Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention

Moran, Ed; Masters, S; Berendt, Anthony R.; McLardy-Smith, P.; Byren, Ivor; Atkins, Bridget L.

doi:10.1016/j.jinf.2007.01.007

Cited by 216 publications

(192 citation statements)

References 14 publications

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“…As similar results have been reported in subsequent studies [7,24], CoNS must be considered an important pathogen for targeting in antimicrobial prophylaxis. Moreover, CoNS has been recognized as the predominant causative organism for prosthetic joint infections [20,21,28], and globally one of the most resistant [14,25]. Moran et al [20] reported that 47% of causative organisms for prosthetic joint infections were CoNS, 60% of which were methicillin-resistant, followed by MSSA.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, CoNS has been recognized as the predominant causative organism for prosthetic joint infections [20,21,28], and globally one of the most resistant [14,25]. Moran et al [20] reported that 47% of causative organisms for prosthetic joint infections were CoNS, 60% of which were methicillin-resistant, followed by MSSA. These findings suggest CoNS, especially with established resistance, is an important pathogen in orthopaedic infection in addition to MRSA, therefore, we focused on CoNS with resistance to cefazolin-the most recommended antimicrobial prophylaxis [3].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, they are clinically considered cefazolin resistant [27,34]. The existence of resistant CoNS seen on a patient's skin [30,37] and the resistance seen in CoNSinfected joints [20,21,28] therefore must be given serious consideration.…”

Section: Introductionmentioning

confidence: 99%

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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified. Questions/purposes We asked whether 2 g of cefazolin would enable effective serum and bone concentrations relative to the current minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus. Patients and Methods We enrolled 43 patients (THA, n = 16; TKA, n = 27) scheduled for primary THAs and primary TKAs. Subjects were given 2 g of cefazolin intravenously before incision. One blood sample and two bone samples were collected from each subject before tourniquet deflation before any additional dose. All samples were assayed at the same laboratory. Minimum inhibitory concentration values were defined based on nationwide surveys. Results Mean (± standard deviation) serum concentration was 170.3 ± 51.3 lg/mL (range, 99.3-370.3 lg/mL). Mean bone concentration was 32.3 ± 15.2 lg/g (range, 11.4-70.0 lg/g) in THA, and 16.0 ± 10.4 lg/g (range, 6.3-46.3 lg/g) in TKA. All serum and bone concentrations exceeded the minimum inhibitory concentration for methicillin-sensitive S. aureus, but some serum levels were marginal and no bone levels exceeded the minimum inhibitory concentration for cefazolin-resistant coagulasenegative Staphylococcus. Conclusions Our data suggest intravenous administration of 2 g of cefazolin achieves the minimum inhibitory concentration for methicillin-sensitive S. aureus in serum and bone, but not the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus in bone, resulting in a potential risk of deep surgical site infections in THAs and TKAs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Published papers report relatively low eradication rates and worse functional outcomes when infection is caused by multiresistant organisms [1, 14-16, 20, 23, 27]. Polymicrobial infections have been less studied [14,18,20]. A very low risk of recurrence (ranging from 0% to 6%) [6,22] has been communicated with oral antibiotics plus two-stage surgery in chronic infections.…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies report rates of eradication of infection but do not evaluate the functional orthopaedic outcomes of the patients [1,14,16,20,23,27]. Eradication of infection and functional outcomes in polymicrobial infections have been less studied [14,18,20].…”

Section: Introductionmentioning

confidence: 99%

Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

Cordero‐Ampuero

Esteban

García-Cimbrelo

2009

Clinical Orthopaedics &Amp; Related Research

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Infected arthroplasties reportedly have a lower eradication rate when caused by highly resistant and/or polymicrobial isolates and in these patients most authors recommend intravenous antibiotics. We asked whether two-stage revision with interim oral antibiotics could eradicate these infections. We prospectively followed 36 patients (mean age, 71.8 years) with late hip arthroplasty infections. Combinations of oral antibiotics were prescribed according to cultures, biofilm, and intracellular effectiveness. The minimum followup was 1 year (mean, 4.4 years; range, 1-12 years). We presumed eradication in the absence of clinical, serologic, and radiographic signs of infection. Infection was eradicated in all 13 patients with highly resistant bacteria who completed a two-stage protocol (10 with methicillin-resistant Staphylococci) and in eight of 11 patients treated with only the first stage (and six of nine with methicillin-resistant Staphylococci). Infection was eradicated in six of six patients with polymicrobial isolates (of sensitive and/or resistant bacteria) who completed a two-stage protocol and in five of seven with polymicrobial isolates treated with only the first surgery. The Harris hip score averaged 88.1 (range, 70-98) in patients who underwent reimplantation and 56.8 (range, 32-76) in patients who underwent resection arthroplasty.

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Epidemiology of Infections in the New Century

Petrosillo¹

2013

Diagnostic Imaging of Infections and Inflammatory Diseases

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Guiding empirical antibiotic therapy in orthopaedics: The microbiology of prosthetic joint infection managed by debridement, irrigation and prosthesis retention

Cited by 216 publications

References 14 publications

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Oral Antibiotics are Effective for Highly Resistant Hip Arthroplasty Infections

Epidemiology of Infections in the New Century

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