Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients

Manning, Laurens; Metcalf, Sarah; Clark, Benjamin M.; Robinson, James O.; Huggan, Paul; Luey, Chris; McBride, Susan; Aboltins, Craig; Nelson, Renjy; Campbell, D.; Solomon, Lucian B.; Schneider, Kellie E.; Loewenthal, Mark; Yates, Piers; Athan, Eugene; Cooper, Darcie; Rad, Babak; Allworth, Tony; Reid, Alistair; Read, Kerry; Leung, P.; Sud, Archana; Nagendra, Vana; Chean, Roy; Lemoh, Chris; Mutalima, Nora; Grimwade, Kate; Sehu, Marjoree; Torda, Adrienne; Aung, Thi; Graves, S.; Paterson, David L.; Davis, Joshua S.

doi:10.1093/ofid/ofaa068

Cited by 34 publications

(37 citation statements)

References 20 publications

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“…Accurate knowledge of the microbiologic etiology of PJI is critical to choosing appropriate antimicrobials and has prognostic implications. Studies on this topic are based on cohort data from the 1990s to early 2000s, small sample sizes, or non-United States data (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Microbiology of hip and knee periprosthetic joint infections: a database study

Tai

Patel

Abdel

et al. 2022

Clinical Microbiology and Infection

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Section: Introductionmentioning

confidence: 99%

Microbiology of hip and knee periprosthetic joint infections: a database study

Tai

Patel

Abdel

et al. 2022

Clinical Microbiology and Infection

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show abstract

“…Although multiple bacterial pathogens have been associated with PJIs, S. aureus is often reported as the most common cause, accounting for approximately 13-44 % of all PJIs (Aggarwal et al, 2014;Manning et al, 2020;Pulido et al, 2008;Tsai et al, 2019). Treatments for PJIs include long courses of antibiotics, debridement of infected tissue and implant removal and replacement (Pelt et al, 2014;Segawa et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Application of a BMP2-binding heparan sulphate to promote periodontal regeneration

Le¹,

Too²,

Tan³

et al. 2021

eCM

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Periodontitis is the most common inflammatory disease that leads to periodontal defects and tooth loss. Regeneration of alveolar bone and soft tissue in periodontal defects is highly desirable but remains challenging. A heparan sulphate variant (HS3) with enhanced affinity for bone morphogenetic protein-2 (BMP2) that, when combined with collagen or ceramic biomaterials, enhances bone tissue regeneration in the axial and cranial skeleton in several animal models was reported previously. In the current study, establishing the efficacy of a collagen/HS3 device for the regeneration of alveolar bone and the adjacent periodontal apparatus and related structures was sought. Collagen sponges loaded with phosphate-buffered saline, HS3, BMP2, or HS3 + BMP2 were implanted into surgically-created intra-bony periodontal defects in rat maxillae. At the 6 week end- point the maxillae were decalcified, and the extent of tissue regeneration determined by histomorphometrical analysis. The combination of collagen/HS3, collagen/BMP2 or collagen/HS3 + BMP2 resulted in a three to four-fold increase in bone regeneration and up to a 1.5 × improvement in functional ligament restoration compared to collagen alone. Moreover, the combination of collagen/HS3 + BMP2 improved the alveolar bone height and reduced the amount of epithelial growth in the apical direction. The implantation of a collagen/ HS3 combination device enhanced the regeneration of alveolar bone and associated periodontal tissues at amounts comparable to collagen in combination with the osteogenic factor BMP2. This study highlights the efficacy of a collagen/HS3 combination device for periodontal regeneration that warrants further development as a point-of-care treatment for periodontitis-related bone and soft tissue loss.

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“…Although multiple bacterial pathogens have been associated with PJIs, S. aureus is often reported as the most common cause, accounting for approximately 13-44 % of all PJIs ( Aggarwal et al, 2014 ; Manning et al, 2020 ; Pulido et al, 2008 ; Tsai et al, 2019 ). Treatments for PJIs include long courses of antibiotics, debridement of infected tissue and implant removal and replacement ( Pelt et al, 2014 ; Segawa et al, 1999 ).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic assessment of N-formyl-methionyl-leucyl-phenylalanine (fMLP) in reducing periprosthetic joint infection

Hamilton¹,

Mohamed²,

Witt³

et al. 2021

eCM

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Despite many preventive measures, including prophylactic antibiotics, periprosthetic joint infection (PJI) remains a devastating complication following arthroplasty, leading to pain, suffering, morbidity and substantial economic burden. Humans have a powerful innate immune system that can effectively control infections, if alerted quickly. Unfortunately, pathogens use many mechanisms to dampen innate immune responses. The study hypothesis was that immunomodulators that can jumpstart and direct innate immune responses (particularly neutrophils) at the surgical site of implant placement would boost immune responses and reduce PJI, even in the absence of antibiotics. To test this hypothesis, N-formyl-methionyl-leucyl-phenylalanine (fMLP) (a potent chemoattractant for phagocytic leukocytes including neutrophils) was used in a mouse model of PJI with Staphylococcus aureus (S. aureus). Mice receiving intramedullary femoral implants were divided into three groups: i) implant alone; ii) implant + S. aureus; iii) implant + fMLP + S. aureus. fMLP treatment reduced S. aureus infection levels by ~ 2-Log orders at day 3. Moreover, fMLP therapy reduced infection-induced peri-implant periosteal reaction, focal cortical loss and areas of inflammatory infiltrate in mice distal femora at day 10. Finally, fMLP treatment reduced pain behaviour and increased weight-bearing at the implant leg in infected mice at day 10. Data indicated that fMLP therapy is a promising novel approach for reducing PJI, if administered locally at surgical sites. Future work will be toward further enhancement and optimisation of an fMLP-based therapeutic approach through combination with antibiotics and/or implant coating with fMLP.

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Clinical Characteristics, Etiology, and Initial Management Strategy of Newly Diagnosed Periprosthetic Joint Infection: A Multicenter, Prospective Observational Cohort Study of 783 Patients

Cited by 34 publications

References 20 publications

Microbiology of hip and knee periprosthetic joint infections: a database study

Microbiology of hip and knee periprosthetic joint infections: a database study

Application of a BMP2-binding heparan sulphate to promote periodontal regeneration

Therapeutic assessment of N-formyl-methionyl-leucyl-phenylalanine (fMLP) in reducing periprosthetic joint infection

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