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Theil C, Bockholt S, Gosheger G, Dieckmann R, Schwarze J, Schulze M, Puetzler J, Moellenbeck B. Surgical Management of Periprosthetic Joint Infections in Hip and Knee Megaprostheses. Medicina (Kaunas) 2024; 60:583. [PMID: 38674229 PMCID: PMC11051768 DOI: 10.3390/medicina60040583] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Periprosthetic joint infection is a feared complication after the megaprosthetic reconstruction of oncologic and non-oncologic bone defects of including the knee or hip joint. Due to the relative rarity of these procedures, however, optimal management is debatable. Considering the expanding use of megaprostheses in revision arthroplasty and the high revision burden in orthopedic oncology, the risk of PJI is likely to increase over the coming years. In this non-systematic review article, we present and discuss current management options and the associated results focusing on studies from the last 15 years and studies from dedicated centers or study groups. The indication, surgical details and results in controlling infection are presented for debridement, antibiotics, irrigation and retention (DAIR) procedure with an exchange of the modular components, single-stage implant exchange, two-stage exchanges and ablative procedures.
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Affiliation(s)
- Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Sebastian Bockholt
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
- Department of Orthopedics, Brüderkrankenhaus Trier, Medical Campus Trier, Nordallee 1, 54292 Trier, Germany
| | - Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Martin Schulze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Puetzler
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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Mira NP, Marshall R, Pinheiro MJF, Dieckmann R, Dahouk SA, Skroza N, Rudnicka K, Lund PA, De Biase D. On the potential role of naturally occurring carboxylic organic acids as anti-infective agents: opportunities and challenges. Int J Infect Dis 2024; 140:119-123. [PMID: 38325748 DOI: 10.1016/j.ijid.2024.01.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
Carboxylic organic acids are intermediates of central carbon metabolic pathways (e.g. acetic, propionic, citric, and lactic acid) long known to have potent antimicrobial potential, mainly at acidic pHs. The food industry has been leveraging those properties for years, using many of these acids as preservatives to inhibit the growth of pathogenic and/or spoilage fungal and bacterial species. A few of these molecules (the most prominent being acetic acid) have been used as antiseptics since Hippocratic medicine, mainly to treat infected wounds in patients with burns. With the growth of antibiotic therapy, the use of carboxylic acids (and other chemical antiseptics) in clinical settings lost relevance; however, with the continuous emergence of multi-antibiotic/antifungal resistant strains, the search for alternatives has intensified. This prospective article raises awareness of the potential of carboxylic acids to control infections in clinical settings, considering not only their previous exploitation in this context (which we overview) but also the positive experience of their safe use in food preservation. At a time of great concern with antimicrobial resistance and the slow arrival of new antimicrobial therapeutics to the market, further exploration of organic acids as anti-infective molecules may pave the way to more sustainable prophylactic and therapeutic approaches.
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Affiliation(s)
- Nuno Pereira Mira
- iBB, Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
| | - Robert Marshall
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Maria Joana F Pinheiro
- iBB, Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, Department of Biological Safety, Berlin, Germany
| | - Nevena Skroza
- Unit of Dermatology, Department of Medico-Surgical Science and Biotechnologies, Sapienza University of Rome, A. Fiorini Hospital, Latina, Italy
| | - Karolina Rudnicka
- Department of Immunology and Infectious Biology, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Peter A Lund
- Associate Laboratory i4HB-Institute for Health and Bioeconomy at Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela De Biase
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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Neuhaus S, Brockmann S, Al Dahouk S, Dieckmann R. Survey on microbial contamination of opened skin care products used for tattooing. J Appl Microbiol 2023; 134:lxad243. [PMID: 37884452 DOI: 10.1093/jambio/lxad243] [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] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 10/28/2023]
Abstract
AIMS Inadequate hygiene measures as well as the use of contaminated inks or non-sterile needles are considered as important infection sources in the process of tattooing. In tattoo parlors and at conventions, it is common practice to apply cosmetic products from bulk packs as lubricants during tattooing and as ointments for tattoo aftercare. The objective of our study was to assess the microbial load of opened skin care products used during tattooing or for tattoo aftercare. METHODS AND RESULTS First, we established a homogenization method suitable for the microbiological examination of water-immiscible products. To this end, we compared the efficiency of FastPrepTM and Stomacher® homogenizers on artificially contaminated petroleum jelly. FastPrep homogenates revealed significantly higher detection rates (≥97%) compared to Stomacher ones (31%-64%). Second, we investigated 106 cosmetic bulk pack products collected from tattoo artists. After FastPrep homogenization for 30 seconds, total aerobic mesophilic bacteria and the presence of Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans were determined through culture. We also tested for Mycobacteria spp. by qPCR. In total, 4.7% of the cosmetic products under study turned out to be contaminated. CONCLUSION The observed microbial contamination of opened skin care bulk packs can hold a risk to introduce bacteria into the fresh skin wound resulting from tattooing and may be a risk factor for post-tattoo infections.
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Affiliation(s)
- Szilvia Neuhaus
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin 10589, Germany
| | - Stefan Brockmann
- Department of Health Protection and Epidemiology, Baden-Wuerttemberg State Health Office, Stuttgart 70191, Germany
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin 10589, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, Aachen 52074, Germany
| | - Ralf Dieckmann
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin 10589, Germany
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da Silva DAV, Dieckmann R, Makarewicz O, Hartung A, Bethe A, Grobbel M, Belik V, Pletz MW, Al Dahouk S, Neuhaus S. Biocide Susceptibility and Antimicrobial Resistance of Escherichia coli Isolated from Swine Feces, Pork Meat and Humans in Germany. Antibiotics (Basel) 2023; 12:antibiotics12050823. [PMID: 37237726 DOI: 10.3390/antibiotics12050823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Phenotypic susceptibility testing of Escherichia (E.) coli is an essential tool to gain a better understanding of the potential impact of biocide selection pressure on antimicrobial resistance. We, therefore, determined the biocide and antimicrobial susceptibility of 216 extended-spectrum β-lactamase-producing (ESBL) and 177 non-ESBL E. coli isolated from swine feces, pork meat, voluntary donors and inpatients and evaluated associations between their susceptibilities. Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of benzalkonium chloride, chlorhexidine digluconate (CHG), chlorocresol (PCMC), glutaraldehyde (GDA), isopropanol (IPA), octenidine dihydrochloride and sodium hypochlorite (NaOCl) showed unimodal distributions, indicating the absence of bacterial adaptation to biocides due to the acquisition of resistance mechanisms. Although MIC95 and MBC95 did not vary more than one doubling dilution step between isolates of porcine and human origin, significant differences in MIC and/or MBC distributions were identified for GDA, CHG, IPA, PCMC and NaOCl. Comparing non-ESBL and ESBL E. coli, significantly different MIC and/or MBC distributions were found for PCMC, CHG and GDA. Antimicrobial susceptibility testing revealed the highest frequency of resistant E. coli in the subpopulation isolated from inpatients. We observed significant but weakly positive correlations between biocide MICs and/or MBCs and antimicrobial MICs. In summary, our data indicate a rather moderate effect of biocide use on the susceptibility of E. coli to biocides and antimicrobials.
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Affiliation(s)
- David Attuy Vey da Silva
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
| | - Ralf Dieckmann
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
| | - Oliwia Makarewicz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
| | - Anita Hartung
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
| | - Astrid Bethe
- Institute of Microbiology and Epizootics, Centre for Infection Medicine, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Mirjam Grobbel
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
| | - Vitaly Belik
- System Modeling Group, Institute of Veterinary Epidemiology and Biostatistics, Department of Veterinary Medicine, Freie Universität Berlin, 14163 Berlin, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Szilvia Neuhaus
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany
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Neuhaus S, Feßler AT, Dieckmann R, Thieme L, Pletz MW, Schwarz S, Al Dahouk S. Towards a Harmonized Terminology: A Glossary for Biocide Susceptibility Testing. Pathogens 2022; 11:pathogens11121455. [PMID: 36558789 PMCID: PMC9780826 DOI: 10.3390/pathogens11121455] [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: 11/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Disinfection is a key strategy to reduce the burden of infections. The contact of bacteria to biocides-the active substances of disinfectants-has been linked to bacterial adaptation and the development of antimicrobial resistance. Currently, there is no scientific consensus on whether the excessive use of biocides contributes to the emergence and spread of multidrug resistant bacteria. The comprehensive analysis of available data remains a challenge because neither uniform test procedures nor standardized interpretive criteria nor harmonized terms are available to describe altered bacterial susceptibility to biocides. In our review, we investigated the variety of criteria and the diversity of terms applied to interpret findings in original studies performing biocide susceptibility testing (BST) of field isolates. An additional analysis of reviews summarizing the knowledge of individual studies on altered biocide susceptibility provided insights into currently available broader concepts for data interpretation. Both approaches pointed out the urgent need for standardization. We, therefore, propose that the well-established and approved concepts for interpretation of antimicrobial susceptibility testing data should serve as a role model to evaluate biocide resistance mechanisms on a single cell level. Furthermore, we emphasize the adaptations necessary to acknowledge the specific needs for the evaluation of BST data. Our approach might help to increase scientific awareness and acceptance.
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Affiliation(s)
- Szilvia Neuhaus
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Correspondence: (S.N.); (R.D.)
| | - Andrea T. Feßler
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Correspondence: (S.N.); (R.D.)
| | - Lara Thieme
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
- Leibniz Center for Photonics in Infection Research, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| | - Mathias W. Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, 07747 Jena, Germany
| | - Stefan Schwarz
- Centre for Infection Medicine, Department of Veterinary Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, 14163 Berlin, Germany
- Veterinary Centre for Resistance Research (TZR), Freie Universität Berlin, 14163 Berlin, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, 10589 Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
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Krenn VT, Liebisch M, Dufour M, Dieckmann R, Krenn V. [Histopathological diagnostics of arthrofibrosis]. Unfallchirurgie (Heidelb) 2022; 125:862-867. [PMID: 35997801 DOI: 10.1007/s00113-022-01239-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
Joint surgery is one of the most important and successful disciplines in surgery; nevertheless, complications still occur, especially in total knee arthroplasty and surgery of the anterior cruciate ligament. A significant disease in this context is arthrofibrosis. This review article presents the cellular and molecular pathogenetic concept of arthrofibrosis, the spectrum of histopathological diagnostics and differential diagnostics and a classification into joint endoprosthesis-associated and non-joint endoprosthesis-associated arthrofibrosis is proposed. The basis of the histopathological diagnostics is the standardized tissue removal with subsequent fixation in formalin. In the case of joint implant failure and the problem of endoprosthesis-associated arthrofibrosis, the histopathological diagnostics can be carried out according to the consensus classification of synovia-like interface membrane (SLIM). Arthrofibrosis is characterized by fibrosis, a high fibroblast cellularity with immunohistochemical detection of cytoplasmic beta catenin expression. The presence of endoprosthesis-associated arthrofibrosis is probable above a threshold of 20 beta catenin positive fibroblasts per high-power field (HPF). The diagnosis of a non-endoprosthesis-associated arthrofibrosis can be classified according to the joint pathology algorithm. Diffuse non-endoprosthesis-associated arthrofibrosis is characterized by generalized proliferation of connective tissue in the whole joint and localized circumscribed arthrofibrosis is characterized by a nodose cyclops-like fibrosis. The clarification of the cause of arthrofibrosis is based on an interdisciplinary cooperation. In addition to the histopathological diagnostics, this includes clinical, surgical, biomechanical, arthroscopic, microbiological, laboratory parameter and radiological findings.
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Affiliation(s)
- V T Krenn
- Sigmund Freud PrivatUniversität Wien, Wien, Österreich
| | - M Liebisch
- Sigmund Freud PrivatUniversität Wien, Wien, Österreich
| | - M Dufour
- Sigmund Freud PrivatUniversität Wien, Wien, Österreich
| | - R Dieckmann
- Brüderkrankenhaus Trier, Akademisches Lehrkrankenhaus, Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, GmbH Trier, Max-Planck-Str. 5, 54296, Trier, Deutschland.
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Schwarze J, Dieckmann R, Gosheger G, Bensmann M, Moellenbeck B, Theil C. Unsuspected Positive Cultures in Planned Aseptic Revision Knee or Hip Arthroplasty-Risk Factors and Impact on Survivorship. J Arthroplasty 2022; 37:1165-1172. [PMID: 35189293 DOI: 10.1016/j.arth.2022.02.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/03/2022] [Revised: 02/03/2022] [Accepted: 02/12/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Unsuspected positive cultures (UPCs) may be found at the time of planned aseptic revision surgery and have previously been associated with decreased implant survival. However, reported rates vary greatly, and potential risk factors are widely unknown. This study investigates the rate of UPCs, implant survival, as well as potential risk factors for UPCs and revision. METHODS This is a retrospective, single-center study on 434 cases of total hip arthroplasty (THA 277) and knee revision arthroplasty (TKA 157) performed between 2010 and 2017. Microbiology culture results, revision-free survival (RFS) and infection-free (IFS) survival, and the potential impact of UPCs as well as patient- or procedure-related risk factors were investigated at a minimum follow-up of 24 months (median 41 months). RESULTS A total of 37% of patients had a positive culture (160/434). 27% (119/434) had a solitary positive culture, and 9% (41/434) had ≥2 positive cultures of the same species. Most commonly, coagulase-negative staphylococci were cultured. Overall, 32% (13/41) of patients with ≥2 positive cultures underwent revision for infection compared with 6% (17/274) of patients with negative cultures. RFS and IFS were reduced if ≥2 cultures were positive. Single positive cultures had no impact on RFS or IFS. Male sex, elevated serum C-reactive protein, and obesity were independently associated with finding ≥2 UPCs in revision THA. CONCLUSION Appearance of ≥2 UPCs in aseptic revision leads to reduced RFS and IFS. Males, obese patients, and patients with elevated serum C-reactive protein planned for THA revision should be considered for extended diagnostics to rule out periprosthetic joint infection.
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Affiliation(s)
- Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Ralf Dieckmann
- Department for Orthopaedics and Trauma Surgery, Krankenhaus der Barmherzigen Brueder Trier, Trier, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Matthias Bensmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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Theil C, Roedl R, Gosheger G, Moellenbeck B, Frommer A, Dieckmann R, Vogt B. Total joint replacement of the hip and knee in patients with arthrogryposis multiplex congenita: a report of six joints. Arch Orthop Trauma Surg 2022; 142:181-188. [PMID: 33040207 PMCID: PMC8783901 DOI: 10.1007/s00402-020-03611-3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Arthrogryposis multiplex congenita (AMC) is a rare congenital condition that leads to severe joint contractures and deformities. As painful joint dysplasia and degeneration might develop over time, total joint replacement (TJR) can be a potential treatment option for these patients. The aim of this study is to investigate functional results, implant survivorship and potential complications in patients with AMC who undergo hip or knee arthroplasty. MATERIALS AND METHODS We retrospectively identified six TJR in three patients at a single centre performed between 2006 and 2019. The median patient age at surgery was 23 years and the median follow-up period was 69 (IQR 55-99) months. We analysed surgical technique, implant survivorship and complications as well as functional outcome determined by pain reported on the Numerical Rating Scale (NRS), patient-reported outcome scores [Oxford Hip Score (OHS), Harris Hip score (HHS), Oxford Knee Score (OKS)], range of motion and ambulatory status. Depending on data distribution means with ranges and median with interquartile range were compared with the Wilcoxon signed rank test or Student's t test. The level of significance was defined at < 0.05. RESULTS In hips, the mean range of motion in flexion/extension (52° vs. 85°, p = 0.014) and in rotation (28° vs. 68°, p = 0.02) as well as mean pain score on the NRS (8.5 vs. 0, p = 0.001), OHS (9 vs. 26, p = 0.031) and HHS (17 vs. 52, p = 0.007) significantly improved. In knees, mean range of motion (55° vs. 93°, p = 0.403), mean pain score on the NRS (0 vs. 7) and the OKS (2 vs. 21) also improved. While the ambulatory status did not change, the patients who were wheelchair dependent reported less problems with transfers to a bed or chair and the patient who ambulated reported an improved walking distance. One total knee arthroplasty (TKA) underwent revision for an acute, late infection 155 months following the initial surgery. CONCLUSIONS TJR is a safe procedure in patients with AMC that effectively improves function and reduces pain irrespective of preoperative ambulatory status.
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Affiliation(s)
- Christoph Theil
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Robert Roedl
- Divison of Children’s Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Adrien Frommer
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
- Divison of Children’s Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Bjoern Vogt
- Divison of Children’s Orthopaedics, Deformity Correction and Foot Surgery, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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Theil C, Schneider KN, Gosheger G, Schmidt-Braekling T, Ackmann T, Dieckmann R, Frommer A, Klingebiel S, Schwarze J, Moellenbeck B. Revision TKA with a distal femoral replacement is at high risk of reinfection after two-stage exchange for periprosthetic knee joint infection. Knee Surg Sports Traumatol Arthrosc 2022; 30:899-906. [PMID: 33564916 PMCID: PMC8901466 DOI: 10.1007/s00167-021-06474-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Megaprosthetic distal femoral reconstruction (DFR) is a limb-salvage procedure to address bone loss following two-stage revision for periprosthetic knee joint infection (PJI). The purpose of this study was to analyze the survival of DFR compared to hinged total knee arthroplasty (TKA). It was hypothesized that DFR was associated with a poorer survival. METHODS In this retrospective single-center study, 97 subjects who underwent two-stage revision of chronic knee PJI were included. Among these, 41 were DFR. The diagnosis of PJI was established using the Musculoskeletal Infection Society (MSIS) criteria. Implant survival was calculated using Kaplan-Meier method and compared with the log-rank test as well as multivariate Cox regression at a minimum follow-up period of 24 months. RESULTS The median follow-up period was 59 (interquartile range (IQR) 45-78) months. Overall, 24% (23/97) of patients required revision surgery for infection. The infection-free survival of rotating hinge revision TKA was 93% (95% Confidence Interval (CI) 86-100%) at five years compared to 50% (95% CI 34-66%) for DFR. In multivariate analysis, the risk factors for reinfection were DFR reconstruction (HR 4.7 (95% CI 1-22), p = 0.048), length of megaprosthesis (HR 1.006 (95% CI 1.001-1.012), p = 0.032) and higher BMI (HR 1.066, 95% CI 1.018-1.116), p = 0.007). 10% (4/41) of patients undergoing DFR underwent amputation to treat recurrent infection. CONCLUSION Megaprosthetic DFR as part of a two-stage exchange for PJI is a salvage treatment that has a high risk for reinfection compared to non-megaprosthetic TKA. Patients must therefore be counseled accordingly. LEVEL OF EVIDENCE Retrospective observational study, Level IV.
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Affiliation(s)
- Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Kristian Nikolaus Schneider
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Tom Schmidt-Braekling
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Thomas Ackmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Ralf Dieckmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Adrien Frommer
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Sebastian Klingebiel
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Schwarze
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Burkhard Moellenbeck
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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10
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Eiden S, Bormann T, Kretzer JP, Dieckmann R, Krenn V. [Typing and particle analysis of squeaking hip endoprostheses : First histopathological analysis to examine the squeaking pathogenesis of ceramic-on-ceramic bearings]. Orthopade 2021; 50:1032-1038. [PMID: 34255131 DOI: 10.1007/s00132-021-04133-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Since the use of ceramic-on-ceramic (CoC) hip endoprostheses complications in the form of squeaking noises have occasionally occurred. OBJECTIVES This is the first histopathological analysis of the synovia-like interface membrane (SLIM) of ceramic squeaking hip endoprostheses with the aim to gain new insights into the squeaking pathogenesis. MATERIALS AND METHODS Seven CoC hip endoprostheses with squeaking pathogenesis are analyzed by SLIM consensus classification, particle algorithm, CD3 quantification, semiquantitative CD68 macrophages, Oil-Red positive macrophages, hemosiderin evaluation and in two cases by energy dispersive X‑ray spectroscopy (EDX). RESULTS In 1733 hip joint prosthesis pathology cases, a squeaking revision incidence of 0.40% was determined. In addition to SLIM type I (1/7), only SLIM type IV (6/7) was detected. 4/7 CoC cases showed combinations of micro, macro and, for the first time, supramacro (166.5 µm) ceramic wear particles. The EDX analysis confirmed the ceramic and an additional metallic abrasion. Increased focal concentrated low inflammatory markers (CD3/CD68) with hemosiderin (5/7) and lipid depositions (Oil-Red positive macrophages) (6/7) occurred. CONCLUSIONS A pathogenetic connection between SLIM type I/IV and squeaking can be assumed. SLIM types showed a partly light microscopic ceramic particle-dependent, partly independent predominantly low-grade inflammation. Hemosiderin and Oil-Red positive macrophages are signs of synovial tissue damage and indicate biomechanical misload (impingement) and dysfunction as cause of the squeaking pathogenesis.
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Affiliation(s)
- Stephanie Eiden
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik GmbH, Max-Planck-Straße 5, 54296, Trier, Deutschland
| | - Therese Bormann
- Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Jan Philippe Kretzer
- Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | | | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik GmbH, Max-Planck-Straße 5, 54296, Trier, Deutschland.
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Theil C, Schneider KN, Gosheger G, Dieckmann R, Deventer N, Hardes J, Schmidt-Braekling T, Andreou D. Does the Duration of Primary and First Revision Surgery Influence the Probability of First and Subsequent Implant Failures after Extremity Sarcoma Resection and Megaprosthetic Reconstruction? Cancers (Basel) 2021; 13:cancers13112510. [PMID: 34063771 PMCID: PMC8196552 DOI: 10.3390/cancers13112510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/02/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Tumor endoprostheses are a common type of reconstruction after the resection of an extremity bone sarcoma. However, in the long-term, first and subsequent implant failures leading to revision surgery are common. One potential risk factor for implant failure is the length of surgery. This study investigates the impact of the length of surgery on prosthetic survival in 568 patients with sarcoma. Patients who had a first implant failure had a longer surgery; however, there were no differences in the infection-free survival, but only in the probability of mechanical failure. Patients with a subsequent revision surgery for infection had a shorter duration of surgery during the first revision. In conclusion, a shorter surgery appears beneficial; however, longer surgeries are not clearly associated with infection. In revision surgery, a longer operating time, indicating a more thorough debridement, may be desirable. Abstract Complications in megaprosthetic reconstruction following sarcoma resection are quite common. While several risk factors for failure have been explored, there is a scarcity of studies investigating the effect of the duration of surgery. We performed a retrospective study of 568 sarcoma patients that underwent megaprosthetic reconstruction between 1993 and 2015. Differences in the length of surgery and implant survival were assessed with the Kaplan–Meier method, the log-rank test and multivariate Cox regressions using an optimal cut-off value determined by receiver operating curves analysis using Youden’s index. 230 patients developed a first and 112 patients a subsequent prosthetic failure. The median duration of initial surgery was 210 min. Patients who developed a first failure had a longer duration of the initial surgery (225 vs. 205 min, p = 0.0001). There were no differences in the probability of infection between patients with longer and shorter duration of initial surgery (12% vs. 13% at 5 years, p = 0.492); however, the probability of mechanical failure was higher in patients with longer initial surgery (38% vs. 23% at 5 years, p = 0.006). The median length of revision surgery for the first megaprosthetic failure was 101 min. Patients who underwent first revision for infection and did not develop a second failure had a longer median duration of the first revision surgery (150 min vs. 120 min, p = 0.016). A shorter length of the initial surgery appears beneficial, however, the notion that longer operating time increases the risk of deep infection could not be reproduced in our study. In revision surgery for infection, a longer operating time, possibly indicating a more thorough debridement, appears to be associated with a lower risk for subsequent revision.
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Affiliation(s)
- Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Correspondence: ; Tel.: +49-2514-4278
| | - Kristian Nikolaus Schneider
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Ralf Dieckmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Orthopedics, Krankenhaus der Barmherzigen Brueder, Nordallee 1, 54292 Trier, Germany
| | - Niklas Deventer
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Jendrik Hardes
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Musculoskeletal Oncology, Essen University Hospital, Hufelandstraße 55, 45147 Essen, Germany
| | - Tom Schmidt-Braekling
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149 Muenster, Germany; (K.N.S.); (G.G.); (R.D.); (N.D.); (J.H.); (T.S.-B.); (D.A.)
- Department of Orthopedic Oncology and Sarcoma Surgery, Sarcoma Centre Berlin-Brandenburg, Helios Klinikum Bad Saarow, 15526 Bad Saarow, Germany
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12
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Ackmann T, Schwarze J, Gosheger G, Schmidt-Braekling T, Schneider KN, Dieckmann R, Klingebiel S, Moellenbeck B, Theil C. The change in plasma D-dimer does not help to guide the timing of reimplantation in two stage exchange for periprosthetic joint infection. Sci Rep 2021; 11:7323. [PMID: 33795812 PMCID: PMC8016946 DOI: 10.1038/s41598-021-86890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Abstract
D-dimer has been included in the criteria by the Musculoskeletal Infection Society in 2018 as a novel parameter to diagnose prosthetic joint infection (PJI). However, it is unclear how D-dimer levels change in between stages of a two-stage exchange. We prospectively investigated 30 patients who underwent a two-stage exchange using a spacer for PJI. D-Dimer, CRP and IL-6 were collected before first and second stage surgery and the difference (Δ) in between stages was calculated. The levels of plasma D-Dimer did not change from first to second stage surgery (2770 ng/ml (IQR, 1600–3770 ng/ml) versus 2340 ng/ml (IQR, 1270–4100 ng/ml); p = 0.8) while CRP (4.0 mg/dl (IQR, 1.7–5.5 mg/dl) versus 0.6 mg/dl (IQR, 0.5–0.8 mg/dl); p < 0.001) and IL-6 (21 pg/ml (IQR, 10–29 pg/ml) versus 6 pg/ml (4–9 pg/ml); p < 0.001) decreased. The ΔD-dimer between both stages was 300 ng/ml (range: − 2820 to 4280 ng/ml), the median ΔCRP was − 3.4 mg/dl (IQR, − 1.2 to − 4.8 mg/dl) and ΔIL-6 was − 13 pg/ml (IQR, − 4 to − 20 pg/ml). In 15 of 30 cases (50%) the D-dimer level increased between both stages, whereas the level of CRP (93%; 28/30) and IL-6 (96%; 28/29) decreased in most patients. As the level of serum D-dimers varies greatly, lacks a uniform decrease and does not identify persisting infection, surgeons should be cautious when using it at the timing of reimplantation.
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Affiliation(s)
- Thomas Ackmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedic Surgery, Barmherzige Brüder Hospital, 54292, Trier, Germany
| | - Sebastian Klingebiel
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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13
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Lüth S, Halbedel S, Rosner B, Wilking H, Holzer A, Roedel A, Dieckmann R, Vincze S, Prager R, Flieger A, Al Dahouk S, Kleta S. Backtracking and forward checking of human listeriosis clusters identified a multiclonal outbreak linked to Listeria monocytogenes in meat products of a single producer. Emerg Microbes Infect 2021; 9:1600-1608. [PMID: 32657219 PMCID: PMC7473094 DOI: 10.1080/22221751.2020.1784044] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 12/24/2022]
Abstract
Due to its high case fatality rate, foodborne listeriosis is considered a major public health concern worldwide. We describe one of the largest listeriosis outbreaks in Germany with 83 cases of invasive listeriosis between 2013 and 2018. As part of the outbreak investigation, we identified a highly diverse Listeria monocytogenes population at a single producer of ready-to-eat meat products. Strikingly, the extensive sampling after identification of a first match between a cluster of clinical isolates and a food isolate allowed for a linkage between this producer and a second, previously unmatched cluster of clinical isolates. Bacterial persistence in the processing plant and indications of cross-contamination events explained long-term contamination of food that led to the protracted outbreak. Based on screening for virulence factors, a pathogenic phenotype could not be ruled out for other strains circulating in the plant, suggesting that the outbreak could have been even larger. As most isolates were sensitive to common biocides used in the plant, hard to clean niches in the production line may have played a major role in the consolidation of the contamination. Our study demonstrates how important it is to search for the origin of infection when cases of illness have occurred (backtracking), but also clearly highlights that it is equally important to check whether a contamination at food or production level has caused disease (forward checking). Only through this two-sided control strategy, foodborne disease outbreaks such as listeriosis can be minimized, which could be a real improvement for public health.
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Affiliation(s)
- Stefanie Lüth
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.,Department of Biology, Chemistry and Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Sven Halbedel
- Department of Infectious Diseases, Robert Koch-Institute, Wernigerode, Germany
| | - Bettina Rosner
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Hendrik Wilking
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Alexandra Holzer
- Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany
| | - Alice Roedel
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Ralf Dieckmann
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Szilvia Vincze
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Rita Prager
- Department of Infectious Diseases, Robert Koch-Institute, Wernigerode, Germany
| | - Antje Flieger
- Department of Infectious Diseases, Robert Koch-Institute, Wernigerode, Germany
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany.,Department of Internal Medicine III, RWTH Aachen University Hospital, Aachen, Germany
| | - Sylvia Kleta
- Department of Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
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14
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Lemoine L, Dieckmann R, Al Dahouk S, Vincze S, Luch A, Tralau T. Microbially competent 3D skin: a test system that reveals insight into host-microbe interactions and their potential toxicological impact. Arch Toxicol 2020; 94:3487-3502. [PMID: 32681188 PMCID: PMC7502063 DOI: 10.1007/s00204-020-02841-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
The skin`s microbiome is predominantly commensalic, harbouring a metabolic potential far exceeding that of its host. While there is clear evidence that bacteria-dependent metabolism of pollutants modulates the toxicity for the host there is still a lack of models for investigating causality of microbiome-associated pathophysiology or toxicity. We now report on a biologically characterised microbial-skin tissue co-culture that allows studying microbe-host interactions for extended periods of time in situ. The system is based on a commercially available 3D skin model. In a proof-of-concept, this model was colonised with single and mixed cultures of two selected skin commensals. Two different methods were used to quantify the bacteria on the surface of the skin models. While Micrococcus luteus established a stable microbial-skin tissue co-culture, Pseudomonas oleovorans maintained slow continuous growth over the 8-day cultivation period. A detailed skin transcriptome analysis showed bacterial colonisation leading to up to 3318 significant changes. Additionally, FACS, ELISA and Western blot analyses were carried out to analyse secretion of cytokines and growth factors. Changes found in colonised skin varied depending on the bacterial species used and comprised immunomodulatory functions, such as secretion of IL-1α/β, Il-6, antimicrobial peptides and increased gene transcription of IL-10 and TLR2. The colonisation also influenced the secretion of growth factors such as VFGFA and FGF2. Notably, many of these changes have already previously been associated with the presence of skin commensals. Concomitantly, the model gained first insights on the microbiome's influence on skin xenobiotic metabolism (i.e., CYP1A1, CYP1B1 and CYP2D6) and olfactory receptor expression. The system provides urgently needed experimental access for assessing the toxicological impact of microbiome-associated xenobiotic metabolism in situ.
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Affiliation(s)
- Lisa Lemoine
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany.
- Department of Biology, Chemistry, Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany.
| | - Ralf Dieckmann
- Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, 12277, Berlin, Germany
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, 12277, Berlin, Germany
| | - Szilvia Vincze
- Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, 12277, Berlin, Germany
| | - Andreas Luch
- Department of Chemical and Product Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
- Department of Biology, Chemistry, Pharmacy, Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany
| | - Tewes Tralau
- Department of Food Safety, German Federal Institute for Risk Assessment (BfR), Max-Dohrn-Strasse 8-10, 10589, Berlin, Germany
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15
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Theil C, Schmidt-Braekling T, Gosheger G, Schwarze J, Dieckmann R, Schneider KN, Möllenbeck B. Clinical use of linezolid in periprosthetic joint infections - a systematic review. J Bone Jt Infect 2020; 6:7-16. [PMID: 32983842 PMCID: PMC7517662 DOI: 10.5194/jbji-6-7-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/20/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction: The most common causative organism in periprosthetic joint
infections (PJIs) is Gram-positive bacteria that are increasingly drug
resistant. In these cases the use of linezolid may be warranted. However,
there are conflicting reports regarding its role in antibiotic treatment of
PJIs. The aim of this review is to gather and analyze clinical results and
treatment details on linezolid in patients with PJIs.
Methods: In August 2019, a comprehensive literature search using MEDLINE
(Pubmed and Ovid) and Cochrane Library was performed. A total of 504 records
were screened, and a total of 16 studies including 372 patients treated with
linezolid for a PJI were included in this review based on the PRISMA
criteria and after quality analysis using the MINOR score and Newcastle–Ottawa
scale, as well as assessing level of evidence. Pooling analysis as well as
descriptive analysis was performed.
Results: Based on the results from the studies included, infection control
was achieved in 80 % (range 30 %–100 %) of patients after a mean follow-up
period of 25 (range 2–66) months. The mean duration of treatment was 58 d
intravenous and orally at a median dose of 600 mg bis in die (b.i.d.)
(range 400–900 b.i.d.). A combination therapy with rifampicin was used in
53 % of patients. MRSA (methicillin-resistant Staphylococcus aureus) infections were present in
29 % and resistant CoNS (coagulase-negative Staphylococcus) in 46 %. Adverse effects
occurred in 33 % of cases, mostly anemia, thrombocytopenia and
gastrointestinal complaints leading to treatment discontinuation in 9 %.
However, great heterogeneity was found with respect to surgical treatment,
diagnosis of infection and indication for linezolid.
Discussion: Linezolid is an appropriate option for treatment of resistant
Gram-positive organisms in PJIs. Most commonly 600 mg b.i.d. is used, and a
combination with rifampicin appears feasible although one must consider
individual increases in doses in these cases. However, adverse effects are
common and there are limited data for long-term use and optimal antibiotic
combinations or individual doses.
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Affiliation(s)
- Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Kristian Nikolaus Schneider
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Burkhard Möllenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Schwarze J, Theil C, Gosheger G, Dieckmann R, Moellenbeck B, Ackmann T, Schmidt-Braekling T. Promising results of revision total hip arthroplasty using a hexagonal, modular, tapered stem in cases of aseptic loosening. PLoS One 2020; 15:e0233035. [PMID: 32574168 PMCID: PMC7310743 DOI: 10.1371/journal.pone.0233035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023] Open
Abstract
Background Modular stems are widely used in revision total hip arthroplasty (THA) with aseptic loosening being a common reason for revision. Despite the good results reported on the use of modular stem designs, there are only few studies focusing on aseptic revisions and few studies on a hexagonal stem design. The goal of this study is to determine stem survival, clinical and functional outcome along with possible risk factors for implant failure in aseptic revision THA. Methods We retrospectively identified 53 patients with aseptic THA revision using a modular hexagonal stem with a minimum follow-up of two years. Femoral bone loss, radiographic and clinical outcomes as well as function measured using the Harris Hip Score (HHS) was assessed. Patients’ previous medical history was analyzed for comorbidities and the body mass index. Stem survival was calculated using the Kaplan-Meier method. Possible risk factors for implant failure were analyzed using the log-rank test. The median age at revision was 69 (IQR 62–73) with a median follow up of 74 months. Results Implant survival rates amounted to 90.4% at 3 and 5 years. The median HHS improved by 47 points (34 (IQR 22–47) vs 81 (IQR 59–90) p<0.001). There was a reduced implant survival after 5 years when the revision stem was used following a previous cemented stem (83.4% vs 100%, p = 0.04). Conclusion A modular, hexagonal stem can be successfully used in aseptic revision THA with remarkable functional results and excellent survivorship. Revision of a cemented stem using this implant might result in reduced survival which must be considered when planning treatment.
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Affiliation(s)
- Jan Schwarze
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
- * E-mail:
| | - Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics, Krankenhaus der Barmherzigen Brüder Trier, Nordallee, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
| | - Thomas Ackmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus, Muenster, Germany
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Roedel A, Dieckmann R, Makarewicz O, Hartung A, Noll M, Pletz MW, Dahouk SA, Vincze S. Evaluation of a Newly Developed Vacuum Dried Microtiter Plate for Rapid Biocide Susceptibility Testing of Clinical Enterococcus Faecium Isolates. Microorganisms 2020; 8:E551. [PMID: 32290364 PMCID: PMC7232460 DOI: 10.3390/microorganisms8040551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/27/2022] Open
Abstract
We investigated the suitability of a newly developed biocide susceptibility test system based on microtiter plates containing vacuum dried biocides as a fast and reliable screening method. The evaluated substances included the cationic biocides benzalkonium chloride (BAC), chlorhexidine dihydrochloride (CHX), cetylpyridinium chloride, didecyldimethylammonium chloride, and octenidine dihydrochloride. Testing a selection of Escherichia coli and enterococci, the biocide microtiter plates provided results comparable to those obtained from broth microdilution according to ISO 20776-1. Broad MIC ranges allowed for testing gram-positive and gram-negative species with the same plate design. In the second part of our study, we applied the established method to analyze the susceptibility of 90 clinical Enterococcus faecium isolates from a German university hospital, as previous studies have indicated a link between reduced susceptibility to substances such as CHX and BAC and vancomycin resistance. We therefore determined MIC and minimum bactericidal concentrations (MBC) for 48 non-clonal vancomycin susceptible and 42 non-clonal vancomycin resistant isolates, but MIC95 and MBC95 were quite similar in both groups. Our easy to handle and ready to use test system enables the routine surveillance of bacterial tolerance towards disinfectants in hospitals. As a result, hygiene measures can be adapted and nosocomial infections controlled despite increasing prevalence of antibiotic-resistant bacteria.
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Affiliation(s)
- Alice Roedel
- German Federal Institute for Risk Assessment, Department of Biological Safety, 10589 Berlin, Germany
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, Department of Biological Safety, 10589 Berlin, Germany
| | - Oliwia Makarewicz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
- Research Campus Infectognostics, 07743 Jena, Germany
| | - Anita Hartung
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
- Research Campus Infectognostics, 07743 Jena, Germany
| | - Matthias Noll
- Institute for Bioanalysis, University of Applied Sciences and Arts, 96450 Coburg, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, 07747 Jena, Germany
- Research Campus Infectognostics, 07743 Jena, Germany
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, Department of Biological Safety, 10589 Berlin, Germany
- Department of Internal Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Szilvia Vincze
- German Federal Institute for Risk Assessment, Department of Biological Safety, 10589 Berlin, Germany
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Noll M, Trunzer K, Vondran A, Vincze S, Dieckmann R, Al Dahouk S, Gold C. Benzalkonium Chloride Induces a VBNC State in Listeria monocytogenes. Microorganisms 2020; 8:microorganisms8020184. [PMID: 32012868 PMCID: PMC7074807 DOI: 10.3390/microorganisms8020184] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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] [Received: 12/22/2019] [Revised: 01/14/2020] [Accepted: 01/23/2020] [Indexed: 02/07/2023] Open
Abstract
The objective of our study was to investigate the effects of benzalkonium chloride (BC) adaptation of L. monocytogenes on the susceptibility to antimicrobial agents and on the viable but non culturable (VBNC) state of the bacterial cells. We adapted L. monocytogenes SLCC2540 to BC by applying BC below minimum inhibitory concentration (MIC) to above minimum bactericidal concentration (MBC). The culturable fractions and the susceptibility of adapted and parental cells to BC were assessed. In addition, cell membrane permeability and glucose uptake were analyzed by multi parametric flow cytometry using the fluorescent agents SYTO9, propidium iodide, and 2-deoxy-2-[(7-nitro-2,1,3-benzoxadiazol-4-yl)amino]-D-glucose (2-NBDG). Adapted cells displayed a two-fold MIC increase of BC and reduced antibiotic susceptibility. At high BC concentrations, the decrease in the number of colony forming units was significantly lower in the population of adapted cells compared to parental cells. At the same time, the number of metabolically active cells with intact membranes was significantly higher than the number of culturable cells. Growth-independent viability assays revealed an adapted subpopulation after BC application that was not culturable, indicating increased abundance of viable but nonculturable (VBNC) cells. Moreover, adapted cells can outcompete non-adapted cells under sublethal concentrations of disinfectants, which may lead to novel public health risks.
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Affiliation(s)
- Matthias Noll
- Institute for Bioanalysis, Department of Applied Sciences, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Straße 2, D-96450 Coburg, Germany; (K.T.); (A.V.); (C.G.)
- Correspondence: ; Tel.: +49-09561-317645
| | - Katharina Trunzer
- Institute for Bioanalysis, Department of Applied Sciences, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Straße 2, D-96450 Coburg, Germany; (K.T.); (A.V.); (C.G.)
| | - Antje Vondran
- Institute for Bioanalysis, Department of Applied Sciences, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Straße 2, D-96450 Coburg, Germany; (K.T.); (A.V.); (C.G.)
| | - Szilvia Vincze
- German Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany; (S.V.); (R.D.); (S.A.D.)
| | - Ralf Dieckmann
- German Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany; (S.V.); (R.D.); (S.A.D.)
| | - Sascha Al Dahouk
- German Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, 10589 Berlin, Germany; (S.V.); (R.D.); (S.A.D.)
| | - Carolin Gold
- Institute for Bioanalysis, Department of Applied Sciences, Coburg University of Applied Sciences and Arts, Friedrich-Streib-Straße 2, D-96450 Coburg, Germany; (K.T.); (A.V.); (C.G.)
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Moellenbeck B, Kalisch T, Gosheger G, Horst F, Seeber L, Theil C, Schmidt-Braekling T, Dieckmann R. Behavioral Conformity of Physical Activity and Sedentary Behavior in Older Couples with One Partner Suffering from End-Stage Osteoarthritis. Clin Interv Aging 2020; 15:61-74. [PMID: 32021134 PMCID: PMC6974415 DOI: 10.2147/cia.s222490] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The present study investigates behavioral conformity regarding physical activity (PA) and sedentary behavior (SB) in older couples where one partner suffers from osteoarthritis (OA). Hereby the question is addressed whether and to what extent the typical physical limitations of OA patients have negative effects on their partners. PATIENTS AND METHODS The habitual PA and SB of end-stage osteoarthritis patients (n = 32, 52-81 years | n = 14 gonarthrosis, n = 18 coxarthrosis), their spouses (n = 32, 50-83 years) and control couples (n = 26 subjects, 52-78 years) were assessed by accelerometry. Besides individual results of accelerometry hourly couple-specific performance ratios were calculated for four parameters of PA (number of steps, vector magnitude (VM), metabolic rate (MET), and total time in moderate-to-vigorous PA (MVPA)) and two parameters of SB (number of sedentary bouts and total time of sedentary bouts per hour). Analyses of covariance were used to explore differences in hourly couple-specific performance ratios between couples affected by osteoarthritis and control couples. RESULTS Significant differences in PA were observed between the three groups, whereby the patients showed the lowest PA and the subjects of the control group the highest PA. In contrast to this, SB did not differ between the three groups. The hourly analyses of couple-specific performance ratios revealed significant differences between the target couples (patients and spouses) and the control couples for all parameters of PA. Thereby, the deviance in PA between the patients and their spouses was always smaller than in control couples and also decreased with age. The investigation of SB, on the other hand, revealed larger deviations between the patients and their spouses as compared to control couples and no changes with age. CONCLUSION This study confirmed the known negative impact of osteoarthritis on the PA and SB of elderly patients. More important, however, was the finding that the patients' spouses adapt to this poor health behavior and show reduced PA as well. Consequentially, spouses of OA patients should be considered as a risk group for inactivity-related diseases in old age. This should be considered in interventions that aim to use the individual support of spouses to increase the PA of OA patients.
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Affiliation(s)
- Burkhard Moellenbeck
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tobias Kalisch
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Frank Horst
- Department of Orthopedics and Traumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Leonie Seeber
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Christoph Theil
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tom Schmidt-Braekling
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Ralf Dieckmann
- Department of General Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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Theil C, Röder J, Gosheger G, Deventer N, Dieckmann R, Schorn D, Hardes J, Andreou D. What is the Likelihood That Tumor Endoprostheses Will Experience a Second Complication After First Revision in Patients With Primary Malignant Bone Tumors And What Are Potential Risk Factors? Clin Orthop Relat Res 2019; 477:2705-2714. [PMID: 31764339 PMCID: PMC6907292 DOI: 10.1097/corr.0000000000000955] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 04/15/2019] [Accepted: 08/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoprosthetic reconstruction of massive bone defects has become the reconstruction method of choice after limb-sparing resection of primary malignant tumors of the long bones. Given the improved survival rates of patients with extremity bone sarcomas, an increasing number of patients survive but have prosthetic complications over time. Several studies have reported on the outcome of first endoprosthetic complications. However, no comprehensive data, to our knowledge, are available on the likelihood of an additional complication and the associated risk factors, despite the impact of this issue on the affected patients. QUESTIONS/PURPOSES (1) What are the types and timing of complications and the implant survivorship free from revision after the first complication? (2) Does survivorship free from repeat revision for a second complication differ by anatomic sites? (3) Is the type of first complication associated with the risk or the type of a second complication? (4) Are patient-, tumor-, and treatment-related factors associated with a higher likelihood of repeat revision? METHODS Between 1993 and 2015, 817 patients underwent megaprosthetic reconstruction after resection of a tumor in the long bones with a single design of a megaprosthetic system. No other prosthetic system was used during the study period. Of those, 75% (616 of 817) had a bone sarcoma. Seventeen patients (3%) had a follow-up of less than 6 months, 4.5% (27 of 599) died with the implant intact before 6 months and 43% (260 of 599 patients) underwent revision. Forty-three percent of patients (260 of 599) experienced a first prosthetic complication during the follow-up period. Ten percent of patients (26 of 260) underwent amputation after the first complication and were excluded from further analysis. Second complications were classified using the classification of Henderson et al. to categorize surgical results. Briefly, this system categorizes complications as wound dehiscence (Type 1); aseptic loosening (Type 2); implant fractures or breakage and periprosthetic fracture (Type 3); infection (Type 4); and tumor progression (Type 5). Implant survival curves were calculated with the Kaplan-Meier method and compared using the log-rank test. Hazard ratios (HR) were estimated with their respective 95% CIs in multivariate Cox regression models. RESULTS A second complication occurred in 49% of patients (115 of 234) after a median of 17 months (interquartile range [IQR] 5 to 48) after the surgery for the first complication. The time to complication did not differ between the first (median 16 months; IQR 5 to 57) and second complication (median 17 months; IQR 5 to 48; p = 0.976). The implant survivorship free from revision surgery for a second complication was 69% (95% CI 63 to 76) at 2 years and 46% (95% CI 38 to 53) at 5 years. The most common mode of second complication was infection 39% (45 of 115), followed by structural complications with 35% (40 of 115). Total bone and total knee reconstructions had a reduced survivorship free from revision surgery for a second complication at 5 years (HR 2.072 [95% CI 1.066 to 3.856]; p = 0.031) compared with single joint replacements. With the numbers we had, we could not show a difference between the survivorship free of revision for a second complication based on the type of the first complication (HR 0.74 [95% CI 0.215 to 2.546]; p = 0.535). We did not detect an association between total reconstruction length, patient BMI, and patient age and survivorship free from revision for a second complication. Patients had a higher risk of second complications after postoperative radiotherapy (HR 1.849 [95% CI 1.092 to 3.132]; p = 0.022) but not after preoperative radiotherapy (HR 1.174 [95% CI 0.505 to 2.728]; p = 0.709). Patients with diabetes at the time of initial surgery had a reduced survivorship free from revision for a second complication (HR 4.868 [95% CI 1.497 to 15.823]; p = 0.009). CONCLUSIONS Patients who undergo revision to treat a first megaprosthetic complication must be counseled regarding the high risk of future complications. With second complications occurring relatively soon after the first revision, regular orthopaedic follow-up visits are advised. Preoperative rather than postoperative radiotherapy should be performed when possible. Future studies should evaluate the effectiveness of different approaches in treating complications considering implant survivorship free of revision for a second complication. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- C Theil
- C. Theil, J. Röder, G. Gosheger, N. Deventer, R. Dieckmann, D. Schorn, J. Hardes, D. Andreou Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, Muenster, Germany
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Roedel A, Dieckmann R, Brendebach H, Hammerl JA, Kleta S, Noll M, Al Dahouk S, Vincze S. Biocide-Tolerant Listeria monocytogenes Isolates from German Food Production Plants Do Not Show Cross-Resistance to Clinically Relevant Antibiotics. Appl Environ Microbiol 2019; 85:e01253-19. [PMID: 31375490 PMCID: PMC6805086 DOI: 10.1128/aem.01253-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
Contamination of food during processing is recognized as a main transmission route of Listeria monocytogenes To prevent microbial contamination, biocides are widely applied as disinfectants in food processing plants. However, there are concerns about the development of antimicrobial resistance in foodborne pathogens due to widespread biocide usage. In our study, 93 L. monocytogenes isolates from German food production facilities were (i) tested for biocide and antibiotic susceptibility using broth microdilution assays, (ii) analyzed for links between reduced biocide susceptibility and antibiotic resistance, and (iii) characterized by whole-genome sequencing, including the detection of genes coding for biocide tolerance, antibiotic resistance, and other virulence factors. Fifteen L. monocytogenes isolates were tolerant to benzalkonium chloride (BAC), and genes conferring BAC tolerance were found in 13 of them. Antibiotic resistance was not associated with biocide tolerance. BAC-tolerant isolates were assigned to 6 multilocus sequence type (MLST) clonal complexes, and most of them harbored internalin A pseudogenes with premature stop codons or deletions (n = 9). Our study demonstrated a high genetic diversity among the investigated isolates including genotypes that are frequently involved in human infections. Although in vitro adaptation studies to biocides have raised concerns about increasing cross-resistance to antibiotics, our results do not provide evidence for this phenomenon in field isolates.IMPORTANCE Foodborne pathogens such as L. monocytogenes can persist in food production environments for a long time, causing perennial outbreaks. Hence, bacterial pathogens are able to survive cleaning and disinfection procedures. Accordingly, they may be repeatedly exposed to sublethal concentrations of disinfectants, which might result in bacterial adaptation to these biocides. Furthermore, antibiotic coresistance and cross-resistance are known to evolve under biocide selection pressure in vitro Hence, antimicrobial tolerance seems to play a crucial role in the resilience and persistence of foodborne pathogens in the food chain and might reduce therapeutic options in infectious diseases.
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Affiliation(s)
- A Roedel
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - R Dieckmann
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - H Brendebach
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - J A Hammerl
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - S Kleta
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - M Noll
- University of Applied Sciences and Arts, Institute for Bioanalysis, Coburg, Germany
| | - S Al Dahouk
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - S Vincze
- German Federal Institute for Risk Assessment, Berlin, Germany
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Sundermann B, Dehghan Nayyeri M, Pfleiderer B, Stahlberg K, Jünke L, Baie L, Dieckmann R, Liem D, Happe T, Burgmer M. Subtle changes of gray matter volume in fibromyalgia reflect chronic musculoskeletal pain rather than disease-specific effects. Eur J Neurosci 2019; 50:3958-3967. [PMID: 31448468 DOI: 10.1111/ejn.14558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/14/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
Fibromyalgia syndrome (FMS) is a chronic pain syndrome. Neuroimaging studies provided evidence of altered gray matter volume (GMV) in FMS but, similarly, in chronic pain of other origin as well. Therefore, the purpose of this study was to evaluate the disease specificity of GMV alterations in FMS by direct comparison. Structural MRI data of the brain were acquired in 25 females with FMS and two different control groups: 21 healthy subjects and 23 patients with osteoarthritis. Regional GMVs were compared by voxel-based morphometry and additional ROI-analyses. In conclusion, we did not identify significant GMV alterations in either FMS or OA patients compared to healthy controls when adopting a conservative statistical approach with multiple comparison correction. However, even under a more liberal approach no FMS-specific GMV changes were found because both pain groups presented increased gray matter volumes in the precentral gyrus and decreased GMV in the angular gyrus/middle occipital gyrus and middle temporal gyrus in comparison with healthy controls. Since no differences between both pain groups could be detected cortical GMV changes in FMS should not be interpreted as FMS-specific but might rather reflect changes in chronic pain in general. This previously held notion is confirmed in this study by direct comparison with a control group consisting of another pain disorder.
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Affiliation(s)
- Benedikt Sundermann
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Mahboobeh Dehghan Nayyeri
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany.,Department of Psychosomatic Medicine and Psychotherapy, LVR Clinic, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Bettina Pfleiderer
- Department of Clinical Radiology, Medical Faculty - University of Muenster - and University Hospital Muenster, Münster, Germany
| | - Kim Stahlberg
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Leonie Jünke
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Lara Baie
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | - Dennis Liem
- Department of General Orthopaedics and Tumororthopaedics, University Hospital Münster, Münster, Germany
| | | | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
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Theil C, Schmidt-Braekling T, Gosheger G, Moellenbeck B, Schwarze J, Dieckmann R. A single centre study of 41 cases on the use of porous tantalum metal implants in acetabular revision surgery. BMC Musculoskelet Disord 2019; 20:238. [PMID: 31113411 PMCID: PMC6530026 DOI: 10.1186/s12891-019-2626-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background This study aims at investigating cup survival of porous tantalum revision cups and identifies risk factors for failure. Methods We retrospectively reviewed 41 patients treated between 2010 and 2012. Main indications were aseptic loosening in 83% and two-stage exchange after periprosthetic joint infection in 17% of cases. Mean follow-up period was 72 months. Femoral megaprostheses were used in 13% of cases. Most defects were classified as Paprosky 3b (29%). Function was assessed using the Harris Hip score. Results Aseptic cup survivorship was 80% at 104 months (95% Confidence Interval 67.4–92.4). Overall implant survival was 73%. Major bone loss defects (Paprosky types 2c to 3b) were associated with a significantly higher rate of failure than minor defects (P = 0.002). There were eight cases of aseptic loosening (19.5%) and two of infection (4.9%). Previous surgeries, indication for acetabular revision, patient-related risk factors and use of megaprostheses did not significantly influence implant survival. The Harris Hip Score improved from a median of 40 (Interquartile range 31–45) to 82 (interquartile range 65–88) postoperative (P < 0.0001). Conclusions In summary, the use of porous tantalum metal implants in acetabular revision surgery achieves good to excellent short- term and mid-term functional results and an acceptable complication rate relative to the extent of defect and previous surgery. However, one should be aware of potential limitations of the implants in addressing large defects and discontinuity.
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Affiliation(s)
- Christoph Theil
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tom Schmidt-Braekling
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jan Schwarze
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopaedics and Tumour Orthopaedics, Muenster University Hospital, Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Vincze S, Al Dahouk S, Dieckmann R. Microbiological Safety of Non-Food Products: What Can We Learn from the RAPEX Database? Int J Environ Res Public Health 2019; 16:ijerph16091599. [PMID: 31067693 PMCID: PMC6538994 DOI: 10.3390/ijerph16091599] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/04/2023]
Abstract
For consumer protection across borders, the European Union has established the rapid alert system for dangerous non-food products (RAPEX), with the overarching goal of preventing or limiting the sale and use of non-food products that present a serious risk for the health and safety of consumers. In our study, we comprehensively analyzed RAPEX notifications associated with products posing a microbiological risk from 2005 through 2017. Additional information was retrieved from national laboratory reports. A total of 243 microbiologically harmful consumer products triggered notifications in 23 out of 31 participating countries. About half of the products were reported by Spain, Germany, and Italy. Notifications mainly included contaminated toys, cosmetics, and chemical products. Depending on the notifying country, measures taken to prevent the spread of dangerous products were predominantly ordered either by public authorities or economic operators. The interval between microbiological diagnosis and the date of RAPEX notifications considerably varied between RAPEX member states, ranging between a few days and 82 weeks. The nature and extent of RAPEX usage substantially differed among member states, calling for harmonization and optimization. Slight modifications to RAPEX could help to systematically record microbiological hazards, which may improve the assessment of potential health risks due to contaminated non-food products.
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Affiliation(s)
- Szilvia Vincze
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany.
| | - Sascha Al Dahouk
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany.
| | - Ralf Dieckmann
- Department of Biological Safety, German Federal Institute for Risk Assessment, 10589 Berlin, Germany.
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Abstract
Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.
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Affiliation(s)
- C. Theil
- Department of Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - T. Schmidt-Braekling
- Department of Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - G. Gosheger
- Department of Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - E. A. Idelevich
- Institute of Medical Microbiology, Muenster University Hospital, Muenster, Germany
| | - B. Moellenbeck
- Department of Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
| | - R. Dieckmann
- Department of Orthopedics and Tumour Orthopedics, Muenster University Hospital, Muenster, Germany
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Dieckmann R, Schmidt-Braekling T, Gosheger G, Theil C, Hardes J, Moellenbeck B. Two stage revision with a proximal femur replacement. BMC Musculoskelet Disord 2019; 20:58. [PMID: 30736777 PMCID: PMC6368731 DOI: 10.1186/s12891-019-2442-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite very good prosthesis retention times, the growing numbers of primary implantations of hip endoprostheses are leading to increasing numbers of revision operations. Periprosthetic infection, particularly in revision implants, often leads to a massive loss of bone stock, so that in a two-stage exchange the only option left is implantation of a megaendoprosthesis. This retrospective study investigated the clinical and functional outcome for patients who received megaendoprostheses in the proximal femur in two-stage exchange procedures. Methods Forty-nine patients were treated between 1996 and 2014 (mean age 71 years, mean follow-up period 52 months). Microorganisms were isolated intraoperatively in 44 patients (89.9%). The reinfection rate was documented in patients who did not undergo any further revision surgery due to mechanical failure (primary) and in patients who had subsequent revisions after reimplantation and subsequent reinfection (secondary). Results The mean C-reactive protein level at the time of reimplantation was 1.25 mg/dL (range 0.5–3.4). The primary success rate with curative treatment for prosthetic joint infection was 92% (four of 49 patients). The secondary success rate with infection revision cases was 82% (three of 17 revision cases). The mean Harris hip score was 69 (range 36–94). The majority of patients needed different types of walking aid or even wheelchairs, and only 50% of the patients were able to walk outside. Conclusions Reinfections occurred in only 8% of patients who underwent two-stage exchanges with a proximal femur replacement. When revision surgery for the proximal femur replacement was required for mechanical reasons, however, the associated reinfections increased the reinfection rate to 18%. Proximal femur replacement achieves a clear reduction in pain, maintenance of leg length, and restoration of limited mobility, and the procedure thus represents a clear alternative to the extensive Girdlestone procedure, which is even more immobilising, or mutilating amputation.
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Affiliation(s)
- Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Christoph Theil
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Jendrik Hardes
- Department of Tumor Orthopedics, Essen University Hospital, Hufelandstraße 55, 45147, Essen, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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Schmidt-Braekling T, Sieber D, Gosheger G, Theil JC, Moellenbeck B, Andreou D, Dieckmann R. Dislocation rates with combinations of anti-protrusio cages and dual mobility cups in revision cases: Are we safe? PLoS One 2019; 14:e0212072. [PMID: 30730966 PMCID: PMC6366705 DOI: 10.1371/journal.pone.0212072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Due to the increasing numbers of revision total hip arthroplasty (THA) procedures being carried out, the frequency of major acetabular defects is also rising. A combination of an anti-protrusio cage and a dual mobility cup has been used in our department since 2007 in order to reduce the dislocation rate associated with complex defects. Although both implants have an important place in endoprosthetics, there are as yet limited data on the dislocation and complication rates with this combination. Methods This retrospective study included all patients in whom a Burch–Schneider cage and a dual mobility cup were implanted in our department between 2007 and 2014 and who had a minimum follow-up period of 24 months. Results The study included 79 patients with a mean follow-up period of 5.3 years. The implant survival rate was 85% at 65 months. Postoperative dislocation occurred in two cases (2.1%), with the first dislocation taking place within the first 3 weeks in both of these patients. Conclusions The present study shows a promising dislocation rate with a combination of an anti-protrusio cage and a dual mobility cup. Particularly in the medium-term follow-up, no further dislocations occurred in the study. A maximum cup inclination of 45° in revision cases was associated with a lower dislocation rate in this group of patients.
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Affiliation(s)
- Tom Schmidt-Braekling
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
- * E-mail:
| | - Dorothee Sieber
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
| | - Jan C. Theil
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
| | - Dimosthenis Andreou
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopaedics and Tumor Orthopaedics, University of Muenster, Muenster, Germany
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Höll S, Blum A, Gosheger G, Dieckmann R, Winter C, Rosenbaum D. Clinical outcome and physical activity measured with StepWatch 3™ Activity Monitor after minimally invasive total hip arthroplasty. J Orthop Surg Res 2018; 13:148. [PMID: 29907134 PMCID: PMC6003151 DOI: 10.1186/s13018-018-0775-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Subjective data and physical examinations of patients after total hip arthroplasty are used to assess the outcome. But regarding the physical activity, no objective data can be delivered by existing scores. The level of activity can be measured objectively by counting gait cycles. The aim of this study was to measure activity levels of patients before and after total hip arthroplasty (THA). METHODS Forty-six patients were included in this prospective study. Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Score (HHS), and physical activity level based on the number of steps per day were assessed 1 week before surgery, 6 weeks postoperatively, and 3 months postoperatively. To assess the general constitution of the patients, the American Society of Anesthesiologists (ASA) score and BMI were determined. The physical activity level was measured by StepWatch 3™ Activity Monitor (SAM; Orthocare Innovations, Seattle, WA, USA). The number of GCs per day was assessed. Spearman's rank correlation coefficients were used to identify an association between age, body mass index (BMI), and American Society of Anesthesiologists classification with the number of gait cycles and to detect correlation between GCs and HHS and GCs and WOMAC. RESULTS From preoperatively to 6 weeks postoperatively, the number of gait cycles did not alter significantly. Three months postoperatively, the number of GC/d and GC/h improved significantly. HHS and WOMAC improved significantly from before surgery to 6 weeks and to 3 months follow-up. The number of gait cycles per day did not correlate with the HHS and the WOMAC score at any point of measurement. Age, BMI, and ASA classification did not influence the results. CONCLUSION By using a StepWatch 3™ Activity Monitor objective data about physical activity before and after THA can be measured reliable. Subjective and objective data in the postoperative period show different results. Physical activity seems to take longer to reach significantly improved values. By counting gait cycles, surgeons do have an additional tool to measure success after THA.
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Affiliation(s)
- Steffen Höll
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
| | - Andreas Blum
- Movement Analysis Laboratory, Institute of Experimental Musculoskeletal Medicine IEMM, University Hospital Münster, Domagkstrasse 3, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
| | - Corinna Winter
- Movement Analysis Laboratory, Institute of Experimental Musculoskeletal Medicine IEMM, University Hospital Münster, Domagkstrasse 3, 48149, Münster, Germany
| | - Dieter Rosenbaum
- Movement Analysis Laboratory, Institute of Experimental Musculoskeletal Medicine IEMM, University Hospital Münster, Domagkstrasse 3, 48149, Münster, Germany.
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Kleta S, Hammerl JA, Dieckmann R, Malorny B, Borowiak M, Halbedel S, Prager R, Trost E, Flieger A, Wilking H, Vygen-Bonnet S, Busch U, Messelhäußer U, Horlacher S, Schönberger K, Lohr D, Aichinger E, Luber P, Hensel A, Al Dahouk S. Molecular Tracing to Find Source of Protracted Invasive Listeriosis Outbreak, Southern Germany, 2012-2016. Emerg Infect Dis 2018; 23:1680-1683. [PMID: 28930013 PMCID: PMC5621528 DOI: 10.3201/eid2310.161623] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We investigated 543 Listeria monocytogenes isolates from food having a temporal and spatial distribution compatible with that of the invasive listeriosis outbreak occurring 2012–2016 in southern Germany. Using forensic microbiology, we identified several products from 1 manufacturer contaminated with the outbreak genotype. Continuous molecular surveillance of food isolates could prevent such outbreaks.
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Dieckmann R, Hammerl JA, Hahmann H, Wicke A, Kleta S, Dabrowski PW, Nitsche A, Stämmler M, Al Dahouk S, Lasch P. Rapid characterisation of Klebsiella oxytoca isolates from contaminated liquid hand soap using mass spectrometry, FTIR and Raman spectroscopy. Faraday Discuss 2018; 187:353-75. [PMID: 27053001 DOI: 10.1039/c5fd00165j] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Microbiological monitoring of consumer products and the efficiency of early warning systems and outbreak investigations depend on the rapid identification and strain characterisation of pathogens posing risks to the health and safety of consumers. This study evaluates the potential of three rapid analytical techniques for identification and subtyping of bacterial isolates obtained from a liquid hand soap product, which has been recalled and reported through the EU RAPEX system due to its severe bacterial contamination. Ten isolates recovered from two bottles of the product were identified as Klebsiella oxytoca and subtyped using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI TOF MS), near-infrared Fourier transform (NIR FT) Raman spectroscopy and Fourier transform infrared (FTIR) spectroscopy. Comparison of the classification results obtained by these phenotype-based techniques with outcomes of the DNA-based methods pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis of whole-genome sequencing (WGS) data revealed a high level of concordance. In conclusion, a set of analytical techniques might be useful for rapid, reliable and cost-effective microbial typing to ensure safe consumer products and allow source tracking.
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Affiliation(s)
- Ralf Dieckmann
- Federal Institute for Risk Assessment, Department of Biological Safety, Max-Dohrn-Str. 8-10, D-10589 Berlin, Germany.
| | - Jens Andre Hammerl
- Federal Institute for Risk Assessment, Department of Biological Safety, Max-Dohrn-Str. 8-10, D-10589 Berlin, Germany.
| | - Hartmut Hahmann
- Landesamt für Verbraucherschutz Sachsen-Anhalt, Fachbereich Lebensmittelsicherheit, Freiimfelder Str. 68, D-06112 Halle, Germany
| | - Amal Wicke
- Landesamt für Verbraucherschutz Sachsen-Anhalt, Fachbereich Lebensmittelsicherheit, Freiimfelder Str. 68, D-06112 Halle, Germany
| | - Sylvia Kleta
- Federal Institute for Risk Assessment, Department of Biological Safety, Max-Dohrn-Str. 8-10, D-10589 Berlin, Germany.
| | | | - Andreas Nitsche
- Robert Koch-Institut, ZBS 1 - Highly Pathogenic Viruses, Seestraße 10, D-13353 Berlin, Germany
| | - Maren Stämmler
- Robert Koch-Institut, ZBS 6 - Proteomics and Spectroscopy, Seestraße 10, D-13353 Berlin, Germany
| | - Sascha Al Dahouk
- Federal Institute for Risk Assessment, Department of Biological Safety, Max-Dohrn-Str. 8-10, D-10589 Berlin, Germany.
| | - Peter Lasch
- Robert Koch-Institut, ZBS 6 - Proteomics and Spectroscopy, Seestraße 10, D-13353 Berlin, Germany
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Brockmann S, Dieckmann R, Geisel B. „Tätowieren – Sichere und hygienische Praxis“ DIN EN 17169:2017 – Der Norm-Entwurf wird vorgestellt. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1639233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Brockmann
- Landratsamt Reutlingen/Kreisgesundheitsamt Gesundheitsschutz, Reutlingen, Germany
| | - R Dieckmann
- Bundesinstitut für Risikobewertung Abteilung für Biologische Sicherheit, Fachgruppe Produkthygiene und Desinfektionsstrategien, Berlin, Germany
| | - B Geisel
- Landesgesundheitsamt BWReferat 93, Stuttgart, Germany
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32
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Dieckmann R, Boone I, Brockmann SO, Hammerl JA, Kolb-Mäurer A, Goebeler M, Luch A, Al Dahouk S. The Risk of Bacterial Infection After Tattooing. Dtsch Arztebl Int 2018; 113:665-671. [PMID: 27788747 DOI: 10.3238/arztebl.2016.0665] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/02/2015] [Accepted: 06/08/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Tattooing is a globally growing trend. Overall prevalence among adults in industrialized countries is around 10-20%. Given the high and increasing numbers of tattooed people worldwide, medical and public health implications emerging from tattooing trends require greater attention not only by the public, but also by medical professionals and health policy makers. METHODS We performed a systematic review of the literature on tattooassociated bacterial infections and bacterial contamination of tattoo inks. Furthermore, we surveyed tattoo inks sampled during an international tattoo convention in Germany to study their microbial status. RESULTS Our systematic review identified 67 cases published between 1984 and 2015, mainly documenting serious bacterial infectious complications after intradermal deposition of tattoo inks. Both local skin infections (e.g. abscesses, necrotizing fasciitis) and systemic infections (e.g. endocarditis, septic shock) were reported. Published bacteriological surveys showed that opened as well as unopened tattoo ink bottles frequently contained clinically relevant levels of bacteria indicating that the manufactured tattoo product itself may be a source of infection. In our bacteriological survey, two of 39 colorants were contaminated with aerobic mesophilic bacteria. CONCLUSION Inappropriate hygiene measures in tattoo parlors and non-medical wound care are major risk factors for tattoo-related infections. In addition, facultative pathogenic bacterial species can be isolated from tattoo inks in use, which may pose a serious health risk.
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Affiliation(s)
- Ralf Dieckmann
- German Federal Institute for Risk Assessment (BfR), Department of Biological Safety, Berlin, Regional Public Health Office, Department for Infection Control, Reutlingen, University Hospital Würzburg, Department of Dermatology, Venereology and Allergology, Würzburg, German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, RWTH Aachen University Hospital, Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), Aachen
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Brockmann S, Dieckmann R, Geisel B. „Hygiene in Tattooing Services“ – Was wird die kommende Europäische Norm für die Überwachung von Tattoo-Studios bringen? Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - R Dieckmann
- Bundesinstitut für Risikobewertung, BfR,, Berlin
| | - B Geisel
- Landesgesundheitsamt BW, Kommunalhygiene, Stuttgart
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Maron B, Bendezu-Quispe G, Dieckmann H, Espinosa C, Garcia P, Dieckmann R. Impact of an Evidence-Based Pediatric Electronic Knowledge System on
Peruvian Physicians’ Perceptions of Care Quality, Learning, Teaching, and
Self-Efficacy. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Rohde A, Hammerl JA, Boone I, Jansen W, Fohler S, Klein G, Dieckmann R, Al Dahouk S. Overview of validated alternative methods for the detection of foodborne bacterial pathogens. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2017.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Schaumburg F, Dieckmann R, Schmidt-Bräkling T, Becker K, Idelevich EA. First description of an Anaerobiospirillum succiniciproducens prosthetic joint infection. New Microbes New Infect 2017; 18:1-2. [PMID: 28443190 PMCID: PMC5394223 DOI: 10.1016/j.nmni.2017.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 10/24/2016] [Revised: 03/01/2017] [Accepted: 03/17/2017] [Indexed: 12/05/2022] Open
Abstract
Anaerobiospirillum succiniciproducens belongs to the normal flora of cats and dogs and can rarely infect humans. Here, we report the first case of an A. succiniciproducens prosthetic joint infection.
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Affiliation(s)
- F Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Germany
| | - R Dieckmann
- Department of General Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany
| | - T Schmidt-Bräkling
- Department of General Orthopaedics and Tumour Orthopaedics, University Hospital Münster, Münster, Germany
| | - K Becker
- Institute of Medical Microbiology, University Hospital Münster, Germany
| | - E A Idelevich
- Institute of Medical Microbiology, University Hospital Münster, Germany
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Schmidt-Braekling T, Streitbuerger A, Gosheger G, Boettner F, Nottrott M, Ahrens H, Dieckmann R, Guder W, Andreou D, Hauschild G, Moellenbeck B, Waldstein W, Hardes J. Silver-coated megaprostheses: review of the literature. Eur J Orthop Surg Traumatol 2017; 27:483-489. [PMID: 28265758 DOI: 10.1007/s00590-017-1933-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/26/2017] [Indexed: 01/06/2023]
Abstract
Periprosthetic infection remains one of the most serious complications following megaendoprostheses. Despite a large number of preventive measures that have been introduced in recent years, it has not been possible to further reduce the rate of periprosthetic infection. With regard to metallic modification of implants, silver in particular has been regarded as highly promising, since silver particles combine a high degree of antimicrobial activity with a low level of human toxicity. This review provides an overview of the history of the use of silver as an antimicrobial agent, its mechanism of action, and its clinical application in the field of megaendoprosthetics. The benefits of silver-coated prostheses could not be confirmed until now. However, a large number of retrospective studies suggest that the rate of periprosthetic infections could be reduced by using silver-coated megaprostheses.
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Affiliation(s)
- Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Arne Streitbuerger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Helmut Ahrens
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wiebke Guder
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Dimosthenis Andreou
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Hauschild
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
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Hoell S, Sieweke A, Gosheger G, Hardes J, Dieckmann R, Ahrens H, Streitbuerger A. Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study. J Orthop Surg Res 2016; 11:93. [PMID: 27562546 PMCID: PMC5000435 DOI: 10.1186/s13018-016-0428-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022] Open
Abstract
Background Two-stage revision (TSR) knee arthroplasty is an established treatment, but failure to control infection still occurs in 4–50 % of cases. The aim of this study was to assess the infection eradication rate, risk factors for failure, and the clinical outcome after two-stage revision knee arthroplasty. Methods This retrospective study included 59 patients who had undergone at least one two-stage revision procedure due to periprosthetic joint infection (PJI). Demographic data, comorbidities, types of implant, and complications were analyzed. Univariate and multivariate logistic regression analysis were used to identify risk factors for failure. Results The infections were controlled in 55 patients (93.2 %). The follow-up period was 4.1 (±2.7) years. Infection control was achieved after the first TSR in 42 patients (71.2 %) and after the second TSR in 13 (76.5 %). The percentage of arthrodesis procedures in patients with infection control increased from 16.75 % after one TSR to 69.2 % after two TSRs. Multivariate logistic regression analysis identified body mass index (BMI) (odds ratio 1.22; 95 % confidence intervals, 1.07 to 1.40; p = 0.004) and smoking (OR 21.52; 95 % CI, 2.60 to 178.19; p = 0.004) as risk factors for failure. Conclusions Two-stage revision protocols can achieve acceptable results even after a second procedure. It is still unclear whether the choice of implant influences failure rates. Risk factors for failure after two-stage revision were identified. Studies with larger sample sizes are needed in order to support these findings and identify further risk factors. To reduce failure rates, programs should be established to treat or minimize risk factors in patients with PJI.
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Affiliation(s)
- Steffen Hoell
- Department of Orthopaedics, Paracelsus Hospital, Am Natruper Holz 69, 49076, Osnabrück, Germany.
| | - Anna Sieweke
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jendrik Hardes
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Helmut Ahrens
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Arne Streitbuerger
- Department of General Orthopaedics and Tumor Orthopaedics, University Hospital, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Elsner U, Henrichs M, Gosheger G, Dieckmann R, Nottrott M, Hardes J, Streitbürger A. Forequarter amputation: a safe rescue procedure in a curative and palliative setting in high-grade malignoma of the shoulder girdle. World J Surg Oncol 2016; 14:216. [PMID: 27526689 PMCID: PMC4986170 DOI: 10.1186/s12957-016-0973-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 04/01/2016] [Accepted: 08/04/2016] [Indexed: 12/15/2022] Open
Abstract
Background Forequarter amputation (FQA) is a surgical treatment of tumors in the upper extremity and shoulder girdle that infiltrate the neurovascular bundles. In both curative and palliative settings, FQA can serve as an effective oncological treatment. Methods This study presents the FQA-related data of 30 patients (mean age 50 years) treated between 2000 and 2012. Their medical condition was high-grade bone or soft tissue sarcoma in 26 and high-grade carcinoma in four cases. Results Mean operation time was 119 min. One major and five minor complications occurred in the postoperative period. Resection margins were wide in 91 % of patients. Local recurrence was observed in four patients after 19 months on average. Patients treated with curative intention had a 5-year survival chance of 39 %. Average survival after palliative amputation was 11 months. Conclusions FQA provides an opportunity for adequate oncological margins in large tumors, while offering relief from tumor-induced distress in palliative situations.
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Affiliation(s)
- Ulrich Elsner
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Marcel Henrichs
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Markus Nottrott
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jendrik Hardes
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Arne Streitbürger
- Department of Orthopedics and Tumororthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Streitbuerger A, Hardes J, Gosheger G, Dieckmann R, Hoell S. Knee salvage in revision arthroplasty after massive bone loss of the femur condyles (≥Engh III) with a single-modular-hinged knee revision implant. Arch Orthop Trauma Surg 2016; 136:1077-83. [PMID: 27370883 DOI: 10.1007/s00402-016-2491-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/03/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE Massive bone loss of the femur condyles in revision arthroplasty often requires modular-hinged revision implants to restore a stable joint situation. In the present series, the outcome after knee revision surgery using a single modular-hinged revision implant in patients with severe bone defects (>Engh III) is investigated. METHODS Sixty patients with severe bone defects (≥Engh III) after failed primary and revision knee arthroplasty were included. Medium follow-up was 47 (range 10-84) months after knee revision surgery. Medium patient age was 70 (range 33-87) years at the time of surgery. An average of 2.3 prior knee operations per patient was performed. 70 % of the patients required the knee revision implant after two-stage revision because of a deep implant infection. RESULTS Estimated 5 year extremity survival was 95 and 65 % implant survival. Reasons for implant revision in decreasing order were reinfection (30 %), aseptic loosening (13 %), and periprosthetic fracture (9.8 %). The average active range of motion in the knee joint was 88° (range 40°-115°) for flexion. An extension deficit of a mean of -6° was (range -50-5° hyper-extension) observed. Patient age influenced the functional results significantly in terms of reduced walking distances and decreased modified WOMAC score. CONCLUSION In consideration of this complex study, population acceptable functional results can be achieved using a modular knee revision endoprosthesis. In younger patients (<60 years), satisfying results in terms of walking ability and overall satisfactory can be expected. The outcome in older multimorbid patients is worse. Yet, operation in these patients can be feasible to restore enough mobility for daily household activities.
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Affiliation(s)
- Arne Streitbuerger
- Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany.
| | - Jendrik Hardes
- Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany
| | - Georg Gosheger
- Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany
| | - Ralf Dieckmann
- Department of Orthopedics, University Hospital of Münster, Albert-Schweitzer-Campus 1, 48149, Münster, NRW, Germany
| | - Steffen Hoell
- Department of Orthopedics, Paracelsus-Klink Osnabrück, Osnabrück, Germany
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Daniilidis K, Yao D, Gosheger G, Berssen C, Budny T, Dieckmann R, Höll S. Does BMI influence clinical outcomes after total knee arthroplasty? Technol Health Care 2016; 24:367-75. [DOI: 10.3233/thc-151128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kiriakos Daniilidis
- Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Germany
| | - Daiwei Yao
- Department of Orthopaedic Surgery, Annastift Hannover (Medical School Hannover, MHH), Germany
| | - Georg Gosheger
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Corinna Berssen
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Tymoteusz Budny
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Ralf Dieckmann
- Department of General Orthopaedics, Tumororthopaedics University Hospital Muenster, Germany
| | - Steffen Höll
- Department of General Orthopaedics, Paracelsus Hospital Osnabrück, Germany
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Hoell S, Moeller A, Gosheger G, Hardes J, Dieckmann R, Schulz D. Two-stage revision arthroplasty for periprosthetic joint infections: What is the value of cultures and white cell count in synovial fluid and CRP in serum before second stage reimplantation? Arch Orthop Trauma Surg 2016; 136:447-52. [PMID: 26757939 DOI: 10.1007/s00402-015-2404-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 11/12/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Besides CRP in serum, white cell counts and cultures of synovial fluid are routinely used to detect periprosthetic joint infections. But the sensitivities of these parameters do vary from 12 to 100 %. In two stage revision arthroplasty before the second stage surgeons have to decide if reimplantation is justified. Therefore, we investigated the value of cultures and white cell count from the synovial fluid with a polymethyl methacrylate spacer in place and CRP in serum before reimplantation to detect persistent infection in a standardized setting. METHODS 115 patients with a two-stage revision hip or knee arthroplasty were included in this study. All patients had an antibiotic loaded polymethylmethacrylate spacer. Retrospectively synovial cultures, white blood count in synovial fluid and CRP in serum were assessed before reimplantation. RESULTS The sensitivity of the synovial cultures was 5 % (95 % CI 0.13-24.87), with a specificity of 99 % (95 % CI 94.27-99.97). For white blood count in synovial fluid the sensitivity was 31.3 %, specificity was 39.1 %. Sensitivity for CRP in serum was 42.10 %, specificity was 84.21 %. CONCLUSION Cultures from synovial fluid and white blood count in synovial fluid and CRP seem to be uncertain parameters to exclude persistent infection. We do not recommend joint aspiration before reimplantation anymore. Further research is necessary to find other markers to confirm or exclude persistent infection.
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Affiliation(s)
- Steffen Hoell
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany.
| | - Andrea Moeller
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
| | - Georg Gosheger
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
| | - Jendrik Hardes
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
| | - Ralf Dieckmann
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
| | - Dino Schulz
- Center of Arthroplasty and Revision Arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany
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Bier N, Jäckel C, Dieckmann R, Brennholt N, Böer SI, Strauch E. Virulence Profiles of Vibrio vulnificus in German Coastal Waters, a Comparison of North Sea and Baltic Sea Isolates. Int J Environ Res Public Health 2015; 12:15943-59. [PMID: 26694432 PMCID: PMC4690967 DOI: 10.3390/ijerph121215031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 12/01/2022]
Abstract
Vibrio vulnificus is a halophilic bacterium of coastal environments known for sporadically causing severe foodborne or wound infections. Global warming is expected to lead to a rising occurrence of V. vulnificus and an increasing incidence of human infections in Northern Europe. So far, infections in Germany were exclusively documented for the Baltic Sea coast, while no cases from the North Sea region have been reported. Regional variations in the prevalence of infections may be influenced by differences in the pathogenicity of V. vulnificus populations in both areas. This study aimed to compare the distribution of virulence-associated traits and genotypes among 101 V. vulnificus isolates from the Baltic Sea and North Sea in order to assess their pathogenicity potential. Furthermore, genetic relationships were examined by multilocus sequence typing (MLST). A high diversity of MLST sequences (74 sequence types) and differences regarding the presence of six potential pathogenicity markers were observed in the V. vulnificus populations of both areas. Strains with genotypes and markers associated with pathogenicity are not restricted to a particular geographic region. This indicates that lack of reported cases in the North Sea region is not caused by the absence of potentially pathogenic strains.
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Affiliation(s)
- Nadja Bier
- National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Mollusks, Department of Biological Safety, Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, Berlin D-10589, Germany.
| | - Claudia Jäckel
- National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Mollusks, Department of Biological Safety, Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, Berlin D-10589, Germany.
| | - Ralf Dieckmann
- National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Mollusks, Department of Biological Safety, Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, Berlin D-10589, Germany.
| | - Nicole Brennholt
- Federal Institute of Hydrology, Am Mainzer Tor 1, Koblenz D-56068, Germany.
| | - Simone I Böer
- Federal Institute of Hydrology, Am Mainzer Tor 1, Koblenz D-56068, Germany.
| | - Eckhard Strauch
- National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Mollusks, Department of Biological Safety, Federal Institute for Risk Assessment, Max-Dohrn-Str. 8-10, Berlin D-10589, Germany.
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Rohde A, Hammerl JA, Appel B, Dieckmann R, Al Dahouk S. Sampling and Homogenization Strategies Significantly Influence the Detection of Foodborne Pathogens in Meat. Biomed Res Int 2015; 2015:145437. [PMID: 26539462 PMCID: PMC4619754 DOI: 10.1155/2015/145437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 05/01/2015] [Indexed: 11/18/2022]
Abstract
Efficient preparation of food samples, comprising sampling and homogenization, for microbiological testing is an essential, yet largely neglected, component of foodstuff control. Salmonella enterica spiked chicken breasts were used as a surface contamination model whereas salami and meat paste acted as models of inner-matrix contamination. A systematic comparison of different homogenization approaches, namely, stomaching, sonication, and milling by FastPrep-24 or SpeedMill, revealed that for surface contamination a broad range of sample pretreatment steps is applicable and loss of culturability due to the homogenization procedure is marginal. In contrast, for inner-matrix contamination long treatments up to 8 min are required and only FastPrep-24 as a large-volume milling device produced consistently good recovery rates. In addition, sampling of different regions of the spiked sausages showed that pathogens are not necessarily homogenously distributed throughout the entire matrix. Instead, in meat paste the core region contained considerably more pathogens compared to the rim, whereas in the salamis the distribution was more even with an increased concentration within the intermediate region of the sausages. Our results indicate that sampling and homogenization as integral parts of food microbiology and monitoring deserve more attention to further improve food safety.
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Affiliation(s)
- Alexander Rohde
- Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany ; Department of Biology, Chemistry and Pharmacy, Free University Berlin, Takustraße 3, 14195 Berlin, Germany
| | - Jens Andre Hammerl
- Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - Bernd Appel
- Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - Ralf Dieckmann
- Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany
| | - Sascha Al Dahouk
- Federal Institute for Risk Assessment, Diedersdorfer Weg 1, 12277 Berlin, Germany
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Degenkolb T, Fog Nielsen K, Dieckmann R, Branco-Rocha F, Chaverri P, Samuels GJ, Thrane U, von Döhren H, Vilcinskas A, Brückner H. Peptaibol, Secondary-Metabolite, and Hydrophobin Pattern of Commercial Biocontrol Agents Formulated with Species of theTrichoderma harzianumComplex. Chem Biodivers 2015; 12:662-84. [DOI: 10.1002/cbdv.201400300] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Indexed: 11/05/2022]
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Rohde A, Hammerl JA, Appel B, Dieckmann R, Al Dahouk S. FISHing for bacteria in food – A promising tool for the reliable detection of pathogenic bacteria? Food Microbiol 2015; 46:395-407. [DOI: 10.1016/j.fm.2014.09.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/15/2014] [Accepted: 09/05/2014] [Indexed: 12/28/2022]
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Abstract
The purpose of this study was to evaluate whether the serum level of interleukin 6 (IL-6) could be used to identify the persistence of infection after the first stage of a two-stage revision for periprosthetic joint infection. Between 2010 and 2011, we prospectively studied 55 patients (23 men, 32 women; mean age 69.5 years; 36 to 86) with a periprosthetic joint infection. Bacteria were identified in two intra-operative tissue samples during re-implantation in 16 patients. These cases were classified as representing persistent infection. To calculate a precise cut-off value which could be used in everyday clinical practice, a 3 x 2 contingency table was constructed and manually defined. We found that a serum IL-6 ≥ 13 pg/mL can be regarded as indicating infection: its positive-predictive value is 90.9%. A serum IL-6 ≤ 8 pg/mL can be regarded as indicating an absence of infection: its negative predictive value is 92.1%. The serum IL-6 level seems to be a reasonable marker for identifying persistent infection after the first stage of a revision joint arthroplasty and before attempting re-implantation. Cite this article: Bone Joint J 2015;97-B:71–5.
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Affiliation(s)
- S. Hoell
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
| | - L. Borgers
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
| | - G. Gosheger
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
| | - R. Dieckmann
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
| | - D. Schulz
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
| | - J. Gerss
- Institute of Biostatistics and Clinical
Research, University Hospital Muenster, Schmeddingstraße
56, 48149 Muenster, Germany
| | - J. Hardes
- Department of General and Tumor Orthopedics, Center
of Arthroplasty and Revision Arthroplasty, University
Hospital Muenster, Albert Schweitzer Campus, Muenster, 48149, Germany
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Dieckmann R, Schulz D, Gosheger G, Becker K, Daniilidis K, Streitbürger A, Hardes J, Hoell S. Two-stage hip revision arthroplasty with a hexagonal modular cementless stem in cases of periprosthetic infection. BMC Musculoskelet Disord 2014; 15:398. [PMID: 25428415 PMCID: PMC4289174 DOI: 10.1186/1471-2474-15-398] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/18/2014] [Indexed: 12/15/2022] Open
Abstract
Background Two-stage revision arthroplasty is today regarded as the gold standard treatment method for deep prosthetic joint infection. The aim of the present study was to evaluate clinical and functional outcomes with the Modular Universal Tumor And Revision System (MUTARS) RS stem in patients undergoing two-stage revisions. Methods The functional and clinical outcomes for 43 patients who had undergone two-stage revision procedures for PJI were analyzed in a retrospective study. The minimum follow-up period was 24 months. Shorter follow-up periods were only observed when there were complications such as loosening or recurrent infection. The mean follow-up period was 3.86 years (range 7 months to 11.6 years). Results The success rate with infection control for PJI was 93%. Reinfection occurred in four cases (7%). The risk of reinfection after MRSA infection was 20.5 times greater (P >0.01) than with sensitive or unknown bacteria. Two aseptic loosening occurred after 7 and 20 months. The average Harris Hip Score was 80 (range 62–93). Conclusion This retrospective study showed a 93% rate of eradication using specific antibiotic therapy. With the modular MUTARS RS stem, there was a low rate of aseptic loosening of 4.6%. MRSA infection was identified as a risk factor for reinfection. The two-stage procedure with modular cementless implants used is therefore appropriate for treating periprosthetic infections associated with hip endoprostheses. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-398) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany.
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Schirmeister F, Wieczorek A, Dieckmann R, Taureck K, Strauch E. Evaluation of molecular methods to discriminate the closely related species Vibrio fluvialis and Vibrio furnissii. Int J Med Microbiol 2014; 304:851-7. [PMID: 25242722 DOI: 10.1016/j.ijmm.2014.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Vibrio furnissii and Vibrio fluvialis are two closely related species which are regarded as emerging human pathogens. Human infections have been mainly associated with consumption of seafood or drinking of contaminated water. V. furnissii strains can be distinguished from V. fluvialis by their ability to produce gas from fermentation of carbohydrates. In this study, we compare two phenotypic (biochemical testing and matrix-assisted laser desorption/ionisation time of flight mass spectrometry, MALDI-TOF MS) and three genotypic techniques (rpoB sequencing, conventional PCR and real-time PCR) for determination of the two species. The methods were evaluated on a collection of 42 V. furnissii and 32 V. fluvialis strains, which were isolated from marine environments and from animals intended for food production. Four of the applied methods allowed the unambiguous discrimination of the two species, while the biochemical testing was the least reliable technique, due to a high variation in the phenotype of gas production from carbohydrates. In view of the One Health concept reliable diagnostic techniques are a prerequisite for preventive public health measurements, as pathogens isolated from animals can cross species borders and methods for detection of sources, reservoirs and ways of transmission of pathogenic bacteria are indispensable for the prevention of infectious diseases in humans and animals.
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Affiliation(s)
- Falko Schirmeister
- Bundesinstitut für Risikobewertung, Federal Institute for Risk Assessment, National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Molluscs, Berlin, Germany
| | - Angelina Wieczorek
- Bundesinstitut für Risikobewertung, Federal Institute for Risk Assessment, National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Molluscs, Berlin, Germany
| | - Ralf Dieckmann
- Bundesinstitut für Risikobewertung, Federal Institute for Risk Assessment, National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Molluscs, Berlin, Germany
| | - Karin Taureck
- Landesuntersuchungsanstalt für das Gesundheits - und Veterinärwesen Sachsen, Standort Dresden, Germany
| | - Eckhard Strauch
- Bundesinstitut für Risikobewertung, Federal Institute for Risk Assessment, National Reference Laboratory for Monitoring Bacteriological Contamination of Bivalve Molluscs, Berlin, Germany.
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Huehn S, Eichhorn C, Urmersbach S, Breidenbach J, Bechlars S, Bier N, Alter T, Bartelt E, Frank C, Oberheitmann B, Gunzer F, Brennholt N, Böer S, Appel B, Dieckmann R, Strauch E. Pathogenic vibrios in environmental, seafood and clinical sources in Germany. Int J Med Microbiol 2014; 304:843-50. [PMID: 25129553 DOI: 10.1016/j.ijmm.2014.07.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Bacteria of the family Vibrionaceae naturally occur in marine and estuarine environments. Only few species of Vibrionaceae are associated with human cases of gastroenteritis, ear and wound infections, caused by ingestion of seafood or contact with Vibrio containing water. Increasing consumption of seafood (fish, fishery products and shellfish) poses a possible source of Vibrio infections in Germany. Additionally, there is a growing concern that abundances of pathogenic vibrios may increase in German coastal waters as a result of e.g. climate change resulting in probably rising surface water temperatures. According to the One Health concept the VibrioNet consortium started in 2010 to investigate the occurrence and relevance of non-cholera vibrios of human concern in Germany. Vibrios from environmental, seafood and clinical sources were analyzed with the aim to find connections between different reservoirs or sources and to identify potential ways of transmission of these pathogens to assess the risk of infections associated with them. Potentially pathogenic strains mostly belong to the species Vibrio parahaemolyticus, Vibrio vulnificus and non-O1/non-O139 Vibrio cholerae. Investigations on imported seafood and mussels from primary production areas confirmed the frequent occurrence of these species. Moreover, studies of German coastal waters and sediments showed the presence and seasonality of these marine bacteria. So far the incidence of clinical cases of vibriosis in Germany is low. Between 1994 and 2013 thirteen cases of Vibrio spp. associated wound infections and/or septicaemia have been reported. However, the high prevalence of vibrios in aquatic environments and aquatic organisms is of concern and demands continued control of food and surveillance for clinical infections with pathogenic vibrios.
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Affiliation(s)
- Stephan Huehn
- Institut für Lebensmittelhygiene, Freie Universität Berlin, Berlin, Germany
| | - Christin Eichhorn
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden, Dresden, Germany
| | - Sara Urmersbach
- Institut für Lebensmittelhygiene, Freie Universität Berlin, Berlin, Germany
| | | | | | - Nadja Bier
- Bundesinstitut für Risikobewertung, Berlin, Germany
| | - Thomas Alter
- Institut für Lebensmittelhygiene, Freie Universität Berlin, Berlin, Germany
| | - Edda Bartelt
- Institut für Fische und Fischereierzeugnisse, LAVES, Cuxhaven, Germany
| | | | | | - Florian Gunzer
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden, Dresden, Germany
| | | | - Simone Böer
- Bundesanstalt für Gewässerkunde, Koblenz, Germany
| | - Bernd Appel
- Bundesinstitut für Risikobewertung, Berlin, Germany
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