Studying Biofilm and Clinical Issues in Orthopedics

Peel, Trisha

doi:10.3389/fmicb.2019.00359

Cited by 16 publications

(15 citation statements)

References 64 publications

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“…Empirical treatment may be needed for PIC until antibiogram data is available and coverage of methicillin-resistant staphylococci should be considered; it should also be borne in mind that C. acnes is usually susceptible to penicillin [43]. Despite the undoubted importance of rifampin and quinolones in the treatment of PJI, these agents are not recommended during the initial treatment phase of infection [2,6]. A preoperative synovial fluid culture is helpful for identification of the causative microorganism and determination of their antimicrobial susceptibility and, in addition, for informing the choice of postoperative antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

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The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

Benito

Mur

Ribera

et al. 2019

JCM

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The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)—including multidrug-resistant organisms (MDRO)—by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama’s scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and “positive intraoperative cultures” (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: <1 month, 2–3 months, 4–12 months, >12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.

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Section: Discussionmentioning

confidence: 99%

“…Biofilm formation when microorganisms attach to the surface of prosthetic devices plays a crucial role in the pathogenesis of PJI [2]. This poses a challenge for the diagnosis of biofilm-embedded microorganisms, and antimicrobial therapy in biofilm-associated pathogens is of limited efficacy [3].…”

Section: Introductionmentioning

confidence: 99%

The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

Benito

Mur

Ribera

et al. 2019

JCM

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“…This rids the planktonic cells from the implant component. Sonication has been shown to successfully dislodge biofilms from the surfaces of resected prosthetic implants [67]. Adding a surfactant can also greatly assist in removing the biofilm from a surface and achieving a homogenous cell suspension.…”

Section: Novel Diagnostic Technologies Limited To Researchmentioning

confidence: 99%

Current and novel diagnostics for orthopedic implant biofilm infections: a review

Ronin

Boyer

Alban

et al. 2021

APMIS

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Biofilm infections involving orthopedic implants are a global problem. They contribute to severe complications and mortality, as well as increased use of antibiotic treatments and development of antibiotic‐resistant microorganisms. More than 1 million hip and knee arthroplasties are performed each year in the United States. These hard‐to‐treat infections lead to patient distress, increased morbidity, and high financial costs to both patients and healthcare systems. There is a need to improve the diagnosis of such biofilm infections to allow for earlier detection and treatment. Current diagnostics rely on clinical signs for infections such as loss of function, fever, rubor, patient history of the predisposing condition, persisting infection, failure of antibiotic treatment, and documentation of antibiotic failure. Below, we present a framework which outlines the data gaps in the conventional laboratory techniques used in clinical diagnostics; we also discuss promising novel diagnostic methods which are currently used solely in research. It is critical to assess these novel infection diagnostic techniques and address the data gaps and clinical hesitance preventing application in a clinical setting. Additionally, the combination of conventional and novel diagnostic technologies would streamline the diagnostic process of biofilm infections associated with orthopedic implants.

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“…As an adjunct to systemic therapy, local antibiotic therapy is increasingly being recognised as a method to improve the prevention and treatment of ODRI ( Kaur et al., 2014 ), while minimising the complications associated with systemic exposure ( Metsemakers et al., 2019 ). Polymethyl methacrylate (PMMA) bone cement remains the most often used delivery vehicle for local antibiotics ( Peel, 2019 ). This is used as prophylaxis for fracture-related infection (FRI) in open fractures when applied as beads, or in primary cemented arthroplasty ( Morgenstern et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

An Antibiotic-Loaded Hydrogel Demonstrates Efficacy as Prophylaxis and Treatment in a Large Animal Model of Orthopaedic Device-Related Infection

Boot

Foster

Guillaume

et al. 2022

Front. Cell. Infect. Microbiol.

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Local antibiotic therapy is increasingly being recognised for its role in preventing and treating orthopaedic device-related infection (ODRI). A bioresorbable, injectable gentamicin-loaded hydrogel has been developed to deliver local antibiotics at the time of surgery with potential for both prevention and treatment of ODRI. In a prophylaxis model, the antibiotic hydrogel was compared with systemic perioperative antibiotic prophylaxis alone in twelve sheep (six per group) at the time of intramedullary (IM) nail insertion to the tibia, which was inoculated with methicillin-sensitive Staphylococcus aureus (MSSA). In a treatment model of single-stage revision surgery, adjunctive antibiotic-loaded hydrogel was compared with systemic antibiotics alone in a single stage revision of MSSA infection associated with a tibia intramedullary nail in eleven sheep (five/six per group). The primary endpoint was quantitative microbiological results of soft tissue, bone and sonicate fluid from explanted hardware at the time of euthanasia. At euthanasia, the control sheep that received no local antibiotics in the prophylaxis model were all culture-positive (median 1x108, range 7x106-3x108 colony forming units, CFU) while only two of six sheep receiving local gentamicin had any culture positive biopsies (median 1x101, range 0 - 1x105 CFU). For the treatment model, sheep receiving only systemic antibiotics were all culture-positive (median 8x105, range 2x103- 9x106 CFU) while only two of six sheep treated with gentamicin-loaded hydrogel had any culture positive biopsies (median 3x102, range 0 - 7x104 CFU). Local gentamicin concentrations measured in extracellular fluid in the tibial canal show a burst release of gentamicin from the hydrogel. Serum gentamicin concentrations peaked in both models at one day post application and were below detection limit thereafter. This study has demonstrated the effective use of a locally delivered antibiotic hydrogel for both the prevention and treatment of ODRI that is superior to that of systemic antibiotics alone. Future studies will endeavour to translate from preclinical to clinical research trials.

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Studying Biofilm and Clinical Issues in Orthopedics

Cited by 16 publications

References 64 publications

The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

Current and novel diagnostics for orthopedic implant biofilm infections: a review

An Antibiotic-Loaded Hydrogel Demonstrates Efficacy as Prophylaxis and Treatment in a Large Animal Model of Orthopaedic Device-Related Infection

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