. [PMID: 38147364 DOI: 10.1093/infdis/jiad588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/01/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023] Open
Abstract
Owing to the presence of microbial biofilm on the implant, the eradication of biofilm-associated infections poses a challenge for antibiotic therapies. The study aimed to investigate the efficacy and safety of the novel antibiotic agent TNP-2092 in the context of implant infections. In vivo, rats with periprosthetic joint infection (PJI) treated with antibiotics showed an increase in body weight and decrease in swelling, temperature, and width of knee, compared with the control group. Meanwhile, inflammatory markers in synovium and serum were decreased in the TNP-2092 group, consistent with the pathological results. Moreover, TNP-2092 was effective in eliminating bacteria and disruption biofilm formation, and further alleviated the abnormal bone absorption and reactive bone changes around the prosthesis. In conclusion, intra-articular injection of TNP-2092 is safe and effective in treating knee PJI in a rat model. The study provides a foundation for the future utilization of TNP-2092 in the management of implant-related infections.
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Affiliation(s)
- Tianyu Dai
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Chi Ma
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
- Department of Orthopedics, The First Affiliated Hospital of Jishou University, Jishou
| | - Fan Zhang
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
| | - Hui Wang
- Department of Pharmacology, Wuhan University School of Basic Medical Sciences, Wuhan
| | - Zhenkun Ma
- Department of Pharmacology & Toxicology, TenNor Therapeutics, Suzhou
| | - Huan Wang
- Department of Pharmacology & Toxicology, TenNor Therapeutics, Suzhou
| | - Yinxian Wen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
- Joint Disease Research Center of Wuhan University, Wuhan University, Wuhan, China
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan
- Joint Disease Research Center of Wuhan University, Wuhan University, Wuhan, China
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Karau MJ, Alarcon Perico D, Guarin Perez SF, Koscianski C, Abdel MP, Patel R, Bedard NA. Duration of cefazolin prophylaxis did not impact infection risk in a murine model of joint arthroplasty. J Orthop Res 2024. [PMID: 38796743 DOI: 10.1002/jor.25903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/22/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
To minimize periprosthetic joint infection (PJI) risk, some clinicians prescribe extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA). Given the limited evidence supporting EAP, we sought to evaluate impact of prophylactic antibiotic duration on PJI risk in a murine TJA model. A titanium prosthesis was implanted into the proximal tibia of 89 mice and inoculated with 102 colony forming units (cfu) of Staphylococcus aureus Xen36. Control mice (n = 20) did not receive antibiotics. Treated mice received either 24 h (n = 35) or 4 days (n = 34) of cefazolin prophylaxis. Cultures were obtained from the prostheses, tibia, femur, and knee tissues 3 weeks after surgery. All mice in the control group developed PJI. Both prophylaxis regimens reduced the rate of PJI relative to the control, with only 2/35 mice in the 24-h cohort (p < 0.0001) and 1/34 in 4-day cohort developing PJI (p < 0.0001). CFU counts from the prostheses, bone and knee tissues were reduced for the 24-h and 4-day prophylaxis cohorts relative to the control (p < 0.0001 for both). There was no difference in rates of PJI or CFU counts between the two prophylaxis cohorts (p = 0.58). Prophylactic cefazolin profoundly reduced rates of PJI in a murine model of TJA in which all control animals developed PJI. Extending cefazolin prophylaxis duration from 24 h to 4 days did not result in improved PJI rates or decreased bacterial loads in infected cases. While these results strongly support use of antibiotic prophylaxis for TJA, EAP did not appear to add benefit in the described mouse model.
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Affiliation(s)
- Melissa J Karau
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Rochester, Minnesota, USA
| | | | | | - Christina Koscianski
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Rochester, Minnesota, USA
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Department of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Rochester, Minnesota, USA
- Department of Medicine, Division of Public Health, Infectious Diseases, and Occupational Medicine, Rochester, Minnesota, USA
| | - Nicholas A Bedard
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Aboona F, Bou-Akl T, Miller AJ, Fry M, Wu B, Pawlitz P, Ren W, Markel DC. Effects of Vancomycin/Tobramycin-Doped Ceramic Composite (Polyvinyl Alcohol Composite-Vancomycin/Tobramycin-Polymeric Dicalcium Phosphate Dihydrate) in a Rat Femur Model Implanted With Contaminated Porous Titanium Cylinders. J Arthroplasty 2024:S0883-5403(24)00424-8. [PMID: 38718912 DOI: 10.1016/j.arth.2024.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) remains common and problematic. We hypothesized that using a bioceramic that provided rapid release of the antibiotics (vancomycin [VAN] or VAN and tobramycin [VAN and TOB]) from a polyvinyl-alcohol-composite (PVA) combined with a delayed and sustained antibiotic release from polymeric-dicalcium-phosphate-dihydrate (PDCPD) ceramic would inhibit S. aureus-associated implant infections. METHODS A total of 50 male Sprague Dawley rats were randomly divided into 5 groups-I: negative control; II: bacteria only; III: bacteria + saline wash; IV: bacteria + PVA-VAN-PDCPD, and V: bacteria + PVA-VAN-TOB-PDCPD. A porous titanium (Ti) implant was press-fit into the rat knee. S. aureus-containing broth was added into the joint space creating a PJI. After 1 week, the joints from groups III to V were washed with saline and the fluid collected for bacterial quantification. This was followed by saline irrigation treatment (groups III to V) and application of the antibiotic-loaded PVA-PDCPD bioceramic (groups IV and V). On day 21, joint fluid was collected, and the implants harvested for bacterial quantification. RESULTS No bacteria were isolated from the negative control (group I). The positive control (group II) was positive on both days 7 and 21. Bacteria were still present on day 21 in the fluid and implant in group III. Groups (IV and V) showed a decrease in the bacterial burden in the fluid and implant on day 21. There were significant differences in bacteria levels in the collected wash fluid and on the implant at day 21 between the saline wash (group III) and treatment groups (IV and V). CONCLUSIONS In this animal model of acute periprosthetic infection, treatment with PVA-VAN-PDCPD and PVA-VAN/TOB-PDCPD reduced bacterial load in the infected joint and the infected Ti implant. Application of PVA-VAN-PDCPD and/or PVA-VAN/TOB-PDCPD after saline irrigation could be used as an addition to the treatment of PJI.
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Affiliation(s)
- Fadi Aboona
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Therese Bou-Akl
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Adam J Miller
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Mike Fry
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Bin Wu
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Paula Pawlitz
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan
| | - Weiping Ren
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan; Virotech Co., Inc., Troy, Michigan
| | - David C Markel
- Section of Orthopaedic Surgery, Ascension-Providence Hospital, Southfield, Michigan; The Core Institute, Novi, Michigan
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Jennings JA, Arts JJ, Abuhussein E, Alt V, Ashton N, Baertl S, Bhattacharyya S, Cain JD, Dintakurthi Y, Ducheyne P, Duffy H, Falconer R, Gautreaux M, Gianotti S, Hamilton JL, Hylen A, van Hoogstraten S, Libos A, Markovics A, Mdingi V, Montgomery EC, Morgenstern M, Obremskey W, Priddy LB, Tate J, Ren Y, Ricciardi B, Tucker LJ, Weeks J, Vanvelk N, Williams D, Xie C, Hickok N, Schwarz EM, Fintan Moriarty T. 2023 International Consensus Meeting on musculoskeletal infection: Summary from the treatment workgroup and consensus on treatment in preclinical models. J Orthop Res 2024; 42:500-511. [PMID: 38069631 DOI: 10.1002/jor.25765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
In vitro and in vivo studies are critical for the preclinical efficacy assessment of novel therapies targeting musculoskeletal infections (MSKI). Many preclinical models have been developed and applied as a prelude to evaluating safety and efficacy in human clinical trials. In performing these studies, there is both a requirement for a robust assessment of efficacy, as well as a parallel responsibility to consider the burden on experimental animals used in such studies. Since MSKI is a broad term encompassing infections varying in pathogen, anatomical location, and implants used, there are also a wide range of animal models described modeling these disparate infections. Although some of these variations are required to adequately evaluate specific interventions, there would be enormous value in creating a unified and standardized criteria to animal testing in the treatment of MSKI. The Treatment Workgroup of the 2023 International Consensus Meeting on Musculoskeletal Infection was responsible for questions related to preclinical models for treatment of MSKI. The main objective was to review the literature related to priority questions and estimate consensus opinion after voting. This document presents that process and results for preclinical models related to (1) animal model considerations, (2) outcome measurements, and (3) imaging.
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Affiliation(s)
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
- Department Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Ezzuddin Abuhussein
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Volker Alt
- Department of Trauma Surgery, University Hospital, Regensburg, Germany
| | - Nicholas Ashton
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Susanne Baertl
- Department of Trauma Surgery, University Hospital, Regensburg, Germany
| | - Sanjib Bhattacharyya
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- XeroThera Inc., Philadelphia, Pennsylvania
| | - Jarrett D Cain
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yogita Dintakurthi
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Paul Ducheyne
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hannah Duffy
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Robert Falconer
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Malley Gautreaux
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Sofia Gianotti
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John L Hamilton
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Annika Hylen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Sanne van Hoogstraten
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Andres Libos
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Department of Orthopaedic Surgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Adrienn Markovics
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Emily C Montgomery
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Mario Morgenstern
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
| | - William Obremskey
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lauren B Priddy
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Jermiah Tate
- Department of Biomedical Engineering, University of Memphis, Memphis, Tennessee, USA
| | - Youliang Ren
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Benjamin Ricciardi
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Luke J Tucker
- Department of Agricultural and Biological Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Jason Weeks
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Niels Vanvelk
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Dustin Williams
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Chao Xie
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
| | - Noreen Hickok
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward M Schwarz
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA
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Fan Y, McCanne M, Yuh J, Lekkala S, Leape CP, Hugard S, Thomson A, Collins JE, Muratoglu OK, Randolph M, Oral E. The efficacy of antibiotic-eluting material in a two-stage model of periprosthetic joint infection. J Orthop Res 2024; 42:460-473. [PMID: 37609941 DOI: 10.1002/jor.25681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/30/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
Periprosthetic joint infections occur in about 2% of patients who undergo primary total joint arthroplasty, a procedure performed over 1 million times in the United States. The gold standard of treatment is a two-stage revision. This study aimed to establish a two-stage procedure in a preclinical small animal model (rat) to test and compare the efficacy of an antibiotic-eluting material in managing infection. Joint replacement was simulated by transchondylarly implanting a polyethylene (PE) plug into the distal femur and a titanium screw in the proximal tibia. Methicillin-sensitive Staphylococcus aureus (MSSA) 108 CFU/mL was injected into the tibial canal and the joint space before wound closure. The control groups were killed on postoperative day (POD) 18 (n = 12) and on POD 42 (n = 4) to assess both early and later-stage outcomes in the control group. The test group underwent revision surgery on POD 18 for treatment using gentamicin-eluting polyethylene (GPE, n = 4) and was observed until POD 42 to evaluate the efficacy of treatment. Our results showed that the bone loss for the treatment group receiving GPE was significantly less than that of the control (p < 0.05), which was supported by the histology images and an AI-tool assisted infection rate evaluation. Gait metrics duty factor imbalance and hindlimb temporal symmetry were significantly different between the treatment and control groups on Day 42. This animal model was feasible for evaluating treatments for peri-prosthetic joint infections (PJI) with a revision surgery and specifically that revision surgery and local antibiotic treatment largely hindered the peri-prosthetic bone loss. Statement of clinical significance: This revision model of peri-prosthetic infection has the potential of comparatively evaluating prophylaxis and treatment strategies and devices. Antibiotic-eluting UHMWPE is devised as at tool in treating PJI while providing weight bearing and joint space preservation.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Madeline McCanne
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jean Yuh
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sashank Lekkala
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Charlotte P Leape
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon Hugard
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Thomson
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Boston College, Boston, Massachusetts, USA
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Randolph
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Cleaver L, Garnett JA. How to study biofilms: technological advancements in clinical biofilm research. Front Cell Infect Microbiol 2023; 13:1335389. [PMID: 38156318 PMCID: PMC10753778 DOI: 10.3389/fcimb.2023.1335389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Biofilm formation is an important survival strategy commonly used by bacteria and fungi, which are embedded in a protective extracellular matrix of organic polymers. They are ubiquitous in nature, including humans and other animals, and they can be surface- and non-surface-associated, making them capable of growing in and on many different parts of the body. Biofilms are also complex, forming polymicrobial communities that are difficult to eradicate due to their unique growth dynamics, and clinical infections associated with biofilms are a huge burden in the healthcare setting, as they are often difficult to diagnose and to treat. Our understanding of biofilm formation and development is a fast-paced and important research focus. This review aims to describe the advancements in clinical biofilm research, including both in vitro and in vivo biofilm models, imaging techniques and techniques to analyse the biological functions of the biofilm.
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Affiliation(s)
- Leanne Cleaver
- Centre for Host-Microbiome Interactions, Faculty of Dental, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
| | - James A. Garnett
- Centre for Host-Microbiome Interactions, Faculty of Dental, Oral & Craniofacial Sciences, King’s College London, London, United Kingdom
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Arciola CR, Ravaioli S, Mirzaei R, Dolzani P, Montanaro L, Daglia M, Campoccia D. Biofilms in Periprosthetic Orthopedic Infections Seen through the Eyes of Neutrophils: How Can We Help Neutrophils? Int J Mol Sci 2023; 24:16669. [PMID: 38068991 PMCID: PMC10706149 DOI: 10.3390/ijms242316669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Despite advancements in our knowledge of neutrophil responses to planktonic bacteria during acute inflammation, much remains to be elucidated on how neutrophils deal with bacterial biofilms in implant infections. Further complexity transpires from the emerging findings on the role that biomaterials play in conditioning bacterial adhesion, the variety of biofilm matrices, and the insidious measures that biofilm bacteria devise against neutrophils. Thus, grasping the entirety of neutrophil-biofilm interactions occurring in periprosthetic tissues is a difficult goal. The bactericidal weapons of neutrophils consist of the following: ready-to-use antibacterial proteins and enzymes stored in granules; NADPH oxidase-derived reactive oxygen species (ROS); and net-like structures of DNA, histones, and granule proteins, which neutrophils extrude to extracellularly trap pathogens (the so-called NETs: an allusive acronym for "neutrophil extracellular traps"). Neutrophils are bactericidal (and therefore defensive) cells endowed with a rich offensive armamentarium through which, if frustrated in their attempts to engulf and phagocytose biofilms, they can trigger the destruction of periprosthetic bone. This study speculates on how neutrophils interact with biofilms in the dramatic scenario of implant infections, also considering the implications of this interaction in view of the design of new therapeutic strategies and functionalized biomaterials, to help neutrophils in their arduous task of managing biofilms.
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Affiliation(s)
- Carla Renata Arciola
- Laboratory of Immunorheumatology and Tissue Regeneration, Laboratory of Pathology of Implant Infections, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Stefano Ravaioli
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (S.R.); (D.C.)
| | - Rasoul Mirzaei
- Venom and Biotherapeutics Molecules Laboratory, Medical Biotechnology Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran 1316943551, Iran;
| | - Paolo Dolzani
- Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| | - Lucio Montanaro
- Laboratory of Immunorheumatology and Tissue Regeneration, Laboratory of Pathology of Implant Infections, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Via San Giacomo 14, 40126 Bologna, Italy
| | - Maria Daglia
- Department of Pharmacy, University of Napoli Federico II, Via D. Montesano 49, 80131 Naples, Italy;
| | - Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all’Impianto, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy; (S.R.); (D.C.)
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9
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Huang S, Wen J, Zhang Y, Bai X, Cui ZK. Choosing the right animal model for osteomyelitis research: Considerations and challenges. J Orthop Translat 2023; 43:47-65. [PMID: 38094261 PMCID: PMC10716383 DOI: 10.1016/j.jot.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 03/22/2024] Open
Abstract
Osteomyelitis is a debilitating bone disorder characterized by an inflammatory process involving the bone marrow, bone cortex, periosteum, and surrounding soft tissue, which can ultimately result in bone destruction. The etiology of osteomyelitis can be infectious, caused by various microorganisms, or noninfectious, such as chronic nonbacterial osteomyelitis (CNO) and chronic recurrent multifocal osteomyelitis (CRMO). Researchers have turned to animal models to study the pathophysiology of osteomyelitis. However, selecting an appropriate animal model that accurately recapitulates the human pathology of osteomyelitis while controlling for multiple variables that influence different clinical presentations remains a significant challenge. In this review, we present an overview of various animal models used in osteomyelitis research, including rodent, rabbit, avian/chicken, porcine, minipig, canine, sheep, and goat models. We discuss the characteristics of each animal model and the corresponding clinical scenarios that can provide a basic rationale for experimental selection. This review highlights the importance of selecting an appropriate animal model for osteomyelitis research to improve the accuracy of the results and facilitate the development of novel treatment and management strategies.
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Affiliation(s)
| | | | - Yiqing Zhang
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xiaochun Bai
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Zhong-Kai Cui
- Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, 510515, China
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10
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Hinz N, Butscheidt S, Jandl NM, Rohde H, Keller J, Beil FT, Hubert J, Rolvien T. Increased local bone turnover in patients with chronic periprosthetic joint infection. Bone Joint Res 2023; 12:644-653. [PMID: 37813394 PMCID: PMC10562080 DOI: 10.1302/2046-3758.1210.bjr-2023-0071.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Aims The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI. Methods Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery. Microstructural and cellular bone parameters were analyzed in bone specimens by histomorphometry on undecalcified sections complemented by tartrate-resistant acid phosphatase immunohistochemistry. Data were compared with control specimens obtained during primary arthroplasty (n = 20) and aseptic revision (n = 20). Results PJI specimens exhibited a higher bone volume, thickened trabeculae, and increased osteoid parameters compared to both control groups, suggesting an accelerated bone turnover with sclerotic microstructure. On the cellular level, osteoblast and osteoclast parameters were markedly increased in the PJI cohort. Furthermore, a positive association between serum (CRP) but not synovial (white blood cell (WBC) count) inflammatory markers and osteoclast indices could be detected. Comparison between different pathogens revealed increased osteoclastic bone resorption parameters without a concomitant increase in osteoblasts in bone specimens from patients with Staphylococcus aureus infection, compared to those with detection of Staphylococcus epidermidis and Cutibacterium spp. Conclusion This study provides insights into the local bone metabolism in chronic PJI, demonstrating osteosclerosis with high bone turnover. The fact that Staphylococcus aureus was associated with distinctly increased osteoclast indices strongly suggests early surgical treatment to prevent periprosthetic bone alterations.
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Affiliation(s)
- Nico Hinz
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma, Surgery and Sports Traumatology, BG Trauma Hospital Hamburg, Hamburg, Germany
| | - Sebastian Butscheidt
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico M. Jandl
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Instiute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Keller
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank T. Beil
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hubert
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Tong K, Wei J, Liu Z, Yang X, Hu Y. The early infection characterization of septic arthritis by Staphylococcus aureus after anterior cruciate ligament reconstruction in a novel rat model. J Orthop Surg Res 2023; 18:522. [PMID: 37481547 PMCID: PMC10362564 DOI: 10.1186/s13018-023-03969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/01/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The present study aimed to explore the time of maximum bacterial load and main colonization knee site in bacterial infection process based on a novel rat model of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR). METHODS Ninety-five Wistar rats with unilateral ACLR, random enrolled into control surgery (CS) group; joint inject (JI) group; presoaking (PS) group, were injected with 30 μl sterile saline or 30 μl × 107 colony forming units/ml Staphylococcus aureus via the knee joint or graft with presoaked Staphylococcus aureus during ACLR, respectively. At 1, 4, 7, 11, and 14 days postoperatively, samples were harvested to evaluate progress of knee joint infection by postoperative body weight, body temperature, knee temperature, knee width, scales of tissue damage, serum inflammatory markers, microbiological counting, microcomputed tomography (Micro-CT), digital radiography, magnetic resonance imaging (MRI) examination, and scanning electron microscopy (SEM). RESULTS No systemic infection was observed in all rats. Comparing with serum inflammatory markers, tissue scores of inflammatory reactions, bacterial counts in the CS group, these data were significantly elevated in the JI group and PS group. The bone mass around the bone tunnel was lower and the soft tissue of knee showed more obvious swelling on MRI in the infection groups than that in the CS group at 7 and 14 days postoperatively. Staphylococcus aureus clusters on the surface of screw and graft were observed in the infection group. The whole colony forming units of Staphylococcus aureus maintained a continuous upward trend peaking 7 and 11 days followed by a balanced curve in the infection groups. Bone and soft tissue were found to have more bacterial counts than graft and screws. CONCLUSION This animal model effectively mimics the acute knee infection after ACLR. We found that the bacterial colonization exhibited the peak of acute infection between 7 and 11 days postoperatively, with the major bacteria loads found in the bone, soft tissue.
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Affiliation(s)
- Kai Tong
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China
| | - Jian Wei
- Department of Joint Orthopedics, Liuzhou People's Hospital, Liuzhou, China
| | - Zilin Liu
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China
| | - Xiaoming Yang
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China.
| | - Yong Hu
- Department of Orthopedics, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuchang District, Wuhan, 430060, China.
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12
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Wei J, Gu H, Tong K. Intra-wound versus systemic vancomycin for preventing surgical site infection induced by methicillin-resistant S. aureus after spinal implant surgery in a rat model. J Orthop Surg Res 2023; 18:299. [PMID: 37055765 PMCID: PMC10100431 DOI: 10.1186/s13018-023-03779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Systemic vancomycin administration pre-operatively for the infection prophylaxis of spinal implant surgery remains unsatisfactory. This study aimed to explore the efficacy and dosage of local use of vancomycin powder (VP) in preventing surgical site infections after spinal implant surgery in a rat model. METHODS Systemic vancomycin (SV; intraperitoneal injection, 88 mg/kg) or intraoperative intra-wound VP (VP0.5: 44 mg/kg, VP1.0: 88 mg/kg, VP2.0: 176 mg/kg) was applied after spinal implant surgery and methicillin-resistant S. aureus (MRSA; ATCC BAA-1026) inoculation in rats. General status, blood inflammatory biomarkers, microbiological and histopathological evaluation were performed during 2 weeks post-surgery. RESULTS No post-surgical deaths, wound complications and obvious signs of vancomycin adverse effects were observed. Bacterial counts, blood and tissue inflammation were reduced in the VP groups compared with the SV group. VP2.0 group showed better outcomes in weight gain and tissue inflammation than the VP0.5 and VP1.0 group. Microbial counts indicated that no bacteria survived in the VP2.0 group, whereas MRSA was detected in VP0.5 and VP1.0 groups. CONCLUSIONS Intra-wound VP may be more effective than systemic administration in preventing infection caused by MRSA (ATCC BAA-1026) after spinal implant surgery in a rat model.
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Affiliation(s)
- Jian Wei
- Department of Orthopedic Surgery, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, 545006, China.
| | - Hanwen Gu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Kai Tong
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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13
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Ibrahim MM, Liu Y, Ure K, Hall CW, Mah TF, Abdelbary H. Establishment of a Novel Rat Model of Gram-Negative Periprosthetic Joint Infection Using Cementless Hip Hemiarthroplasty. J Bone Joint Surg Am 2023; 105:42-52. [PMID: 36598474 DOI: 10.2106/jbjs.22.00094] [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] [Indexed: 01/05/2023]
Abstract
BACKGROUND Gram-negative periprosthetic joint infections (GN-PJIs) present unique challenges. Our aim was to establish a clinically representative GN-PJI model that recapitulates biofilm formation in vivo. We also hypothesized that biofilm formation on the implant surface would affect its ability to osseointegrate. METHODS Three-dimensionally-printed medical-grade titanium hip implants were used to replace the femoral heads of male Sprague-Dawley rats. GN-PJI was induced using 2 bioluminescent Pseudomonas aeruginosa strains: a reference strain (PA14-lux) and a mutant biofilm-defective strain (ΔflgK-lux). Infection was monitored in real time using an in vivo imaging system (IVIS) and magnetic resonance imaging (MRI). Bacterial loads were quantified utilizing the viable colony count. Biofilm formation at the bone-implant interface was visualized using field-emission scanning electron microscopy (FE-SEM). Implant stability, as an outcome, was directly assessed by quantifying osseointegration using microcomputed tomography, and indirectly assessed by identifying gait-pattern changes. RESULTS Bioluminescence detected by the IVIS was focused on the hip region and demonstrated localized infection, with greater ability of PA14-lux to persist in the model compared with the ΔflgK-lux strain, which is defective in biofilm formation. This was corroborated by MRI, as PA14-lux induced relatively larger implant-related abscesses. Biofilm formation at the bone-implant interface induced by PA14-lux was visualized using FE-SEM versus defective-biofilm formation by ΔflgK-lux. Quantitatively, the average viable colony count of the sonicated implants, in colony-forming units/mL, was 3.77 × 108 for PA14-lux versus 3.65 × 103 for ΔflgK-lux, with a 95% confidence interval around the difference of 1.45 × 108 to 6.08 × 108 (p = 0.0025). This difference in the ability to persist in the model was reflected significantly on implant osseointegration, with a mean intersection surface of 4.1 × 106 ± 1.99 × 106 μm2 for PA14-lux versus 6.44 × 106 ± 2.53 × 106 μm2 for ΔflgK-lux and 7.08 × 106 ± 1.55 × 106 μm2 for the noninfected control (p = 0.048). CONCLUSIONS To our knowledge, this proposed, novel in vivo biofilm-based model is the most clinically representative for GN-PJI to date, since animals can bear weight on the implant, poor osseointegration was associated with biofilm formation, and localized PJI was assessed by various modalities. CLINICAL RELEVANCE This model will allow for more reliable testing of novel biofilm-targeting therapeutics.
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Affiliation(s)
- Mazen M Ibrahim
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Orthopaedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Yun Liu
- Materials Characterization Core Facility, Centre for Advanced Materials Research (CAMaR), University of Ottawa, Ottawa, Ontario, Canada
| | - Kerstin Ure
- Animal Behavior and Physiology Core, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clayton W Hall
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Thien-Fah Mah
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hesham Abdelbary
- Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
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14
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Ashar H, Singh A, Ektate K, More S, Ranjan A. Treating methicillin-resistant Staphylococcus aureus (MRSA) bone infection with focused ultrasound combined thermally sensitive liposomes. Int J Hyperthermia 2023; 40:2211278. [PMID: 37437891 DOI: 10.1080/02656736.2023.2211278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Chronic bone infection caused by Staphylococcus aureus biofilms in children and adults is characterized by reduced antibiotic sensitivity. In this study, we assessed 'heat-targeted, on-demand' antibiotic delivery for S. aureus killing by combining ciprofloxacin (CIP)-laden low-temperature sensitive liposomes (LTSLs) with local high-intensity focused ultrasound (HIFU) induced bone heating in a rat model of bone infection. METHODS CIP-LTSLs were prepared using the thin-film hydration and extrusion method. Bone infection was established by surgically implanting an orthopedic K-wire colonized with methicillin-resistant S. aureus (MRSA) strain into rat's femurs. For bone heating, ultrasound-guided HIFU exposures were performed to achieve a local temperature of 40-42 °C (∼15 min) concurrently with intravenous injection of CIP-LTSLs or CIP. CIP biodistribution was determined spectrophotometrically and therapeutic efficacy was determined by bacteriological, histological and scanning electron microscopy (SEM) analyses. RESULTS CIP-LTSLs in the range of 183.5 nm ± 1.91 showed an encapsulation efficiency of >70% at 37 °C and a complete release at ∼42 °C. The metal implantation method yielded medullary osteomyelitis characterized by suppurative changes (bacterial and pus pockets) by day 10 in bones and adjoining muscle tissues. HIFU heating significantly improved CIP delivery from LTSLs in bones, resulting in a significant reduction in MRSA load compared to HIFU and CIP alone groups. These were also verified by histology and SEM, wherein a distinct reduction in S. aureus population in the infected metal wires and tissues from the combinatorial therapy was noted. CONCLUSION HIFU improved CIP delivery to bones, achieving clearance of hard-to-treat MRSA biofilms.
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Affiliation(s)
- Harshini Ashar
- Department of Physiological Sciences, College of Veterinary Medicine, OK State University, Stillwater, OK, USA
| | - Akansha Singh
- Department of Physiological Sciences, College of Veterinary Medicine, OK State University, Stillwater, OK, USA
| | - Kalyani Ektate
- Department of Physiological Sciences, College of Veterinary Medicine, OK State University, Stillwater, OK, USA
| | - Sunil More
- Department of Veterinary Pathobiology, College of Veterinary Medicine, Oklahoma State University, Stillwater, OK, USA
| | - Ashish Ranjan
- Department of Physiological Sciences, College of Veterinary Medicine, OK State University, Stillwater, OK, USA
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15
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Choi S, Lee H, Hong R, Jo B, Jo S. Application of Multi-Layered Temperature-Responsive Polymer Brushes Coating on Titanium Surface to Inhibit Biofilm Associated Infection in Orthopedic Surgery. Polymers (Basel) 2022; 15:polym15010163. [PMID: 36616511 PMCID: PMC9823637 DOI: 10.3390/polym15010163] [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: 12/01/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
Infection associated with biomedical implants remains the main cause of failure, leading to reoperation after orthopedic surgery. Orthopedic infections are characterized by microbial biofilm formation on the implant surface, which makes it challenging to diagnose and treat. One potential method to prevent and treat such complications is to deliver a sufficient dose of antibiotics at the onset of infection. This strategy can be realized by coating the implant with thermoregulatory polymers and triggering the release of antibiotics during the acute phase of infection. We developed a multi-layered temperature-responsive polymer brush (MLTRPB) coating that can release antibiotics once the temperature reaches a lower critical solution temperature (LCST). The coating system was developed using copolymers composed of diethylene glycol methyl ether methacrylate and 2-hydroxyethyl methacrylate by alternatively fabricating monomers layer by layer on the titanium surface. LCST was set to the temperature of 38-40 °C, a local temperature that can be reached during infection. The antibiotic elution characteristics were investigated, and the antimicrobial efficacy was tested against S. aureus species (Xen29 ATCC 29 213) using one to four layers of MLTRPB. Both in vitro and in vivo assessments demonstrated preventive effects when more than four layers of the coating were applied, ensuring promising antibacterial effects of the MLTRPB coating.
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Affiliation(s)
- Sookyung Choi
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
| | - Hyeonjoon Lee
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Ran Hong
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
- Department of Pathology, Chosun University Hospital, Gwangju 61453, Republic of Korea
| | - Byungwook Jo
- School of Engineering, Chosun University, Gwangju 61452, Republic of Korea
| | - Suenghwan Jo
- School of Medicine, Chosun University Medical School, Gwangju 61452, Republic of Korea
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea
- Correspondence: ; Tel.: +82-62-220-3147
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16
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Poilvache H, Van Bambeke F, Cornu O. Development of an innovative in vivo model of PJI treated with DAIR. Front Med (Lausanne) 2022; 9:984814. [PMID: 36314026 PMCID: PMC9606572 DOI: 10.3389/fmed.2022.984814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Prosthetic Joint Infection (PJI) are catastrophic complications of joint replacement. Debridement, implant retention, and antibiotic therapy (DAIR) is the usual strategy in acute infections but fails in 45% of MRSA infections. We describe the development of a model of infected arthroplasty in rabbits, treated with debridement and a course of vancomycin with clinically relevant dosage. Materials and methods A total of 15 rabbits were assigned to three groups: vancomycin pharmacokinetics (A), infection (B), and DAIR (C). All groups received a tibial arthroplasty using a Ti-6Al-4V implant. Groups B and C were infected per-operatively with a 5.5 log10 MRSA inoculum. After 1 week, groups C infected knees were surgically debrided. Groups A and C received 1 week of vancomycin. Pharmacokinetic profiles were obtained in group A following 1st and 5th injections. Animals were euthanized 2 weeks after the arthroplasty. Implants and tissue samples were processed for bacterial counts and histology. Results Average vancomycin AUC0–12 h were 213.0 mg*h/L (1st injection) and 207.8 mg*h/L (5th injection), reaching clinical targets. All inoculated animals were infected. CFUs were reproducible in groups B. A sharp decrease in CFU was observed in groups C. Serum markers and leukocytes counts increased significantly in infected groups. Conclusion We developed a reproducible rabbit model of PJI treated with DAIR, using vancomycin at clinically relevant concentrations.
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Affiliation(s)
- Hervé Poilvache
- Neuro Musculo-Skeletal Laboratory, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium,Cellular and Molecular Pharmacology Laboratory, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium,Orthopedic Surgery and Traumatology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium,*Correspondence: Hervé Poilvache,
| | - Françoise Van Bambeke
- Cellular and Molecular Pharmacology Laboratory, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Olivier Cornu
- Neuro Musculo-Skeletal Laboratory, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium,Orthopedic Surgery and Traumatology Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
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17
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Li J, Cheung WH, Chow SK, Ip M, Leung SYS, Wong RMY. Current therapeutic interventions combating biofilm-related infections in orthopaedics : a systematic review of in vivo animal studies. Bone Joint Res 2022; 11:700-714. [PMID: 36214177 PMCID: PMC9582863 DOI: 10.1302/2046-3758.1110.bjr-2021-0495.r3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims Biofilm-related infection is a major complication that occurs in orthopaedic surgery. Various treatments are available but efficacy to eradicate infections varies significantly. A systematic review was performed to evaluate therapeutic interventions combating biofilm-related infections on in vivo animal models. Methods Literature research was performed on PubMed and Embase databases. Keywords used for search criteria were “bone AND biofilm”. Information on the species of the animal model, bacterial strain, evaluation of biofilm and bone infection, complications, key findings on observations, prevention, and treatment of biofilm were extracted. Results A total of 43 studies were included. Animal models used included fracture-related infections (ten studies), periprosthetic joint infections (five studies), spinal infections (three studies), other implant-associated infections, and osteomyelitis. The most common bacteria were Staphylococcus species. Biofilm was most often observed with scanning electron microscopy. The natural history of biofilm revealed that the process of bacteria attachment, proliferation, maturation, and dispersal would take 14 days. For systemic mono-antibiotic therapy, only two of six studies using vancomycin reported significant biofilm reduction, and none reported eradication. Ten studies showed that combined systemic and topical antibiotics are needed to achieve higher biofilm reduction or eradication, and the effect is decreased with delayed treatment. Overall, 13 studies showed promising therapeutic potential with surface coating and antibiotic loading techniques. Conclusion Combined topical and systemic application of antimicrobial agents effectively reduces biofilm at early stages. Future studies with sustained release of antimicrobial and biofilm-dispersing agents tailored to specific pathogens are warranted to achieve biofilm eradication. Cite this article: Bone Joint Res 2022;11(10):700–714.
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Affiliation(s)
- Jie Li
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon K. Chow
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Sharon Y. S. Leung
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, China
| | - Ronald M. Y. Wong
- Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong, China, Ronald Man Yeung Wong. E-mail:
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Su Y, Yrastorza JT, Matis M, Cusick J, Zhao S, Wang G, Xie J. Biofilms: Formation, Research Models, Potential Targets, and Methods for Prevention and Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2203291. [PMID: 36031384 PMCID: PMC9561771 DOI: 10.1002/advs.202203291] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/31/2022] [Indexed: 05/28/2023]
Abstract
Due to the continuous rise in biofilm-related infections, biofilms seriously threaten human health. The formation of biofilms makes conventional antibiotics ineffective and dampens immune clearance. Therefore, it is important to understand the mechanisms of biofilm formation and develop novel strategies to treat biofilms more effectively. This review article begins with an introduction to biofilm formation in various clinical scenarios and their corresponding therapy. Established biofilm models used in research are then summarized. The potential targets which may assist in the development of new strategies for combating biofilms are further discussed. The novel technologies developed recently for the prevention and treatment of biofilms including antimicrobial surface coatings, physical removal of biofilms, development of new antimicrobial molecules, and delivery of antimicrobial agents are subsequently presented. Finally, directions for future studies are pointed out.
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Affiliation(s)
- Yajuan Su
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jaime T. Yrastorza
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Mitchell Matis
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jenna Cusick
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Siwei Zhao
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Guangshun Wang
- Department of Pathology and MicrobiologyCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
| | - Jingwei Xie
- Department of Surgery‐Transplant and Mary & Dick Holland Regenerative Medicine ProgramCollege of MedicineUniversity of Nebraska Medical CenterOmahaNE68198USA
- Department of Mechanical and Materials EngineeringCollege of EngineeringUniversity of Nebraska‐LincolnLincolnNE68588USA
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19
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Li Y, Wuermanbieke S, Zhang X, Mu W, Ma H, Qi F, Sun X, Amat A, Cao L. Effects of intra-articular D-amino acids combined with systemic vancomycin on an experimental Staphylococcus aureus-induced periprosthetic joint infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:716-727. [PMID: 35346597 DOI: 10.1016/j.jmii.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/25/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The D-isoforms of amino acids (D-AAs) exhibit anti-biofilm potential against a diverse range of bacterial species in vitro, while its role in vivo remains unclear. The aim of this study was to investigate the effects of a combination of D-AAs and vancomycin on a PJI rat model. METHODS Eight-week-old male SD rats were randomized to the control group, sham group, vancomycin group, D-AAs-vancomycin group. After treatment for 6 weeks, we analysed the levels of inflammatory factors in serum, behavioural change, imaging manifestations. The anti-biofilm ability of D-AAs was detected by crystal violet staining and scanning electron microscope observation, and its ability to assist antibiotics in killing bacteria was assessed by culture of bacteria. Additionally, micro-CT and histological analysis were used to evaluate the impact of D-AAs combined with vancomycin on the bone remodelling around the prosthesis. RESULTS The group treated with a D-AAs-vancomycin combination sustained normal weight gain and exhibited reduced the serum levels of α2M, IL-1β, IL-6, IL-10, TNF-α and PGE2. Moreover, treated with D-AAs in combination with vancomycin improved the weight-bearing activity performance, increased the sizes and widths of distal femurs, and improved Rissing scale scoring. In particular, treatment using D-AAs enhanced the ability of vancomycin to eradicate Staphylococcus aureus, as demonstrated by the dispersion of existing biofilms and the inhibition of biofilm formation that occurred in a concentration-dependent manner. This treatment combination also resulted in a reduction in bacterial burden with in the soft tissues, bones, and implants. Furthermore, D-AAs-vancomycin combination treatment attenuated abnormal bone remodelling around the implant, as evidenced by an observed increase in BMD, BV/TV, and Tb.Th and the presence of reduced Trap+ osteoclasts and elevated osterix+ osteo-progenitors. CONCLUSIONS Combining D-AAs with vancomycin provides an effective therapeutic strategy for the treatment of PJI by promoting biofilm dispersion to enhance antimicrobial activity.
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Affiliation(s)
- Yicheng Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | | | - Xiaogang Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Wenbo Mu
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hairong Ma
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Xinjiang Uygur Autonomous Region Clinical Research Center for Orthopedic Diseases, Urumqi, China
| | - Fei Qi
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xiaoyue Sun
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Abdusami Amat
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
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20
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Wei J, Tong K, Wang H, Wen Y, Chen L. Intra-articular versus systemic vancomycin for the treatment of periprosthetic joint infection after debridement and spacer implantation in a rat model. Bone Joint Res 2022; 11:371-385. [PMID: 35708551 PMCID: PMC9233408 DOI: 10.1302/2046-3758.116.bjr-2021-0319.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims Treatment outcomes for methicillin-resistant Staphylococcus aureus (MRSA) periprosthetic joint infection (PJI) using systemic vancomycin and antibacterial cement spacers during two-stage revision arthroplasty remain unsatisfactory. This study explored the efficacy and safety of intra-articular vancomycin injections for PJI control after debridement and cement spacer implantation in a rat model. Methods Total knee arthroplasty (TKA), MRSA inoculation, debridement, and vancomycin-spacer implantation were performed successively in rats to mimic first-stage PJI during the two-stage revision arthroplasty procedure. Vancomycin was administered intraperitoneally or intra-articularly for two weeks to control the infection after debridement and spacer implantation. Results Rats receiving intra-articular vancomycin showed the best outcomes among the four treatment groups, with negative bacterial cultures, increased weight gain, increased capacity for weightbearing activities, increased residual bone volume preservation, and reduced inflammatory reactions in the joint tissues, indicating MRSA eradication in the knee. The vancomycin-spacer and/or systemic vancomycin failed to eliminate the MRSA infections following a two-week antibiotic course. Serum vancomycin levels did not reach nephrotoxic levels in any group. Mild renal histopathological changes, without changes in serum creatinine levels, were observed in the intraperitoneal vancomycin group compared with the intra-articular vancomycin group, but no changes in hepatic structure or serum alanine aminotransferase or aspartate aminotransferase levels were observed. No local complications were observed, such as sinus tract or non-healing surgical incisions. Conclusion Intra-articular vancomycin injection was effective and safe for PJI control following debridement and spacer implantation in a rat model during two-stage revision arthroplasties, with better outcomes than systemic vancomycin administration. Cite this article: Bone Joint Res 2022;11(6):371–385.
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Affiliation(s)
- Jian Wei
- Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center of Wuhan University, Wuhan, China
| | - Kai Tong
- Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center of Wuhan University, Wuhan, China
| | - Hui Wang
- Department of Pharmacology, Department of Basic Medicine, Wuhan University, Wuhan, China
| | - Yinxian Wen
- Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center of Wuhan University, Wuhan, China
| | - Liaobin Chen
- Department of Joint Surgery and Sports Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center of Wuhan University, Wuhan, China
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21
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Visperas A, Santana D, Ju M, Milbrandt NB, Tsai YH, Wickramasinghe S, Klika AK, Piuzzi NS, Samia ACS, Higuera-Rueda CA. Standardized quantification of biofilm in a novel rabbit model of periprosthetic joint infection. J Bone Jt Infect 2022; 7:91-99. [PMID: 35505905 PMCID: PMC9051660 DOI: 10.5194/jbji-7-91-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Periprosthetic joint infection (PJI) is one of the most
devastating complications of total joint arthroplasty. The underlying
pathogenesis involves the formation of bacterial biofilm that protects the
pathogen from the host immune response and antibiotics, making eradication
difficult. The aim of this study was to develop a rabbit model of knee PJI
that would allow reliable biofilm quantification and permit the study of
treatments for PJI. In this work,
New Zealand white rabbits (n=19) underwent knee joint arthrotomy,
titanium tibial implant insertion, and inoculation with Xen36 (bioluminescent
Staphylococcus aureus) or a saline control after capsule closure. Biofilm was quantified via
scanning electron microscopy (SEM) of the tibial explant 14 d after
inoculation (n=3 noninfected, n=2 infected). Rabbits underwent
debridement, antibiotics, and implant retention (DAIR) (n=6) or sham
surgery (n=2 noninfected, n=6 infected) 14 d after inoculation, and
they were sacrificed 14 d post-treatment. Tibial explant and periprosthetic tissues
were examined for infection.
Laboratory assays supported bacterial infection in infected
animals. No differences in weight or C-reactive protein (CRP) were detected after
DAIR compared to sham treatment. Biofilm coverage was significantly
decreased with DAIR treatment when compared with sham treatment (61.4 % vs.
90.1 %, p<0.0011) and was absent in noninfected control
explants. In summary, we have developed an experimental rabbit hemiarthroplasty knee
PJI model with bacterial infection that reliably produces quantifiable
biofilm and provides an opportunity to introduce treatments at 14 d. This
model may be used to better understand the pathogenesis of this condition
and to measure treatment strategies for PJI.
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Affiliation(s)
- Anabelle Visperas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Santana
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Minseon Ju
- Department of Chemistry, Case Western Reserve University, Cleveland, OH, USA
| | | | - Yu Hsin Tsai
- Department of Chemistry, Case Western Reserve University, Cleveland, OH, USA
| | | | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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22
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Sokhi UK, Xia Y, Sosa B, Turajane K, Nishtala SN, Pannellini T, Bostrom MP, Carli AV, Yang X, Ivashkiv LB. Immune Response to Persistent Staphyloccocus Aureus Periprosthetic Joint Infection in a Mouse Tibial Implant Model. J Bone Miner Res 2022; 37:577-594. [PMID: 34897801 PMCID: PMC8940655 DOI: 10.1002/jbmr.4489] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 12/27/2022]
Abstract
Staphyloccocus aureus is one of the major pathogens in orthopedic periprosthetic joint infection (PJI), a devastating complication of total joint arthroplasty that often results in chronic and persistent infections that are refractory to antibiotics and require surgical interventions. Biofilm formation has been extensively investigated as a reason for persistent infection. The cellular composition, activation status, cytokine profile, and role of the immune response during persistent S. aureus PJI are incompletely understood. In this study, we used histology, multiparametric flow cytometry, and gene expression analysis to characterize the immune response in a clinically relevant orthopedic PJI model. We tested the hypothesis that persistent S. aureus infection induces feedback mechanisms that suppress immune cell activation, thereby affecting the course of infection. Surprisingly, persistent infection was characterized by strikingly high cytokine gene expression indicative of robust activation of multiple components of innate and adaptive immunity, along with ongoing severe neutrophil-dominated inflammation, in infected joint and bone tissues. Activation and expansion of draining lymph nodes and a bone marrow stress granulopoiesis reaction were also maintained during late phase infection. In parallel, feedback mechanisms involving T-cell inhibitory receptors and exhaustion markers, suppressive cytokines, and regulatory T cells were activated and associated with decreased T-cell proliferation and tissue infiltration during the persistent phase of infection. These results identify the cellular and molecular components of the mouse immune response to persistent S. aureus PJI and indicate that neutrophil infiltration, inflammatory cytokine responses, and ongoing lymph node and bone marrow reactions are insufficient to clear infection and that immune effector mechanisms are suppressed by feedback inhibitory pathways. These immune-suppressive mechanisms are associated with diminished T-cell proliferation and tissue infiltration and can be targeted as part of adjuvant immunotherapeutic strategies in combination with debridement of biofilm, antibiotics, and other therapeutic modalities to promote eradication of infection. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Upneet K Sokhi
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, NY, USA
| | - Yunwei Xia
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, NY, USA
| | - Branden Sosa
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Kathleen Turajane
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Sita N Nishtala
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Tania Pannellini
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Department of Pathology, Hospital for Special Surgery, New York, NY, USA
| | - Mathias P Bostrom
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedics, Weill Cornell Medicine, New York, NY, USA
| | - Alberto V Carli
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Xu Yang
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,Arthroplasty Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Lionel B Ivashkiv
- Research Institute, Hospital for Special Surgery, New York, NY, USA.,David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, NY, USA.,Department of Medicine, Weill Cornell Medicine, New York, NY, USA.,Immunology and Microbial Pathogenesis Program, Weill Cornell Medicine, New York, NY, USA
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23
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Tong K, Wei J, Li Z, Wang H, Wen Y, Chen L. Evaluation of the Efficacy of Vancomycin-Soaked Autograft to Eliminate Staphylococcus aureus Contamination After Anterior Cruciate Ligament Reconstruction: Based on an Infected Rat Model. Am J Sports Med 2022; 50:932-942. [PMID: 35099312 DOI: 10.1177/03635465211068114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vancomycin-soaked autograft application in anterior cruciate ligament reconstruction (ACLR) significantly reduces postoperative infection rates. However, the optimal vancomycin concentrations and time of vancomycin presoaking of autografts for preventing infection are still unknown. PURPOSE To evaluate the efficacy of vancomycin-soaked autografts in preventing infection in rats with ACLR. STUDY DESIGN Controlled laboratory study. METHODS A total of 102 tendons of Wistar rats were harvested under sterile conditions from fresh cadaveric legs. Contamination with 2.0 × 104 colony forming units per milliliter of Staphylococcus aureus and soaking in different vancomycin concentrations for different soaking times was performed in vitro. In vivo, after being contaminated with S. aureus and soaked with optimal vancomycin solution treatment and sterile saline, the grafts were implanted in rat knees to finish ACLR surgery. At 2, 4, and 12 weeks after surgery, samples were harvested to observe signs of infection and tendon-bone incorporation via general postoperative conditions, serum inflammatory markers, microbiological counting, knee radiographs, micro-computed tomography, histologic staining, scanning electron microscopy, and biomechanical testing. RESULTS Bacterial contamination was eliminated when at least 5 or 10 mg/mL of vancomycin was applied for 30 minutes in vitro. Rats in the vancomycin-soaked graft group (5 mg/mL of vancomycin for 30 minutes) showed no significant signs of infection and fewer positive cultures than did those without presoaking. The vancomycin-soaked graft group had reduced serum inflammatory markers, tissue scores, inflammatory reactions in the joint tissue, and radiographic evidence of periarticular osseous destruction compared with the control group. At postoperative week 12, the vancomycin-soaked graft group showed good outcomes in tendon-bone incorporation via micro-computed tomography, histologic staining, and biomechanical testing. CONCLUSION In a rat model of infection after ACLR, presoaking grafts in a 5-mg/mL vancomycin solution for 30 minutes could effectively prevent S. aureus contamination without affecting tendon-bone incorporation and knee function. CLINICAL RELEVANCE The present study could provide a specific solution for the use of vancomycin in the prevention of infection after ACLR clinically.
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Affiliation(s)
- Kai Tong
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center Wuhan University, Wuhan University, Wuhan, China
| | - Jian Wei
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center Wuhan University, Wuhan University, Wuhan, China
| | - Zhenyu Li
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center Wuhan University, Wuhan University, Wuhan, China
| | - Hui Wang
- Department of Pharmacology, Department of Basic Medicine, Wuhan University, Wuhan, China
| | - Yinxian Wen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center Wuhan University, Wuhan University, Wuhan, China
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.,Joint Disease Research Center Wuhan University, Wuhan University, Wuhan, China
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24
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Staphylococcus aureus and Acinetobacter sp. inhibit osseointegration of orthopaedic implants. Infect Immun 2022; 90:e0066921. [PMID: 35099267 DOI: 10.1128/iai.00669-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacterial infections routinely cause inflammation and thereby impair osseointegration of orthopaedic implants. Acinetobacter spp., which causes osteomyelitis following trauma, on or off the battlefield, was however reported to cause neither osteomyelitis nor osteolysis in rodents. We therefore compared the effects of Acinetobacter strain M2 to those of Staphylococcus aureus in a murine implant infection model. Sterile implants and implants with adherent bacteria were inserted in the femur of mice. Bacterial burden, levels of pro-inflammatory cytokines, and osseointegration were measured. All infections were localized to the implant site. Infection with either S. aureus or Acinetobacter strain M2 increased the levels of pro-inflammatory cytokines and the chemokine CCL2 in the surrounding femurs, inhibited bone formation around the implant, and caused loss of the surrounding cortical bone leading to decreases in both histomorphometric and biomechanical measures of osseointegration. Genetic deletion of TLR2 and TLR4 from the mice partially reduced the effects of Acinetobacter strain M2 on osseointegration but did not alter the effects of S. aureus. This is the first report that Acinetobacter spp. impair osseointegration of orthopaedic implants in mice and the murine model developed for this study will be useful for future efforts to clarify the mechanism of implant failure due to Acinetobacter spp. and to assess novel diagnostic tools or therapeutic agents.
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25
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Jordan SC, Hall PR, Daly SM. Nonconformity of biofilm formation in vivo and in vitro based on Staphylococcus aureus accessory gene regulator status. Sci Rep 2022; 12:1251. [PMID: 35075262 PMCID: PMC8786897 DOI: 10.1038/s41598-022-05382-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022] Open
Abstract
Staphylococcus aureus is an opportunistic, pathogenic bacteria that causes significant morbidity and mortality. As antibiotic resistance by S. aureus continues to be a serious concern, developing novel drug therapies to combat these infections is vital. Quorum sensing inhibitors (QSI) dampen S. aureus virulence and facilitate clearance by the host immune system by blocking quorum sensing signaling that promotes upregulation of virulence genes controlled by the accessory gene regulator (agr) operon. While QSIs have shown therapeutic promise in mouse models of S. aureus skin infection, their further development has been hampered by the suggestion that agr inhibition promotes biofilm formation. In these studies, we investigated the relationship between agr function and biofilm growth across various S. aureus strains and experimental conditions, including in a mouse model of implant-associated infection. We found that agr deletion was associated with the presence of increased biofilm only under narrow in vitro conditions and, crucially, was not associated with enhanced biofilm development or enhanced morbidity in vivo.
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Affiliation(s)
- S Caroline Jordan
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA
| | - Pamela R Hall
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA
| | - Seth M Daly
- Department of Pharmaceutical Sciences, University of New Mexico College of Pharmacy, Albuquerque, NM, 87131, USA.
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26
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Cyphert EL, Zhang N, Learn GD, Hernandez CJ, von Recum HA. Recent Advances in the Evaluation of Antimicrobial Materials for Resolution of Orthopedic Implant-Associated Infections In Vivo. ACS Infect Dis 2021; 7:3125-3160. [PMID: 34761915 DOI: 10.1021/acsinfecdis.1c00465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While orthopedic implant-associated infections are rare, revision surgeries resulting from infections incur considerable healthcare costs and represent a substantial research area clinically, in academia, and in industry. In recent years, there have been numerous advances in the development of antimicrobial strategies for the prevention and treatment of orthopedic implant-associated infections which offer promise to improve the limitations of existing delivery systems through local and controlled release of antimicrobial agents. Prior to translation to in vivo orthopedic implant-associated infection models, the properties (e.g., degradation, antimicrobial activity, biocompatibility) of the antimicrobial materials can be evaluated in subcutaneous implant in vivo models. The antimicrobial materials are then incorporated into in vivo implant models to evaluate the efficacy of using the material to prevent or treat implant-associated infections. Recent technological advances such as 3D-printing, bacterial genomic sequencing, and real-time in vivo imaging of infection and inflammation have contributed to the development of preclinical implant-associated infection models that more effectively recapitulate the clinical presentation of infections and improve the evaluation of antimicrobial materials. This Review highlights the advantages and limitations of antimicrobial materials used in conjunction with orthopedic implants for the prevention and treatment of orthopedic implant-associated infections and discusses how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers in the selection of an appropriate orthopedic implant-associated infection preclinical model to evaluate novel antimicrobial materials.
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Affiliation(s)
- Erika L. Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Greg D. Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
| | - Christopher J. Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York 14853, United States
- Hospital for Special Surgery, New York, New York 10021, United States
| | - Horst A. von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106, United States
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27
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Wei J, Tong K, Zhou S, Wang H, Wen Y, Chen L. Intra-wound vancomycin powder for the eradication of periprosthetic joint infection after debridement and implant exchange: experimental study in a rat model. BMC Microbiol 2021; 21:333. [PMID: 34876010 PMCID: PMC8650465 DOI: 10.1186/s12866-021-02399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background Intra-wound vancomycin powder (VP) has been used in clinical practice to prevent periprosthetic joint infection (PJI) after primary knee/hip arthroplasty. The role of intra-wound VP in the setting of debridement and implant exchange after PJI remains undefined. This study aimed to explore the efficacy and safety of intra-wound VP in the control of methicillin-resistant S. aureus (MRSA) infection after debridement and implant exchange. Methods PJI modeling by knee prosthesis implantation and MRSA inoculation, debridement and implant exchange were performed in Wistar rats successively to mimic the one-stage exchange arthroplasty of PJI patients. Two weeks of systemic vancomycin (SV) or/and intraoperative intra-wound VP of single dosage were applied after revision surgery. Results No post-surgery deaths, incision complications and signs of drug toxicity were observed. The microbial counts of SV or intra-wound VP group were significantly reduced compared with the control group, while bacteria were still detected on the bone, soft-tissue and prosthesis. The elimination of bacterial counts, along with improvement of tissue inflammation and serum inflammatory markers, were observed in the rats with SV plus intra-wound VP. Serum levels of vancomycin in all groups were lower than that of causing nephrotoxicity, while no statistic difference was observed in the serum biochemical marker among the groups. Conclusions Intra-wound VP is effective after debridement and implant exchange in our current rat PJI model. Neither SV nor intra-wound VP alone could eradicate the bacteria within a two-weeks treatment course, while SV plus intra-wound VP could eliminate the MRSA infection, without notable hepatic or renal toxicity and any incision complications.
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Affiliation(s)
- Jian Wei
- Department of Joint Orthopedics, Affiliated Liutie Central Hospital of Guangxi Medical University, Liuzhou, 545007, China
| | - Kai Tong
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, China
| | - Siqi Zhou
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, China
| | - Hui Wang
- Department of pharmacology, Basic Medical School of Wuhan University, Wuhan, 430071, China
| | - Yinxian Wen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, China.
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No.169, Donghu Road, Wuhan, 430071, China.
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28
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Intra-articular vancomycin for the prophylaxis of periprosthetic joint infection caused by methicillin-resistant S. aureus after total knee arthroplasty in a rat model: the dosage, efficacy, and safety. Antimicrob Agents Chemother 2021; 66:e0164121. [PMID: 34807762 DOI: 10.1128/aac.01641-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although intra-articular vancomycin powder (VP) is sometimes applied before the closure of the incision to prevent periprosthetic joint infection (PJI) after joint replacement, the dosage, efficacy and safety remain controversial. This study aimed to explore the dosage, efficacy, and safety of intra-articular VP in the prophylaxis of infection after total knee arthroplasty (TKA) in a rat model. Sixty male rats were randomly divided into five groups after receiving TKA surgery: Control (no antibiotics); systemic vancomycin (SV) (intraperitoneal injection, 88 mg/kg, equal to 1g in a patient weighted 70kg); VP0.5, VP1.0 and VP2.0 (44 mg/kg, 88 mg/kg and 176 mg/kg respectively, intra-articular). All animals were inoculated in the knee with methicillin-resistant S. aureus (MRSA). General status, serum biomarkers, radiology, microbiological assay and histopathological tests were assessed within 14 days post-operatively. Compared with the Control and SV groups, bacterial counts, knee-width, tissue inflammation, and osteolysis were reduced in the VP0.5, VP1.0 and VP2.0 groups, without notable bodyweight loss and incision complications. Among all the VP groups, VP1.0 and VP2.0 groups presented superior outcomes in the knee-width and tissue inflammation than the VP0.5 group. Microbial culture indicated that no MRSA survived in the knee of VP1.0 and VP2.0 groups, while bacteria growth was observed in VP0.5 group. No obvious changes in the structure and functional biomarkers of liver and kidney were observed in both SV and VP groups. Therefore, intra-articular vancomycin powder at the dosage from 88 mg/kg to 176 mg/kg may be effective and safe in preventing PJI induced by methicillin-resistant S. aureus in the rat TKA model.
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29
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Hamilton J, Mohamed M, Witt B, Wimmer M, Shafikhani S. Therapeutic assessment of N-formyl-methionyl-leucyl-phenylalanine (fMLP) in reducing periprosthetic joint infection. Eur Cell Mater 2021; 42:122-138. [PMID: 34435345 PMCID: PMC8459619 DOI: 10.22203/ecm.v042a09] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Despite many preventive measures, including prophylactic antibiotics, periprosthetic joint infection (PJI) remains a devastating complication following arthroplasty, leading to pain, suffering, morbidity and substantial economic burden. Humans have a powerful innate immune system that can effectively control infections, if alerted quickly. Unfortunately, pathogens use many mechanisms to dampen innate immune responses. The study hypothesis was that immunomodulators that can jumpstart and direct innate immune responses (particularly neutrophils) at the surgical site of implant placement would boost immune responses and reduce PJI, even in the absence of antibiotics. To test this hypothesis, N-formyl-methionyl-leucyl-phenylalanine (fMLP) (a potent chemoattractant for phagocytic leukocytes including neutrophils) was used in a mouse model of PJI with Staphylococcus aureus (S. aureus). Mice receiving intramedullary femoral implants were divided into three groups: i) implant alone; ii) implant + S. aureus; iii) implant + fMLP + S. aureus. fMLP treatment reduced S. aureus infection levels by ~ 2-Log orders at day 3. Moreover, fMLP therapy reduced infection-induced peri-implant periosteal reaction, focal cortical loss and areas of inflammatory infiltrate in mice distal femora at day 10. Finally, fMLP treatment reduced pain behaviour and increased weight-bearing at the implant leg in infected mice at day 10. Data indicated that fMLP therapy is a promising novel approach for reducing PJI, if administered locally at surgical sites. Future work will be toward further enhancement and optimisation of an fMLP-based therapeutic approach through combination with antibiotics and/or implant coating with fMLP.
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Affiliation(s)
- J.L. Hamilton
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612-3806, USA,Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3806, USA
| | - M.F. Mohamed
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3806, USA
| | - B.R. Witt
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612-3806, USA
| | - M.A. Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612-3806, USA,Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3806, USA
| | - S.H. Shafikhani
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612-3806, USA,Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL 60612-3806, USA,Cancer Center, Rush University Medical Center, Chicago, IL 60612-3806, USA,Address for correspondence: Sasha H. Shafikhani, Department of Medicine, Division of Hematology, Oncology and Cell Therapy, Department of Microbial Pathogens and Immunity, Cancer Center, Rush University Medical Center, 1735 W. Harrison Street, Chicago, IL 60612-3806, USA. Telephone number: +1 3129421368
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30
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Local Application of Vancomycin in One-Stage Revision of Prosthetic Joint Infection Caused by Methicillin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2021; 65:e0030321. [PMID: 34181479 DOI: 10.1128/aac.00303-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The rate of eradication of periprosthetic joint infection (PJI) caused by methicillin-resistant Staphylococcus aureus (MRSA) is still not satisfactory with systemic vancomycin administration after one-stage revision arthroplasty. This study aimed to explore the effectiveness and safety of intraarticular (IA) injection of vancomycin in the control of MRSA PJI after one-stage revision surgery in a rat model. Two weeks of intraperitoneal (IP) and/or IA injection of vancomycin was used to control the infection after one-stage revision surgery. The MRSA PJI rats treated with IA injection of vancomycin showed better outcomes in skin temperature, bacterial counts, biofilm on the prosthesis, serum α1-acid glycoprotein levels, residual bone volume, and inflammatory reaction in the joint tissue, compared with those treated with IP vancomycin, while the rats treated with IP and IA administration showed the best outcomes. However, only the IP and IA administration of vancomycin could eradicate MRSA. Minimal changes in renal pathology were observed in the IP and IP plus IA groups but not in the IA group, while no obvious changes were observed in the liver or in levels of serum markers, including creatinine, alanine aminotransferase, and aspartate aminotransferase. Therefore, IA use of vancomycin is effective and safe in the MRSA PJI rat model and is better than systemic administration, while IA and systemic vancomycin treatment could eradicate the infection with a 2-week treatment course.
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Hadden WJ, Ibrahim M, Taha M, Ure K, Liu Y, Paish ADM, Holdsworth DW, Abdelbary H. 2021 Frank Stinchfield Award: A novel cemented hip hemiarthroplasty infection model with real-time in vivo imaging in rats : an animal study. Bone Joint J 2021; 103-B:9-16. [PMID: 34192921 DOI: 10.1302/0301-620x.103b7.bjj-2020-2435.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to develop an in vivo model of periprosthetic joint infection (PJI) in cemented hip hemiarthroplasty, and to monitor infection and biofilm formation in real-time. METHODS Sprague-Dawley rats underwent cemented hip hemiarthroplasty via the posterior approach with pre- and postoperative gait assessments. Infection with Staphylococcus aureus Xen36 was monitored with in vivo photoluminescent imaging in real-time. Pre- and postoperative gait analyses were performed and compared. Postmortem micro (m) CT was used to assess implant integration; field emission scanning electron microscopy (FE-SEM) was used to assess biofilm formation on prosthetic surfaces. RESULTS All animals tolerated surgery well, with preservation of gait mechanics and weightbearing in control individuals. Postoperative in vivo imaging demonstrated predictable evolution of infection with logarithmic signal decay coinciding with abscess formation. Postmortem mCT qualitative volumetric analysis showed high contact area and both cement-bone and cement-implant interdigitation. FE-SEM revealed biofilm formation on the prosthetic head. CONCLUSION This study demonstrates the utility of a new, high-fidelity model of in vivo PJI using cemented hip hemiarthroplasty in rats. Inoculation with bioluminescent bacteria allows for non-invasive, real-time monitoring of infection. Cite this article: Bone Joint J 2021;103-B(7 Supple B):9-16.
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Affiliation(s)
- William J Hadden
- The Ottawa Hospital Division of Orthopaedic Surgery, Ottawa, Canada.,The University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Mazen Ibrahim
- The University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Mariam Taha
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kerstin Ure
- The Animal Behaviour & Physiology Core, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Yun Liu
- Materials Characterization Core Facility, Centre for Advanced Materials Research (CAMaR), University of Ottawa, Ottawa, Canada
| | - Adam D M Paish
- Department of Medical Biophysics, Bone & Joint Institute, Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, Western University, London, Canada
| | - David W Holdsworth
- Department of Medical Biophysics, Bone & Joint Institute, Dr. Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, Western University, London, Canada
| | - Hesham Abdelbary
- The Ottawa Hospital Division of Orthopaedic Surgery, Ottawa, Canada.,The University of Ottawa Faculty of Medicine, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
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Sang S, Guo G, Yu J, Zhang X. Antibacterial application of gentamicin-silk protein coating with smart release function on titanium, polyethylene, and Al 2O 3 materials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 124:112069. [PMID: 33947562 DOI: 10.1016/j.msec.2021.112069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023]
Abstract
Peri-implant infection after hip and knee arthroplasty is a common and serious complication. Titanium (Ti), polyethylene (PE), and Al2O3 materials used as joint prosthesis materials have good biocompatibility and mechanical strength but no antibacterial effect. This study aimed to provide a theoretical basis for the design and manufacture of joint prosthesis materials with antibacterial effect. We applied a coating of gentamicin-silk protein (GS-Silk) on the surface of these materials. We characterized the Ti, PE, and Al2O3 materials coated with GS-Silk (experimental group) and performed in vivo and in vitro experiments to test antibacterial activity. Scanning electron microscopy confirmed successful GS-Silk coating, and infrared spectroscopy confirmed successful loading of gentamicin onto the three materials. Nanoscratch test proved that the GS-Silk coating is relatively reliable on the surface of these three materials. The antibacterial effect of the coating in vitro and in vivo was verified by performing bacteriostatic ring test in vitro, bacterial adhesion test, and subendothelial implant infection test. We demonstrated that GS-Silk coating can effectively load gentamicin onto Ti, PE, and Al2O3 materials and change the gentamicin release rate with a change in the solution pH to achieve intelligent release. The GS-Silk coating is relatively reliable on the surface of these three materials. Ti, PE, and Al2O3 materials coated with GS-Silk have good antibacterial ability, both in vivo and in vitro.
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Affiliation(s)
- Shang Sang
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Geyong Guo
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinlong Yu
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China.
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33
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Hernandez CJ. Musculoskeletal Microbiology: The Microbiome in Orthopaedic Biomechanics. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2021; 19. [PMID: 34151053 DOI: 10.1016/j.cobme.2021.100290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Orthopaedic biomechanics and bioengineering is a founding discipline of biomedical engineering that focuses on the effects of mechanical stress and strain on musculoskeletal tissues during growth, function and repair. In the past decade the gut microbiome has emerged as a contributor to disease processes throughout the body, but only recently has been shown to influence orthopaedic biomechanics. Here I review emergent findings showing that the gut microbiome can regulate important aspects of the musculoskeletal system including growth and development; tissue failure and disease; and orthopaedic surgery. These early findings suggest that the microbiome may help answer questions in orthopaedic biomechanics that are not well addressed by current interventions, and highlights the promise of the emerging field of "Musculoskeletal Microbiology".
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Affiliation(s)
- Christopher J Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA.,Hospital for Special Surgery, New York, NY, USA
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34
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Löwik CAM, Parvizi J, Jutte PC, Zijlstra WP, Knobben BAS, Xu C, Goswami K, Belden KA, Sousa R, Carvalho A, Martínez-Pastor JC, Soriano A, Wouthuyzen-Bakker M. Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty. Clin Infect Dis 2021; 71:630-636. [PMID: 31504331 DOI: 10.1093/cid/ciz867] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/30/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. METHODS We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up <1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. RESULTS We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1-2 was 42% (95/226), the rate for Week 3-4 was 38% (143/378), the rate for Week 5-6 was 29% (29/100), and the rate for Week 7-12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P < .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. CONCLUSIONS DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.
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Affiliation(s)
- Claudia A M Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wierd P Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Chi Xu
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Karan Goswami
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Katherine A Belden
- Department of Infectious Diseases, Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ricardo Sousa
- Department of Orthopaedic Surgery, Centro Hospitalar do Porto, Porto, Portugal
| | - André Carvalho
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Juan Carlos Martínez-Pastor
- Department of Orthopaedic Surgery and Traumatology, University of Barcelona, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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35
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Vaz K, Scarborough M, Bottomley N, Kendrick B, Taylor A, Price A, Alvand A, Jackson W. Debridement, antibiotics and implant retention (DAIR) for the management of knee prosthetic joint infection. Knee 2020; 27:2013-2015. [PMID: 32950374 DOI: 10.1016/j.knee.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND While two-stage revision arthroplasty is viewed as the gold standard for the treatment of knee periprosthetic joint infection (PJI) in terms of infection eradication, it is associated with significant cost along with patient morbidity and mortality. Debridement, antibiotics, and implant retention (DAIR) is an attractive option as it has demonstrated better patient outcomes, comparable implant longevity to primary arthroplasty, and significantly reduced cost when successful. Given the heterogeneity of what is defined as a DAIR the literature is highly variable in terms of its efficacy from the perspective of infection eradication. METHODS In the setting of a previously well-functioning, well-fixed arthroplasty with an acceptable soft tissue envelope and a treatable organism we report our methods for proceeding with a DAIR procedure, both unicompartmental and total knee. RESULTS With the above methods we have demonstrated improved patient outcomes when compared to one- or two-stage arthroplasty with lower patient morbidity. Implant longevity in the setting of a successful DAIR is equivalent to those of a primary arthroplasty. CONCLUSIONS With appropriate indications and good surgical technique as described we believe DAIR is an excellent option in the treatment of periprosthetic joint infection. We hope that with a well-defined protocol as outlined we can gain a better understanding of the efficacy of DAIR procedure with more homogeneity to the procedure to better define when they are most successful while improving patient outcomes and reducing cost.
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Affiliation(s)
- Kenneth Vaz
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom.
| | - Matthew Scarborough
- Infectious Diseases, Microbiology, and General Medicine, Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - Nicholas Bottomley
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - Ben Kendrick
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - Adrian Taylor
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - Andrew Price
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - Abtin Alvand
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom
| | - William Jackson
- Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Old Road, Oxford OX3 7LD, United Kingdom.
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36
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Paish ADM, Nikolov HN, Welch ID, El-Warrak AO, Teeter MG, Naudie DDR, Holdsworth DW. Image-based design and 3D-metal printing of a rat hip implant for use in a clinically representative model of joint replacement. J Orthop Res 2020; 38:1627-1636. [PMID: 32369210 DOI: 10.1002/jor.24706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 02/04/2023]
Abstract
The aim of this study was to obtain micro-computed tomography derived measurements of the rat proximal femur, to create parameterized rat hip implants that could be surgically installed in a clinically representative small animal model of joint replacement. The proximal femoral anatomy of N = 25 rats (male, Sprague-Dawley, 390-605 g) was quantified. Key measurements were used to parameterize computer-aided design models of monoblock rat femoral implants. Linear regression analysis was used to determine if rat hip dimensions could be predicted from animal weight. A correlation analysis was used to determine how implants could be scaled to create a range of sizes. Additive manufacturing (3D printing) was used to create implants in medical-grade metal alloys. Linear regressions comparing rat weight to femoral head diameter and neck-head axis length revealed a significant nonzero slope (P < .05). Pearson's correlation analysis revealed five significant correlations between key measurements in the rat femur (P < .05). Implants were installed into both cadaveric and live animals; iterative design modifications were made to prototypes based on these surgical findings. Animals were able to tolerate the installation of implants and were observed ambulating on their affected limbs postoperatively. Clinical significance: We have developed a preclinical rat hip hemiarthroplasty model using image-based and iterative design techniques to create 3D-metal printed implants in medical-grade metal alloys. Our findings support further development of this model for use as a low-cost translational test platform for preclinical orthopaedic research into areas such as osseointegration, metal-on-cartilage wear, and periprosthetic joint infection.
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Affiliation(s)
- Adam D M Paish
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Hristo N Nikolov
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Ian D Welch
- Animal Care Services, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander O El-Warrak
- Surgery Team, Premier Veterinary Group by Ethos Animal Health, Orland Park, Illinois
| | - Matthew G Teeter
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas D R Naudie
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - David W Holdsworth
- Bone and Joint Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
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37
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Sosa BR, Niu Y, Turajane K, Staats K, Suhardi V, Carli A, Fischetti V, Bostrom M, Yang X. 2020 John Charnley Award: The antimicrobial potential of bacteriophage-derived lysin in a murine debridement, antibiotics, and implant retention model of prosthetic joint infection. Bone Joint J 2020; 102-B:3-10. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1590.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims Current treatments of prosthetic joint infection (PJI) are minimally effective against Staphylococcus aureus biofilm. A murine PJI model of debridement, antibiotics, and implant retention (DAIR) was used to test the hypothesis that PlySs2, a bacteriophage-derived lysin, can target S. aureus biofilm and address the unique challenges presented in this periprosthetic environment. Methods The ability of PlySs2 and vancomycin to kill biofilm and colony-forming units (CFUs) on orthopaedic implants were compared using in vitro models. An in vivo murine PJI model of DAIR was used to assess the efficacy of a combination of PlySs2 and vancomycin on periprosthetic bacterial load. Results PlySs2 treatment reduced 99% more CFUs and 75% more biofilm compared with vancomycin in vitro. A combination of PlySs2 and vancomycin in vivo reduced the number of CFUs on the surface of implants by 92% and in the periprosthetic tissue by 88%. Conclusion PlySs2 lysin was able to reduce biofilm, target planktonic bacteria, and work synergistically with vancomycin in our in vitro models. A combination of PlySs2 and vancomycin also reduced bacterial load in periprosthetic tissue and on the surface of implants in a murine model of DAIR treatment for established PJI. Cite this article: Bone Joint J 2020;102-B(7 Supple B):3–10.
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Affiliation(s)
| | - YingZhen Niu
- Hospital for Special Surgery, New York, New York, USA
- Hebei Medical University Third Affiliated Hospital, Department of Joint Surgery, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, China
| | | | - Kevin Staats
- Hospital for Special Surgery, Department of Orthopedics and Trauma Surgery, New York, New York, USA
- Medical University of Vienna, Department of Orthopedics and Trauma Surgery, Vienna, Austria
| | | | - Alberto Carli
- Hospital for Special Surgery, New York, New York, USA
| | | | | | - Xu Yang
- Hospital for Special Surgery, New York, New York, USA
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38
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Factors predictive of Cutibacterium periprosthetic shoulder infections: a retrospective study of 342 prosthetic revisions. J Shoulder Elbow Surg 2020; 29:1177-1187. [PMID: 31668686 DOI: 10.1016/j.jse.2019.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/26/2019] [Accepted: 08/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutibacterium are the most common cause of periprosthetic shoulder infections, as defined by ≥2 deep cultures. Established Cutibacterium periprosthetic infections cannot be resolved without prosthesis removal. However, the decision for implant removal must be made from an assessment of infection risk before the results of intraoperative cultures are finalized. We hypothesized that the risk for a Cutibacterium infection is associated with characteristics that are available at the time of revision arthroplasty. METHODS In a retrospective review of 342 patients having prosthetic revisions between 2006 and 2018 for whom definitive deep culture results were available, we used univariate and multivariate analyses to compare the preoperative and intraoperative characteristics of 101 revisions with Cutibacterium periprosthetic infections to the characteristics of 241 concurrent revisions not meeting the definition of infection. RESULTS Patients with definite Cutibacterium periprosthetic infections were younger (59 ± 10 vs. 64 ± 12, P < .001), were more likely to be male (91% vs. 44%, P < .001), were more likely to have had their index procedure performed for primary osteoarthritis (54% vs. 39%, P = .007), were more likely to be taking testosterone supplements (8% vs. 2%, P = .02), had lower American Society of Anesthesiologists scores (1.9 ± 0.7 vs. 2.3 ± 0.7, P < .001), and had lower body mass indices (29 ± 5 vs. 31 ± 7, P = .005). Patients with definite Cutibacterium periprosthetic infections also had significantly higher preoperative loads of Cutibacterium on their unprepared skin surface (1.7 ± 0.9 vs. 0.4 ± 0.8, P < .001) and were more likely to have the surgical finding of synovitis (41% vs. 16%, P < .001). CONCLUSIONS The risk of definite Cutibacterium periprosthetic infections is associated with observations that can be made before or at the time of revision arthroplasty.
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39
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Experimental reproduction of periprosthetic joint infection: Developing a representative animal model. Knee 2020; 27:1106-1112. [PMID: 31982249 DOI: 10.1016/j.knee.2019.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Infection after arthroplasty (prosthetic joint infection; PJI) is a devastating complication that can lead to functional loss of the affected limb. The purpose of the present study is to develop an animal model of PJI using a three-dimensional printed species-specific implant, which is a step forward for future research to develop new therapeutic strategies. METHODS Fifteen New Zealand White rabbits were employed to reproduce PJI by intra-articular inoculation of 105 cfu/ml of Staphylococcus aureus ATCC® 29213. Three-dimensional printing technology was used to design a species-specific four-millimeter-thick implant maintaining the anatomical irregularities of the tibial-articular surface. Response to bacterial inoculation was monitored by clinical (weight and temperature), hematological (leukocyte, lymphocyte and platelet counts) and biochemical (erythrocyte sedimentation rate) analyses at the time of inoculation and seven days thereafter, when microbiological samples for culture were also taken. RESULTS All animals recovered from surgery and all displayed full weight-bearing four days postoperatively. Fourteen of the 15 tested animals (93.3%) presented positive microbiological cultures. A statistically significant increase was found in the number of platelets and leukocytes, as well as a significant decrease in the percentage of lymphocytes, with P = 0.0001 in all cases. CONCLUSIONS An experimental model faithfully reproducing the periprosthetic infection environment and achieving a high rate of infection has been designed. The use of three-dimensional printed species-specific implants allows rapid postoperative recovery of animals and the development of a stable biofilm. These characteristics make it an interesting model to study its pathogenesis and possible therapeutic strategies.
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40
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Fan Y, Xiao Y, Sabuhi WA, Leape CP, Gil D, Grindy S, Muratoglu OK, Bedair H, Collins JE, Randolph M, Oral E. Longitudinal Model of Periprosthetic Joint Infection in the Rat. J Orthop Res 2020; 38:1101-1112. [PMID: 31808572 DOI: 10.1002/jor.24556] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/30/2019] [Indexed: 02/04/2023]
Abstract
The majority of periprosthetic joint infections occur shortly after primary joint replacement (<3 months) and require the removal of all implant components for the treatment period (~4 months). A clinically relevant animal model of periprosthetic infection should, therefore, establish an infection with implant components in place. Here, we describe a joint replacement model in the rat with ultrahigh molecular weight polyethylene (UHMWPE) and titanium components inoculated at the time of surgery by methicillin-sensitive Staphylococcus aureus (S. aureus), which is one of the main causative microorganisms of periprosthetic joint infections. We monitored the animals for 4 weeks by measuring gait, weight-bearing symmetry, von Frey testing, and micro-CT as our primary endpoint analyses. We also assessed the infection ex vivo using colony counts on the implant surfaces and histology of the surrounding tissues. The results confirmed the presence of a local infection for 4 weeks with osteolysis, loosening of the implants, and clinical infection indicators such as redness, swelling, and increased temperature. The utility of specific gait analysis parameters, especially temporal symmetry, hindlimb duty factor imbalance, and phase dispersion was identified in this model for assessing the longitudinal progression of the infection, and these metrics correlated with weight-bearing asymmetry. We propose to use this model to study the efficacy of using different local delivery regimens of antimicrobials on addressing periprosthetic joint infections. Statement of clinical significance: We have established a preclinical joint surgery model, in which postoperative recovery can be monitored over a multi-week course by assessing gait, weight-bearing, and allodynia. This model can be used to study the efficacy of different combinations of implant materials and medication regimens. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1101-1112, 2020.
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Affiliation(s)
- Yingfang Fan
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Yinbo Xiao
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Wali A Sabuhi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Charlotte P Leape
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Dmitry Gil
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Scott Grindy
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Hany Bedair
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mark Randolph
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ebru Oral
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
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Abstract
BACKGROUND Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty. Given the mortality and morbidity associated with PJI and the challenges in treating it, there has been increased interest in risk factors that can be modified before surgery. In this study, we used a novel mouse model to consider the role of the gut microbiome as a risk factor for PJI. QUESTIONS/PURPOSES (1) Does the state of the gut microbiota before surgery influence the likelihood of developing an established infection in a mouse model of PJI? (2) How does the state of the gut microbiota before surgery influence the local and systemic response to the presence of an established infection in a mouse model of PJI? METHODS Male C57Bl/6 mice were divided into two groups: those with modified microbiome [INCREMENT]microbiome (n = 40) and untreated mice (n = 42). In [INCREMENT]microbiome mice, the gut flora were modified using oral neomycin and ampicillin from 4 weeks to 16 weeks of age. Mice received a titanium tibial implant to mimic a joint implant and a local inoculation of Staphylococcus aureus in the synovial space (10 colony forming units [CFUs]). The proportion of animals developing an established infection in each group was determined by CFU count. The local and systemic response to established infection was determined using CFU counts in surrounding joint tissues, analysis of gait, radiographs, body weight, serum markers of inflammation, and immune cell profiles and was compared with animals that received the inoculation but resisted infection. RESULTS A greater proportion of animals with disrupted gut microbiota had infection (29 of 40 [73%]) than did untreated animals (21 of 42 [50%]; odds ratio, 2.63, 95% CI, 1.04-6.61; p = 0.035). The immune response to established infection in mice with altered microbiota was muted; serum amyloid A, a marker of systemic infection in mice, was greater than in mice with disrupted gut microbiota with infection (689 µg/dL; range, 68-2437 µg/dL, p < 0.05); infection associated increases in monocytes and neutrophils in the spleen and local lymph node in untreated mice but not were not observed in mice with disrupted gut microbiota. CONCLUSIONS The findings from this in vivo mouse model suggest that the gut microbiota may influence susceptibility to PJI. CLINICAL RELEVANCE These preclinical findings support the idea that the state of the gut microbiome before surgery may influence the development of PJI and justify further preclinical and clinical studies to develop appropriate microbiome-based interventions.
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Thompson JM, Miller LS. Preclinical Optical Imaging to Study Pathogenesis, Novel Therapeutics and Diagnostics Against Orthopaedic Infection. J Orthop Res 2019; 37:2269-2277. [PMID: 31342546 DOI: 10.1002/jor.24428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
Preclinical in vivo optical imaging includes bioluminescence imaging (BLI) and fluorescence imaging (FLI), which provide noninvasive and longitudinal monitoring of biological processes in an in vivo context. In vivo BLI involves the detection of photons of light from bioluminescent bacteria engineered to naturally emit light in preclinical animal models of infection. Meanwhile, in vivo FLI involves the detection of photons of a longer emission wavelength of light after exposure of a fluorophore to a shorter excitation wavelength of light. In vivo FLI has been used in preclinical animal models to detect fluorescent-labeled host proteins or cells (often in engineered fluorescent reporter mice) to understand host-related processes, or to detect injectable near-infrared fluorescent probes as a novel approach for diagnosing infection. This review describes the use of in vivo optical imaging in preclinical models of orthopaedic implant-associated infection (OIAI), including (i) pathogenesis of the infectious course, (ii) monitoring efficacy of antimicrobial prophylaxis and therapy and (iii) evaluating novel near-infrared fluorescent probes for diagnosing infection. Finally, we describe optoacoustic imaging and fluorescence image-guided surgery, which are recent technologies that have the potential to translate to diagnosing and treating OIAI in humans. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2269-2277, 2019.
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Affiliation(s)
- John M Thompson
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Lloyd S Miller
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21231
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland, 21218
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Jie K, Deng P, Cao H, Feng W, Chen J, Zeng Y. Prosthesis design of animal models of periprosthetic joint infection following total knee arthroplasty: A systematic review. PLoS One 2019; 14:e0223402. [PMID: 31581252 PMCID: PMC6776332 DOI: 10.1371/journal.pone.0223402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The number of periprosthetic joint infections (PJI) after total knee arthroplasty (TKA) is increasing annually. Animal models have been used to clarify their clinical characteristics and the infection mechanism of pathogenic bacteria, However, since the prosthesis design of animal models is not uniform, it is difficult to simulate the environment of clinical PJI. OBJECTIVES To retrospect the progress on the prosthesis design of animal models of PJI after TKA and to summarize the criteria for evaluating a clinically representative model of PJI. METHODS This systematic review was reported on the basis of Systematic Reviews and Meta-Analyzes (PRISMA). Pubmed, EMbase, Cochrane Library, Web of Science, Wanfang Data and China National Knowledge Infrastructure were researched for animal models of PJI after TKA from database establishment to April 2019 according to Chinese and English retrieval words, including "periprosthetic joint infections and total knee arthroplasty," "periprosthetic joint infections and model," "periprosthetic joint infections and biofilm," and "total knee arthroplasty and model." RESULTS A total of 12 quantitative studies were enrolled in our study finally: 8 representative studies described prosthesis designs used in PJI animal models, 4 studies described prosthesis designs in non-infected animal models which were suitable for infection models. The major problems need to be dealed with were prosthesis, installation location, material, the function of separating the articular and medullary cavity, fixation manner, and the procedure of preserving the posterior cruciate ligament. CONCLUSION A highly representative design of the animal prosthesis of PJI should meet the following criteria: the surface of the prosthesis is smooth with the formation of biofilm, composed of titanium-6Al-4V or cobalt-chromium-molybdenum alloy; prosthesis can bear weight and is highly stable; and it can connect the joint cavity and medullary cavity simultaneously. To reach a more reliable conclusion, further experiments and improvements are required.
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Affiliation(s)
- Ke Jie
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Peng Deng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
- The Third Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Houran Cao
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Wenjun Feng
- The Third Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Jinlun Chen
- The Third Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
| | - Yirong Zeng
- The Third Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Baiyun District, Guangzhou, Guangdong Province, China
- * E-mail:
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Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: evaluation of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28:S32-S66. [PMID: 31196514 DOI: 10.1016/j.jse.2019.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/20/2019] [Indexed: 02/01/2023]
Abstract
The Second International Consensus Meeting on Orthopedic Infections was held in Philadelphia, Pennsylvania, in July 2018. More than 800 experts from all 9 subspecialties of orthopedic surgery and allied fields of infectious disease, microbiology, and epidemiology were assembled to form the International Consensus Group. The shoulder workgroup reached consensus on 27 questions related to culture techniques, inflammatory markers, and diagnostic criteria used to evaluate patients for periprosthetic shoulder infection. This document contains the group's recommendations and rationale for each question related to evaluating periprosthetic shoulder infection.
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López-Torres II, Sanz-Ruíz P, León-Román VE, Navarro-García F, Priego-Sánchez R, Vaquero-Martín J. 3D printing in experimental orthopaedic surgery: do it yourself. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:967-973. [PMID: 30864016 DOI: 10.1007/s00590-019-02415-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Periprosthetic infection is considered an increasing incidence pathology whose therapeutic strategies can be defined as unsatisfactory. Currently, animal models are employed to study its physiopathology and strategic therapies, but non-species-specific materials are implanted as foreign bodies. The use of these implants implies intrinsic instability, which hinders the development of a biofilm on their surfaces and complicates the post-operative recovery of the animal. The objective of the present study is the design of a species-specific implant for the New Zealand white (NZW) rabbit by means of 3D printing. MATERIALS AND METHODS A CT scan of the knee of a NZW rabbit was performed, and the tibial surface was reconstructed in order to fabricate a species-specific tibial plateau using Horos® and Autodesk® Meshmixer™ software. This implant was inserted in fifteen NZW rabbits, and the assessment of its stability was based on the position of the limb at rest and the animal weight-bearing capacity. Biofilm formation on the surface was demonstrated by crystal violet staining. RESULTS A 1.81 cm × 1 cm × 1.24 cm stainless steel implant was designed. It consisted of a 4-mm-thick tibial plate with a rough surface and an eccentric metaphyseal anchoring. All of the animals exhibited hyperflexion of the operated limb immediately post-operative, and 100% could apply full weight bearing from day 5 after surgery. CONCLUSIONS The species-specific design of implants in experimental surgery encourages rapid recovery of the animal and the development of a biofilm on their surfaces, making them ideal for the study of the physiopathology and for establishing possible therapeutic targets for prosthetic infection.
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Affiliation(s)
| | - Pablo Sanz-Ruíz
- Gregorio Marañón General Hospital, C/Doctor Esquerdo 46, Madrid, Spain.,Surgery Department, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Federico Navarro-García
- Department of microbiology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | | | - Javier Vaquero-Martín
- Gregorio Marañón General Hospital, C/Doctor Esquerdo 46, Madrid, Spain.,Surgery Department, Faculty of Medicine, Complutense University, Madrid, Spain
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Miller RJ, Thompson JM, Zheng J, Marchitto MC, Archer NK, Pinsker BL, Ortines RV, Jiang X, Martin RA, Brown ID, Wang Y, Sterling RS, Mao HQ, Miller LS. In Vivo Bioluminescence Imaging in a Rabbit Model of Orthopaedic Implant-Associated Infection to Monitor Efficacy of an Antibiotic-Releasing Coating. J Bone Joint Surg Am 2019; 101:e12. [PMID: 30801375 PMCID: PMC6738548 DOI: 10.2106/jbjs.18.00425] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In vivo bioluminescence imaging (BLI) provides noninvasive monitoring of bacterial burden in animal models of orthopaedic implant-associated infection (OIAI). However, technical limitations have limited its use to mouse and rat models of OIAI. The goal of this study was to develop a larger, rabbit model of OIAI using in vivo BLI to evaluate the efficacy of an antibiotic-releasing implant coating. METHODS A nanofiber coating loaded with or without linezolid-rifampin was electrospun onto a surgical-grade locking peg. To model OIAI in rabbits, a medial parapatellar arthrotomy was performed to ream the femoral canal, and a bright bioluminescent methicillin-resistant Staphylococcus aureus (MRSA) strain was inoculated into the canal, followed by retrograde insertion of the coated implant flush with the articular surface. In vivo BLI signals were confirmed by ex vivo colony-forming units (CFUs) from tissue, bone, and implant specimens. RESULTS In this rabbit model of OIAI (n = 6 rabbits per group), implants coated without antibiotics were associated with significantly increased knee width and in vivo BLI signals compared with implants coated with linezolid-rifampin (p < 0.001 and p < 0.05, respectively). On day 7, the implants without antibiotics were associated with significantly increased CFUs from tissue (mean [and standard error of the mean], 1.4 × 10 ± 2.1 × 10 CFUs; p < 0.001), bone (6.9 × 10 ± 3.1 × 10 CFUs; p < 0.05), and implant (5.1 × 10 ± 2.2 × 10 CFUs; p < 0.05) specimens compared with implants with linezolid-rifampin, which demonstrated no detectable CFUs from any source. CONCLUSIONS By combining a bright bioluminescent MRSA strain with modified techniques, in vivo BLI in a rabbit model of OIAI demonstrated the efficacy of an antibiotic-releasing coating. CLINICAL RELEVANCE The new capability of in vivo BLI for noninvasive monitoring of bacterial burden in larger-animal models of OIAI may have important preclinical relevance.
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Affiliation(s)
- Robert J. Miller
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John M. Thompson
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jesse Zheng
- Departments of Biomedical Engineering (J.Z.) and Materials Science and Engineering (X.J., R.A.M., H.-Q.M., and L.S.M.), Translational Tissue Engineering Center (X.J., R.A.M., H.-Q.M., and L.S.M.), Institute for NanoBioTechnology (X.J., R.A.M., and H.-Q.M.), and Whitaker Biomedical Engineering Institute (H.-Q.M.), Johns Hopkins University, Baltimore, Maryland
| | - Mark C. Marchitto
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nathan K. Archer
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bret L. Pinsker
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roger V. Ortines
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xuesong Jiang
- Departments of Biomedical Engineering (J.Z.) and Materials Science and Engineering (X.J., R.A.M., H.-Q.M., and L.S.M.), Translational Tissue Engineering Center (X.J., R.A.M., H.-Q.M., and L.S.M.), Institute for NanoBioTechnology (X.J., R.A.M., and H.-Q.M.), and Whitaker Biomedical Engineering Institute (H.-Q.M.), Johns Hopkins University, Baltimore, Maryland
| | - Russell A. Martin
- Departments of Biomedical Engineering (J.Z.) and Materials Science and Engineering (X.J., R.A.M., H.-Q.M., and L.S.M.), Translational Tissue Engineering Center (X.J., R.A.M., H.-Q.M., and L.S.M.), Institute for NanoBioTechnology (X.J., R.A.M., and H.-Q.M.), and Whitaker Biomedical Engineering Institute (H.-Q.M.), Johns Hopkins University, Baltimore, Maryland
| | - Isabelle D. Brown
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yu Wang
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S. Sterling
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hai-Quan Mao
- Departments of Biomedical Engineering (J.Z.) and Materials Science and Engineering (X.J., R.A.M., H.-Q.M., and L.S.M.), Translational Tissue Engineering Center (X.J., R.A.M., H.-Q.M., and L.S.M.), Institute for NanoBioTechnology (X.J., R.A.M., and H.-Q.M.), and Whitaker Biomedical Engineering Institute (H.-Q.M.), Johns Hopkins University, Baltimore, Maryland
| | - Lloyd S. Miller
- Departments of Dermatology (R.J.M., M.C.M., N.K.A., B.L.P., R.V.O., I.D.B., Y.W., and L.S.M.) and Orthopaedic Surgery (J.M.T., R.S.S., and L.S.M.) and Division of Infectious Diseases, Department of Medicine (L.S.M.), Johns Hopkins University School of Medicine, Baltimore, Maryland,Departments of Biomedical Engineering (J.Z.) and Materials Science and Engineering (X.J., R.A.M., H.-Q.M., and L.S.M.), Translational Tissue Engineering Center (X.J., R.A.M., H.-Q.M., and L.S.M.), Institute for NanoBioTechnology (X.J., R.A.M., and H.-Q.M.), and Whitaker Biomedical Engineering Institute (H.-Q.M.), Johns Hopkins University, Baltimore, Maryland
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Bargon R, Bruenke J, Carli A, Fabritius M, Goel R, Goswami K, Graf P, Groff H, Grupp T, Malchau H, Mohaddes M, Novaes de Santana C, Phillips KS, Rohde H, Rolfson O, Rondon A, Schaer T, Sculco P, Svensson K. General Assembly, Research Caveats: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S245-S253.e1. [PMID: 30348560 DOI: 10.1016/j.arth.2018.09.076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Elkins JM, Kates S, Lange J, Lange J, Lichstein P, Otero J, Soriano A, Wagner C, Wouthuyzen-Bakker M. General Assembly, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S181-S185. [PMID: 30348558 DOI: 10.1016/j.arth.2018.09.069] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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49
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Thompson JM, Miller RJ, Ashbaugh AG, Dillen CA, Pickett JE, Wang Y, Ortines RV, Sterling RS, Francis KP, Bernthal NM, Cohen TS, Tkaczyk C, Yu L, Stover CK, DiGiandomenico A, Sellman BR, Thorek DL, Miller LS. Mouse model of Gram-negative prosthetic joint infection reveals therapeutic targets. JCI Insight 2018; 3:121737. [PMID: 30185667 DOI: 10.1172/jci.insight.121737] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/26/2018] [Indexed: 12/23/2022] Open
Abstract
Bacterial biofilm infections of implantable medical devices decrease the effectiveness of antibiotics, creating difficult-to-treat chronic infections. Prosthetic joint infections (PJI) are particularly problematic because they require prolonged antibiotic courses and reoperations to remove and replace the infected prostheses. Current models to study PJI focus on Gram-positive bacteria, but Gram-negative PJI (GN-PJI) are increasingly common and are often more difficult to treat, with worse clinical outcomes. Herein, we sought to develop a mouse model of GN-PJI to investigate the pathogenesis of these infections and identify potential therapeutic targets. An orthopedic-grade titanium implant was surgically placed in the femurs of mice, followed by infection of the knee joint with Pseudomonas aeruginosa or Escherichia coli. We found that in vitro biofilm-producing activity was associated with the development of an in vivo orthopedic implant infection characterized by bacterial infection of the bone/joint tissue, biofilm formation on the implants, reactive bone changes, and inflammatory immune cell infiltrates. In addition, a bispecific antibody targeting P. aeruginosa virulence factors (PcrV and Psl exopolysaccharide) reduced the bacterial burden in vivo. Taken together, our findings provide a preclinical model of GN-PJI and suggest the therapeutic potential of targeting biofilm-associated antigens.
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Affiliation(s)
| | | | | | | | - Julie E Pickett
- Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yu Wang
- Department of Dermatology, and
| | | | | | - Kevin P Francis
- PerkinElmer, Hopkinton, Massachusetts, USA.,Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | - Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, California, USA
| | | | | | - Li Yu
- Statistical Sciences, MedImmune, Gaithersburg, Maryland, USA
| | | | | | | | - Daniel Lj Thorek
- Department of Radiology and Radiological Sciences, Division of Nuclear Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cancer Molecular and Functional Imaging Program, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, and
| | - Lloyd S Miller
- Department of Orthopaedic Surgery.,Department of Dermatology, and.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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Carli AV, Bhimani S, Yang X, de Mesy Bentley KL, Ross FP, Bostrom MPG. Vancomycin-Loaded Polymethylmethacrylate Spacers Fail to Eradicate Periprosthetic Joint Infection in a Clinically Representative Mouse Model. J Bone Joint Surg Am 2018; 100:e76. [PMID: 29870449 DOI: 10.2106/jbjs.17.01100] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty. Current animal models of PJI do not effectively recreate the clinical condition and thus provide limited help in understanding why treatments fail. We developed a mouse model of the first-stage surgery of a 2-stage revision for PJI involving a 3-dimensionally printed Ti-6Al-4V implant and a mouse-sized cement spacer that elutes vancomycin. METHODS Vancomycin was mixed with polymethylmethacrylate (PMMA) cement and inserted into custom-made mouse-sized spacer molds. Twenty C57BL/6 mice received a proximal tibial implant and an intra-articular injection of 3 × 10 colony-forming units of Staphylococcus aureus Xen36. At 2 weeks, 9 mice underwent irrigation and debridement of the leg with revision of the implant to an articulating vancomycin-loaded PMMA spacer. Postoperatively, mice underwent radiography and serum inflammatory-marker measurements. Following euthanasia of the mice at 6 weeks, bone and soft tissues were homogenized to quantify bacteria within periprosthetic tissues. Implants and articulating spacers were either sonicated to quantify adherent bacteria or examined under scanning electron microscopy (SEM) to characterize the biofilm. RESULTS Vancomycin-loaded PMMA spacers eluted vancomycin for ≤144 hours and retained antimicrobial activity. Control mice had elevated levels of inflammatory markers, radiographic evidence of septic loosening of the implant, and osseous destruction. Mice treated with a vancomycin-loaded PMMA spacer had significantly lower levels of inflammatory markers (p < 0.01), preserved tibial bone, and no intra-articular purulence. Retrieved vancomycin-loaded spacers exhibited significantly lower bacterial counts compared with implants (p < 0.001). However, bacterial counts in periprosthetic tissue did not significantly differ between the groups. SEM identified S. aureus encased within biofilm on control implants, while vancomycin-loaded spacers contained no bacteria. CONCLUSIONS This animal model is a clinically representative model of PJI treatment. The results suggest that the antimicrobial effects of PMMA spacers are tightly confined to the articular space and must be utilized in conjunction with thorough tissue debridement and systemic antibiotics. CLINICAL RELEVANCE These data provide what we believe to be the first insight into the effect of antibiotic-loaded cement spacers in a clinically relevant animal model and justify the adjunctive use of intravenous antibiotics when performing a 2-stage revision for PJI.
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Affiliation(s)
| | | | - Xu Yang
- Hospital for Special Surgery, New York, NY
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