Copper Bead Therapy in Severe Bone Infection: A Rabbit Tibial Model.

OBJECTIVE: We investigated the benefits of a local preventive therapy based on copper beads against severe bone infection using a rabbit open tibial fracture model. MATERIALS AND METHODS: Cotton mesh balls soaked in a very high concentration of Staphylococcus aureus ATCC 6538 culture were inoculated in drilled holes of the tibiae of treated and control groups. The treated group was also implanted with small copper beads simultaneously, as prevention therapy. RESULTS: Survival rate in the treated group was 67% compared with 25% in the control group (difference 40%, for a 95% confidence interval: 40%, 93.4%). The few remaining animals in the control group had bone lesions which developed into osteomyelitis, while the tibiae of treated group had clear signs of reparatory processes. Sixty days after inoculation, signs of local-only toxicity were observed in healthy tibia of a separate non-infected control group. Drawbacks of copper toxicity were weighed against the threat of septicaemia and also against prolonged use of powerful systemic antibiotic medications in severe bone contamination. CINICAL SIGNIFICANCE: It was found that the proposed therapy prevented septicaemia and the spread of infection, and it also induced reparatory processes. The findings of this study may be relevant in antisepsis of open fractures in less appropriate medical settings (such as military camps or remote locations), as well as in severe bone infections.

Adding vancomycin to perioperative prophylaxis decreases deep sternal wound infections in high-risk cardiac surgery patients.

OBJECTIVES: Perioperative prophylaxis with cephalosporins reduces sternal wound infections (SWIs) after cardiac surgery. However, more than 50% of coagulase-negative staphylococci, an important pathogen, are cephalosporin resistant. The aim of this study was to determine the impact of adjunctive vancomycin on SWIs in high-risk patients. METHODS: We conducted a pre- and postintervention study in an academic hospital. Preintervention (2010-2011), all patients received prophylaxis with 1.5 g of cefuroxime for 48 h. During the intervention period (2012-2013), high-risk patients additionally received 1 g of vancomycin. High-risk status was defined as body mass index ≤18 or ≥ 30 kg/m2, reoperation, renal failure, diabetes mellitus, chronic obstructive pulmonary disease or immunosuppressive medication. Time series analysis was performed to study SWI trends and logistic regression to determine the effect of adding vancomycin adjusting for high-risk status. RESULTS: A total of 3902 consecutive patients (n = 1915 preintervention and n = 1987 postintervention) were included, of which 1493 (38%) patients were high-risk patients. In the high-risk group, 61 of 711 (8.6%) patients had SWI before and 30 of 782 (3.8%) patients after the intervention. Focusing on deep SWI (DSWI), 33 of 711 (4.6%) patients had DSWI before and 13 of 782 (1.7%) patients afterwards; the absolute risk difference of 2.9% yielded a number-needed-to-treat of 34 to prevent 1 DSWI. Corrected for high-risk status, adding vancomycin significantly reduced the overall SWI rate (odds ratio 0.42, 95% confidence interval 0.26-0.67; P < 0.001) and the subset of DSWI (odds ratio 0.30, 95% confidence interval 0.14-0.62; P = 0.001). The rate of SWI in low-risk patients remained unchanged. CONCLUSIONS: Adding vancomycin to standard antibiotic prophylaxis in high-risk patients significantly reduced DSWI after cardiac surgery.

Study on the corrosion resistance and anti-infection of modified magnesium alloy.

In this paper, a low-cost and multifunctional hydroxyapatite (HA)/pefloxacin (PFLX) drug eluting layer is coated on magnesium (Mg) alloy through a simple hydrothermal and dip process. The drug PFLX could provide effective prevention for bone infection and inflammation due to its broad-spectrum antibacterial property. And HA would promote the growth of new bone and further improve the biocompatibility of implants. Besides, both PFLX and HA exhibits excellent corrosion protection for Mg alloy substrate. This coating is of great value for improving the application of Mg alloy as biomaterials.

A short artificial antimicrobial peptide shows potential to prevent or treat bone infections.

Infection of bone is a severe complication due to the variety of bacteria causing it, their resistance against classical antibiotics, the formation of a biofilm and the difficulty to eradicate it. Antimicrobial peptides (AMPs) are naturally occurring peptides and promising candidates for treatment of joint infections. This study aimed to analyze the effect of short artificial peptides derived from an optimized library regarding (1) antimicrobial effect on different bacterial species, (2) efficacy on biofilms, and (3) effect on osteoblast­like cells. Culturing the AMP-modifications with Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus (including clinical isolates of MRSA and MSSA) and Staphylococcus epidermidis identified one candidate that was most effective against all bacteria. This AMP was also able to reduce biofilm as demonstrated by FISH and microcalorimetry. Osteoblast viability and differentiation were not negatively affected by the AMP. A cation concentration comparable to that physiologically occurring in blood had almost no negative effect on AMP activity and even with 10% serum bacterial growth was inhibited. Bacteria internalized into osteoblasts were reduced by the AMP. Taken together the results demonstrate a high antimicrobial activity of the AMP even against bacteria incorporated in a biofilm or internalized into cells without harming human osteoblasts.

[Glucocorticoid therapy in rheumatoid arthritis - contra]. / Glukokortikoid-Therapie bei rheumatoider Arthritis ­ Contra.

Corticosteroids have a pleiotropic mechanism of action and influence a great number of cellular functions. This does not only result in a broad therapeutic effect, but in a large number of adverse events as well. It has been shown that about 60 % of all patients with rheumatoid arthritis in Germany are receiving corticosteroids and about every fifth of them more than the equivalence of 7.5 mg prednisone per day. Already small doses increase the risk f. e. for osteoporosis or cataract, as well as for severe infections. The benefit of a treatment with low dose corticosteroids in inhibiting the radiological erosivity of the disease is low and does not outweigh the risks.

Methicillin-susceptible strains responsible for postoperative orthopedic infection are not selected by the use of cefazolin in prophylaxis.

Comparison of methicillin-susceptible Staphylococcus aureus (MSSA) isolates responsible for bone and joint infection (BJI, n=73) and nasal colonization (n=57) revealed similar prevalence of ß-lactamase (blaZ) type A production, associated with cefazolin hydrolysis, suggesting that blaZ type A-carrying MSSA isolates implicated in postoperative BJI are not selected by cefazolin prophylaxis.

Motivo de consulta de urgencias por cirugía maxilofacial en un hospital venezolano desde 2006 hasta 2012. Estudio retrospective / Causes of maxillofacial emergency consultations in a Venezuelan hospital between 2006 and 2012. A retrospective study

El departamento de Cirugía Bucal y Maxilofacial del Hospital General del Oeste Dr. José Gregorio Hernández (OMS-GTH), ubicado en la ciudad de Caracas (Venezuela) proporciona atención de urgencia las 24 h del día, los 365 días del año. Objetivo. Determinar la edad, el sexo y el motivo de consulta más frecuente en las urgencias de OMS-GTH entre enero de 2006 y diciembre de 2012. Método. Hemos realizado un estudio transversal retrospectivo epidemiológico de los pacientes atendidos en las urgencias de OMS-GTH mediante una evaluación de 7.531 historias clínicas de los pacientes tratados entre ese período. Resultados. Predominó el sexo masculino con el 58,3% (n = 4.391); la edad promedio fue de 16 a 30 años de edad; el 46,5% (n = 3.509) de los pacientes presentaron trauma de tejidos blandos 65,71% (n = 4.949), el 15,1% (n = 1.139) fracturas faciales y el 15,9% (n = 1.203) infecciones odontogénicas. Conclusión. La población masculina entre 16 y 30 años es más propensa a trauma de tejidos blandos (AU)

The department of Oral and Maxillofacial Surgery of the West General Hospital Dr. José Gregorio Hernández (OMS-WGH) located in the city of Caracas, Venezuela, provides emergency care 24 h a day, 365 days a year. Objective. To determine the age, gender and most frequent reason for consultation in the emergency room of the OMS-WGH between January 2006 and December 2012. Method. A cross-sectional retrospective epidemiological study was conducted on patients seen in the emergency room of the OMS-WGH, by evaluating 7,531 medical records of patients treated in that period. Results. There was a predominance of males with 58.3% (n = 4,391), and a mean age of 16 to 30 years old, with 46.5% (n = 3,509) of the patients having soft tissue trauma 65.71% (n = 4,949), 15.1% (n = 1,139) facial fractures, and 15.9% (n = 1,203) odontogenic infections. Conclusion. The male population between 16 and 30 years are more prone to soft tissue trauma (AU)

Revisión de los efectos beneficiosos de la ingesta de colágeno hidrolizado sobre la salud osteoarticular y el envejecimiento dérmico / An overview of the beneficial effects of hydrolysed collagen intake on joint and bone health and on skin ageing

Introducción: el colágeno hidrolizado (CH) es una mezcla de péptidos de colágeno con un peso molecular (PM) inferior a 5.000 Da. Se obtiene de la gelatinización y posterior hidrólisis enzimática de colágeno nativo procedente de tejidos animales ricos en esta proteína. Existe abundante evidencia científica sobre el efecto positivo que la toma de CH ejerce sobre las patologías osteoarticulares degenerativas y el envejecimiento dérmico. Objetivo: revisar los estudios científicos existentes actualmente sobre el CH y evaluar su acción terapéutica sobre algunos tejidos colaginosos como cartílagos, huesos y piel. Resultados: hasta la fecha se han realizado más de 60 estudios científicos (in vitro, in vivo, clínicos y de biodisponibilidad) sobre la efectividad del CH a la hora de reducir las consecuencias del deterioro y pérdida de colágeno tisular como son el dolor y el desgaste articular (artrosis), la pérdida de masa ósea (osteoporosis) y el envejecimiento dérmico. Conclusiones: los estudios preclínicos indican que el CH estimula la regeneración de los tejidos colaginosos, potenciando la síntesis de colágeno tisular y también de los restantes componentes minoritarios de dichos tejidos (proteoglicanos y ácido hialurónico). Los estudios clínicos demuestran que la ingesta continuada de CH ayuda a reducir el dolor articular de desgaste, a ralentizar la pérdida de masa ósea y a atenuar los signos de envejecimiento dérmico. Estos resultados, junto con su alto nivel de seguridad y tolerancia, hacen del CH un suplemento adecuado para tomar a largo plazo, indicado para prevenir y tratar enfermedades crónicas degenerativas (artrosis y osteoporosis), así como para prevenir y atenuar el envejecimiento dérmico (AU)

Introduction: hydrolysate Collagen (HC) consists of small peptides with a molecular weight lower than 5.000 Da. produced from gelatinization and subsequent enzymatic hydrolysis of native collagen which is found in rich collagenic animal tissues. There is much evidence about the HC ingestion positive effect over degenerative joint and bones diseases. Objective: the aim of this article is to review the present scientific studies about HC and to evaluate the HC ingestion therapeutical effects on some collagenic tissues as cartilage, bones and skin. Results: up to date, there are more than 60 scientific studies (in vitro, in vivo, clinics and on bioavailability) about HC ingestion efficacy on reducing collagen damage and loss consequences as joint pain and erosion (osteoarthritis), bone density loss (osteoporosis) and skin ageing Conclusions: preclinical studies show that HC stimulates collagenic tissue regeneration by increasing not only collagen synthesis but minor components (glycosaminoglycans and hyaluronic acid) synthesis as well. Clinical studies show that HC continual ingestion helps to reduce and prevent joint pain, bone density loss and skin ageing. These results as well as its high level of tolerance and safety make HC ingestion attractive for a long-term use in bone and joint degenerative diseases and in fight against skin ageing (AU)

A clinical perspective on musculoskeletal infection treatment strategies and challenges.

Orthopaedic implants improve the quality of life of patients, but the risk of postoperative surgical site infection poses formidable challenges for clinicians. Future directions need to focus on prevention and treatment of infections associated with common arthroplasty procedures, such as the hip, knee, and shoulder, and nonarthroplasty procedures, including trauma, foot and ankle, and spine. Novel prevention methods, such as nanotechnology and the introduction of antibiotic-coated implants, may aid in the prevention and early treatment of periprosthetic joint infections with goals of improved eradication rates and maintaining patient mobility and satisfaction.

Clinical and histomorphometrical study on titanium dioxide-coated external fixation pins.

BACKGROUND: Pin site infection is the most common and significant complication of external fixation. In this work, the efficacy of pins coated with titanium dioxide (TiO(2)) for inhibition of infection was compared with that of stainless steel control pins in an in vivo study. METHODS: Pins contaminated with an identifiable Staphylococcus aureus strain were inserted into femoral bone in a rat model and exposed to ultraviolet A light for 30 minutes. On day 14, the animals were sacrificed and the bone and soft tissue around the pin were retrieved. The clinical findings and histological findings were evaluated in 60 samples. RESULTS: Clinical signs of infection were present in 76.7% of untreated pins, but in only 36.7% of TiO(2)-coated pins. The histological bone infection score and planimetric rate of occupation for bacterial colonies and neutrophils in the TiO(2)-coated pin group were lower than those in the control group. The bone-implant contact ratio of the TiO(2)-coated pin group was significantly higher (71.4%) than in the control pin group (58.2%). The TiO(2) was successful in decreasing infection both clinically and histomorphometrically. CONCLUSION: The photocatalytic bactericidal effect of TiO(2) is thought to be useful for inhibiting pin site infection after external fixation.

Infections associated with spinal implants.

Spinal infections represent a difficult challenge to treating clinicians. Infections in the presence of implants are even more so. In this review the literature appears to reflect a change of practice in which the aim is to retain implants if possible. The newer spinal procedures such as disc replacements pose different problems largely due to the more difficult access. The situation in the spine is more difficult than in general orthopaedics when dealing with infection due to the requirement for stability and to protect neurological function. The main thrust of management, therefore, is early diagnosis and a high index of suspicion followed by adequate if not radical management in a multidisciplinary setting. In the event prevention is better than cure and therefore consideration of the various mechanisms to avoid infection must be taken. There are some 'novel' considerations for the avoidance of infection alongside the tried and tested techniques. There are also new procedures for wound closure and the elimination of dead space.

Development of a hydroxyapatite coating containing silver for the prevention of peri-prosthetic infection.

We hypothesized that the electrochemical deposition of hydroxyapatite (EHA) can be used to incorporate silver (Ag), providing a controlled and sustained release of Ag ions at a bactericidal concentration. Six groups were investigated: electrochemical co-precipitation of HA and Ag (EHA/Ag); EHA pre-coated discs treated in AgN0(3) (EHA/AgN0(3)); plasma sprayed HA (PHA) pre-coated discs treated in AgN0(3) (PHA/AgN0(3)); EHA with 2 "layers" of Ag (EHA/Ag/2 layers); EHA coating only; and PHA coating only. Scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) and X-ray diffraction (XRD) analyses quantified coating thickness, calcium/phosphorous ratio, and % atomic silver content, respectively. Inductively coupled plasma-mass spectrometry quantified the amount of Ag released in phosphate-buffered saline, and zone of inhibition tests on agar plates using a lawn of Staph aureus were quantified in each group. XRD and EDX analysis confirmed the presence of Ag in all coatings. EHA coated discs with two layers of Ag and the EHA discs soaked in AgN0(3) showed significantly higher zones of inhibition at all time points when compared with all other groups (except PHA/AgN0(3) on day 0). This study demonstrated that Ag ions can be incorporated into a HA coating using an electrochemical technique.

¿Se pueden prevenir las caries en las visitas pediátricas de control? / Can dental caries be prevented during control visits?

A pesar de que la caries es una enfermedad infecciosa potencialmente prevenible, continúa siendo una enfermedad muy frecuente y con graves repercusiones para la salud general del niño. Como los pediatras y el equipo de enfermería tienen el mayor contacto con los niños y su familia durante las primeras etapas de desarrollo, es evidente que se convierten en los profesionales que mejor pueden aconsejar a los padres para prevenir las caries. Objetivo. Justificar la importancia de integrar las medidas y consejos de salud oral en las visitas de control y plasmar las pautas preventivas adecuadas por edades. Método. Amplia revisión bibliográfica de las pautas de salud oral por edades a integrar en las visitas de control. Conclusiones. Debido a que la mayoría de infantes están expuestos a visitas de control médicas pero no odontológicas, el pediatra y su equipo de enfermería juegan el papel más importante en la prevención de caries durante los primeros años de vida. Por ello es esencial ofrecer a los padres pautas de salud bucal sencillas y uniformes, con el fin de reducir la prevalencia de esta enfermedad prevenibleb (AU)

Dental caries is a potentially preventable infectious disease. However, it is still a common disease in children, with serious implications in a child’s general health. As pediatricians and nurses hace the closest contact with children and their families during the first stages of development, they are the professionals who can best advice parents to prevent dental caries. Aim of the study. To justify the importance of integrating oral health preventive measures into pediatric control visits. Moreover this revision aims to clarify preventive oral health recommendations by ages. Method. Thorough literature revision of oral health guidelines by ages, which can be integrated into pediatric control visits. Conclusions. As most babies are exposed to medical but not to dental care, pediatricians and their staff play the most important role in preventing dental decay during the first years of life. For this reason, it seems essential to offer simple and standardized advice on oral health in order to reduce the prevalence of this preventable disease (AU)

[Extracorporeal high hydrostatic pressure as a new technology for the disinfection of infected bone specimens]]. / Extrakorporale hydrostatische Hochdruckbehandlung als neues Verfahren zur Desinfektion infizierter Knochenpräparate.

BACKGROUND: Allogeneic bone transplantation is at risk of infection, and established disinfection methods typically compromise bone quality. High hydrostatic pressure (HHP) is well established for disinfection in food technology, and also it does protect biomechanical and biological properties of bone. This study is the first investigation of HHP regarding disinfection of bone biopsies. MATERIALS AND METHODS: Bone biopsies of 34 patients with chronic infections were subjected to HHP and assessed for persisting bacterial growth. In series 1, bone biopsies were proceeded directly to HHP (10 min; maximal pressure Pmax 600 MPa). In series 2, HHP was applied after 5-day incubation in growth media (10 min or 2x30 min; Pmax 600 MPa). Furthermore, HHP-induced changes of bacterial morphology on artificially infected bone samples were evaluated by scanning electron microscopy (SEM). RESULTS: For series 1, 71% of the bone samples were sterilised by HHP (n=17), compared to 38% of the untreated control samples, which were obtained during the same surgery (n=8). For series 2, after prior incubation, HHP disinfected 7% of the bone specimens (n=55), all control samples showed bacterial growth (n=33). Destruction of cell wall integrity of Gram-negative strains was observed by SEM. CONCLUSION: The effectiveness of HHP for bone disinfection should be improved by optimising treatment parameters. Infections with barosensitive Gram-negative bacteria or yeast might represent possible clinical indications.