Molecular and Antibiofilm Approaches to Prosthetic Joint Infection

Trampuž, Andrej; Osmon, Douglas R.; Hanssen, Arlen D.; Steckelberg, James M.; Patel, Robin

doi:10.1097/01.blo.0000087324.60612.93

Cited by 270 publications

(178 citation statements)

References 97 publications

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“…Debridement and retention and a two-stage exchange with spacer implantation are only indicated if antibiotics with high biofilm activity are available for the detected pathogen [6,42,43]. Antibiotic therapy should therefore combine bactericidal substances with those having biofilm activity (i.e.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Wimmer

Randau

Petersdorf

et al. 2013

International Orthopaedics (SICOT)

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Purpose Current concepts in the treatment of prosthetic joint infections include prosthetic retention and exchange strategies according to published recommendations. A useful algorithm should fit for each type of prosthetic joint infection, even the most complicated situations. We present the outcome of 147 patients with prosthetic joint infections of the hip or the knee joint in an unselected population in clinical routine. Methods Between November 2006 and November 2009, 147 consecutive patients with prosthetic joint infections of the hip or knee were treated according to an algorithm based on the concept published by Zimmerli et al. in 2004. Causative organism, duration of infection, patient comorbidities, surgical treatment, antibiotic treatment, and outcome of treatment were analysed retrospectively. According to the criteria duration of infection, stability of prosthesis, local and systemic risk factors, and susceptibility of the causative pathogen, patients were treated either with debridement and retention or a longinterval two-stage procedure. Results A pathogen could be detected in 82.8 % of the patients, gram-positive cocci being most common. Twentyseven patients were treated with debridement and retention and 120 were treated with a two-stage procedure. In 68 cases difficult-to-treat pathogens could be detected, a polymicrobial infection was found in 51 patients. Definitely free of infection were 71.6 % after a two-stage procedure, and 70.4 % after debridement and retention. Conclusions Our data indicates that the applied algorithm is suitable to be applied as a day-to-day routine, and we confirmed that published results from the literature can be reproduced in an inhomogeneous patient cohort.

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Section: Discussionmentioning

confidence: 99%

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Wimmer

Randau

Petersdorf

et al. 2013

International Orthopaedics (SICOT)

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“…Our study confirms the hypothesis that bacteria exist at the site of instrumentation after debridement and perioperative antibiotic administration for pyogenic vertebral osteomyelitis. Bacteria were detected from retrieved spinal implants as well as surrounding bones by bacterial culture and/or pyrosequencing methods in 17 In this study, ultrasonication technique, which has been proved effective for disrupting the biofilm and dislodging bacteria from implants [29,33,34], was used to detect bacteria. In a study of 78 patients with aseptic failure and/or infection of prosthetic hip or knee infection [31], sonicate fluid and tissue cultures from removed implants were compared for microorganism detection.…”

Section: Discussionmentioning

confidence: 99%

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

et al. 2013

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Objective This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation. Methods Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85 %) of all 20 animals. The positive rate for bacteria presence was 45 % by culture and 80 % by pyrosequencing method. Results Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culturepositive animals. Conclusion Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the ''culprit'' for the persistence or recurrence of infection.

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“…The biofilm also makes the bacteria difficult to detect with conventional microbiologic culture. The sensitivity of diagnostic assays has been improved by the use of techniques that dislodge adherent bacteria from the biofilm [13]. Sonication and/or vortexing increases the number of bacteria isolated from retrieved joint implants [8,14,16].…”

Section: Introductionmentioning

confidence: 99%

Improved Detection of Biofilm-formative Bacteria by Vortexing and Sonication: A Pilot Study

Kobayashi

Oethinger

Tuohy

et al. 2009

Clinical Orthopaedics &Amp; Related Research

110

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Bacteria such as staphylococci commonly encountered in orthopaedic infections form biofilms and adhere to bone implants and cements. Various methods to disrupt the biofilm and enhance bacterial detection have been reported. We will describe the effectiveness of vortexing and sonication to improve the detection of biofilmformative bacteria from polymethylmethacrylate by conventional quantitative bacterial culture and real-time quantitative PCR. We used a single biofilm-formative Staphylococcus aureus strain and 20 polymethylmethacrylate coupons as an in vitro biofilm model; four coupons were used for each of two control groups or three experimental sonication times (1, 5, and 30 minutes). Vortexing the cement without sonication increased the yield of adherent bacteria to a considerable extent. The combination of vortexing and sonication further enhanced the yield regardless of the duration of sonication. Quantitative conventional cultures correlated with quantitative PCR assay. The combination of vortexing and sonication to disrupt the bacterial biofilm followed by quantitative PCR and/or culture seems to be a sensitive method for detecting bacteria adherent to bone cement.

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Molecular and Antibiofilm Approaches to Prosthetic Joint Infection

Cited by 270 publications

References 97 publications

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections

Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

Improved Detection of Biofilm-formative Bacteria by Vortexing and Sonication: A Pilot Study

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