Mitigation and Education

doi:10.1002/jor.22547

Cited by 12 publications

(6 citation statements)

References 108 publications

(105 reference statements)

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“…ageing, autoimmunity, obesity and diabetes). 93-96 Thus, it is not surprising that the two most recent large clinical trials with active S. aureus vaccines (StaphVAX (polysaccharide capsular antigens CP5 and CP8), 97 and V710 (IsdB) 98 ) failed to meet their primary endpoints. However, what was very surprising was that V710 vaccination was associated with increased sepsis, multi-organ failure and death in patients undergoing heart valve replacement who developed S. aureus infections, 98 which is consistent with the finding that high titres of anti-IsdB antibodies are associated with these adverse events in total joint arthroplasty patients.…”

Section: New Approaches For Prevention and Treatmentmentioning

confidence: 99%

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

et al. 2016

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Orthopaedic and trauma device-related infection (ODRI) remains one of the major complications in modern trauma and orthopaedic surgery.Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, leading to infections that negatively impact clinical outcome and significantly increase healthcare expenditure.The following review summarises the microbiological profile of modern ODRI, the impact antibiotic resistance has on treatment outcomes, and some of the principles and weaknesses of the current systemic and local antibiotic delivery strategies.The emerging novel strategies aimed at preventing or treating ODRI will be reviewed. Particular attention will be paid to the potential for clinical impact in the coming decades, when such interventions are likely to be critically important.The review focuses on this problem from an interdisciplinary perspective, including basic science innovations and best practice in infectious disease. IntroductionOrthopaedic and trauma device-related infection (ODRI) remains a major complication in modern trauma and orthopaedic surgery. 1 Despite best practice in medical and surgical management, neither prophylaxis nor treatment of ODRI is effective in all cases, and can lead to infections that negatively impact clinical outcome and significantly increase healthcare expenditure. 2 Pre-operative and correctly-timed prophylactic antibiotic intervention is mandatory for a majority of orthopaedic procedures. However, despite this, the incidence of infection following elective orthopaedic surgery is in the range of 0.7% to 4.2%, 3-7 while the incidence can be much higher in trauma cases where infection rates range from approximately 1% after operative fixation of closed low-energy fractures, to more than 30% in complex open tibia fractures. 8,9 Treatment success rates vary, with between 57% and 88% often reported. [10][11][12] Current curative approaches (radical debridement, revision surgery and prolonged antibiotic therapy) often result in significant socioeconomic costs, not to mention the risk of life-long functional impairment for the patient. Against this background, and with the increasing issue of antibiotic-resistant bacteria, the problem of ODRI is set to continue to pose a challenge for practising clinicians in the coming decades. The clinical and microbiological challenges of modern device-related infectionsThe most prevalent species in ODRIs are Staphylococci. [13][14][15][16][17] Staphylococcus (S.) aureus accounts for between 20% and 30% of cases of infection after fracture fixation and prosthetic joint infections (PJI), with coagulase-negative staphylococci (CoNS) accounting for 20%-40% of cases, [13][14][15][16] including small colony variants. 18 Other Gram-positive cocci including Streptococci (1%-10%) and Enterococci (3%-7%) are less frequently encountered. Infections caused by Gram-negative bacilli, including Pseudomonas aeruginosa and Enterobacteriaceae account for approximately 6%-17%, [13][14][15][16...

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Section: New Approaches For Prevention and Treatmentmentioning

confidence: 99%

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

et al. 2016

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“…Notably, cirrhosis, hypothyroidism, urinary tract infection (UTI), illicit drug abuse, alcohol abuse, ischemic heart disease and renal disease were not significantly associated with PJI [19], despite them being cited as risk factors in other studies [21-24]. Expert consensus strongly agrees that history of previous surgery, poorly controlled diabetes mellitus (glucose > 200 mg/L or hemoglobin A1c > 7%), malnutrition, morbid obesity, active liver disease, chronic renal disease, excessive smoking (>1 pack per day), excessive alcohol consumption (>40 units per week), intravenous drug abuse, recent hospitalization, extended stay in a rehabilitation facility, male gender, diagnosis of post-traumatic arthritis, inflammatory arthropathy, and severe immunodeficiency are all risk factors for SSI and PJI [25]. …”

Section: Epidemiologymentioning

confidence: 99%

“…These bacteria represent the causative organism in approximately 4-7% of PJIs in large series [12, 25], and their management is typically considered challenging [43]. They appear to affect THA and TKA equally [25]. Zmistowski, et al .…”

Section: Microorganismsmentioning

confidence: 99%

“…[91]. Although it remains a controversial topic and there is recent strong consensus against universal screening and decolonization of all patients undergoing TJA [25], available evidence suggests that screening (particularly with cultures versus PCR testing), decolonization with intranasal mupirocin and chlorhexidine soap baths, and perioperative vancomycin for MRSA-positive patients is likely a cost-effective paradigm to prevent MRSA PJI [91]. Additionally, novel implants that have surface treatments minimizing microbial adhesion are on the horizon, preventing biofilm formation, and exhibiting bacteriocidal properties [92].…”

Section: Managementmentioning

confidence: 99%

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Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty

McLawhorn¹,

Nawabi²,

Ranawat³

2016

TOORTHJ

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Background:Periprosthetic joint infection (PJI) is a devastating complication following lower extremity total joint arthroplasty (TJA). It is a leading cause of morbidity and revision following TJA. As such, PJI is a significant driver of healthcare costs. The prevalence of PJI related to resistant and atypical organisms is increasing, and approximately 10-30% of PJIs are culture-negative. The purpose of this review is to summarize the current epidemiology, diagnostics, and management of PJI associated with resistant and atypical pathogens and of culture-negative PJIs.Methods:The published literature related to the epidemiology, diagnosis, and management of atypical, drug-resistant, and culture-negative PJI is reviewed.Results:The clinical diagnosis of PJI is often challenging, particularly when pathogens are fastidious or when antibiotics have been administered empirically. Molecular diagnostic studies, such as synovial α-defensin, may provide rapid, accurate identification of PJI, even in the setting of concurrent antibiotics administration or systemic inflammatory disease. Once PJI is diagnosed, two-stage exchange arthroplasty remains the gold standard for treating PJI with resistant microorganisms, since there is a high rate of treatment failure with irrigation and debridement and with one-stage exchange arthroplasty.Conclusion:Additional research is needed to define the optimal treatment of PJIs associated with rare pathogens, such as fungi and mycobacteria. There is a need for inexpensive, reliable tests that rapidly detect specific microbial species and antimicrobial susceptibilities. Additional research is also required to define the specific organisms, clinical scenarios, surgical techniques, and antimicrobial regimens that allow for reproducible treatment success with prosthetic retention strategies.

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“…The presence of any local or systemic infection is considered to be a contraindication for elective joint arthroplasty [3]. The infection may exist in the urinary tract, skin, nails as well as the oral cavity [4].…”

Section: Before the Day Of Surgerymentioning

confidence: 99%

The Prevention of Periprosthetic Joint Infections

Küçükdurmaz

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

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Mitigation and Education

Cited by 12 publications

References 108 publications

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

Orthopaedic device-related infection: current and future interventions for improved prevention and treatment

Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty

The Prevention of Periprosthetic Joint Infections

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