Journal of Bone and Joint Infection最新文献

{"title":"Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads","authors":"E. McPherson, J. Jennings, Omar Yunis, M. Harris, M. Dipane, Nora L. Curtin, Madhav Chowdhry, A. Wassef, J. Bumgardner, Scott P. Noel","doi":"10.5194/jbji-7-117-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-117-2022","url":null,"abstract":"Abstract Introduction: Local antimicrobial delivery via calcium sulfate (CaSO 4 ) beads is used as an adjunctive treatment for periprosthetic joint infection. There is limited clinical information describing the performance of antimicrobial-loaded CaSO 4 (ALCS) in large-scale applications. We developed a simulated large joint model to study properties of eluting ALCS. Methods: The in vitro testing platform was an adapted standardized model for tribological testing of prosthetic total hips and total knees (ASTM F732). The model was 70 mL total fluid volume, 25 % bovine serum, and 75 % phosphate-buffered saline, using ISO standard 14242-1 for human synovial fluid simulation. Four brands of CaSO 4 were evaluated. Each 10 mL of CaSO 4 was loaded with 1.2 grams (g) of tobramycin and 1 g of vancomycin powders. A 35 mL bead volume, equaling 175 beads, of each product was placed in incubated flasks. The test period was 6 weeks with scheduled interval fluid exchanges. Fluid samples were tested for antibiotic and calcium concentrations and pH. Results: Antibiotic elution showed an initial burst on Day 1, followed by a logarithmic reduction over 1 week. Tobramycin fully eluted within 2.5 weeks. Vancomycin showed sustained release over 6 weeks. Calcium ion concentrations were high, with gradual decrease after 3 weeks. All four CaSO 4 products were inherently acidic. Fluid became more acidic with the addition of antibiotics primarily driven by vancomycin. Discussion: Clinicians should be cognizant of tobramycin elution burst with ALCS in large loads. The main driver of acidic pH levels was vancomycin. We propose that joint complications may result from lowered fluid acidity, and we suggest clinical study of synovial pH.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"117 - 125"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41620885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylaxis and treatment of infection in long bones using an antibiotic-loaded ceramic coating with interlocking intramedullary nails","authors":"Emilie-Ann Downey, Kayla M. Jaime, Taylor J. Reif, A. Makhdom, S. Rozbruch, A. Fragomen","doi":"10.5194/jbji-7-101-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-101-2022","url":null,"abstract":"Abstract Background: The study was done (1) to report on our recent experience with antibiotic-loaded calcium sulfate-coated interlocking intramedullary nails (CS-IMN) for infection prevention or infection eradication and (2) to compare the efficacy of CS-IMN versus antibiotic-loaded polymethylmethacrylate-coated IMN (PMMA-IMN) for infection eradication. Methods: We retrospectively reviewed the medical records of consecutive patients who underwent a limb salvage procedure for infection cure or infection prevention with PMMA-IMN or CS-IMN. We reviewed patient demographics, host-type, pre-operative infecting organisms, intraoperative cultures, as well as our main outcomes: infection control rate, achievement of union/fusion, and limb salvage. Results: 33 patients were treated with CS-IMN: 9 patients with goal of infection cure and 24 patients for infection prophylaxis. When used for infection prophylaxis, there was a 100 % ( 24/24 patients) prevention of infection rate, 95.5 % union rate ( 21/22 patients), and 100 % ( 24/24 patients) limb salvage rate. Nine patients were treated with CS-IMN to eradicate infection and were compared to a cohort of 28 patients who were treated with PMMA-IMN. The infection was eradicated in 7/9 patients (77.8 %) in the CS-IMN group versus 21/26 patients (80 %) in the PMMA-IMN group ( p=0.44 ). Bone union/fusion was achieved in 8/9 patients (88.9 %) in the CS-IMN group versus 21/24 patients (87.5 %) in the PMMA-IMN group ( p=0.11 ). The limb salvage rate in the CS-IMN group was 100 % ( 9/9 patients) versus 89 % ( 25/28 patients) in the PMMA-IMN group. Conclusions: CS-IMN are safe and easy to use, and we have therefore expended our indications for them. CS-IMN are very effective at infection prophylaxis in high-risk cases where infection is suspected. Early analysis suggests that CS-IMN are non-inferior to PMMA-IMN for infection eradication. This is our preliminary data that show this novel technique to be safe in a small cohort and may be as effective as the more established method. Future studies with larger cohorts of patients will be required to confirm these findings.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"101 - 107"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48167873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized quantification of biofilm in a novel rabbit model of periprosthetic joint infection","authors":"Anabelle Visperas, Daniel C Santana, Minseon Ju, Nathalie B. Milbrandt, Y. Tsai, S. Wickramasinghe, A. Klika, N. Piuzzi, A. Samia, C. Higuera-Rueda","doi":"10.5194/jbji-7-91-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-91-2022","url":null,"abstract":"Abstract Periprosthetic joint infection (PJI) is one of the most devastating complications of total joint arthroplasty. The underlying pathogenesis involves the formation of bacterial biofilm that protects the pathogen from the host immune response and antibiotics, making eradication difficult. The aim of this study was to develop a rabbit model of knee PJI that would allow reliable biofilm quantification and permit the study of treatments for PJI. In this work, New Zealand white rabbits ( n=19 ) underwent knee joint arthrotomy, titanium tibial implant insertion, and inoculation with Xen36 (bioluminescent Staphylococcus aureus) or a saline control after capsule closure. Biofilm was quantified via scanning electron microscopy (SEM) of the tibial explant 14 d after inoculation ( n=3 noninfected, n=2 infected). Rabbits underwent debridement, antibiotics, and implant retention (DAIR) ( n=6 ) or sham surgery ( n=2 noninfected, n=6 infected) 14 d after inoculation, and they were sacrificed 14 d post-treatment. Tibial explant and periprosthetic tissues were examined for infection. Laboratory assays supported bacterial infection in infected animals. No differences in weight or C-reactive protein (CRP) were detected after DAIR compared to sham treatment. Biofilm coverage was significantly decreased with DAIR treatment when compared with sham treatment (61.4 % vs. 90.1 %, p<0 .0011) and was absent in noninfected control explants. In summary, we have developed an experimental rabbit hemiarthroplasty knee PJI model with bacterial infection that reliably produces quantifiable biofilm and provides an opportunity to introduce treatments at 14 d. This model may be used to better understand the pathogenesis of this condition and to measure treatment strategies for PJI.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"91 - 99"},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43722360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints","authors":"E. Portier, V. Zeller, Y. Kerroumi, B. Heym, S. Marmor, P. Chazerain","doi":"10.5194/jbji-7-81-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-81-2022","url":null,"abstract":"Abstract Background: Arthroplasty after septic arthritis (SA) treatment raises diagnostic and therapeutic questions. The main objective was to evaluate infection-free survival of patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) post-SA. Other objectives were to describe the population's characteristics, surgical strategies, results of preoperative examinations and cultures of intraoperative samples taken at implantation, and postoperative antibiotic therapy. Methods: This is a retrospective, observational, monocenter study, from January 2005 to May 2019, including all patients undergoing TKA or THA with prior or ongoing SA in the same joint. Infection–free survival was analyzed and reported. Results: Forty-seven patients, 29 men, 49 joints operated on (30 knees, 19 hips), were included. Median SA-to-arthroplasty interval was 32 [1–216] weeks. It was <2 years for 43 joints and <6 months for 19 joints. Six patients underwent arthroplasty while still on SA treatment. One-stage arthroplasty was done for 43 joints and two-stage arthroplasty for 6 joints. Eight (16 %) cultures of intraoperative specimens were positive. Median durations of postoperative antibiotic therapy were 10 d for sterile cultures and 82 d for those that were positive. At 2 years, infection-free survival rate was 95.9 % ( ±0.02 ). After a median follow-up of 47 [18–142] months, no SA relapse was observed, but five patients developed new periprosthetic joint infections (PJIs) with a different microorganism. Conclusion: Arthroplasty may be a post-SA option, even within a short period of time. One-stage arthroplasty can be done if synovectomy is thorough, intraoperative samples are taken and antibiotics are administered until those culture results become available. We observed no SA relapse, but new PJIs occurred.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"81 - 90"},"PeriodicalIF":0.0,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43968035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebral osteomyelitis and epidural abscess due to Listeria monocytogenes – case report and review of literature","authors":"Olayinka Adebolu, J. Sommer, A. Idowu, N. Lao, Talha Riaz","doi":"10.5194/jbji-7-75-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-75-2022","url":null,"abstract":"Abstract We describe a case of native vertebral osteomyelitis (NVO) secondary to Listeria monocytogenes in a patient with polymyalgia rheumatica receiving chronic steroids. Treatment required surgical debridement of the epidural phlegmon and combination therapy with intravenous ampicillin and gentamicin.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"75 - 79"},"PeriodicalIF":0.0,"publicationDate":"2022-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46183887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acidosis due to 5-oxoprolinase inhibition by flucloxacillin in a patient with shoulder prosthesis joint infection","authors":"Julia Elisabeth Lenz, V. Alt, T. Dienemann","doi":"10.5194/jbji-7-71-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-71-2022","url":null,"abstract":"Abstract We report a case of a 64-year-old female patient with severe metabolic acidosis. Inhibition of 5-oxoprolinase by flucloxacillin was found to be the cause of the metabolic derailment.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"71 - 74"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49242298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The presence of a draining sinus is associated with failure of re-implantation during two-stage exchange arthroplasty","authors":"A. Gabrielli, Alan E. Wilson, R. Wawrose, M. Dombrowski, M. O’Malley, B. Klatt","doi":"10.5194/jbji-7-55-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-55-2022","url":null,"abstract":"Abstract Background: Reinfection rates after two-stage exchange arthroplasty for prosthetic joint infection (PJI) have been reported as high as 33 % in the literature. Understanding risk factors for treatment failure will help to preoperatively counsel patients on the likelihood of successful treatment and possibly influence the surgeon's treatment algorithm. This study aimed to delineate whether the presence of a draining sinus tract is associated with risk of failure of two-stage exchange arthroplasty. Methods: We performed a single institution, multi-center retrospective chart review of outcomes of patients treated for PJI with two-stage exchange arthroplasty between June 2006 and May 2016. For patients treated prior to 2011, PJI was defined based on the preoperative work-up and intraoperative findings as determined by the attending surgeon. After 2011, PJI was defined using MSIS consensus criteria. All patients had a minimum of follow-up of 2 years or treatment failure prior to 2 years. Treatment failure was defined as reinfection or failure to complete two-stage exchange secondary to persistent infection or other host factors. Operative reports and clinical notes were reviewed to assess for presence of a draining sinus tract. Results: 240 patients were treated for PJI with intended two-stage exchange arthroplasty. The overall rate of treatment failure was 29.6 % ( 71/240 ), while the overall rate of reinfection was 13.3 % ( 32/240 ). A total of 39 patients did not complete second stage revision; final treatment for these patients was amputation, fusion, or chronic antibiotic suppression. A total of 52 of 240 patients (21.7 %) had a draining sinus tract at presentation. Patients with a sinus tract were significantly less likely to be replanted compared to those without a sinus tract at presentation (13.3 % vs. 26.9 %, p=0.02 ). However, when accounting for all mechanisms of treatment failure, including reinfection following replantation, there was no statistically significant difference detected between the sinus and no-sinus groups (27.7 % vs. 36.5 %, p=0.22 ). Discussion: A draining sinus tract represents a chronic, deep infectious process with ultimate compromise of overlying soft tissues. Thus we hypothesized it would be associated with failure in a two-stage exchange arthroplasty. These data demonstrate that patients with a draining sinus are significantly less likely to undergo re-implantation. This provides evidence to the paucity of data surrounding draining sinuses and two-stage PJI treatment.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"55 - 60"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48091422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the time come for regional periprosthetic joint infection centers in the United States? A first-year experience","authors":"M. Adrados, Michael M. Valenzuela, B. Springer, S. Odum, T. Fehring, Jesse E. Otero","doi":"10.5194/jbji-7-51-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-51-2022","url":null,"abstract":"Abstract Several fields of orthopedics have concluded benefits from volume thresholds. We postulate that we could similarly optimize periprosthetic joint infection (PJI) treatment by creating a regional referral center, concentrating expertise and resources. Here, we review our reasoning and our first-year experience of a PJI referral center in the United States.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"51 - 53"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43082914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients","authors":"R. L. Hansen, M. Bue, A. Borgognoni, K. Petersen","doi":"10.5194/jbji-7-35-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-35-2022","url":null,"abstract":"Abstract Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( n   =  26), gait difficulties ( n   =  10) and intermittent fever ( n   =  9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( n   =  24), computer tomography (CT) ( n   =  17) and/or PET-CT ( n   =  10), predominantly displaying bone destruction/erosion of the symphysis ( n   =  13), abscess ( n   =  12) and/or fistula ( n   =  5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"35 - 42"},"PeriodicalIF":0.0,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44411672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early periprosthetic hip joint infection managed by cementless one-stage revision - a case series.","authors":"Kristoffer Riemer, Jeppe Lange","doi":"10.5194/jbji-7-43-2022","DOIUrl":"10.5194/jbji-7-43-2022","url":null,"abstract":"<p><p><b>Background</b>: Early periprosthetic hip joint infection (PJI) is traditionally treated with debridement, antibiotics, and implant retention (DAIR). However, infection control rates after DAIR-treated periprosthetic hip joint infection do not exceed 77 %. Cementless one-stage revision of chronic PJI by the Cementless One-stage Revision of Infected Hip Arthroplasty (CORIHA) protocol has been evaluated positively with a 91 % success rate. We wanted to evaluate the effectiveness of cementless one-stage revision following the CORIHA protocol for early PJI in elective primary total hip arthroplasty, regarding risk of re-operation with exchange of implants. <b>Methods</b>: We identified 18 patients in our center with early ( <math><mrow><mo>≤</mo> <mn>6</mn></mrow> </math> -week postoperative) PJI after primary total hip arthroplasty (THA) treated with one-stage cementless revision in the period January 2012-March 2018. Treatment followed the CORIHA protocol. Primary outcome was retention of implants at the most recent follow-up. Patients were followed for a minimum of 3 years. <b>Results</b>: Mean follow-up time was 60 months (39-105). All patients retained their implants, but two required superficial soft tissue debridement due to persistent wound seepage. <b>Conclusion</b>: Cementless one-stage revision appears to be an effective treatment of early PJI after primary THA and at least an equal choice of treatment compared with DAIR. Whether the potential benefit of a lower re-revision rate for postoperative PJI outweighs the increased surgical complexity of the CORIHA procedure needs further evaluation.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 1","pages":"43-50"},"PeriodicalIF":1.8,"publicationDate":"2022-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41664974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}