Archive for May, 2018

Biofilm and the Role of Antibiotics in the Treatment of Periprosthetic Hip and Knee Joint Infections.

Open Orthop J. November 30, 2016 V.10 P.636-645.

Mirza YH1, Tansey R1, Sukeik M2, Shaath M3, Haddad FS1.

Author information

1 Department of Trauma and Orthopaedics, University of College London Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.

2 Department of Trauma and Orthopaedics, Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom.

3 Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunay’s Road, Crumpsall, M8 5RB, United Kingdom.

Abstract

An increasing demand for lower limb arthroplasty will lead to a proportionate increase in the need for revision surgery. A notable proportion of revision surgery is secondary to periprosthetic joint infections (PJI). Diagnosing and eradicating PJI can form a very difficult challenge. An important cause of PJI is the formation of a bacterial biofilm on the implant surface. Our review article seeks to describe biofilms; their definitions and formation, common causative bacteria, prophylactic and therapeutic antibiotic therapy.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398090/pdf/TOORTHJ-10-636.pdf

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May 31, 2018 at 12:58 pm

Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification.

World J Orthop. May 18, 2017 V.8 N.5 P.400-411.

George DA1, Drago L1, Scarponi S1, Gallazzi E1, Haddad FS1, Romano CL1.

Author information

1 David A George, Fares S Haddad, Department of Trauma and Orthopaedics, University College London Hospitals, London NW1 2BU, United Kingdom.

Abstract

AIM:

To undertook a systematic review to determine factors that increase a patient’s risk of developing lower limb periprosthetic joint infections (PJI).

METHODS:

This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio (OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias.

RESULTS:

Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies (14.8%) reviewed PJI of the hip, 3 (11.21%) of the knee, and 20 (74.1%) reviewed both joints. Nineteen studies (70.4%) were retrospective and 8 (29.6%) prospective. Record bias was identified in the majority of studies (66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids (OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50 (OR = 18.3, P < 0.001), tobacco use (OR = 12.76, 95%CI: 2.47-66.16, P = 0.017), body mass index below 20 (OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes (OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease (OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).

CONCLUSION:

We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5434347/pdf/WJO-8-400.pdf

May 31, 2018 at 12:56 pm

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review.

J Clin Microbiol. September 2017 V.55 N.9 P.2765-2774.

Wouthuyzen-Bakker M1, Benito N2, Soriano A3.

Author information

1 Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands m.wouthuyzen-bakker@umcg.nl

2 Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

3 Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Abstract

Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group (P = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively (P = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648712/pdf/zjm2765.pdf

May 31, 2018 at 12:54 pm

Relative vaccine effectiveness of high-dose vs standard-dose influenza vaccines among Veterans Health Administration patients.

Journal of Infectious Diseases May 5,  2018  V.217 N.11 P.1718-1727  

Young-Xu Y et al.

We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population.

Methods

This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015–2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders.

Results

We evaluated 104965 standard-dose and 125776 high-dose recipients; matching decreased the population to 49091 standard-dose and 24682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%–43%) against influenza- or pneumonia-associated hospitalization, 7% (95% CI, −2% to 14%) against all-cause hospitalization, 14% (95% CI, −8% to 32%) against influenza- or pneumonia-associated outpatient visit, 5% (95% CI, 2%–8%) against all-cause outpatient visit, and 38% (95% CI, −5% to 65%) against laboratory-confirmed influenza.

Conclusions

In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.

FULL TEXT

https://academic.oup.com/jid/article/217/11/1718/4858294

PDF (CLIC en PDF)

May 31, 2018 at 8:30 am

Is there an association between periprosthetic joint infection and low vitamin D levels?

Int Orthop. July 2014 V.38 N.7 P.1499-504.  doi: 10.1007/s00264-014-2338-6.

Maier GS1, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U.

Author information

1 Department of Trauma Surgery, Justus-Liebig-University, Giessen, Germany, gerrit.s.maier@gmx.de.

Abstract

PURPOSE:

Vitamin D is increasingly being recognized as an important mediator of immune function and may have a preventive role in the pathogenesis of periprosthetic joint infection. To the best of our knowledge, no other study has examined possible associations between periprosthetic joint infection and vitamin D deficiency. We investigated the rate of vitamin D deficiency in patients treated for periprosthetic joint infection and whether vitamin D deficiency is independent of other risk factors for vitamin D deficiency in patients with periprosthetic joint infection.

METHODS:

Serum 25-hydroxyvitamin D (25OHD) levels of every patient scheduled to receive a total prosthesis either of the hip, knee, or shoulder in the orthopaedic department of the Johannes-Guttenberg-University Hospital in Mainz, Germany (109 patients), were measured after admission. Furthermore, serum 25OHD levels were measured for every patient presenting with periprosthetic joint infection (n = 50) or aseptic loosening of the prosthesis (n = 31) scheduled to undergo revision surgery. The prevalence of normal (> 30 ng/ml), insufficient (20-30 ng/ml), and deficient (<20 ng/ml) 25OHD levels was determined.

RESULTS:

All tested patient subgroups showed low vitamin D levels. Statistical analysis found no significant difference in vitamin D levels comparing patients with prosthesis and patients with aseptic prosthesis loosening (p = 0.58). Significant differences in 25OHD levels were found comparing patients with periprosthetic joint infection and patients scheduled for primary arthroplasty (p < 0.001). In addition, we found a significant difference (p < 0,001) in 25OHD levels of patients with periprosthetic joint infection compared with patients with aseptic prosthesis loosening.

CONCLUSION:

We found a high frequency of vitamin D deficiency in patients being treated by primary arthroplasty and those with aseptic joint prosthetic loosening and periprosthetic joint infection. Vitamin D deficiency was severe in patients with periprosthetic joint infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071483/pdf/264_2014_Article_2338.pdf

 

May 29, 2018 at 11:06 am

Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee.

BMC Infect Dis. March 18, 2014 V.14 P.144.      doi: 10.1186/1471-2334-14-144.

Schmolders J, Hischebeth GT, Friedrich MJ, Randau TM, Wimmer MD, Kohlhof H, Molitor E, Gravius S1.

Author information

1 Department for Orthopaedic and Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.sascha.gravius@ukb.uni-bonn.de.

Abstract

BACKGROUND:

Periprosthetic joint infections (PJI) are often treated by two stage exchange with the use of an antibiotic impregnated spacer. Most of the two-stage exchange algorithms recommend the implantation of an antibiotic-impregnated spacer during the first stage for a period of 2-24 weeks before reimplantation of the new prosthesis. For the spacer to have a therapeutic effect, the local antibiotic concentration must be greater than the minimal inhibition concentration (MIC) against the pathogens causing the PJI. It must remain so for the entire spacer period, otherwise recurrence of infection or resistances might occur. The question as to whether a sufficient concentration of antibiotics in vivo is reached for the entire spacer period has not been answered satisfactorily.

CASE PRESENTATION:

We here present a case of a histologically confirmed chronic PJI 20 month after primary arthroplasty. The primary knee arthroplasty was performed due to osteoarthritis of the joint. Initial assessment did not detect a causative pathogen, and two stage exchange with a vancomycin-gentamycin impregnated spacer was performed. At the time of reimplantation, sonication of the explanted spacer revealed a multi-resistant strain of staphylococcus epidermidis on the device and in the joint. Adaption of the therapy and prolonged treatment successfully eradicated the infection.

CONCLUSION:

According to the authors’ knowledge, the case presented here confirms for the first time the surface contamination (proven through sonication) of a vancomycin-/gentamicin- impregnated Vancogenx®-spacer with a MRSE after ten weeks of implantation.This case study demonstrates the difficulties still associated with the diagnostics of PJI and the published different two stage treatment regimes with the use of antibiotic impregnated spacers.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995155/pdf/1471-2334-14-144.pdf

May 29, 2018 at 11:04 am

Minireview – Nipah Virus Infection

Journal of Clinical Microbiology June 2018 V.56 N.6

Brenda S. P. Ang, Tchoyoson C. C. Lim and Linfa Wang

a Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore

b Lee Kong Chian School of Medicine, Singapore

c National University of Singapore, Singapore

d Department of Neuroradiology, National Neuroscience Institute, Singapore

e Duke-NUS Medical School, Singapore

f Programme in Emerging Infectious Disease, Duke-NUS Medical School, Singapore

g Duke Global Health Institute, Duke University, Durham, North Carolina, USA

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998. Clinical presentation ranges from asymptomatic infection to fatal encephalitis. Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India. In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission. Bats are the main reservoir for this virus, which can cause disease in humans and animals. There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

abstract

http://jcm.asm.org/content/56/6/e01875-17.abstract?etoc

PDF

http://jcm.asm.org/content/56/6/e01875-17.full.pdf+html

May 28, 2018 at 9:32 am

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