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

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

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

Author information

1 Department of Trauma and Orthopaedics, University 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

 

June 20, 2017 at 7:08 pm

Clinical and Microbiological Characteristics of Bacteroides Prosthetic Joint Infections.

J Bone Jt Infect. 2017 Mar 19;2(3):122-126.

Shah N1, Osmon D1, Tande AJ1, Steckelberg J1, Sierra R2, Walker R1, Berbari EF1.

Author information

1 Division of Infectious Disease, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract

Clinical and microbiological characteristics of patients with Bacteroides prosthetic joint infection (PJI) have not been well described in the literature.

The aim of this retrospective cohort study was to assess the outcome of patients with Bacteroides PJI and to review risk factors associated with failure of therapy.

Between 1/1969 and 12/2012, 20 episodes of Bacteroides PJI in 17 patients were identified at our institution. The mean age of the patients in this cohort at the time of diagnosis was 55.6 years; 59% (n=10) had knee involvement. Twenty four percent (n=4) had diabetes mellitus, and 24% had a history of either gastrointestinal (GI) or genitourinary (GU) pathology prior to the diagnosis of PJI. Thirty five percent (n=6) were immunosuppressed.

The initial medical/surgical strategy was resection arthroplasty (n=9, 50%) or debridement and implant retention (n=5, 28%). Thirty seven percent (n=7) were treated with metronidazole. Eighty percent (n=4) of patients that failed therapy had undergone debridement and retention of their prosthesis, as compared to none of those treated with resection arthroplasty. Seventy percent (n=14) of patient episodes were infection free at their last date of follow up.

In conclusion, a significant proportion of patients with Bacteroides PJI are immunosuppressed and have an underlying GI or GU tract pathology. Retention and debridement of the prosthesis is associated with a higher risk of treatment failure.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441143/pdf/jbjiv02p0122.pdf

June 20, 2017 at 5:39 pm

Candida Prosthetic Joint Infection. A Review of Treatment Methods.

J Bone Jt Infect. 2017 Feb 5;2(2):114-121.

Cobo F1, Rodríguez-Granger J1, Sampedro A1, Aliaga-Martínez L2, Navarro-Marí JM1.

Author information

1 Department of Microbiology, Hospital Virgen de las Nieves, Granada, Spain.

2 Department of Internal Medicine, Hospital Virgen de las Nieves, Granada, Spain.

Abstract

Fungal microorganisms are still a rare cause of bone and joint infections. We report a new case of knee prosthetic joint infection due to Candida albicans in a patient with a previous two-stage right knee arthroplasty for septic arthritis due to S. epidermidis occurred several months ago. Moreover, the treatment in 76 cases of Candida prosthetic joint infection has been discussed. Forty patients were female and mean age at diagnosis was 65.7 (± SD 18) yrs. No risk factors for candidal infection were found in 25 patients. Infection site was the knee in 38 patients and hip in 36; pain was present in 44 patients and swelling in 24. The most frequent species was C. albicans, followed by C. parapsilosis. Eleven patients were only treated with antifungal drugs being the outcome favourable in all of them. Two-stage exchange arthroplasty was performed in 30 patients, and resection arthroplasty in other 30; in three patients one-stage exchange arthroplasty was done. A favourable outcome was found in 58 patients after antifungal plus surgical treatment, in 11 after antifungal treatment alone and in one after surgery alone. The type of treatment is still not clearly defined and an algorithm for treatment in fungal PJI should be established, but various types of surgical procedures may be applied.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441142/pdf/jbjiv02p0114.pdf

June 20, 2017 at 2:24 pm

Use of Chlorhexidine Preparations in Total Joint Arthroplasty.

J Bone Jt Infect. 2017 Jan 1;2(1):15-22.

George J1, Klika AK1, Higuera CA1.

Author information

1 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423571/pdf/jbjiv02p0015.pdf

June 20, 2017 at 2:21 pm

Treatment of Periprosthetic Joint Infection Using Antimicrobials: Dilute Povidone-Iodine Lavage.

J Bone Jt Infect. 2017 Jan 1;2(1):10-14.             doi: 10.7150/jbji.16448. eCollection 2017.

Ruder JA1, Springer BD2.

Author information

1 Carolinas Medical Center, Department of Orthopaedics.

2 OrthoCarolina Hip and Knee Center, Charlotte, NC 28207.

Abstract

Periprosthetic joint infections (PJI) remain a challenge for the orthopaedic surgeon to treat and remain a leading cause of failure of both primary and revision total joint arthroplasty. Once a PJI develops, surgical treatment is generally indicated and includes an aggressive irrigation and debridement. One component of the irrigation and debridement involves the use of an antiseptic irrigating solution. In primary and revision TJA, dilute povidone-iodine lavage can be performed prior to wound closure. Approximately 17.5mL of 10% povidone-iodine is diluted with 500-1000cc of normal saline. The wound is then irrigated with the dilute povidone-iodine for 3 minutes. The dilute povidone-iodine is then thoroughly irrigated and washed out of the wound with normal saline prior to wound closure. The use of dilute povidone-iodine lavage prior to wound closure has been shown to reduce the risk of deep surgical site infection in multiple surgical specialties. In primary TJA, it has been demonstrated to reduce the risk of infection, without any associated adverse effects. It is also included in multiple protocols for the surgical treatment of PJI. Dilute povidone-iodine lavage provides a safe and inexpensive method to reduce the rate of PJI in TJA.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423577/pdf/jbjiv02p0010.pdf

June 19, 2017 at 7:20 pm

Pseudomonas Prosthetic Joint Infections: A Review of 102 Episodes.

J Bone Jt Infect. 2016 Jun 4;1:25-30.

Shah NB1, Osmon DR1, Steckelberg JM1, Sierra RJ2, Walker RC1, Tande AJ1, Berbari EF1.

Author information

1 Department of Internal Medicine and Division of Infectious Disease, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA.

Abstract

Background: The outcome of patients with Pseudomonas prosthetic joint infection (PS PJI) has not been well studied. The aim of this retrospective cohort study was to assess the outcome of patients with Pseudomonas PJI and to review risk factors associated with failure of therapy. Methods: Between 1/1969 and 12/2012, 102 episodes of PS PJI in 91 patients were identified. Results: The mean age at the time of diagnosis was 67.4 years; forty three percent had knee involvement. Over 40 percent had either diabetes mellitus or a history of gastrointestinal or genitourinary surgery. Nearly half (48 out of 102 episodes) received aminoglycoside monotherapy, while 25% received an anti-pseudomonal cephalosporin. The 2-year cumulative survival free from failure was 69% (95% CI, 56%-82%). Patients treated with resection arthroplasty, two-stage exchange, and debridement with implant retention had a 2-year cumulative survival free from failure of 80% (95% CI, 66%-95%), 83% (95% CI, 60%-100%), and 26% (95% CI, 23%-29%) respectively (P=0.0001). Conclusions: PS PJI’s are associated with a high failure rate. Patients treated with debridement and implant retention had a worse outcome.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423557/pdf/jbjiv01p0025.pdf

June 19, 2017 at 12:57 pm

Therapeutic Vaccine for Genital Herpes Simplex Virus-2 Infection: Findings From a Randomized Trial

J Infect Dis 2017 March  215 (6): 856-864.

EDITOR’S CHOICE

David I. Bernstein  Anna Wald  Terri Warren  Kenneth Fife  Stephen Tyring  Patricia Lee Nick Van Wagoner  Amalia Magaret  Jessica B. Flechtner  Sybil Tasker 

Background.

Genital herpes simplex virus type 2 (HSV-2) infection causes recurrent lesions and frequent viral shedding. GEN-003 is a candidate therapeutic vaccine containing HSV-2 gD2∆TMR and ICP4.2, and Matrix-M2 adjuvant.

Methods.

Persons with genital herpes were randomized into 3 dose cohorts to receive 3 intramuscular doses 21 days apart of 10 µg, 30 µg, or 100 µg of GEN-003, antigens without adjuvant, or placebo. Participants obtained genital swab specimens twice daily for HSV-2 detection and monitored genital lesions for 28-day periods at baseline and at intervals after the last dose.

Results.

One hundred and thirty-four persons received all 3 doses. Reactogenicity was associated with adjuvant but not with antigen dose or dose number. No serious adverse events were attributed to GEN-003. Compared with baseline, genital HSV-2 shedding rates immediately after dosing were reduced with GEN-003 (from 13.4% to 6.4% for 30 μg [P < .001] and from 15.0% to 10.3% for 100 µg [P < .001]). Lesion rates were also significantly (P < .01) reduced immediately following immunization with 30 µg or 100 µg of GEN-003. GEN-003 elicited increases in antigen binding, virus neutralizing antibody, and T-cell responses.

Conclusions.

GEN-003 had an acceptable safety profile and stimulated humoral and cellular immune responses. GEN-003 at doses of 30 µg and 100 µg reduced genital HSV shedding and lesion rates.

Clinical Trials Registration. NCT01667341 (funded by Genocea).

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/6/10.1093_infdis_jix004/2/jix004.pdf?Expires=1497965455&Signature=LauwpzltUYdtPj-H4tzcv2QzeU0yI3QyDcTqjGRLhjT~-XCUpAxn5BbzFiTp0ULZNyAvV-WM1DB1W0yaAhUFMS-IBk9m5ZwRyCmL~4xJE2-Lv2rP3ulYPSwj7pBBulLdtF8uAioy6Ux3qfPWSaVsQuvODlSK-jCGvf3xNmq28536uP8sr3mUO12YEXNss8BjjdigOEPGWz8rNL64V5vYHXgBmfSvLArPryGPTLn3gNgPKqU8JHQVUJ~obkccGjIAOfn-XRd8KwzbzLHhlxj0lUZQvqLpNnJs-n~DMe8N9jY0WINI4-gehCrKkfzY3Y4mwZVXXqPioYdoLhIgqqrkAA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

J Infect Dis. March 2017 15;215(6):844-846.             

EDITORIAL COMMENTARY – Vaccination to Reduce Reactivation of Herpes Simplex Virus Type 2.

Cohen JI1.

Author information

1 Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

A protein vaccine containing two herpes simplex antigens with adjuvant in patients with recurrent genital herpes appeared to be safe and modestly reduced viral shedding and lesion number, but the effect duration is uncertain.

abstract

https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jix006

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/6/10.1093_infdis_jix006/2/jix006.pdf?Expires=1497965228&Signature=gwESX5NV2RD2GozSjrMAEFaEYaf3vIjFRiQC2XG8jcqqlijr94CfhTm7efRIQ9I69d77L2-XHMHtpU~1jBDeIib3jVulLhT71~HytY0YIP2Ya4ltHmgyxOiMw5ZJUmnaZUt1P-GXnnPetSISsZQSRAYNtyUqhxd0tBy5ss0sjeGprnnukP13Ea-YA7b~svo3w5gBf4bR8hb5R0Xa7EYbBwbxP1OejrExMz3USyJr2EHFs2igtcWng2HUNtVzwpGIC33SVRgu8EuC31S8afvMRtihFmhZch3iAWEYDtaYoRoAZoMa0BUhMceRIbkk993QeQpz8wioDFuxS7dbZW1GMQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

June 19, 2017 at 8:37 am

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