Prosthetic Joint Infection Caused by Gram-Negative Organisms

Zmistowski, Benjamin; Fedorka, Catherine J.; Sheehan, Eoin; Deirmengian, Gregory K.; Austin, Matthew S.; Parvızı, Javad

doi:10.1016/j.arth.2011.03.044

Cited by 167 publications

(121 citation statements)

References 13 publications

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“…Although several studies, including the present study, have demonstrated that MRSA is reduced in patients with vancomycin, no studies to our knowledge have observed a reduced rate of Gram-positive organism. This finding can likely be explained by the narrower coverage of vancomycin compared with cefazolin and is important because infection with organisms other than Gram-positives such as atypical organisms and Gramnegative infection has been associated with poor treatment outcomes [10,17]. Because of the potential for narrower coverage, another antibiotic can be added such as cefazolin or teicoplanin, which is commonly done in Europe, or monotherapy with antibiotics of broader coverage such as aztreonam, levofloxacin, or clindamycin.…”

Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. Questions/purposes (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy?Methods We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between b-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. Results After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI,; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI,

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Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This is evident in an analysis of success in treating gram-negative periprosthetic joint infection at this institution, where the current authors (B.Z. and J.P.) found that a large proportion of patients (26% [six of twenty-three]) did not complete a twostage exchange because of death 53 . Lastly, MRSA is a particularly virulent organism that can cause persistent periprosthetic joint infection and increased cost of treatment 49,53,56 .…”

Section: Periprosthetic J O I N T I N F E C T I O N I N C R E a S E Smentioning

confidence: 94%

“…The effect of periprosthetic joint infection on patient mortality within thirty days is inconclusive, possibly stemming from a type-II error or an indication that no difference exists in the initial insult required in treating periprosthetic joint infection compared with aseptic failure. Other authors have provided anecdotal evidence of increased mortality in patients receiving treatment for periprosthetic joint infection [52][53][54] . Most recently, Berend et al reported 4% mortality within ninety days 52 .…”

Section: Periprosthetic J O I N T I N F E C T I O N I N C R E a S E Smentioning

confidence: 99%

Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

Zmistowski

Karam

Durinka

et al. 2013

The Journal of Bone & Joint Surgery

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553

291

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“…Based on the in vitro release experiments, loading with gentamicin-encapsulated liposomes was selected as the best method to test antibacterial properties against E. coli, which is the most frequently isolated microorganism from gram-negative periprosthetic joint infections [52][53][54].…”

Section: As Sintered None Etched Selective Etching (4 Days) Etched+lomentioning

confidence: 99%

Selective etching of injection molded zirconia-toughened alumina: Towards osseointegrated and antibacterial ceramic implants

et al. 2016

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Due to their outstanding mechanical properties and excellent biocompatibility, zirconiatoughened alumina (ZTA) ceramics have become the gold standard in orthopedics for the fabrication of ceramic bearing components over the last decade. However, ZTA is bioinert, which hampers its implantation in direct contact with bone. Furthermore, periprosthetic joint infections are now the leading cause of failure for joint arthroplasty prostheses. To address both issues, an improved surface design is required: a controlled micro-and nano-roughness can promote osseointegration and limit bacterial adhesion whereas surface porosity allows loading and delivery of antibacterial compounds. In this work, we developed an integrated strategy aiming to provide both osseointegrative and antibacterial properties to ZTA surfaces. The microtopography was controlled by injection molding. Meanwhile a novel process involving the selective dissolution of zirconia (selective etching) was used to produce nano-roughness and interconnected nanoporosity. Potential utilization of the porosity for loading and delivery of antibiotic molecules was demonstrated, and the impact of selective etching on mechanical properties and hydrothermal stability was shown to be limited. The combination of injection molding and selective etching thus appears promising for fabricating a new generation of ZTA components implantable in direct contact with bone.3

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Prosthetic Joint Infection Caused by Gram-Negative Organisms

Cited by 167 publications

References 13 publications

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

Selective etching of injection molded zirconia-toughened alumina: Towards osseointegrated and antibacterial ceramic implants

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