What’s New in Musculoskeletal Infection: Update on Biofilms

Nana, Arvind; Nelson, Sandra; McLaren, A. C.; Chen, Antonia F.

doi:10.2106/jbjs.16.00300

Cited by 38 publications

(20 citation statements)

References 215 publications

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“…A therapy with biofilm-active antibiotics, such as rifampin or fluoroquinolones, was started only after reimplantation, when all drains were removed, the wound was dry, and the bacterial load was reduced by initial antimicrobial therapy not to cause the emergence of resistance [23, 24]. If medically stable, patients received antimicrobial therapy at home through a peripherally inserted central catheter (PICC) line, when oral antimicrobial therapy was not possible due to multiple drug resistance.…”

Section: Methodsmentioning

confidence: 99%

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

et al. 2019

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BackgroundTwo-stage exchange arthroplasty is still the preferred treatment choice for chronic PJI. However, the results remain unpredictable. We analyzed the treatment success of patients with an infected hip prosthesis, who were treated according to a standardized algorithm with a multidisciplinary team approach and evaluated with a strict definition of failure.MethodsIn this single-center prospective cohort study, all hip PJI episodes from March 2013 to May 2015 were included. Treatment failure was assessed according to the Delphi-based consensus definition. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. Patients were dichotomized into two groups depending on the number of previous septic revisions, duration of prosthesis-free interval, positive culture with difficult-to-treat microorganisms, microbiology at explantation, and microbiology at reimplantation.ResultsEighty-four patients with hip PJI were the subject of this study. The most common isolated microorganisms were coagulase-negative staphylococci (CNS) followed by Staphylococcus aureus and Propionibacterium. Almost half of the study cohort (46%) had at least one previous septic revision before admission. The Kaplan-Meier estimated infection-free survival after 3 years was 89.3% (95% CI, 80% to 94%) with 30 patients at risk. The mean follow-up was 33.1 months (range, 24–48 months) with successful treatment of PJI. There were no statistical differences in infect eradication rate among the dichotomized groups.ConclusionsHigh infect eradication rates were achieved in a challenging cohort using a standardized two-stage exchange supported by a multidisciplinary approach.

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Section: Methodsmentioning

confidence: 99%

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

et al. 2019

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“…All commonly used orthopaedic materials are susceptible to colonization by biofilm-forming bacteria including cobalt-chromium, titanium, polyethylene, polymethyl methacrylate (PMMA) and ceramics. 26,41 In vitro studies have shown ceramics to have advantageous physical-chemical surface properties to discourage biofilm formation when compared to other implant materials demonstrating reduced bacterial adhesion and slower biofilm development. 42 Clinically there has been evidence of an anti-infective effect of ceramic bearings compared to polyethylene; in an infected total hip arthroplasty retrieval study higher bacterial counts were observed on polyethylene liners compared with ceramic liners.…”

Section: Surface Modification and Biofilm Formationmentioning

confidence: 99%

Implant materials and prosthetic joint infection: the battle with the biofilm

2019

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Prosthetic joint infection (PJI) is associated with poor clinical outcomes and is expensive to treat. Although uncommon overall (affecting between 0.5% and 2.2% of cases), PJI is one of the most commonly encountered complications of joint replacement and its incidence is increasing, putting a significant burden on healthcare systems. Once established, PJI is extremely difficult to eradicate as bacteria exist in biofilms which protect them from antibiotics and the host immune response. Improved understanding of the microbial pathology in PJI has generated potential new treatment strategies for prevention and eradication of biofilm associated infection including modification of implant surfaces to prevent adhesion of bacteria. Much research is currently ongoing looking at different implant surface coatings and modifications, and although most of this work has not translated into clinical medicine there has been some early clinical success.Cite this article: EFORT Open Rev 2019;4:633-639. DOI: 10.1302/2058-5241.4.180095

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“…Standard protocols for treatment and management are largely inconsistent, with little data to support drawing definitive conclusions for optimal treatment strategies . Current treatment strategies largely fall into one of two categories: Prophylactic treatment for any bacterial activity to prevent biofilm formation, or mechanical disruption and/or explantation after biofilm formation.…”

Section: Current Clinical Practicementioning

confidence: 99%

Periprosthetic bacterial biofilm and quorum sensing

Mooney

Pridgen

Manasherob

et al. 2018

Journal Orthopaedic Research

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Periprosthetic joint infection (PJI) is a common complication after total joint arthroplasty leading to severe morbidity and mortality. With an aging population and increasing prevalence of total joint replacement procedures, the burden of PJI will be felt not only by individual patients, but in increased healthcare costs. Current treatment of PJI is inadequate resulting in incredibly high failure rates. This is believed to be largely mediated by the presence of bacterial biofilms. These polymicrobial bacterial colonies form within secreted extracellular matrices, adhering to the implant surface and local tissue. The biofilm architecture is believed to play a complex and critical role in a variety of bacterial processes including nutrient supplementation, metabolism, waste management, and antibiotic and immune resistance. The establishment of these biofilms relies heavily on the quorum sensing communication systems utilized by bacteria. Early stage research into disrupting bacterial communication by targeting quorum sensing show promise for future clinical applications. However, prevention of the biofilm formation via early forced induction of the biofilm forming process remains yet unexplored. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2331-2339, 2018.

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What’s New in Musculoskeletal Infection: Update on Biofilms

Cited by 38 publications

References 215 publications

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange

Implant materials and prosthetic joint infection: the battle with the biofilm

Periprosthetic bacterial biofilm and quorum sensing

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