Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies

Tzeng, Alice; Tzeng, Tony H.; Vasdev, Sonia; Korth, Kyle; Healey, Travis L.; Parvızı, Javad; Saleh, Khaled J.

doi:10.1016/j.diagmicrobio.2014.08.018

Cited by 68 publications

(57 citation statements)

References 108 publications

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“…Emerging evidence has shown that biofilms play a key role in the pathophysiology of PJI and antibiotic resistance . Biofilms are surface attached communities of bacterial cells that possess defense mechanisms that make them more difficult to detect and eradicate using conventional conventional therapies.…”

Section: Pathogenesis Of Biofilm Formation On Implantsmentioning

confidence: 99%

“…Emerging evidence has shown that biofilms play a key role in the pathophysiology of PJI and antibiotic resistance. [6][7][8][9][10][11] Biofilms are surface attached communities of bacterial cells that possess defense mechanisms that make them more difficult to detect and eradicate using conventional conventional therapies. Biofilm can be found on implanted hardware and biofilm bacteria can adhere to surrounding tissue and the bone next to the implant.…”

mentioning

confidence: 99%

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Current review—The rise of bacteriophage as a unique therapeutic platform in treating peri‐prosthetic joint infections

Akanda

Taha

Abdelbary

2017

Journal Orthopaedic Research

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Peri-prosthetic joint infection (PJI) is one of the most serious and dreaded complications after total joint replacement (TJR). Due to an aging population and the constant rise in demand for TJR, the incidence of PJI is also increasing. Successful treatment of PJI is challenging and is associated with high failure rates. One of the main causes for treatment failure is bacterial biofilm formation on implant surfaces and the adherence of biofilm bacteria on tissue and bone next to the implant. Biofilms are protective shields to bacterial cells and possess many unique properties that leads to antibiotic resistance. New therapeutic platforms are currently being explored to breakdown biofilm matrix in order to enhance the efficacy of antibiotics. Bacteriophages (phages) is one of these unique therapeutic platforms that can degrade biofilms as well as target the killing of bacterial cells. Preclinical studies of biofilm-mediated infections have demonstrated the ability of phage to eradicate biofilms and clear infections by working synergistically with antibiotics. There is strong preclinical evidence that phage can reduce the concentration of antibiotics required to treat an infection. These findings support a promising role for phages as a future clinical adjunct to antibiotics. In addition, phage therapy can be personalized to target a specific bacterial strain. Clinical studies using phage therapy are limited in Western literature; but phase I studies have established good safety profile with no adverse outcomes reported. In order to translate phage therapy to treat PJI in clinics, further preclinical testing is still required to study optimal delivery methods as well as the interaction between phage and the immune system in vivo. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1051-1060, 2018.

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Section: Pathogenesis Of Biofilm Formation On Implantsmentioning

confidence: 99%

mentioning

confidence: 99%

Current review—The rise of bacteriophage as a unique therapeutic platform in treating peri‐prosthetic joint infections

Akanda

Taha

Abdelbary

2017

Journal Orthopaedic Research

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“…Well‐documented work has shown the predominance of Gram‐positive bacteria in such infections (such as Staphylococcus aureus and Staphylococcus epidermidis ) . There is increasing evidence showing the formation of biofilms and is a mechanism of chronic infection and tolerance to antibiotic therapy . It has been shown that components as small as sutures can harbor biofilm formation and growth in PJI.…”

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confidence: 99%

Mapping bacterial biofilms on recovered orthopaedic implants by a novel agar candle dip method

Moley

McGrath

Granger

et al. 2019

APMIS

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Dusane DH. Mapping bacterial biofilms on recovered orthopaedic implants by a novel agar candle dip method. APMIS 2019; 127: 123-130.While the detrimental effects of periprosthetic joint infections (PJIs) are well known, the process of biofilm formation on orthopaedic hardware is unclear. Previous work has shown that encasement of explant hardware in agar can aid in identifying biofilms. This study tested the utility of agar 'candle dip' method in detecting and mapping the location of biofilm on infected orthopedic components. Explant components from 15 patients were rinsed, briefly submerged in agar to create a surface coating, and incubated. Larger components were coated by pipetting agar over them. After incubation, colony outgrowth on the component surface was documented (candle dip status). Data were compared with clinical laboratory results (clinical culture status) and the PJI diagnosis using Musculoskeletal Infection Society criteria (MSIS status). All six patients classified as MSIS and clinical culture positive were also positive with the candle dip technique. Of the nine candle dip negative cases, four were positive and five were negative for both MSIS and clinical culture status. Candle dip may be negative in few cases due to the residual antibiotic eluting from the spacers, limiting the growth of bacterial biofilms on the components. The candle dip method shows promise for biofilm mapping but requires additional testing to evaluate the clinical diagnostic potential.

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“…Similarly, customized grids of DNA microarrays consisting of thousands of probes for ribosomal or antibiotic-resistance genes of the most common PJI pathogens can be fabricated to capture fluorescently labeled DNA in clinical samples. This strategy can decrease the cost and improve the time-efficiency of FISH and PCR [53]. …”

Section: Biofilm Visualization and Sequencing-based Biomolecular Methodsmentioning

confidence: 99%

Advancements in Diagnosing Periprosthetic Joint Infections after Total Hip and Knee Arthroplasty

Patel

Alijanipour

Parvızı

2016

TOORTHJ

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Periprosthetic joint infection (PJI) is a complication of total joint arthroplasty that is challenging to diagnose. Currently, there is no “gold standard” for definite diagnosis of PJI. A multi-criteria definition has been described for PJI based on microbiology cultures, serum markers, such as erythrocyte sedimentation rate and C-reactive protein (CRP), synovial fluid biomarkers, such as leukocyte esterase and histopathology assessment of the periprosthetic tissue. The conventional serum markers are generally nonspecific and can be elevated in inflammatory conditions. Therefore, they cannot be relied on for definite diagnosis of PJI. Hence, with the use of proteomics, synovial fluid biomarkers such as α-defensin, IL-6, and CRP have been proposed as more accurate biomarkers for PJI. Current methods to culture micro-organisms have several limitations, and can be false-negative and false-positive in a considerable number of cases. In an attempt to improve culture sensitivity, diagnostic methods to target biofilms have recently been studied. The understanding of the concept of biofilms has also allowed for the development of novel techniques for PJI diagnosis, such as visualizing biofilms with fluorescent in-situ hybridization and detection of bacteria via DNA microarray. Lastly, the use of amplification-based molecular techniques has provided methods to identify specific species of bacteria that cause culture-negative PJI. While diagnosing PJI is difficult, these advances could be valuable tools for clinicians.

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Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies

Cited by 68 publications

References 108 publications

Current review—The rise of bacteriophage as a unique therapeutic platform in treating peri‐prosthetic joint infections

Current review—The rise of bacteriophage as a unique therapeutic platform in treating peri‐prosthetic joint infections

Mapping bacterial biofilms on recovered orthopaedic implants by a novel agar candle dip method

Advancements in Diagnosing Periprosthetic Joint Infections after Total Hip and Knee Arthroplasty

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