The Use of Erythromycin and Colistin-Loaded Cement in Total Knee Arthroplasty Does Not Reduce the Incidence of Infection

Hinarejos, Pedro; Guirro, Pau; Leal, Joan; Montserrat, Ferran; Pelfort, Xavier; Sorli, M.L.; Horcajada, Juan Pablo; Puig, Lluís

doi:10.2106/jbjs.l.00901

Cited by 91 publications

(86 citation statements)

References 26 publications

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“…However, the rate of infection in the control arms was high in both studies, 13.5% in the diabetics and 3.1% in the nondiabetics, limiting the generalizability of these results to populations with lower rates of infection. A larger study that randomized 2,948 patients undergoing primary knee arthroplasty to receive erythromycin-and colistin-loaded PMMA or plain PMMA found no difference in the deep infection rates at 1 year (47). As acknowledged by the authors of that study, these results cannot be generalized to other, more frequently used antimicrobials.…”

Section: Antimicrobial-loaded Pmma At Prosthesis Implantationmentioning

confidence: 80%

“…Some of these factors include male gender (6,8,20,36,46,47), smoking (21), antecedent bacteremia (during the previous year) (48), and antecedent septic arthritis of the index joint (26). The biological plausibility for some of these factors, such as gender, is uncertain.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Accordingly, prevention of surgical site infection through perioperative antimicrobial prophylaxis, meticulous surgical techniques, and infection control practices is critically important and is discussed in Prevention, below. A prolonged procedure duration is associated with an increased risk of PJI (8,25,26,44,46,47), with a 9% increase in risk for each additional 15-min increment (18). This may be due to an increased time available for microbial contamination of the joint or may be a surrogate for other comorbidities, such as obesity, or both.…”

Section: Risk Factorsmentioning

confidence: 99%

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Prosthetic Joint Infection

2014

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SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.

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Section: Antimicrobial-loaded Pmma At Prosthesis Implantationmentioning

confidence: 80%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Prosthetic Joint Infection

2014

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“…69 However, multiple other studies have shown that bone cement loaded with antibiotics did not significantly reduce infection rates. 70,71 Therefore, it is still unclear whether the traditional method of loading bone cement with antibiotics effectively reduces the infection rate following arthroplasty. However, the number of resistant bacterial strains is currently increasing, and if effective measures are not taken, incurable infectious diseases and small wounds may lead to death.…”

Section: Bone Cementmentioning

confidence: 99%

The antimicrobial activity of nanoparticles: present situation and prospects for the future

Wang¹,

Hu²,

Shao³

2017

IJN

2,914

1,792

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Nanoparticles (NPs) are increasingly used to target bacteria as an alternative to antibiotics. Nanotechnology may be particularly advantageous in treating bacterial infections. Examples include the utilization of NPs in antibacterial coatings for implantable devices and medicinal materials to prevent infection and promote wound healing, in antibiotic delivery systems to treat disease, in bacterial detection systems to generate microbial diagnostics, and in antibacterial vaccines to control bacterial infections. The antibacterial mechanisms of NPs are poorly understood, but the currently accepted mechanisms include oxidative stress induction, metal ion release, and non-oxidative mechanisms. The multiple simultaneous mechanisms of action against microbes would require multiple simultaneous gene mutations in the same bacterial cell for antibacterial resistance to develop; therefore, it is difficult for bacterial cells to become resistant to NPs. In this review, we discuss the antibacterial mechanisms of NPs against bacteria and the factors that are involved. The limitations of current research are also discussed.

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“…Studies have demonstrated a significant reduction in infection rates using antibiotic-impregnated cement in total hip arthroplasty and total knee arthroplasty patient populations (15,16). Conversely, other studies indicated limited clinical benefit, albeit with various antibiotics and concentrations (17,18) and poor descriptions of elution kinetics (19). Additionally, once the antibiotics have eluted from a nonabsorbable cement, the surface becomes a foreign body that is subject to bacterial colonization and biofilm formation (20,21).…”

mentioning

confidence: 99%

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

Howlin

Brayford

Webb

et al. 2015

Antimicrob Agents Chemother

193

188

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e Periprosthetic infection (PI) causes significant morbidity and mortality after fixation and joint arthroplasty and has been extensively linked to the formation of bacterial biofilms. Poly(methyl methacrylate) (PMMA), as a cement or as beads, is commonly used for antibiotic release to the site of infection but displays variable elution kinetics and also represents a potential nidus for infection, therefore requiring surgical removal once antibiotics have eluted. Absorbable cements have shown improved elution of a wider range of antibiotics and, crucially, complete biodegradation, but limited data exist as to their antimicrobial and antibiofilm efficacy. Synthetic calcium sulfate beads loaded with tobramycin, vancomycin, or vancomycin-tobramycin dual treatment (in a 1:0.24 [wt/wt] ratio) were assessed for their abilities to eradicate planktonic methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis relative to that of PMMA beads. The ability of the calcium sulfate beads to prevent biofilm formation over multiple days and to eradicate preformed biofilms was studied using a combination of viable cell counts, confocal microscopy, and scanning electron microscopy of the bead surface. Biofilm bacteria displayed a greater tolerance to the antibiotics than their planktonic counterparts. Antibiotic-loaded beads were able to kill planktonic cultures of 10 6 CFU/ml, prevent bacterial colonization, and significantly reduce biofilm formation over multiple days. However, established biofilms were harder to eradicate. These data further demonstrate the difficulty in clearing established biofilms; therefore, early preventive measures are key to reducing the risk of PI. Synthetic calcium sulfate loaded with antibiotics has the potential to reduce or eliminate biofilm formation on adjacent periprosthetic tissue and prosthesis material and, thus, to reduce the rates of periprosthetic infection. P eriprosthetic infection (PI) is a serious complication of total joint arthroplasty with high rates of associated morbidity (1, 2), and a growing body of data suggests that bacterial biofilms are the underlying cause (3-9). Within a biofilm, bacteria display a Ն1,000-fold tolerance to antibiotics than their planktonic counterparts (10) and significant resistance to innate and adaptive host immunity (11). Moreover, biofilms associated with orthopedic hardware are typically difficult to culture using conventional clinical microbiological methods, and the lack of a definitive diagnosis may result in an underestimate of infection rates (12, 13). Consequently, the underlying infection is difficult to diagnose and treat (6, 7), and often the only effective intervention is the twin strategy of thorough debridement and prostheses removal (14).Existing prevention strategies include the use of antibiotic-loaded poly(methyl methacrylate) (PMMA) cement spacers or beads to elevate local antibiotic levels at the surgical site. Studies have demonstrated a significant reduction in infection rates using antibiotic-impregnated ce...

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The Use of Erythromycin and Colistin-Loaded Cement in Total Knee Arthroplasty Does Not Reduce the Incidence of Infection

Cited by 91 publications

References 26 publications

Prosthetic Joint Infection

Prosthetic Joint Infection

The antimicrobial activity of nanoparticles: present situation and prospects for the future

Antibiotic-Loaded Synthetic Calcium Sulfate Beads for Prevention of Bacterial Colonization and Biofilm Formation in Periprosthetic Infections

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