Beneficial Effect of TaON-Ag Nanocomposite Titanium on Antibacterial Capacity in Orthopedic Application.

PURPOSE: In this study, a novel oxygenated nanocomposite thin film, TaON-Ag, was investigated in vitro and in vivo to evaluate its biocompatibility and antibacterial ability. MATERIAL AND METHODS: The antibacterial ability of TaON-Ag nanocomposite-coated titanium (Ti) was evaluated using the Kirby-Bauer disk diffusion susceptibility test. The effects of TaON-Ag nanocomposite-coated metal on osteogenesis were further evaluated in an in vitro osteogenic culture model with rat marrow-derived mesenchymal stem cells (rMSCs). Furthermore, titanium rods coated with TaON-Ag were implanted into a rat femur fracture model either with or without osteomyelitis to investigate the effects of TaON-Ag in osteogenesis. RESULTS: The TaON-Ag-coated Ti exhibited an effective antibacterial effect against Staphylococcus aureus, coagulase-negative Staphylococcus, and the Gram-negative strains Escherichia coli and Pseudomonas aeruginosa. Using an osteogenic culture with rMSCs and a rat femoral fracture model, the TaON-Ag-coated Ti did not interfere with the ossification of rMSCs in vitro or during fracture healing in vivo. Field-emission scanning electron microscopy (FE-SEM) revealed that coating with TaON-Ag could inhibit pathogen adhesion and biofilm formation in both Staphylococcus aureus and Escherichia coli. CONCLUSION: Using the proposed novel oxygenation process, TaON-Ag nanocomposite-coated Ti yielded robust biocompatibility and antibacterial ability against common microorganisms in orthopedic infections, thereby demonstrating potential for use in clinical applications.

Protection of Surgical Team from COVID-19 during Bipolar Hemiarthroplasty in an Infected Elderly Patient.

The novel coronavirus disease 2019 (COVID-19), which began in Wuhan, China, has rapidly flared up all over the world, evolving into a pandemic. During these critical times, we should give emphasis on infection prevention for the health care staff as well as appropriate patient management in order to maintain the health care system. We report our experience in protecting a surgical team from COVID-19 infection during a bipolar hemiarthroplasty in an infected patient. This case highlights the importance of appropriate protection of the health care staff and education in minimizing the risk of transmission of the infection and maintaining the health care system.

Infections caused by Tissierella praeacuta: A report of two cases and literature review.

Herein we report two cases of infections caused by Tissierella praeacuta and a review of the literature. The first case was a septic pseudarthrosis of the left femur after multiple fractures. Two per-operative samples were positive with T. praeacuta. The patient was successfully treated by piperacillin - tazobactam and metronidazole. The second case was a bacteremia in a patient suffering from pyonephrosis and a hepatic abscess. The treatment was meropenem. No relapses were observed in both cases. Identification of the strains using MALDI-TOF coupled to mass spectrometry (MS) (Beckman coulter, France) was inconclusive in the two cases. Identification by 16S rRNA sequencing was then performed. This bacterium was susceptible to beta-lactams, chloramphenicol, rifampicine and metronidazole.

A threshold for concern? C-reactive protein levels following operatively managed neck of femur fractures can detect infectious complications with a simple formula.

INTRODUCTION: C-reactive protein (CRP) rises in response to multiple stimuli, including surgical procedures and infections. Deviations from the predicted CRP response to a given procedure may be an early indication of a postoperative complication. METHODS: Three hundred and fifty-four patients with an operatively managed neck of femur fracture admitted over a 1-year period to an NHS Hospital Trust were included. CRP values collected during the postoperative period were retrospectively examined, and objective evidence of postoperative complications was sought. Data analysis explored daily CRP thresholds that maximised sensitivity and specificity for the detection of patients with a postoperative complication. RESULTS: From the 5th to the 30th postoperative day, a CRP value in excess of the threshold defined by the formula 500/d (where d represents the number of postoperative days) retrospectively detected patients with a postoperative complication with a sensitivity of 0.97 and specificity of 0.82. Patients with a CRP value above the 500/d threshold during this period had a significantly increased 30-day mortality (10.0% vs. 3.9%, RR=2.74, p=0.03). CONCLUSION: Following operatively managed neck of femur fractures, a CRP value in excess of the threshold defined by the formula 500/d may indicate the presence of a postoperative complication and defines a group with increased mortality. In this context, a prompt wound review and septic screen could promote the early detection and management of infectious postoperative complications.

Candida glabrata: an unusual fungal infection following a total hip replacement.

A 60-year-old woman, after a femoral neck fracture and joint replacement, underwent a Girdlestone's procedure and received aggressive antimicrobial therapy in order to completely eradicate the fungal infection Candida glabrata. In the majority of such cases, a revised hip arthroplasty would be considered following debridement. However, due to the recurrence of this infection and a key associated risk factor, radical removal with concurrent drug therapy was the only option.

MRSA colonisation in patients with proximal femur fractures in a German trauma centre: incidence, infection rates and outcomes.

PURPOSE: The aim of this study was to assess the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in patients admitted into a level 1 German trauma centre with proximal femur fractures, to correlate this incidence with defined risk factors for MRSA colonisation and to determine its influence on morbidity and mortality. METHODS: Between August and November 2006, 65 patients were included in the study. Cotton-tipped swab samples were taken from the nose, throat, groin and any skin defects in the emergency room. The following factors were recorded: age, gender, any concomitant diseases, the fracture type and treatment device, skin lesions, hospitalisation within the last year, any urinary or vascular catheters, a nasogastric or gastrostomy tube, an ileal stoma, the use of a respirator and antibiotic therapy within the last year. During follow-up, data concerning any surgical site infections; any chest, urinary or vascular catheter infections; the success of decontamination and death within 1 year after surgery were collected. RESULTS: The risk factors for MRSA colonisation were positive in 40 patients. The incidence of MRSA colonisation was 17%, which is higher than in most comparable studies but consistent with some very recent publications. The nosocomial infection rates, surgical site infection rates and mortality within the 1-year follow-up period were significantly higher in the MRSA-colonised patients. CONCLUSION: The high incidence of MRSA in this study supports the need for systematic detection of MRSA-colonised patients. In our hospital, any patient with positive risk factors for MRSA colonisation is swabbed in the emergency room and treated as MRSA positive until proven otherwise.

Relationship between haematoma in femoral neck fractures contamination and early postoperative prosthetic joint infection.

INTRODUCTION: Prosthetic joint infection (PJI) after femoral neck fracture is associated with a higher mortality, morbidity and economic costs. Although is well known that the presence of a post surgical haematoma is associated with infection, in our knowledge there are no articles evaluating the contamination of the femoral neck fracture haematoma and the possible relationship with early postoperative PJI. The aim of our study was to evaluate the prevalence of positive cultures from haematoma in patients with femoral neck fracture and the relationship with early PJI. METHODS: A prospective observational study was performed. All patients who underwent hiphemiarthroplasty for a femoral neck fracture from April'08 to February'09 were included. Three samples were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood of haematoma inoculated into blood culture flasks. Patients received the standard prophylaxis. RESULTS: A total of 109 patients were treated during this period in our center, 16 were excluded for mistakes during taking samples or for receiving extra antibiotic treatment after or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative cultures were positive. Four patients developed an early PJI caused by Gram-negative bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative intraopertive cultures was 3.1% while in the group with one or more positive cultures was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate inpatients with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that caused the PJI was the same that had been isolated from the haematoma. CONCLUSION: The haematoma in femoral neck fractures was contaminated in 31.2% of cases before surgery. The contamination of the haematoma with a GNB was associated with a higher risk of early postoperative PJI.

Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among patients with femoral neck fractures: implication for antibiotic prophylaxis.

Fifteen (8.4%) of 179 patients admitted with femoral neck fractures carried MRSA. Among 96 patients admitted from their homes, only 2 (2%) were carriers, whereas 13 (15.6%) of 83 patients from nursing or residential homes or long-term-care facilities were colonized (P = .001). Routine prophylaxis with vancomycin is recommended in the latter group.

Histoplasmosis as the cause of a pathological fracture.

We report the case of an 82-year-old man with a pathological fracture of the hip caused by infection with Histoplasma capsulatum var capsulatum. He was treated by a hemiarthroplasty and with oral itraconazole.