General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Boyle, K Keely; Kuo, Feng-Chih; Horcajada, Juan Pablo; Hughes, Harriet; Cavagnaro, Luca; Marculescu, Camelia; McLaren, A. C.; Nodzo, Scott R.; Riccio, Giovanni; Sendi, Parham; Silibovsky, Randi; Stammers, John; Tan, Timothy L.; Wimmer, Matthias

doi:10.1016/j.arth.2018.09.074

Cited by 17 publications

(23 citation statements)

References 188 publications

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“…In contrast, a limited strain-dependent effect of flucloxacillin was observed against MSSA biofilms in the absence of pulse lavage. Flucloxacillin is a narrow spectrum β-lactam antibiotic, directed against Staphylococci and Streptococci , which is recommended in combination with rifampicin for MSSA and methicillin-susceptible S. epidermidis prosthetic joint infections, alongside nafcillin and oxacillin ( 31 – 33 ). Only a few conflicting studies have been published about the in vitro effect of flucloxacillin against S. aureus biofilms, pointing toward a variable, strain-dependent effect ( 34 – 37 ), analogous to our observations.…”

Section: Discussionmentioning

confidence: 99%

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model

et al. 2020

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Background: Prosthetic joint infections (PJI) are difficult to treat complications of joint arthroplasty. Debridement with implant retention is a common treatment strategy and frequently involves the use of pulsed lavage (PL). However, PL effects on biofilms and antibiotic activity have been scarcely studied in-vitro. We report the effects of PL, vancomycin or flucloxacillin used independently or in combination against Staphylococcus aureus biofilms. Methods: Biofilms of 3 methicillin-susceptible (MSSA) and of 3 methicillin-resistant (MRSA) S. aureus were grown on Ti6Al4V coupons in TGN (TSB + 1%glucose + 2%NaCl). After 24 h, PL was applied to half of the samples (50 mL saline from 5 cm). Samples were either reincubated for 24 h in TGN or TGN + flucloxacillin or vancomycin. Analyses included CFUs counts, biomass assays or fluorescence microscopy. Results: PL transiently reduced bacterial counts by 3-4 Log 10 CFU/coupon, but bacterial regrowth to baseline levels was seen after 24 h. At 20 mg/L, flucloxacillin reduced both the CFU counts (3 Log 10 CFU/coupon) and biomass (−70%) in one MSSA only, while vancomycin had no effects against MRSA. PL combined with a 24 h reincubation with vancomycin or flucloxacillin at 20 mg/L was synergistic (−5 to 6.5 Log 10 CFU/coupon; 81-100% biomass reduction). Fluorescence microscopy confirmed that PL removed most of the biofilm and that subsequent antibiotic treatment partially killed bacteria. Conclusions: While PL only transiently reduces the bacterial load and antibiotics at clinically relevant concentrations show no or limited activity on biofilms, their combination is synergistic against MRSA and MSSA biofilms. These results highlight the need for thorough PL before antibiotic administration in PJI.

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Section: Discussionmentioning

confidence: 99%

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model

et al. 2020

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“…Fluoroquinolones are the first choice as anti-biofilm antibiotics for the treatment of GN-PJI (Boyle et al, 2019). However, emergence and spread of resistance to fluoroquinolones and aminoglycosides has decreased the existing treatment options for GN infections (Tucaliuc et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…However, emergence and spread of resistance to fluoroquinolones and aminoglycosides has decreased the existing treatment options for GN infections (Tucaliuc et al, 2015). Combination therapy with fosfomycin has been recommended, particularly against fluoroquinolone resistant organisms (Boyle et al, 2019). Nonetheless, there is a lack of systematic studies investigating antibiotic combinations under the same experimental settings on GN biofilms.…”

Section: Discussionmentioning

confidence: 99%

Synergistic Activity of Fosfomycin, Ciprofloxacin, and Gentamicin Against Escherichia coli and Pseudomonas aeruginosa Biofilms

et al. 2019

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Gram-negative (GN) rods cause about 10% periprosthetic joint infection (PJI) and represent an increasing challenge due to emergence of antimicrobial resistance. Escherichia coli and Pseudomonas aeruginosa are among the most common cause of GN-PJI and ciprofloxacin is the first-line antibiotic. Due to emergence of fluoroquinolone resistance, we evaluated in vitro the activity of fosfomycin, ciprofloxacin, and gentamicin, alone and in combinations, against E. coli and P. aeruginosa biofilms. Conventional microbiological tests and isothermal microcalorimetry were applied to investigate the anti-biofilm activity of the selected antibiotics against standard laboratory strains as well as clinical strains isolated from patients with prosthetic joint associated infections. The biofilm susceptibility to each antibiotic varied widely among strains, while fosfomycin presented a poor anti-biofilm activity against P. aeruginosa. Synergism of two-pair antibiotic combinations was observed against different clinical strains from both species. Highest synergism was found for the fosfomycin/gentamicin combination against the biofilm of E. coli strains (75%), including a gentamicin-resistant but fosfomycin-susceptible strain, whereas the gentamicin/ciprofloxacin combination presented synergism with higher frequency against the biofilm of P. aeruginosa strains (71.4%). A hypothetical bacteriolysis effect of gentamicin could explain why combinations with this antibiotic seem to be particularly effective. Still, the underlying mechanism of the synergistic effect on biofilms is unknown. In conclusion, combinatorial antibiotic application has shown to be more effective against biofilms compared to monotherapy. Further in vivo and clinical studies are essential to define the potential treatment regimen based on our results.

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“…Many reports have revealed that Gram-positive cocci, especially S. aureus and coagulase-negative staphylococci (CNS) were the most common infective organisms for PJI [17][18][19]. Empirical antibiotic treatment of early PJIs include coverage of vancomycin was recommended until de nitive culture results become available [20].…”

Section: Discussionmentioning

confidence: 99%

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

Wang

Jiang

2020

Preprint

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Background Despite vancomycin has been widely used in orthopedics, the details of vancomycin usage in orthopedics remains unknown. The purpose of the study was to evaluate the usage profile of intravenous vancomycin medication in orthopedics. Methods The medical records of inpatients receiving intravenous vancomycin medication from January 2015 to December 2019 in a single center of orthopedics department were retrospectively reviewed. The gender, age, diagnosis, surgical information, microbiological data, duration of vancomycin medication were collected. The related data were analyzed and compared between subgroups. Results A total of 258 cases receiving intravenous vancomycin medication (≥ 3 days) were enrolled. The mean age was 57.3 years. There were 141 cases in treatment and 117 in Prophylaxis group. The mean duration of vancomycin medication was 11.2 days. The duration was longer in Treatment than Prophylaxis group (14.8 versus 6.9 days, P < 0.05). The main reasons for treatment were PJI after TKA (46.7%) and THA (18.2%) in Joint subgroup and SSI after spine surgery (51.5%) for Spine subgroup. For prophylaxis usage, the main reasons were postoperative clinical suspicious infection. The bacteria responsible for infections in Treatment group were S. epidermidis (34.6%), S. aureus (31.8%), other Staphylococcus (12.1%), MRSA (7.5%), Streptococcus (7.5%), Enterococcus faecalis (3.7%) and Bacillus (2.8%). Conclusion Taken together, our research firstly revealed the treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics. It provides the different purposes, main causes, bacteriological data and medication duration for treatment and prophylaxis vancomycin usage in orthopedics.

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General Assembly, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Cited by 17 publications

References 188 publications

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Staphylococcus aureus Biofilms in an in-vitro Model

Synergistic Activity of Fosfomycin, Ciprofloxacin, and Gentamicin Against Escherichia coli and Pseudomonas aeruginosa Biofilms

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

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