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Abedi AA, Varnum C, Pedersen AB, Gromov K, Hallas J, Iversen P, Jakobsen T, Jimenez-Solem E, Kidholm K, Kjerulf A, Lange J, Odgaard A, Rosenvinge FS, Solgaard S, Sperling K, Stegger M, Christensen R, Overgaard S. Effect of single versus multiple prophylactic antibiotic doses on prosthetic joint infections following primary total hip arthroplasty in patients with osteoarthritis at public and private hospitals in Denmark: protocol for a nationwide cross-over, cluster randomised, non-inferiority trial [The Pro-Hip-Quality Trial]. BMJ Open 2023; 13:e071487. [PMID: 37604637 PMCID: PMC10445366 DOI: 10.1136/bmjopen-2022-071487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/21/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION A feared complication after total hip arthroplasty (THA) is prosthetic joint infection (PJI), associated with high morbidity and mortality. Prophylactic antibiotics can reduce the risk of PJI. However, there is no consensus on the dosages and current recommendations are based on a low evidence level. The objective is to compare the effect of a single versus multiple doses of prophylactic antibiotics administered within 24 hours on PJI. METHODS AND ANALYSIS The study is designed as a cross-over, cluster randomised, non-inferiority trial. All clinical centres use both antibiotic practices (1 year of each intervention). All Danish orthopaedic surgery departments will be involved: Based on quality databases, 2-year cohorts of approximately 20 000 primary THAs conducted at 39 public and private hospitals, will be included. INCLUSION CRITERIA age ≥18 years, all indications for THA except patients operated due to acute or sequelae from proximal femoral or pelvic fractures or bone tumour or metastasis. The primary outcome is PJI within 90 days after primary THA. Secondary outcomes include (1) serious adverse events, (2) potential PJI, (3) length of hospitalisation stay, (4) cardiovascular events, (5) hospital-treated infections, (6) community-based antibiotic use, (7) opioid use and (8) use of acetaminophen and non-steroidal anti-inflammatory drugs. All outcome measures will be extracted from national databases. Analyses will be based on the intention-to-treat population. Non-inferiority will be shown if the upper limit of the two-sided 95% CI for the OR is less than 1.32 for the single dose as compared with multiple doses. The results will establish best practice on antibiotic prophylaxis dosages in the future. ETHICS AND DISSEMINATION This study has been approved by Committees on Health Research Ethics for The Capital Region of Denmark (21069108) and The Danish Medicines Agency (2021091723). All results will be presented in peer-reviewed medical journals and international conferences. TRIAL REGISTRATION NUMBER NCT05530551.
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Affiliation(s)
- Armita Armina Abedi
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Claus Varnum
- Department of Orthopedics, Lillebaelt Hospital - University Hospital Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Jesper Hallas
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Pernille Iversen
- The Danish Clinical Quality Program- National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Thomas Jakobsen
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Espen Jimenez-Solem
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense Universitetshospital, Odense, Denmark
| | - Anne Kjerulf
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jeppe Lange
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Århus Universitet Klinisk Institut, Aarhus, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Søren Solgaard
- Department of Hip and Knee Surgery, Copenhagen University Hospital, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Kim Sperling
- Department of Orthopedic Surgery, Nastved Hospital, Nastved, Denmark
| | - Marc Stegger
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Robin Christensen
- Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Leta TH, Fenstad AM, Lygre SHL, Lie SA, Lindberg-Larsen M, Pedersen AB, W-Dahl A, Rolfson O, Bülow E, Ashforth JA, Van Steenbergen LN, Nelissen RGHH, Harries D, De Steiger R, Lutro O, Hakulinen E, Mäkelä K, Willis J, Wyatt M, Frampton C, Grimberg A, Steinbrück A, Wu Y, Armaroli C, Molinari M, Picus R, Mullen K, Illgen R, Stoica IC, Vorovenci AE, Dragomirescu D, Dale H, Brand C, Christen B, Shapiro J, Wilkinson JM, Armstrong R, Wooster K, Hallan G, Gjertsen JE, Chang RN, Prentice HA, Paxton EW, Furnes O. The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania. Acta Orthop 2023; 94:416-425. [PMID: 37565339 PMCID: PMC10416222 DOI: 10.2340/17453674.2023.17737] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). PATIENTS AND METHODS This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. RESULTS ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). CONCLUSION The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.
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Affiliation(s)
- Tesfaye H Leta
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Faculty of Health Science, VID Specialized University, Norway; Department of Population Health Sciences, Weill Medical College of Cornell University, USA; Department of Medical Device Surveillance & Assessment, Kaiser Permanente, USA.
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway
| | - Stein Håkon L Lygre
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Occupational Medicine, Haukeland University Hospital, Norway
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Institutes of Dentistry, University of Bergen, Norway
| | - Martin Lindberg-Larsen
- The Danish Knee Arthroplasty Register, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark
| | - Alma B Pedersen
- The Danish Knee Arthroplasty Register, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark
| | - Annette W-Dahl
- The Swedish Arthroplasty Register, Sweden; Department of Clinical Sciences Lund, Division of Orthopedics, Lund University, Lund, Sweden
| | - Ola Rolfson
- The Swedish Arthroplasty Register, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Bülow
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre of Registers Västra Götaland, Gothenburg, Sweden
| | | | | | - Rob G H H Nelissen
- The Dutch Arthroplasty Register, the Netherlands; Department of Orthopedics, Leiden University Medical Center, the Netherlands
| | - Dylan Harries
- South Australian Health and Medical Research Institute, Australia
| | - Richard De Steiger
- The Australian Orthopaedic Association National Joint Replacement Registry, Australia
| | - Olav Lutro
- Department of Medicine, Stavanger University Hospital, Norway
| | | | - Keijo Mäkelä
- The Finnish Arthroplasty Register, Finland; Turku University Hospital and University of Turku, Turku, Finland
| | | | | | | | | | | | - Yinan Wu
- The Germany Arthroplasty Registry, Germany
| | - Cristiana Armaroli
- Arthroplasty Registry of the Autonomous Province of Trento (PATN), Clinical Epidemiology Service, Provincial Agency for Health Services of Trento (APSS), Italy
| | - Marco Molinari
- Orthopedics and Traumatology Operative Unit, Cavalese Hospital, Provincial Agency for Health Services of Trento (APSS), Italy
| | - Roberto Picus
- Arthroplasty Register of Autonomous Province of Bolzano (PABZ), Observatory of Health, Health Department AP of Bolzano, Italy
| | | | - Richard Illgen
- American Joint Replacement Registry, USA; University of Wisconsin-Madison School of Medicine and Public Health, Department of Orthopedic Surgery and Rehabilitation, USA
| | - Ioan C Stoica
- Romanian Arthroplasty Registry, Romania; University of Medicine and Pharmacy - Carol Davila - Bucharest - UMFCD Bucharest, Romania; Foisor Orthopedic Hospital, Romania
| | - Andreea E Vorovenci
- Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania
| | - Dan Dragomirescu
- Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania
| | - Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Christian Brand
- Swiss National Hip & Knee Joint Registry, Switzerland; Institute of Social and Preventive Medicine, SwissRDL, University of Bern; Switzerland
| | - Bernhard Christen
- Swiss National Hip & Knee Joint Registry, Switzerland; Articon, Bern, Switzerland
| | - Joanne Shapiro
- The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
| | - J Mark Wilkinson
- The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Richard Armstrong
- The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
| | - Kate Wooster
- The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Richard N Chang
- Medical Device Surveillance & Assessment, Kaiser Permanente, USA
| | | | | | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
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Tvilum A, Johansen MI, Glud LN, Ivarsen DM, Khamas AB, Carmali S, Mhatre SS, Søgaard AB, Faddy E, de Vor L, Rooijakkers SHM, Østergaard L, Jørgensen NP, Meyer RL, Zelikin AN. Antibody-Drug Conjugates to Treat Bacterial Biofilms via Targeting and Extracellular Drug Release. Adv Sci (Weinh) 2023; 10:e2301340. [PMID: 37290045 PMCID: PMC10427384 DOI: 10.1002/advs.202301340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Indexed: 06/10/2023]
Abstract
The treatment of implant-associated bacterial infections and biofilms is an urgent medical need and a grand challenge because biofilms protect bacteria from the immune system and harbor antibiotic-tolerant persister cells. This need is addressed herein through an engineering of antibody-drug conjugates (ADCs) that contain an anti-neoplastic drug mitomycin C, which is also a potent antimicrobial against biofilms. The ADCs designed herein release the conjugated drug without cell entry, via a novel mechanism of drug release which likely involves an interaction of ADC with the thiols on the bacterial cell surface. ADCs targeted toward bacteria are superior by the afforded antimicrobial effects compared to the non-specific counterpart, in suspension and within biofilms, in vitro, and in an implant-associated murine osteomyelitis model in vivo. The results are important in developing ADC for a new area of application with a significant translational potential, and in addressing an urgent medical need of designing a treatment of bacterial biofilms.
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Affiliation(s)
- Anne Tvilum
- Department of ChemistryAarhus UniversityAarhus C8000Denmark
| | - Mikkel I. Johansen
- Department of Clinical MedicineAarhus UniversityAarhus N8200Denmark
- Department of Infectious DiseasesAarhus University HospitalAarhus N8200Denmark
| | - Lærke N. Glud
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
| | - Diana M. Ivarsen
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
| | - Amanda B. Khamas
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
| | | | - Snehit Satish Mhatre
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
| | - Ane B. Søgaard
- Department of ChemistryAarhus UniversityAarhus C8000Denmark
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
| | - Emma Faddy
- Department of Clinical MedicineAarhus UniversityAarhus N8200Denmark
| | - Lisanne de Vor
- Department of Medical MicrobiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Lars Østergaard
- Department of Clinical MedicineAarhus UniversityAarhus N8200Denmark
- Department of Infectious DiseasesAarhus University HospitalAarhus N8200Denmark
| | - Nis P. Jørgensen
- Department of Infectious DiseasesAarhus University HospitalAarhus N8200Denmark
| | - Rikke L. Meyer
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
- Department of BiologyAarhus UniversityAarhus C8000Denmark
| | - Alexander N. Zelikin
- Department of ChemistryAarhus UniversityAarhus C8000Denmark
- Interdisciplinary Nanoscience Centre (iNANO)Aarhus UniversityAarhus C8000Denmark
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Allen J, Abdelmonem M, Fieraru G, Guyver P. Introducing A Day-Case Shoulder Arthroplasty Pathway In The UK - How We Did It. Shoulder Elbow 2023; 15:311-320. [PMID: 37325384 PMCID: PMC10268136 DOI: 10.1177/17585732221079582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 09/20/2023]
Abstract
Background As the demand for elective orthopaedics grows, day-case arthroplasty is gaining popularity. The aim of this study was to create a safe and reproducible pathway for day-case shoulder arthroplasty (DCSA) based upon a literature review and discussion with the local multidisciplinary team (MDT). Methods A literature review was performed using OVID MEDLINE and Embase databases reporting 90-day complication and admission rates following DCSA. Minimum follow-up was 30 days. Day-case was defined as discharge on the same day of surgery. Results The literature review revealed a mean 90-day complication rate of 7.7% [range, 0-15.9%] and mean 90-day readmission rate of 2.5% [range 0-9.3%]. A pilot protocol was devised based upon the literature review and consisted of 5 phases: (1) pre-operative assessment, (2) intra-operative phase, (3) post-operative phase, (4) follow-up, and (5) readmission protocol. This was presented, discussed, amended, and ultimately ratified by the local MDT. In May 2021 the unit successfully completed its first day-case shoulder arthroplasty. Discussion This study proposes a safe and reproducible pathway for DCSA. Patient selection, well-defined protocols and communication within the MDT are important factors to achieve this. Further studies with extended follow-up will be needed to gauge long-term success within our unit.
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Affiliation(s)
- James Allen
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - Mohamed Abdelmonem
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Gabriel Fieraru
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
| | - Paul Guyver
- Derriford Hospital, University Hospitals Plymouth NHS Trust, Huddersfield, UK
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Berger C, Parai C, Tillander J, Bergh P, Wennergren D, Brisby H. High Risk for Persistent Peri-Prosthetic Infection and Amputation in Mega-Prosthesis Reconstruction. J Clin Med 2023; 12:jcm12103575. [PMID: 37240683 DOI: 10.3390/jcm12103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
A peri-prosthetic joint infection is a feared complication after mega-prosthesis reconstruction of large bone defects. The current study investigates how patients operated with a mega-prosthesis due to sarcoma, metastasis, or trauma, are affected by a deep infection focusing on re-operations, risk for persistent infection, arthrodesis, or subsequent amputation. Time to infection, causative bacterial strains, mode of treatment and length of hospital stay are also reported. A total of 114 patients with 116 prostheses were evaluated, a median of 7.6 years (range 3.8-13.7) after surgery, of which 35 (30%) were re-operated due to a peri-prosthetic infection. Of the infected patients, the prosthesis was still in place in 51%, 37% were amputated, and 9% had an arthrodesis. The infection was persistent in 26% of the infected patients at follow-up. The mean total length of hospital stay was 68 (median 60) days and the mean number of reoperations was 8.9 (median 6.0). The mean length of antibiotic treatment was 340 days (median 183). Coagulase-negative staphylococci and Staphylococcus aureus were the most frequent bacterial agents isolated in deep cultures. No MRSA- or ESBL-producing Enterobacterales were found but vancomycin-resistant Enterococcus faecium was isolated in one patient. In summary, there is a high risk for peri-prosthetic infection in mega-prostheses, resulting in persistent infection or amputation relatively often.
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Affiliation(s)
- Christina Berger
- Institution of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, 416 45 Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Catharina Parai
- Institution of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, 416 45 Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Jonatan Tillander
- Institution of Biomedicine, Department of Infectious Diseases, University of Gothenburg, 413 90 Gothenburg, Sweden
| | - Peter Bergh
- Department of Orthopedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - David Wennergren
- Institution of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, 416 45 Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Helena Brisby
- Institution of Clinical Sciences, Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, 416 45 Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Zhu Y, Weng X, Zhang J, Mao J. Protective effect of additional cathelicidin antimicrobial peptide PR-39 on prosthetic-joint infections. J Orthop Surg (Hong Kong) 2023; 31:10225536231175237. [PMID: 37144863 DOI: 10.1177/10225536231175237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Prosthetic-joint infection (PJI) is one of the severest complications after arthroplasty. However, antibiotics are not effective in the bacteria in biofilm outside the prosthetic-joint. Antimicrobial peptides have an efficient antimicrobial activity in staphylococcus aureus compared with conventional antibiotics. METHODS Bone marrow stem cells (BMSCs) were isolated, cultured and transfected with cathelicidins antimicrobial peptides proline-arginine-rich 39 amino acid peptide (PR-39) lentivirus. The expression of PR-39 gene in BMSCs was detected by RT-PCR, and the antibacterial activity of PR-39 was measured by agar diffusion method. The transfection efficiency was detected by fluorescence microscopy. The infection model of artificial knee joint in rabbits were established. Kirschner wire was used as the knee joint implant to implant the distal femur through the femoral intercondylar fossa of rabbits. 24 rabbits were randomly divided into 2 groups for the above operations: group A was inoculated 0.5 mL into the joint cavity immediately after the incision was sutured 1 × 107 Staphylococcus aureus of colony forming unit (CFU), group B was inoculated with Staphylococcus aureus and PR-39. After operation, the wound conditions and histological changes were observed by X-ray and optical microscope respectively, CRP and erythrocyte sedimentation rate were measured by test assay. RESULTS The transfection efficiency of lentivirus vectortransfected BMSCs was 74.09%. The supernatant of lentivirus vector had obvious inhibitory effect on Staphylococcus aureus, and the antibacterial rate was 98.43%. 100% infection observed in group A while few infection observed in group B; serum CRP and ESR at a high level in group A while decreased in group B after operation. There were no significant difference in CRP and ESR between the pLV/PR-39 group and pLV/EGFP group at day 1 and 3 respectively after surgery. However, CRP and ESR in the pLV/PR-39 groupwere significantly lower than the pLV/EGFP group at day 7 and 14 respectively after operation. CONCLUSIONS Rabbits planted BMSCs expressing PR-39 were significantly increased resistance to Staphylococcus aureus in PJI than control group thus showing great potential for preventing implant-associated infection. It will provide a potential new therapeutic agent for implant-associated infection.
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Affiliation(s)
- Yongjun Zhu
- Department of Orthopedics, The Ninth People's Hospital of Chongqing, Chongqing, China
- Department of Pharmacology, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Xuan Weng
- Department of Orthopedics, The Yubei District people's Hospital of Chongqing, Chongqing, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingxin Mao
- Department of Pharmacology, Chongqing Medical and Pharmaceutical College, Chongqing, China
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
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Parsons T, French J, Oshima T, Figueroa F, Neri T, Klasan A, Putnis S. International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty. Antibiotics (Basel) 2022; 11:1669. [DOI: 10.3390/antibiotics11111669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.
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Marino AC, Robinson ED, Durden JA, Cox HL, Mathers AJ, Shaffrey ME. The effects of avoiding extended antimicrobial drain prophylaxis on Clostridioides difficile and postprocedural infection rates: a 5-year retrospective. J Neurosurg 2022; 137:1-7. [PMID: 35171828 DOI: 10.3171/2021.11.jns211459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postprocedural infection is a consequential complication of neurosurgical intervention. Periprocedural antimicrobial prophylaxis is routinely administered to prevent infection, and in some cases, continued for extended periods while surgical drains remain in place. However, there is little evidence that extended antimicrobial administration is necessary to reduce postprocedural infection, and extended antimicrobials can be associated with harm, such as Clostridioides difficile infection. The authors sought to evaluate whether shortening the duration of postprocedural antimicrobial prophylaxis would decrease the incidence of C. difficile infection without increasing the incidence of postprocedural infection. METHODS In this retrospective study, two general neurosurgical cohorts were examined. In one cohort, postoperative antimicrobial prophylaxis was limited to 24 hours; in the other, some patients received extended postoperative antimicrobial prophylaxis while surgical drains or external ventricular drains (EVDs) remained in place. Rates of infection with C. difficile as well as postprocedural infection after surgery and EVD placement were compared. RESULTS Seven thousand two hundred four patients undergoing 8586 surgical procedures and 413 EVD placements were reviewed. The incidence of C. difficile infection decreased significantly from 0.5% per procedural encounter to 0.07% with the discontinuation of extended postprocedural antibiotics within 90 days of a procedure. Rates of postprocedural infection and EVD infection did not significantly change. Results were similar in subgroups of patients with closed suction drains as well as cranial and spine subgroups. CONCLUSIONS Discontinuation of extended antimicrobial prophylaxis was associated with a significant decrease in the incidence of C. difficile infection without a concomitant change in postprocedural infections or EVD-associated infection. This study provides evidence in support of specialtfy-wide discontinuation of extended postoperative antimicrobial prophylaxis, even in the presence of closed suction drains.
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Affiliation(s)
| | - Evan D Robinson
- 2Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia
| | | | - Heather L Cox
- 2Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia
- 4Department of Pharmacy Services, University of Virginia Health, Charlottesville, Virginia
| | - Amy J Mathers
- 2Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia
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Ghert M, Schneider P, Guyatt G, Thabane L, Vélez R, O'Shea T, Randall RL, Turcotte R, Wilson D, Wunder JS, Baptista AM, Cheng EY, Doung YC, Ferguson PC, Giglio V, Hayden J, Heels-Ansdell D, Khan SA, Sampath Kumar V, McKay P, Miller B, van de Sande M, Zumárraga JP, Bhandari M. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial. JAMA Oncol 2022; 8:345-353. [PMID: 34989778 PMCID: PMC8739829 DOI: 10.1001/jamaoncol.2021.6628] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Question Can a 5-day regimen of postoperative, prophylactic, intravenous antibiotics reduce the rate of surgical site infections in patients with a lower extremity bone tumor undergoing complex endoprosthetic reconstruction compared with a 1-day regimen? Findings In this randomized clinical trial including 604 patients in the primary analysis, the 5-day regimen did not reduce the rate of surgical site infection compared with the 1-day regimen, although it resulted in a higher rate of antibiotic-related complications, notably Clostridioides difficile–associated colitis. Meaning The results of this study suggest that prolonging use of postoperative antibiotics beyond 1 day does not reduce the rate of surgical site infection but increases the risk of clinically significant antibiotic-related complications. Importance The use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited. Objective To assess the effect of a 5-day regimen of postoperative, prophylactic, intravenous antibiotics compared with a 1-day regimen on the rate of surgical site infections within 1 year after surgery. Design, Setting, and Participants This randomized clinical superiority trial was performed at 48 clinical sites in 12 countries from January 1, 2013, to October 29, 2019. The trial included patients with a primary bone tumor or a soft tissue sarcoma that had invaded the femur or tibia or oligometastatic bone disease of the femur or tibia with expected survival of at least 1 year who required surgical management by excision and endoprosthetic reconstruction. A total of 611 patients were enrolled, and 7 were excluded for ineligibility. Interventions A 1- or 5-day regimen of postoperative prophylactic intravenous cephalosporin (cefazolin or cefuroxime) that began within 8 hours after skin closure and was administered every 8 hours thereafter. Those randomized to the 1-day regimen received identical saline doses every 8 hours for the remaining 4 days; patients, care providers, and outcomes assessors were blinded to treatment regimen. Main Outcomes and Measures The primary outcome in this superiority trial was a surgical site infection (superficial incisional, deep incisional, or organ space) classified according to the criteria established by the Centers for Disease Control and Prevention within 1 year after surgery. Secondary outcomes included antibiotic-related complications, unplanned additional operations, oncologic and functional outcomes, and mortality. Results Of the 604 patients included in the final analysis (mean [SD] age, 41.2 [21.9] years; 361 [59.8%] male; 114 [18.9%] Asian, 43 [7.1%] Black, 34 [5.6%] Hispanic, 15 [2.5%] Indigenous, 384 [63.8%] White, and 12 [2.0%] other), 293 were randomized to a 5-day regimen and 311 to a 1-day regimen. A surgical site infection occurred in 44 patients (15.0%) allocated to the 5-day regimen and in 52 patients (16.7%) allocated to the 1-day regimen (hazard ratio, 0.93; 95% CI, 0.62-1.40; P = .73). Antibiotic-related complications occurred in 15 patients (5.1%) in the 5-day regimen and in 5 patients (1.6%) allocated to the 1-day regimen (hazard ratio, 3.24; 95% CI, 1.17-8.98; P = .02). Other secondary outcomes did not differ significantly between treatment groups. Conclusions and Relevance This randomized clinical trial did not confirm the superiority of a 5-day regimen of postoperative intravenous antibiotics over a 1-day regimen in preventing surgical site infections after surgery for lower extremity bone tumors that required an endoprosthesis. The 5-day regimen group had significantly more antibiotic-related complications. Trial Registration ClinicalTrials.gov Identifier: NCT01479283
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Affiliation(s)
| | - Michelle Ghert
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Patricia Schneider
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Roberto Vélez
- Hospital Vall d'Hebron, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Timothy O'Shea
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento
| | - Robert Turcotte
- Division of Orthopaedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - David Wilson
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jay S Wunder
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - André Mathias Baptista
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Edward Y Cheng
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis
| | - Yee-Cheen Doung
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland
| | - Peter C Ferguson
- University of Toronto Musculoskeletal Oncology Unit, Mount Sinai Hospital, Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Victoria Giglio
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - James Hayden
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, India
| | | | - Paula McKay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Benjamin Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City
| | - Michiel van de Sande
- Department of Orthopaedic Surgery, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | - Juan P Zumárraga
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Christensen DD, Moschetti WE, Brown MG, Lucas AP, Jevsevar DS, Fillingham YA. Perioperative Antibiotic Prophylaxis: Single and 24-Hour Antibiotic Dosages are Equally Effective at Preventing Periprosthetic Joint Infection in Total Joint Arthroplasty. J Arthroplasty 2021; 36:S308-S313. [PMID: 33712358 DOI: 10.1016/j.arth.2021.02.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Perioperative antibiotic prophylaxis is used to prevent surgical site infection and periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). Secondary to a national shortage of cefazolin, patients at our institution began receiving a single preoperative prophylactic antibiotic dose for primary TJA and no 24-hour postoperative antibiotic prophylaxis. The purpose of the study was to compare the efficacy of single-dose antibiotic use versus 24-hour dosing of prophylactic antibiotics in the prevention of acute PJI and short-term complications after primary TJA. METHODS A retrospective review of 3317 patients undergoing primary TJA performed from January 2015 to December 2019 identified 554 patients who received a single dose of preoperative antibiotic prophylaxis during the antibiotic shortage and 2763 patients who received post-TJA 24-hour antibiotic prophylaxis before the shortage. Patient records were evaluated for acute PJI, superficial infection, 90-day reoperation, and 90-day complications. RESULTS There were no significant differences in patient characteristics between single-dose and 24-hour antibiotic groups. Similarly, there were no significant differences in rates of acute PJI (0.7% vs 0.2%; P = .301), superficial infection (2.4% vs 1.4%; P = .221), 90-day reoperation (2.1% vs 1.1%; P = .155), and 90-day complications (9.9% vs 7.9%; P = .169) between single and 24-hour antibiotic dose. Post hoc power analysis demonstrated adequate sample size, beta = 93%. CONCLUSION Single-dose prophylactic antibiotics did not lead to an increased risk of acute PJI or short-term complications after TJA. Our study suggests that administration of a single antibiotic dose may be safely considered in patients undergoing routine primary TJA.
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Affiliation(s)
- David D Christensen
- Dartmouth Hitchcock Medical Center, Lebanon, NH; Dartmouth College Geisel School of Medicine, Hanover, NH
| | - Wayne E Moschetti
- Dartmouth Hitchcock Medical Center, Lebanon, NH; Dartmouth College Geisel School of Medicine, Hanover, NH
| | - Marcel G Brown
- Dartmouth College Geisel School of Medicine, Hanover, NH
| | | | - David S Jevsevar
- Dartmouth Hitchcock Medical Center, Lebanon, NH; Dartmouth College Geisel School of Medicine, Hanover, NH
| | - Yale A Fillingham
- Dartmouth Hitchcock Medical Center, Lebanon, NH; Dartmouth College Geisel School of Medicine, Hanover, NH
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Maver T, Mastnak T, Mihelič M, Maver U, Finšgar M. Clindamycin-Based 3D-Printed and Electrospun Coatings for Treatment of Implant-Related Infections. Materials (Basel) 2021; 14:1464. [PMID: 33802712 DOI: 10.3390/ma14061464] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
This study presents the development and characterisation of two novel bioactive coatings deposited on TiAlV and AISI 316LVM substrates. The coatings were prepared using 3D printing and electrospinning. The 3D-printed coating consisted of the cellulose nanofibril suspension, alginate, and carboxymethylcellulose (CMC), while CMC and polyethylene oxide were used to prepare the electrospun coating. Both coatings were loaded with the antibiotic clindamycin (CLIN), which is a bacteriostatic lincosamide known for its activity against streptococci, staphylococci, pneumococci, Bacteroides species, and other anaerobes. Initial characterisation of the coatings was performed by attenuated total reflectance Fourier transform infrared spectroscopy, field emission scanning electron microscopy, and atomic force microscopy. Furthermore, the contact angle measurements, swelling rate, and biodegradability of the coatings were investigated. The released concentration of CLIN in PBS (pH = 7.4 at 25 °C) was determined by UV-VIS spectrophotometry. The coatings’ biocompatibility was determined using an MTT (3(4,5 dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide) assay using an osteoblast cell culture (hFOB 1.19, ATCC CRL 11372).
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12
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Veltman ES, Lenguerrand E, Moojen DJF, Whitehouse MR, Nelissen RGHH, Blom AW, Poolman RW. Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients. Acta Orthop 2020; 91:794-800. [PMID: 32698642 PMCID: PMC8023957 DOI: 10.1080/17453674.2020.1794096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods - A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results - For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28-35), 39 (25-59), and 23 (15-34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24-31), 40 (24-62), and 24 (16-36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation - In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.
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MESH Headings
- Anti-Bacterial Agents/administration & dosage
- Antibiotic Prophylaxis/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Cefazolin/administration & dosage
- Cefuroxime/administration & dosage
- Dose-Response Relationship, Drug
- Duration of Therapy
- Female
- Humans
- Male
- Middle Aged
- Netherlands/epidemiology
- Outcome and Process Assessment, Health Care
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/epidemiology
- Prosthesis-Related Infections/prevention & control
- Prosthesis-Related Infections/surgery
- Reoperation/methods
- Reoperation/statistics & numerical data
- Risk Adjustment/methods
- Risk Adjustment/statistics & numerical data
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dirk Jan F Moojen
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospital Bristol NHS Foundation Trust and University of Bristol, UK
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospital Bristol NHS Foundation Trust and University of Bristol, UK
| | - Rudolf W Poolman
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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13
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Ierano CE, Thursky K, Marshall C, Koning S, James R, Johnson S, Imam N, Worth LJ, Peel T. Identifying targets for improvement using a nationally standardized survey: Surgical antimicrobial prophylaxis in orthopedic surgery. Infect Control Hosp Epidemiol 2020; 41:1419-28. [PMID: 32838821 DOI: 10.1017/ice.2020.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surgical antimicrobial prophylaxis (SAP) is commonly administered in orthopedic procedures. Research regarding SAP appropriateness for specific orthopedic procedures is limited and is required to facilitate targeted orthopedic prescriber behavior change. OBJECTIVES To describe SAP prescribing and appropriateness for orthopedic procedures in Australian hospitals. DESIGN, SETTING, AND PARTICIPANTS Multicenter, national, quality improvement study with retrospective analysis of data collected from Australian hospitals via Surgical National Antimicrobial Prescribing Survey (Surgical NAPS) audits from January 1, 2016, to April 15, 2019, were analyzed. METHODS Logistic regression identified hospital, patient and surgical factors associated with appropriateness. Adjusted appropriateness was calculated from the multivariable model. Additional subanalyses were conducted on smaller subsets to calculate the adjusted appropriateness for specific orthopedic procedures. RESULTS In total, 140 facilities contributed to orthopedic audits in the Surgical NAPS, including 4,032 orthopedic surgical episodes and 6,709 prescribed doses. Overall appropriateness was low, 58.0% (n = 3,894). This differed for prescribed procedural (n = 3,978, 64.7%) and postprocedural doses (n = 2,731, 48.3%). The most common reasons for inappropriateness, when prophylaxis was required, was timing for procedural doses (50.9%) and duration for postprocedural prescriptions (49.8%). The adjusted appropriateness of each orthopedic procedure group was low for procedural SAP (knee surgery, 54.1% to total knee joint replacement, 74.1%). The adjusted appropriateness for postprocedural prescription was also low (from hand surgery, 40.7%, to closed reduction fractures, 68.7%). CONCLUSIONS Orthopedic surgical specialties demonstrated differences across procedural and postprocedural appropriateness. The metric of appropriateness identifies targets for quality improvement and is meaningful for clinicians. Targeted quality improvement projects for orthopedic specialties need to be developed to support optimization of antimicrobial use.
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14
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Nodzo SR, Boyle KK, Frisch NB. Nationwide Organism Susceptibility Patterns to Common Preoperative Prophylactic Antibiotics: What Are We Covering? J Arthroplasty 2019; 34:S302-S306. [PMID: 30745218 DOI: 10.1016/j.arth.2019.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many periprosthetic joint infections (PJIs) are caused by organisms not susceptible to first-generation cephalosporins. We sought to evaluate the national susceptibility patterns of organisms to cefazolin and, or oxacillin, clindamycin, and vancomycin using antibiogram data. METHODS Publically available regional and state antibiograms were evaluated for antibiotic susceptibility patterns to commonly infecting gram-positive organisms. The number of isolates tested in each antibiogram and percent of strains susceptible to oxacillin, clindamycin, and vancomycin were recorded. Oxacillin is used as a surrogate to cefazolin in antibiograms. A comparison of antibiotic susceptibilities was performed. RESULTS Seven state and 38 regional antibiograms were reviewed. Oxacillin was a sensitive antibiotic in 99.2 ± 4.8% of methicillin-sensitive Staphylococcus aureus (MSSA) isolates, 0 ± 0% of methicillin-resistant Staphylococcus aureus (MRSA) isolates, 44.5 ± 13.7% of coagulase-negative staphylococcus organism isolates (CNS), and 30.6 ± 10.5% of Staphylococcus epidermidis isolates. Clindamycin was a sensitive antibiotic in 75.8 ± 8.4% of MSSA isolates, 60.2 ± 13.2% of MRSA isolates, 60.3 ± 11.4% of CNS isolates, and 56.2 ± 6.5% of S epidermidis isolates. Vancomycin was a sensitive antibiotic in 99.9 ± 0.4% of MSSA isolates, 99.8 ± 0.4% of MRSA isolates, 99.8 ± 0.5% of CNS isolates, and 99.6 ± 0.7% of S epidermidis isolates. Clindamycin was significantly less sensitive in MSSA isolates as compared with oxacillin and vancomycin (P < .0001). Oxacillin was significantly less sensitive in CNS, S epidermidis, and MRSA isolates as compared with clindamycin and vancomycin (P < .0001). CONCLUSION The national clindamycin susceptibility pattern is limited to MSSA and may not have an optimal susceptibility profile suitable for use as a prophylactic antibiotic. Cefazolin continues to have excellent coverage against MSSA.
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Affiliation(s)
- Scott R Nodzo
- Mike O'Callaghan Medical Center, Department of Orthopedics, Las Vegas, NV
| | - K Keely Boyle
- Department of Orthopedics, University at Buffalo, Buffalo, NY
| | - Nicholas B Frisch
- Ascencion Crittenton Hospital, Department of Orthopedics, Rochester, MI
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15
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Ryan SP, Kildow BJ, Tan TL, Parvizi J, Bolognesi MP, Seyler TM. Is There a Difference in Infection Risk Between Single and Multiple Doses of Prophylactic Antibiotics? A Meta-analysis. Clin Orthop Relat Res 2019; 477:1577-1590. [PMID: 30811357 PMCID: PMC6999965 DOI: 10.1097/corr.0000000000000619] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/04/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prevention of surgical site infection guidelines issued by the Centers for Disease Control and Prevention (CDC) recently recommended that only a single dose of preoperative antibiotics be administered to patients undergoing clean-contaminated procedures based on data from a variety of surgical disciplines. For orthopaedic procedures, where postoperative infections can have significant consequences, the existing evidence for this recommendation is widely debated. QUESTIONS/PURPOSES Is there a difference in postoperative infection risk when utilizing a single dose of preoperative antibiotics compared with multiple doses of perioperative antibiotics for orthopaedic procedures where implants are placed? METHODS MEDLINE, EMBASE, Google Scholar, and Cochrane were systematically reviewed for randomized controlled trials (RCTs) of a single dose of preoperative antibiotics compared with pre- and postoperative prophylaxis from 1980 to 2017 for all orthopaedic procedures where implants were being placed. Infection (both superficial and deep) as a primary outcome through all available followup was required for inclusion. Fourteen RCTs detailing 9691 orthopaedic procedures were included for analysis, including seven arthroplasty, one spine, and six general orthopaedic trials (two specific to hip fracture fixation). Pooled infection outcomes were analyzed with random-effects modeling in light of study heterogeneity. Bias was evaluated using the Cochrane risk of bias tool as well as a funnel plot for publication bias, and quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Bias was largely uncertain; however, a high risk of bias was noted in four studies. No significant overall publication bias was noted. The quality of evidence was determined to be very low based on the GRADE tool, downgraded based on risk of bias, inconsistency, and imprecision. Despite the quality of evidence, the data were pooled in light of the current recommendations from the CDC to critically evaluate the recommendation that a single dose of antibiotics be utilized. RESULTS There were no differences in infection risk between single- versus multiple-dose groups (single: 83 of 4263 [2%], multiple: 101 of 5428 [2%]; odds ratio, 0.92 [95% confidence interval, 0.56-1.51]; p = 0.740, I = 36% for statistical heterogeneity). CONCLUSIONS There is no difference in infection risk between a single dose and multiple doses of perioperative antibiotics for orthopaedic procedures where implants are utilized, consistent with recent recommendations. However, the quality of evidence for orthopaedic procedures is low, and a randomized study with a sufficient sample size is needed to examine the issue before universal adoption of a single antibiotic dose. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Sean P Ryan
- S. P. Ryan, B. J. Kildow, M. P. Bolognesi, T. M. Seyler, Duke University Hospital, Durham, NC, USA T. L. Tan, J. Parvizi, Rothman Institute, Philadelphia, PA, USA
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16
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Abstract
Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user's cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma. Cite this article: C. L. Romanò, H. Tsuchiya, I. Morelli, A. G. Battaglia, L. Drago. Antibacterial coating of implants: are we missing something? Bone Joint Res 2019;8:199-206. DOI: 10.1302/2046-3758.85.BJR-2018-0316.
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Affiliation(s)
- C. L. Romanò
- Studio Medico Associato Cecca-Romanò, Milan, Italy
| | - H. Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - I. Morelli
- Specialty School of Orthopaedics, University of Milan, Milan, Italy
| | - A. G. Battaglia
- Specialty School of Orthopaedics, University of Milan, Milan, Italy
| | - L. Drago
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Thornley P, Vicente M, MacDonald A, Evaniew N, Ghert M, Velez R. Causes and Frequencies of Reoperations After Endoprosthetic Reconstructions for Extremity Tumor Surgery: A Systematic Review. Clin Orthop Relat Res 2019; 477:894-902. [PMID: 30801278 DOI: 10.1097/CORR.0000000000000630] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Excision of bone tumors and endoprosthetic reconstruction allow patients early weightbearing and a potential functional advantage compared with amputation. These reconstructions do not restore the limb to normal status, however, and patients are subject to complications that may result in revision or loss of the limb. Because better understanding of these complications based on current information might help the patient and surgeon in decision-making, we undertook a systematic review of studies published on this topic. QUESTIONS/PURPOSES (1) What are the primary modes and proportion of failure of tumor endoprostheses in patients undergoing reconstruction after excision of primary extremity bone sarcomas? METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library for all studies published from April 15, 1998, to April 15, 2018. Three reviewers independently reviewed studies reporting endoprosthetic reconstruction survival and events requiring revision for primary extremity bone tumors treated with endoprosthetic reconstruction for inclusion and performed independent data extraction. We excluded all studies with fewer than five patients, any systematic review/meta-analyses, and any study not reporting on primary extremity bone tumors. All discrepancies were resolved by the study's senior author. Data extracted from included studies were any reoperation event for wound dehiscence, any operative fixation for a pathologic fracture, and any revision of the primary endoprosthesis for implant wear or breakage, deep infection not amenable to prosthesis retention, or for local recurrence. We assessed the overall quality of the evidence with the Methodological Index for Non-Randomized Studies (MINORS) approach with a higher MINORS score representative of a more methodologically rigorous study with a total possible score of 16 points for noncomparative and 24 points for comparative studies. Forty-nine studies met criteria for inclusion from an initial search return of 904 studies, of which no studies were randomized controlled trials. From a total patient population of 2721, there was a mean followup of 93 months (range, 1-516 months) with loss to followup or death occurring in 447 of 2118 (21%) patients with six studies not providing loss to followup data. The mean MINORS score was 14 for prospective studies and 11 for retrospective studies. RESULTS Overall, there were 1283 reoperations among the 2721 (47%) patients. Reoperation for mechanical endoprosthetic events (soft tissue dehiscence or periarticular soft tissue instability, aseptic loosening, or implant wear/fracture) occurred in 907 of 2721 (33%) patients. Aseptic loosening occurred at a mean of 75 months (range, 1-376 months) in 212 of 315 patients (67%). Deep infection requiring removal of the initial prosthesis occurred in 247 of 2721 (9%) patients with deep infection occurring at a mean of 24 months (range, 1-372 months) in the 190 infections (77%) with time to infection data available. Local recurrence rates requiring revision or amputation occurred in 129 (5%) of all patients. There was an overall primary endoprosthesis survival rate without any surgical reintervention of 63% among reporting studies at a mean of 79 months followup. CONCLUSIONS Failures of endoprosthetic reconstructions after extremity tumor surgery are common, most often resulting from implant wear or fracture, aseptic loosening, and infection. Importantly, the aggregated data are the first to attempt to quantify the time to specific complication types within this patient population. Deep infection not amenable to endoprosthesis retention appears to occur approximately 2 years postoperatively in most patients, with aseptic loosening occurring most commonly at 75 months. Although endoprosthetic reconstruction is one of the most common forms of reconstruction after bone tumor resection, the quality of published evidence regarding this procedure is of low quality with high loss to followup and data quality limiting interstudy analysis. The quality of the evidence is low with high loss to followup and inconsistent reporting of times to reintervention events. Although the most common modes of endoprosthetic failure in this population are well known, creation of quality prospective, collaborative databases would assist in clarifying and informing important elements of the followup process for these patients. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Tan TL, Shohat N, Rondon AJ, Foltz C, Goswami K, Ryan SP, Seyler TM, Parvizi J. Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses. J Bone Joint Surg Am 2019; 101:429-437. [PMID: 30845037 DOI: 10.2106/jbjs.18.00336] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent surgical site infection prevention guidelines recommend that no additional prophylactic antibiotics be administered after the surgical incision is closed in clean-contaminated procedures. Although there is ample evidence to support this recommendation in non-arthroplasty surgery, there is concern about extending these guidelines to surgical procedures with an implant such as total joint arthroplasty (TJA). The aim of this study was to compare the efficacy of a single dose of prophylactic antibiotics with that of multiple doses of antibiotics for prevention of periprosthetic joint infection (PJI) in patients undergoing TJA. METHODS A retrospective study of 20,682 primary TJAs carried out from 2006 to 2017 was performed. Patients who received a single dose of prophylactic antibiotics (n = 4,523) were compared with patients who received multiple doses of antibiotics (n = 16,159). A previously validated PJI risk score was assigned to each patient. Patients who developed PJI within 1 year were identified, and a multivariate logistic regression analysis was performed to control for potential confounders. Analyses using propensity score matching and regression adjustment were also performed. RESULTS The overall PJI rate was 0.60% (27 of 4,523) for patients who received a single dose of antibiotics compared with 0.88% (142 of 16,159) for those who received multiple doses. There was no difference in the PJI rate between patients who received a single dose of antibiotics and those who received multiple doses in the univariate (adjusted odds ratio [OR] = 0.674, p = 0.064), multivariate (OR = 0.755, p = 0.205), or propensity score matched analysis (OR = 0.746, p = 0.277). Furthermore, multiple doses did not demonstrate any additional benefit for patients with a high preoperative risk of PJI (p = 0.136). CONCLUSIONS This study supports the notion that the administration of additional antibiotics following skin closure may not be required for primary TJA, regardless of the patient's preoperative risk of PJI. The findings of this large retrospective study highlight the need for a randomized, prospective study on which to base guidelines. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Noam Shohat
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Alexander J Rondon
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol Foltz
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karan Goswami
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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19
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Aboltins CA, Berdal JE, Casas F, Corona PS, Cuellar D, Ferrari MC, Hendershot E, Huang W, Kuo FC, Malkani A, Reyes F, Rudelli S, Safir O, Seyler T, Tan TL, Townsend R, Tuncay I, Turner D, Winkler H, Wouthuyzen-Bakker M, Yates AJ, Zahar A. Hip and Knee Section, Prevention, Antimicrobials (Systemic): Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S279-88. [PMID: 30348572 DOI: 10.1016/j.arth.2018.09.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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20
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Calabrò F, Coen M, Franceschini M, Franco-Cendejas R, Hewlett A, Segreti J, Senneville E. Hip and Knee Section, Treatment, Antimicrobial Suppression: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S483-S485. [PMID: 30348571 DOI: 10.1016/j.arth.2018.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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21
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ter Meer M, Dillion R, Nielsen SM, Walther R, Meyer RL, Daamen WF, van den Heuvel LP, van der Vliet JA, Lomme RMLM, Hoogeveen YL, Schultze Kool LJ, Schaffer JE, Zelikin AN. Innate glycosidic activity in metallic implants for localized synthesis of antibacterial drugs. Chem Commun (Camb) 2019; 55:443-446. [DOI: 10.1039/c8cc08737g] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The unexpected discovery presented herein is that industrialized metallic wires can perform conversion of the glucuronide prodrugs with ensuing antibacterial effects.
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Affiliation(s)
- Marja ter Meer
- Department of Radiology and Nuclear Medicine
- Radboud university medical center
- Nijmegen
- The Netherlands
| | - Ross Dillion
- Fort Wayne Metals Research Products Corp
- Research and Development
- Fort Wayne
- USA
| | | | - Raoul Walther
- Department of Chemistry
- Aarhus University
- Aarhus
- Denmark
| | - Rikke L. Meyer
- iNano Interdisciplinary Nanoscience Centre
- Aarhus University
- Aarhus
- Denmark
| | - Willeke F. Daamen
- Department of Biochemistry
- Radboud Institute for Molecular Life Sciences
- Radboud university medical center
- Nijmegen
- The Netherlands
| | - Lambertus P. van den Heuvel
- Department of Pediatrics/Pediatric Nephrology
- Radboud university medical center
- Nijmegen
- The Netherlands
- Department of Development and Regeneration/Pediatrics
| | | | | | - Yvonne L. Hoogeveen
- Department of Radiology and Nuclear Medicine
- Radboud university medical center
- Nijmegen
- The Netherlands
| | - Leo J. Schultze Kool
- Department of Radiology and Nuclear Medicine
- Radboud university medical center
- Nijmegen
- The Netherlands
| | - Jeremy E. Schaffer
- Fort Wayne Metals Research Products Corp
- Research and Development
- Fort Wayne
- USA
| | - Alexander N. Zelikin
- iNano Interdisciplinary Nanoscience Centre
- Aarhus University
- Aarhus
- Denmark
- Department of Chemistry
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22
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Walther R, Nielsen SM, Christiansen R, Meyer RL, Zelikin AN. Combatting implant-associated biofilms through localized drug synthesis. J Control Release 2018; 287:94-102. [PMID: 30138714 PMCID: PMC6176123 DOI: 10.1016/j.jconrel.2018.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/10/2018] [Accepted: 08/15/2018] [Indexed: 02/07/2023]
Abstract
Bacterial contamination of implantable biomaterials is a significant socioeconomic and healthcare burden. Indeed, bacterial colonization of implants after surgery has a high rate of incidence whereas concurrent prophylaxis using systemic antibiotics has limited clinical success. In this work, we develop enzyme-prodrug therapy (EPT) to prevent and to treat bacteria at interfaces. Towards the overall goal, novel prodrugs for fluoroquinolone antibiotics were developed on a privileged glucuronide scaffold. Whereas carbamoyl prodrugs were not stable and not suitable for EPT, glucuronides containing self-immolative linker between glucuronic acid masking group and the antibiotic were stable in solution and readily underwent bioconversion in the presence of β-glucuronidase. Surface coatings for model biomaterials were engineered using sequential polymer deposition technique. Resulting coatings afforded fast prodrug conversion and mediated antibacterial measures against planktonic species as evidenced by pronounced zone of bacterial growth inhibition around the biomaterial surface. These biomaterials coupled with the glucuronide prodrugs also effectively combatted bacteria within established biofilms and also successfully prevented bacterial colonization of the surface. To our knowledge, this is the first report of EPT engineered to the surface of biomaterials to mediate antibacterial measures.
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Affiliation(s)
- Raoul Walther
- Department of Chemistry, Aarhus University, Aarhus 8000, Denmark
| | - Signe Maria Nielsen
- Interdisciplinary Nanoscience Centre (iNANO), Aarhus University, Aarhus 8000, Denmark
| | - Rikke Christiansen
- Interdisciplinary Nanoscience Centre (iNANO), Aarhus University, Aarhus 8000, Denmark
| | - Rikke L Meyer
- Interdisciplinary Nanoscience Centre (iNANO), Aarhus University, Aarhus 8000, Denmark.
| | - Alexander N Zelikin
- Department of Chemistry, Aarhus University, Aarhus 8000, Denmark; Interdisciplinary Nanoscience Centre (iNANO), Aarhus University, Aarhus 8000, Denmark.
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23
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Gualtierotti R, Parisi M, Ingegnoli F. Perioperative Management of Patients with Inflammatory Rheumatic Diseases Undergoing Major Orthopaedic Surgery: A Practical Overview. Adv Ther 2018; 35:439-456. [PMID: 29556907 PMCID: PMC5910481 DOI: 10.1007/s12325-018-0686-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 02/06/2023]
Abstract
Patients with inflammatory rheumatic diseases often need orthopaedic surgery due to joint involvement. Total hip replacement and total knee replacement are frequent surgical procedures in these patients. Due to the complexity of the inflammatory rheumatic diseases, the perioperative management of these patients must envisage a multidisciplinary approach. The frequent association with extraarticular comorbidities must be considered when evaluating perioperative risk of the patient and should guide the clinician in the decision-making process. However, guidelines of different medical societies may vary and are sometimes contradictory. Orthopaedics should collaborate with rheumatologists, anaesthesiologists and, when needed, cardiologists and haematologists with the common aim of minimising perioperative risk in patients with inflammatory rheumatic diseases. The aim of this review is to provide the reader with simple practical recommendations regarding perioperative management of drugs such as disease-modifying anti-rheumatic drugs, corticosteroids, non-steroidal anti-inflammatory drugs and tools for a risk stratification for cardiovascular and thromboembolic risk based on current evidence for patients with inflammatory rheumatic diseases.
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Abstract
The Center for Disease Control and Prevention recently released their 2017 Guideline for the Prevention of Surgical Site Infection. One of their recommendations is the ordering of a single dose of preoperative prophylactic antibiotics with no subsequent postoperative dosing; this recommendation includes perioperative antibiotics for patients undergoing total joint arthroplasty. At this time, the American Association of Hip and Knee Surgeons (AAHKS) does not agree with this recommendation vis-a-vis total joint arthroplasty because it contradicts current international standards of care with limited evidence and study. AAHKS still recommends postoperative antibiotics and recommends further research. Both the Board of Counselors and Board of Specialty Societies of the American Academy of Orthopaedic Surgeons have endorsed this AAHKS recommendation through an advisory opinion; the American Academy of Orthopaedic Surgeons Board of Directors adopted that advisory opinion in June 2017. A 2017 Foundation for Arthroplasty Research and Education prospective, randomized study is being undertaken to provide level I evidence for or against single-dose vs 24-hour antibiotic prophylaxis in primary total knee arthroplasty.
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Affiliation(s)
- Adolph J. Yates
- Corresponding author. 9400 West Higgins Road, Suite 230, Rosemont, IL, 60016, USA. Tel.: +1 412 802 4100.9400 West Higgins Road, Suite 230RosemontIL60016USA
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25
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Göçer H, Yazici AK, Polat AV. Should venous doppler ultrasonography be routinely applied before lower extremity major orthopedic surgery? Niger Med J 2017; 58:32-36. [PMID: 29238126 PMCID: PMC5715564 DOI: 10.4103/0300-1652.218410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Hip-knee arthroplasty and knee arthroscopy (KA) is frequently applied in the orthopaedic surgery. The approach does not exist related with the preoperative asymptomatic deep venous thrombosis (DVT). In this study, the patients who would undergo surgery lower extremity were screened for asymptomatic DVT, using the venous Doppler ultrasonography (USG). Patients and Methods DVT was screened by venous Doppler USG in the patients who would undergo hip-knee arthroplasty and KA between the dates of November 2013 and September 2015. The patients were investigated regarding the age, gender, and the planned operation. The cases were separated to the following three groups: group I (<49 years), Group II (49-69 years), and Group III (≥70 years). Results The study included 222 patients; of these, 174 were female and 48 were male. Group I, Group II, and Group III included 45, 115, and 62 patients, respectively. Of the six patients determined to exist with DVT, 2 (1.73%) were in Group II, and 4 (6.45%) were in Group III. Conclusion Although the differences were not found to be statistically significant, it may be useful to screen asymptomatic DVT by Doppler USG in the preoperative period in the 70-year-old male patients, and in those over 70.
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Affiliation(s)
- Hasan Göçer
- Department of Orthopaedics, Hospital of Ondokuz Mayis University, Samsun, Turkey
| | | | - Ahmet Veysel Polat
- Department of Radiology, Hospital of Ondokuz Mayis University, Samsun, Turkey
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26
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Bereza PL, Ekiel A, Auguściak-duma A, Aptekorz M, Wilk I, Wojciechowski P, Kusz DJ, Martirosian G. Identification of Asymptomatic Prosthetic Joint Infection: Microbiologic and Operative Treatment Outcomes. Surg Infect (Larchmt) 2017; 18:582-7. [DOI: 10.1089/sur.2016.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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27
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Saeed K, Dryden M, Bassetti M, Bonnet E, Bouza E, Chan M, Cortes N, Davis JS, Esposito S, Giordano G, Gould I, Hartwright D, Lye D, Marin M, Morgan-Jones R, Lajara-Marco F, Righi E, Romano CL, Segreti J, Unal S, Williams RL, Yalcin AN. Prosthetic joints: shining lights on challenging blind spots. Int J Antimicrob Agents 2017; 49:153-161. [DOI: 10.1016/j.ijantimicag.2016.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/23/2016] [Accepted: 10/01/2016] [Indexed: 12/12/2022]
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28
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Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017;224:59-74. [PMID: 27915053 DOI: 10.1016/j.jamcollsurg.2016.10.029] [Citation(s) in RCA: 538] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
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29
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Gallo J, Panacek A, Prucek R, Kriegova E, Hradilova S, Hobza M, Holinka M. Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection. Materials (Basel) 2016; 9:E337. [PMID: 28773461 PMCID: PMC5503077 DOI: 10.3390/ma9050337] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023]
Abstract
Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty associated with increased morbidity and mortality. There is a growing body of evidence that bacterial colonization and biofilm formation are critical pathogenic events in PJI. Thus, the choice of biomaterials for implanted prostheses and their surface modifications may significantly influence the development of PJI. Currently, silver nanoparticle (AgNP) technology is receiving much interest in the field of orthopaedics for its antimicrobial properties and a strong anti-biofilm potential. The great advantage of AgNP surface modification is a minimal release of active substances into the surrounding tissue and a long period of effectiveness. As a result, a controlled release of AgNPs could ensure antibacterial protection throughout the life of the implant. Moreover, the antibacterial effect of AgNPs may be strengthened in combination with conventional antibiotics and other antimicrobial agents. Here, our main attention is devoted to general guidelines for the design of antibacterial biomaterials protected by AgNPs, its benefits, side effects and future perspectives in PJI prevention.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
| | - Ales Panacek
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Robert Prucek
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 3, Olomouc 779 00, Czech Republic.
| | - Sarka Hradilova
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Martin Hobza
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
| | - Martin Holinka
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
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30
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Affiliation(s)
- A H R W Simpson
- The Bone and Joint Journal, 22 Buckingham Street, London, WC2N 6ET, UK
| | - J Dave
- The Royal London Hospital, Barts Health NHS Trust, 3rd floor Pathology and Pharmacy Building, 80 Newark Street, London, E1 2ES, UK
| | - M Ghert
- The Bone and Joint Journal, 22 Buckingham Street, London, WC2N 6ET, UK
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31
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Affiliation(s)
- Andrew M Morris
- Department of Medicine, Mount Sinai Hospital, University Health Network (Morris); University of Toronto (Morris); Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre (Gollish); Department of Surgery, University of Toronto (Gollish), Toronto, Ont.
| | - Jeffrey Gollish
- Department of Medicine, Mount Sinai Hospital, University Health Network (Morris); University of Toronto (Morris); Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre (Gollish); Department of Surgery, University of Toronto (Gollish), Toronto, Ont
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