Hip and Knee Section, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Anemüller, Ruben; Belden, Katherine; Brause, Barry D.; Citak, Mustafa; Pozo, J.L. del; Frommelt, Lars; Gehrke, Thorsten; Hewlett, Angela; Higuera, Carlos A.; Hughes, Harriet; Kheir, Michael M.; Kim, Kang il; Konan, Sujith; Lausmann, Christian; Marculescu, Camelia; Morata, Laura; Ramírez, Isabel; Roßmann, Markus; Silibovsky, Randi; Soriano, Álex; Suh, Gina A.; Vogely, Charles; Volpin, Andrea; Yombi, Jean Cyr; Zahár, Ákos; Zimmerli, Werner

doi:10.1016/j.arth.2018.09.032

Cited by 42 publications

(34 citation statements)

References 190 publications

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“…Other options in the treatment of Gram-positive infections include aminoglycosides, which have the additional advantage of providing excellent elution characteristics from bone cement and can be used as a local treatment, particularly combined with glycopeptides (Badha et al, 2019). However, as a relevant amount of these drugs might be absorbed, systemic complications must be monitored for at least 8 weeks especially if systemic treatment is performed as well (Edelstein et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Clinical use of linezolid in periprosthetic joint infections – a systematic review

Theil

Schmidt-Braekling

Gosheger

et al. 2020

J. Bone Joint Infect.

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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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Section: Discussionmentioning

confidence: 99%

Clinical use of linezolid in periprosthetic joint infections – a systematic review

Theil

Schmidt-Braekling

Gosheger

et al. 2020

J. Bone Joint Infect.

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“…All infected cases were treated according to the latest guidelines of the Infectious Diseases Society of America (IDSA) 23,24 . The IDSA is a medical association of health care professionals who specialize in infectious diseases and recommend diagnosis and treatment algorithms based on the actual evidence.…”

Section: Methodsmentioning

confidence: 99%

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Matziolis

Brodt

Böhle

et al. 2020

Sci Rep

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Locally applied vancomycin is increasingly being used in primary hip and knee arthroplasty to reduce the risk of infection. Despite encouraging initial results, considerable debate remains on the basis of the data currently available. In particular, it has been unclear up to now whether local vancomycin is suitable to further reduce the risk of infection even if the rate of infection is already low (< 1%). In this monocentric retrospective cohort study, all primary total hip and knee arthroplasties performed between 2013 and 2018 were included. After a change in procedure at the hospital, 1 g vancomycin powder was applied intraarticularly before wound closure. The remaining perioperative procedure was constant over the investigation period. The follow-up was one year. The presence of an infection according to the currently valid MSIS criteria was defined as the endpoint. In patients with TKA two infections (0.3%) were observed under vancomycin prophylaxis in contrast to 44 infections (1.3%) in the control group (p = 0.033). In patients with THA two infections (0.5%) were observed under vancomycin prophylaxis and 48 infections (1.1%) in the control group without local vancomycin but this difference was statistically not significant. No wound complications requiring revision were observed as a result of the vancomycin. On the basis of the results of this study, intraarticular application of vancomycin powder in total hip and knee arthroplasty may be considered. Prospective randomized studies have to confirm this promising results prior a common recommendation. Level of Evidence III Retrospective cohort study. Infections after endoprosthetic hip or knee replacement, in spite of all perioperative improvements, are observed with an incidence of 1-2% 1-4. Despite the apparently low risk, efforts to further reduce the risk are sensible in light of the consequences for the patients concerned, with the potential for several follow-up operations and the often limited functional outcome. In spinal surgery, the reduction in the rate of infection through locally applied vancomycin was established more than 10 years ago and has been well documented by meta-analyses and animal experiments 5-8. The positive effect is set against minor complications caused in 0.3% of cases, mostly culture-negative seroma formation 9, so that it is even used successfully in children 10. Otte et al. were able to show that intrawound vancomycin powder lowers the infection rate after knee and hip arthroplasty from 1.6 to 0.5%, compared with a control group 11. In a subgroup analysis, the effect in revision operations was even greater, with a reduction of the infection rate from 3.9 to 0%. Patel et al. showed a reduction in the infection rate through vancomycin of 2.7-0.3% and determined a number needed to treat (NNT) of 47.5 12. Systemic side effects were not observed. The local application of vancomycin was assessed to be safe and cost-effective. Dial et al. observed a similar effect in primary hip arthroplasty, with a lowering of the infection rate...

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“…For the prophylaxis purpose, the most common reasons focus in postoperative suspicious infection with clinical signs, such as incision problem, pyrexia, extreme increase of CRP and ESR. The eradication of infections in orthopedics often requires long-term therapy for a duration of intravenous vancomycin usage [8,12]. The mean duration of vancomycin medication was longer in Treatment than Prophylaxis group in our study.…”

Section: Discussionmentioning

confidence: 49%

“…Sixty years after its introduction into clinical practice, vancomycin continues to be recommended intravenously as a treatment for severe and complicated infections and is the most common antibiotic agent used against perioperative infections when no other antibiotic was available [7]. The implantassociated and SSI are among the most dreaded complications encountered by orthopedic surgeons, which are associated with increased length of hospital stay, decreased patient satisfaction, and increased morbidity and mortality [8]. All these reasons further popularized the usage of vancomycin in orthopedics.…”

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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Hip and Knee Section, Treatment, Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Cited by 42 publications

References 190 publications

Clinical use of linezolid in periprosthetic joint infections – a systematic review

Clinical use of linezolid in periprosthetic joint infections – a systematic review

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

The Treatment and Prophylaxis Usage Profile of Intravenous Vancomycin Medication in Orthopedics

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