Orthopaedic Implant-Associated Staphylococcal Infections: A Critical Reappraisal of Unmet Clinical Needs Associated with the Implementation of the Best Antibiotic Choice

Abstract

Infections associated with orthopaedic implants represent a major health concern characterized by a remarkable incidence of morbidity and mortality. The wide variety of clinical scenarios encountered in the heterogeneous world of infections associated with orthopaedic implants makes the implementation of an optimal and standardized antimicrobial treatment challenging. Antibiotic bone penetration, anti-biofilm activity, long-term safety, and drug choice/dosage regimens favouring outpatient management (i.e., long-acting or oral agents) play a major role in regards to the chronic evolution of these infections. The aim of this multidisciplinary opinion article is to summarize evidence supporting the use of the different anti-staphylococcal agents in terms of microbiological and pharmacological optimization according to bone penetration, anti-biofilm activity, long-term safety, and feasibility for outpatient regimens, and to provide a useful guide for clinicians in the management of patients affected by staphylococcal infections associated with orthopaedic implants Novel long-acting lipoglycopeptides, and particularly dalbavancin, alone or in combination with rifampicin, could represent the best antibiotic choice according to real-world evidence and pharmacokinetic/pharmacodynamic properties. The implementation of a multidisciplinary taskforce and close cooperation between microbiologists and clinicians is crucial for providing the best care in this scenario.

Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence

“…), had several virtual meetings for developing algorithms for targeted antimicrobial therapy of severe MSSA and MRSA infections. Algorithms were organized for different sites of infection (namely infective endocarditis [IE], primary bloodstream infections [BSIs], infections associated with intracardiac/intravascular devices, community-acquired pneumonia [CAP], infection-related ventilator-associated complications (IVACs), central nervous system [CNS] infections, and necrotizing skin and soft tissue infections), and therapeutic strategies were based also on PK/PD features [ 10 , 14 ]. A researcher (M.G.)…”

On‐Demand Magnetically‐Activated Drug Delivery from Additively Manufactured Porous Bone Implants to Tackle Antibiotic‐Resistant Infections

“…[13] In isolates from infected biomaterials, the highest occurrence rates of resistant phenotypes are registered with some gram-negative strains (20%-40%), [9] and include the notorious methicillin-resistant Staphylococcus aureus (MRSA). [6,14] Due to the uncertain future role of antibiotics in IAI, there has been a move toward the development of antibacterial biomaterials endowed with local-action mechanisms and the possibility to prevent IAIs in the first place. Direct antibacterial biomaterials intended for orthopedic applications can be divided into three major categories: anti-adhesive/repelling surfaces, contact killing surfaces, and antibacterial-leaching surfaces, each of them exhibiting varying pros and cons.…”

“…[ 13 ] In isolates from infected biomaterials, the highest occurrence rates of resistant phenotypes are registered with some gram‐negative strains (20%–40%), [ 9 ] and include the notorious methicillin‐resistant Staphylococcus aureus (MRSA). [ 6,14 ]…”

Non-biofilm-forming Staphylococcus epidermidis planktonic cell supernatant induces alterations in osteoblast biological function

“…PJI is 1–9% common in all hip or knee arthroplasty patients 7 , 8 , and treatment success ranges from 30 to 90% 9 . Staphylococcus aureus , Staphylococcus epidermidis , and other coagulase-negative staphylococci (CNS) are responsible for 50% of PJI cases 10 , and in chronic PJI S. aureus and S. epidermidis are the most incidence 11 .…”