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

Beaubien, Brian de; Belden, Katherine; Bell, Kevin; Boyle, K. Keely; Cordero‐Ampuero, José; Valle, Craig J. Della; Eijer, Henk; Ferry, Christopher; Janz, Viktor; Kessler, Bernard; Kratky, Adam; Lachiewicz, Anne; Martin, Kimberly E.; Murillo, Óscar; Nijhof, Marc W.; Nodzo, Scott R.; Petrie, Michael J.; Stockley, I; Suleiman, Linda I.

doi:10.1016/j.arth.2018.09.033

Cited by 18 publications

(29 citation statements)

References 48 publications

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“…Linezolid offers the advantage of very good, oral bioavailability (Thompson et al, 2017) and its broad spectrum against Gram-positive bacteria facing current resistance patterns (Deroche et al, 2019;Lourtet-Hascoet et al, 2018) of organisms encountered in the treatment of PJI. Based on the reports available and included in this review a remission of the infection can be expected in around 80 % of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, microbiological results are changing with increasing prevalence of resistant strains (Drago et al, 2017;De Vecchi et al, 2018), particularly methicillinresistant (MR) coagulase-negative Staphylococcus (CoNS) now being the main pathogen detected (Lourtet-Hascoet et al, 2018;Hipfl et al, 2019;Tevell et al, 2019). In this context, linezolid is a potential antimicrobial treatment option addressing resistant Staphylococcus (Deroche et al, 2019) as well as reducing the need for long-term inpatient treatment given its excellent oral bioavailability (Kutscha-Lissberg et al, 2003). However, linezolid can have some feared adverse C. Theil et al: Clinical use of linezolid in periprosthetic joint infections effects such as cytopenia, particularly of leukocytes and neuropathy, that might lead to treatment discontinuation (Legout et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…While current consensus statements and widely used treatment guidelines recommend the use of linezolid only for (vancomycin-)resistant Enterococcus or as an alternative treatment for resistant Staphylococcus (Anemuller et al, 2019;de Beaubien et al, 2019;Osmon et al, 2013b), there are several reports that recommend its use as either an empirical treatment (Deroche et al, 2019;Takoudju et al, 2018) or for early oral treatment reducing the need for in-hospital intravenous treatment with good results (Oussedik and Haddad, 2008;Legout et al, 2010;Cobo et al, 2013). Furthermore, in implant-related infections rifampicin and its derivatives needs to be considered as a potential drug for combined treatment considering its anti-biofilm properties in staphylococcal infections (Zimmerli and Sendi, 2019).…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Remarkably, despite the broad clinical use of ALBC since 1980s, 21 this practice has not been successfully extended to other carriers. At the 2018 ICM, there was a strong consensus (supermajority agreement, delegate vote = agree: 80%, disagree: 13%, and abstain: 7%), that “The use of antibiotic‐loaded ceramic bone graft substitutes, specifically calcium sulfate and calcium phosphate‐based materials, to locally deliver antibiotics at sites of MSKI, specifically SSI, FRI, and PJI, 22 has not been shown to be effective in the management of SSI/FRI/PJI.” 4 This consensus is consistent with the most recent peer‐reviewed literature on this topic, which has also not shown sufficient outcome evidence to prove the efficacy of ALBC in the management of osteoarticular infections 5–7 . This absence of efficacy data may be due to the lack of randomized clinical trials designed to answer this question.…”

Section: Introductionmentioning

confidence: 99%

“…A case in point was the 2018 International Consensus Meeting (ICM), 3 which included 869 delegates from 92 countries, who derived recommendations with rationales for 652 consensus questions (https://icmphilly.com). Furthermore, specific 2018 ICM Research Workgroups (RW) addressed: high‐priority MSKI research questions (https://www.ors.org/icm-2018-research-agenda-workgroup/), 4 questions pertaining specifically to PJI of the hip and knee (https://icmphilly.com/wp-content/uploads/2018/11/Hip-and-Knee.pdf), 5–7 and biofilm questions (https://www.ors.org/icm-2018-biofilm-workgroup/). 8 One clinically relevant and frequently discussed topic (https://www.ors.org/wp-content/uploads/2019/01/Question-8.pdf) that drew great attention by all three of these independent RW is the use of antibiotic‐loaded methylmethacrylate bone cement (ALBC), and the use of bone graft extender/substitutes (calcium sulphate/calcium phosphate) as antibiotic carriers, in the treatment and prevention of surgical site infection (SSI), fracture‐related infection (FRI), and PJI.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant antibiotic‐loaded bone cement: Concerns with current use and research to make it work

Schwarz

McLaren

Sculco

et al. 2020

Journal Orthopaedic Research

106

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Antibiotic‐loaded bone cement (ALBC) is broadly used to treat orthopaedic infections based on the rationale that high‐dose local delivery is essential to eradicate biofilm‐associated bacteria. However, ALBC formulations are empirically based on drug susceptibility from routine laboratory testing, which is known to have limited clinical relevance for biofilms. There are also dosing concerns with nonstandardized, surgeon‐directed, hand‐mixed formulations, which have unknown release kinetics. On the basis of our knowledge of in vivo biofilms, pathogen virulence, safety issues with nonstandardized ALBC formulations, and questions about the cost‐effectiveness of ALBC, there is a need to evaluate the evidence for this clinical practice. To this end, thought leaders in the field of musculoskeletal infection (MSKI) met on 1 August 2019 to review and debate published and anecdotal information, which highlighted four major concerns about current ALBC use: (a) substantial lack of level 1 evidence to demonstrate efficacy; (b) ALBC formulations become subtherapeutic following early release, which risks induction of antibiotic resistance, and exacerbated infection from microbial colonization of the carrier; (c) the absence of standardized formulation protocols, and Food and Drug Administration‐approved high‐dose ALBC products to use following resection in MSKI treatment; and (d) absence of a validated assay to determine the minimum biofilm eradication concentration to predict ALBC efficacy against patient specific micro‐organisms. Here, we describe these concerns in detail, and propose areas in need of research.

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Selecting a high‐dose antibiotic‐laden cement knee spacer

Hollyer

Ivanov

Kappagoda³

et al. 2023

Journal Orthopaedic Research

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Prosthetic joint infection [PJI] after total knee arthroplasty (TKA) remains a common and challenging problem for joint replacement surgeons and patients. Once the diagnosis of PJI has been made, patient goals and characteristics as well as the infection timeline dictate treatment. Most commonly, this involves a two‐stage procedure with the removal of all implants, debridement, and placement of a static or dynamic antibiotic spacer. Static spacers are commonly indicated for older, less healthy patients that would benefit from soft tissue rest after initial debridement. Mobile spacers are typically used in younger, healthier patients to improve quality of life and reduce soft‐tissue contractures during antibiotic spacer treatment. Spacers are highly customizable with regard to antibiotic choice, cement variety, and spacer design, each with reported advantages, drawbacks, and indications that will be covered in this article. While no spacer is superior to any other, the modern arthroplasty surgeon must be familiar with the available modalities to optimize treatment for each patient. Here we propose a treatment algorithm to assist surgeons in deciding on treatment for PJI after TKA.

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

Cited by 18 publications

References 48 publications

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

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

Adjuvant antibiotic‐loaded bone cement: Concerns with current use and research to make it work

Selecting a high‐dose antibiotic‐laden cement knee spacer

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