Multidrug-Resistant Organisms in the Setting of Periprosthetic Joint Infection—Diagnosis, Prevention, and Treatment

Siljander, Matthew P.; Sobh, Ali; Baker, Kevin C.; Baker, Erin A.; Kaplan, Lige

doi:10.1016/j.arth.2017.07.045

Cited by 48 publications

(58 citation statements)

References 173 publications

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“…In acute infections, the main objective is to avoid biofilm formation around the prosthetic material through a careful procedure that includes irrigation, debridement, the exchange of modular components and broad-spectrum antibiotic therapy 6 . The prognosis in these cases can be discouraging when associated with risk factors such as multidrug-resistant bacteria, rheumatic diseases, diabetes and smoking 2,9,10,12,14,15 .…”

Section: Discussionmentioning

confidence: 99%

“…In acute cases where a mature biofilm has not yet been formed on the surface of the prosthetic material, the most used treatment is DAIR with exchange of the modular components 6,7 . The factors that contribute to poor prognosis in the treatment of PJI include age, gender, ethnicity, diabetes, rheumatic disease, obesity, malnutrition and multidrug-resistant infections 2,9,10,11 .…”

Section: Introductionmentioning

confidence: 99%

“…The emergence of multidrug-resistant bacteria in hospital environments is a phenomenon that accompanies the development of new antimicrobials and their indiscriminate use. Some studies have demonstrated that infections by these agents represent an important risk factor for PJI treatment failure 2 . The universe of drug resistant bacteria is very complex with a miscellaneous of pathogens with resistance profiles ranging to one or few commonly used antibiotics, in particular methicillin- Some authors 12 have suggested that infections in TKA by multidrug-resistant microorganisms other than MRSA have worse results in the two-stage exchange of modular components, with an increase incidence of prosthesis failure and even an increase in limb amputation.…”

Section: Introductionmentioning

confidence: 99%

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Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

Rudelli

Giglio

Carvalho

et al. 2020

Preprint

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BACKGROUND: evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention.METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrugsensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated. BackgroundPeriprosthetic joint infection (PJI) is one of the most demanding and challenging complications for orthopedic surgeons 1 . It has a low incidence in total hip (THA) and total knee (TKA) arthroplasty, ranging between 0.2 and 2% of primary procedures 2,3 . Despite its low incidence, PJI is the third leading cause of revision THA in the United States, representing 14.8% of all revision surgeries 4 . The ageing population has led to an increase number of arthroplasties performed worldwide, and the amount of cases of PJI is estimated to grow significantly in the coming decades 3 . Kurtz et al. 5

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

Rudelli

Giglio

Carvalho

et al. 2020

Preprint

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“…Systemic antibiotic therapy is a critical aspect of treating PJI, however, increasing bacterial resistance to conventional antimicrobial agents creates significant treatment challenges 146,147 . Over the past decade, novel antibiotics with broad‐spectrum activity against Gram‐positive organisms such as daptomycin, which is a cyclic lipopeptide, and linezolid, an oxazolidinone, have been developed to expand treatment options for resistant infections 108–110 .…”

Section: New Advancements In the Treatment Of Musculoskeletal Infectionmentioning

confidence: 99%

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

Ricciardi

Muthukrishnan

Masters

et al. 2020

Journal Orthopaedic Research

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Prosthetic joint infection (PJI) is a devastating complication that results in substantial costs to society and patient morbidity. Advancements in our knowledge of this condition have focused on prevention, diagnosis, and treatment, in order to reduce rates of PJI and improve patient outcomes. Preventive measures such as optimization of patient comorbidities, and perioperative antibiotic usage are intensive areas of current clinical research to reduce the rate of PJI. Improved diagnostic tests such as synovial fluid (SF) α‐defensin enzyme‐linked immunosorbent assay, and nucleic acid‐based tests for serum, SF, and tissue cultures, have improved diagnostic accuracy and organism identification. Increasing the diversity of available antibiotic therapy, immunotherapy, and alternative implant coatings remain promising treatments to improve infection eradication in the setting of PJI.

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“…The cost of treatment of a single episode of PJI can escalate to USD 50,000 or more (9). The increase in antibiotic resistance among hospital-acquired infections like PJI has also increased the risk of failing to successfully treat PJI (15, 16). It is therefore clear that PJI presents a major challenge from both a health-care and economic perspective (17).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Vancomycin on the Viability and Osteogenic Potential of Bone-derived Mesenchymal Stem Cells

Booysen

Gijsen

Deane

et al. 2018

Preprint

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Multidrug-Resistant Organisms in the Setting of Periprosthetic Joint Infection—Diagnosis, Prevention, and Treatment

Cited by 48 publications

References 173 publications

Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection

The Effects of Vancomycin on the Viability and Osteogenic Potential of Bone-derived Mesenchymal Stem Cells

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