Impact of antibiotic prophylaxis in second-stage surgery in joint prosthesis infection treated with two-stage exchange. A multicenter case-control study.

INTRODUCTION: After two-stage exchange due to prosthetic joint infection (PJI), the new prosthesis carries a high risk of reinfection (RePJI). There isn`t solid evidence regarding the antibiotic prophylaxis in 2nd-stage surgery. The objective of this study is to describe what antibiotic prophylaxis is used in this surgery and evaluate its impact on the risk of developing RePJI. METHODS: Retrospective multicenter case-control study in Spanish hospitals. The study included cases of PJI treated with two-stage exchange and subsequently developed a new infection. For each case, two controls were included, matched by prosthesis location, center, and year of surgery. The prophylaxis regimens were grouped based on their antibacterial spectrum, and we calculated the association between the type of regimen and the development of RePJI using conditional logistic regression, adjusted for possible confounding factors. RESULTS: We included 90 cases from 12 centers, which were compared with 172 controls. The most frequent causative microorganism was Staphylococcus epidermidis with 34 cases (37.8%). Staphylococci were responsible for 50 cases (55.6%), 32 of them (64%) methicillin-resistant. Gram-negative bacilli were involved in 30 cases (33.3%), the most common Pseudomonas aeruginosa. In total, 83 different antibiotic prophylaxis regimens were used in 2nd-stage surgery, the most frequent a single preoperative dose of cefazolin (48 occasions; 18.3%); however, it was most common a combination of a glycopeptide and a beta-lactam with activity against Pseudomonas spp (99 cases, 25.2%). In the adjusted analysis, regimens that included antibiotics with activity against methicillin-resistant staphylococci AND Pseudomonas spp were associated with a significantly lower risk of RePJI (adjusted OR = 0.24; 95% IC: 0.09-0.65). CONCLUSIONS: The lack of standardization in 2nd-satge surgery prophylaxis explains the wide diversity of regimens used in this procedure. The results suggest that antibiotic prophylaxis in this surgery should include an antibiotic with activity against methicillin-resistant staphylococci and Pseudomonas.

Short-term outcomes of a multicentre prospective study using a "visible" polyvinylidene fluoride onlay mesh for the prevention of midline incisional hernia.

INTRODUCTION: Prophylactic meshes in high-risk patients prevent incisional hernias, although there are still some concerns about the best layer to place them in, the type of fixation, the mesh material, the significance of the level of contamination, and surgical complications. We aimed to provide answers to these questions and information about how the implanted material behaves based on its visibility under magnetic resonance imaging (MRI). METHOD: This is a prospective multicentre observational cohort study. Preliminary results from the first 3 months are presented. We included general surgical patients who had at least two risk factors for developing an incisional hernia. Multivariate logistic regression was used. A polyvinylidene fluoride (PVDF) mesh loaded with iron particles was used in an onlay position. MRIs were performed 6 weeks after treatment. RESULTS: Between July 2016 and June 2022, 185 patients were enrolled in the study. Surgery was emergent in 30.3% of cases, contaminated in 10.7% and dirty in 11.8%. A total of 5.6% of cases had postoperative wound infections, with the requirement of stoma being the only significant risk factor (OR = 7.59, p = 0.03). The formation of a seroma at 6 weeks detected by MRI, was associated with body mass index (OR = 1.13, p = 0.02). CONCLUSIONS: The prophylactic use of onlay PVDF mesh in midline laparotomies in high-risk patients was safe and effective in the short term, regardless of the type of surgery or the level of contamination. MRI allowed us to detect asymptomatic seromas during the early process of integration. STUDY REGISTRATION:  This protocol was registered at ClinicalTrials.gov (NCT03105895).

Global research output and highly-cited publications on prosthetic joint infections: A bibliometric analysis (2003-2022).

Backgroundand aims: Prosthetic Joint Infection (PJI) is a serious clinical problem after Arthroplasty. The research field on PJI is emerging, but there is a paucity of information on the most impactful publications on it. This prompted us to conduct a bibliometric analysis of the global research output, from 2003 to 2022, to identify the growth of publications, the key players in this research field and to evaluate the characteristics of highly-cited publications (HCPs) on the PJI. Methods: Publications related to PJI research were identified globally from the Scopus database, using specific keywords, covering the literature from 2003 to 2022. The HCPs were considered those with 100 or more citations. Information on publication year, citation count, funding sources, title, author, journal, country, institution, research area, and strategic keywords were collected from these HCPs. Publication data was imported into Microsoft Excel and analyzed further using VOSviewer and R software. Results: There were 182 HCPs (3.12%), which received a total citation of 124701 (average CPP of 21.41), with the citation range from 100 to 1921. Research articles were the most predominant publications (69.2%), but their average citations per paper (CPP) of 189.78 was lower than that of Review articles (average CPP: 253.17). The USA has been the leading country in terms of total publications (31.58%), and HCPs (36.99%), followed by Switzerland, Spain, UK and China. There were no HCPs from developing countries. J. Parvizi of Thomas Jefferson University, USA (with a total publications of 31 and an average CPP of 315.7), and W. Zimmerli of Basel University, Switzerland (with a TP of 11 and an average CPP of 341.9), were the most productive and impactful authors in PJI global research output. Conclusion: This bibliometric analysis identified the most productive and impactful authors, organizations, countries, and journals in the research of PJI, of the last two decades.

Optimal selection of specimens for metagenomic next-generation sequencing in diagnosing periprosthetic joint infections.

Objective: This study aimed to assess the diagnostic value of metagenomic next-generation sequencing (mNGS) across synovial fluid, prosthetic sonicate fluid, and periprosthetic tissues among patients with periprosthetic joint infection (PJI), intending to optimize specimen selection for mNGS in these patients. Methods: This prospective study involved 61 patients undergoing revision arthroplasty between September 2021 and September 2022 at the First Affiliated Hospital of Zhengzhou University. Among them, 43 cases were diagnosed as PJI, and 18 as aseptic loosening (AL) based on the American Musculoskeletal Infection Society (MSIS) criteria. Preoperative or intraoperative synovial fluid, periprosthetic tissues, and prosthetic sonicate fluid were collected, each divided into two portions for mNGS and culture. Comparative analyses were conducted between the microbiological results and diagnostic efficacy derived from mNGS and culture tests. Furthermore, the variability in mNGS diagnostic efficacy for PJI across different specimen types was assessed. Results: The sensitivity and specificity of mNGS diagnosis was 93% and 94.4% for all types of PJI specimens; the sensitivity and specificity of culture diagnosis was 72.1% and 100%, respectively. The diagnostic sensitivity of mNGS was significantly higher than that of culture (X2 = 6.541, P=0.011), with no statistically significant difference in specificity (X2 = 1.029, P=0.310). The sensitivity of the synovial fluid was 83.7% and the specificity was 94.4%; the sensitivity of the prosthetic sonicate fluid was 90.7% and the specificity was 94.4%; and the sensitivity of the periprosthetic tissue was 81.4% and the specificity was 100%. Notably, the mNGS of prosthetic sonicate fluid displayed a superior pathogen detection rate compared to other specimen types. Conclusion: mNGS can function as a precise diagnostic tool for identifying pathogens in PJI patients using three types of specimens. Due to its superior ability in pathogen identification, prosthetic sonicate fluid can replace synovial fluid and periprosthetic tissue as the optimal sample choice for mNGS.

Does Using Highly Porous Tantalum in Revision Total Hip Arthroplasty Reduce the Rate of Periprosthetic Joint Infection? A Systematic Review and Meta-Analysis.

Background: Studies suggest tantalum (Ta) implants may have inherent antibacterial properties. However, there is no consensus regarding the effectiveness of Ta in preventing periprosthetic joint infection (PJI) after revision total hip arthroplasty (rTHA). Methods: We searched 5 main databases for articles reporting the rate of PJI following rTHA using Ta implants from inception to February 2022. The PJI rates of the Ta group were meta-analyzed, compared with the control group, and represented as relative risks (RRs) in forest plots. Results: We identified 67 eligible studies (28,414 joints) for assessing the prevalence of PJI following rTHA using Ta implants. Among these studies, only 9 compared the Ta implant group with a control group. The overall PJI rate following rTHA using Ta implants was 2.9% (95% confidence interval [CI]: 2.2%-3.8%), while it was 5.7% (95% CI = 4.1%-7.8%) if only septic revisions were considered. Comparing the Ta and control groups showed a significantly lower PJI rate following all-cause rTHA with an RR = 0.80 (95% CI = 0.65-0.98, P < .05). There was a trend toward lower reinfection rates in the Ta group after rTHA in septic cases, although the difference was not statistically significant (RR = 0.75, 95% CI = 0.44-1.29, P = .30). Conclusions: Ta implants are associated with a lower PJI rate following all-cause rTHA but not after septic causes. Despite positive results, the clinical significance of Ta still remains unclear since the PJI rate was only reduced by 20%. Level of Evidence: IV.

How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery - Surgical technique and case report.

Managing chronic periprosthetic infections in patients who have undergone limb-salvage surgery following a malignant bone tumor with megaprosthesis often involves a two-stage revision surgery with the use of a cement-spacer. This paper show details the preparation of a self-made intramedullary metal-stabilized mega-cement spacer for patients needing a two-stage revision surgery due to infection after oncologic bone tumor resection and limb-salvage surgery with megaprosthesis and present two clinical cases treated with this technique. The report provides a practical surgical technique to create a cement hip mega-spacer using readily available tools in most orthopedic surgical settings.

Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection.

BACKGROUND: Periprosthetic joint infection (PJI) in total knee arthroplasty may result in 2-stage revision surgery. There are limited data describing outcomes when the first stage is completed at an outside hospital and the patient is referred to a tertiary center. We hypothesized that patients have greater success when both surgeries occur at a single center. METHODS: There were 25 knee PJI patients who presented with an antibiotic spacer and had a minimum 2-year follow-up who were retrospectively identified at a single tertiary referral center from 2014 to 2021. A cohort matched for age, sex, body mass index, Elixhauser comorbidity measure, spacer type, infectious organism, and year of surgery was established with patients who had both stages completed at the investigating institution. Modified Delphi success criteria of no subsequent surgery or reinfection with any species were compared. RESULTS: The transferred group demonstrated a treatment success of 40% compared to 84% in the continuous group (P < .01). The transferred group was more likely to have an additional procedure between stages (44 versus 8%, P < .01), with a higher number of surgeries after primary total knee arthroplasty (4.8 versus 3.0, P < .01), between stages (1.4 versus 0.2, P < .01), and after second stage (0.8 versus 0.2, P = .03). The transferred group had longer durations between stages (20.1 versus 7.0 weeks, P < .01). CONCLUSION: Patients who have PJIs transferred between stages demonstrated higher treatment failure. Surgeons should consider transfer early with a goal of continuous management by a single institution.

Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection.

Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.

Increased recognition of Q fever aortitis as a chronic manifestation of Q fever in tropical North Queensland, Australia.

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas.

Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection / Comparação entre procedimentos cirúrgicos no tratamento da infecção de prótese do quadril

Abstract Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.

Resumo Objetivo Comparar a taxa de cura, o tempo de recuperação e a pontuação na escala funcional de Merle d'Aubigné-Postel (EFMA) entre a cirurgia em tempo único (C1T) e a cirurgia em dois tempos (C2T) no tratamento de infecções protéticas do quadril, considerando as características sociodemográficas e clínicas dos pacientes. Materiais e Métodos Foi realizado um estudo retrospectivo num único centro, entre 2011 e 2014, com um total de 37 casos estudados, sendo 26 tratados com C1T e 11 com C2T. Foram comparadas a taxa de cura, o tempo de recuperação e a pontuação EFMA entre os dois grupos, bem como as características sociodemográficas e clínicas dos pacientes. Foram também consideradas as complicações cirúrgicas e o agente infeccioso mais comum. Resultados O grupo C1T teve uma recuperação funcional mais rápida do que o grupo C2T, mas não houve diferenças significativas na taxa de cura, nas complicações cirúrgicas ou na pontuação EFMA. No entanto, o grupo C1T era significativamente mais jovem, o que pode ter influenciado os resultados. Staphylococcus spp. foi o agente infeccioso mais comum (62%). Conclusão Embora a C2T pareça ser superior em termos de cura de infecção, a C1T pode ser preferível para uma recuperação funcional mais rápida. No entanto, as características individuais dos pacientes devem ser consideradas na escolha do tratamento. São necessárias mais pesquisas com um tamanho de amostra maior para confirmar estes resultados.

Impact of Bundled Intervention on Outcomes of Patients Undergoing Clean Orthopedic Surgeries With Hardware Implants: Small Prospective Randomized Controlled Trial.

Background: Prosthesis-related infections (PRIs) and surgical site infections (SSIs) remain one of the most devastating complications among patients undergoing clean orthopedic surgeries. Prevention strategies are critical to reduce infection rates in orthopedic surgeries. The current study aimed to determine the effectiveness of a set of evidence-based practices (bundled intervention) in reducing the incidence of PRIs and SSIs among patients undergoing clean orthopedic surgeries with hardware implants. Patients and Methods: A prospective, interventional randomized controlled trial was conducted for a period of three years. A total of 597 patients were enrolled, and depending on their Staphylococcus aureus carrier status were categorized into carrier group (n = 98) and non-carrier group (n = 499). Only carrier group patients were analyzed for effectiveness of bundled interventions, after being randomly assigned to two subgroups: interventional carrier group (ICG; n = 50) and non-interventional carrier group (NICG; n = 48). Results: Of the 597 patients, 98 (16.4%) were colonized with Staphylococcus aureus, among whom 9 (19.4%) had methicillin resistance. During follow-up, overall infection rate of 1.1% was observed (PRI, 0.3%; SSI, 0.8%). There was no case of PRI/SSI in the ICG. However, in the NICG, one patient developed SSI because of methicillin-resistant Staphylococcus aureus. An endogenous source of infection was demonstrated by pulsed field gel electrophoresis (PFGE). The SSI rate was higher in the NICG (p = 0.002). In the non-carrier group (n = 499), SSIs/PRIs occurred among 1.2% of the patients, because of organisms other than Staphylococcus aureus. Conclusions: Benefit of bundle intervention approach could be demonstrated. Further studies assessing the effectiveness of the individual components of the bundle can inform clinical practice greatly.

Microbiological Profile of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries.

Objective We studied the microbiological profile of periprosthetic knee infections treated in a Brazilian tertiary hospital. Methods The study included all patients undergoing revision surgery for total knee arthroplasty (RTKA) between November 2019 and December 2021, with a diagnosis of periprosthetic infection confirmed per the 2018 International Consensus Meeting (ICM) criteria. Results Sixty-two patients had a periprosthetic joint infection (PJI) per the 2018 ICM criteria. Cultures were monomicrobial in 79% and polymicrobial in 21% of cases. The most frequent bacterium in microbiological tissue and synovial fluid cultures was Staphylococcus aureus , observed in 26% of PJI patients. Periprosthetic joint infection with negative cultures occurred in 23% of patients. Conclusion Our results show the following: i) a high prevalence of Staphylococcus as an etiological agent for knee PJI; ii) a high incidence of polymicrobial infections in early infections; iii) the occurrence of PJI with negative cultures in approximately one fourth of the subjects.

Thermal susceptibility and antibiotic synergism of methicillin-resistant Staphylococcus aureus biofilms.

Methicillin-Resistant Staphylococcus aureus (MRSA) biofilms are among the most dangerous infections on medical implants, typically requiring surgical explantation and replacement. This study investigated the thermal susceptibility of MRSA biofilms to thermal shocks from 60 to 80 °C for 1-30 min as well as the effect of various antibiotics (most notably methicillin) on thermal mitigation. Pre- and post-shock exposure to three different classes of antibiotics (ciprofloxacin, tobramycin, and methicillin) at concentrations ranging from 0.25 to 128 µg mL-1 were investigated. MRSA biofilms exhibited thermal susceptibility comparable to other common nosocomial pathogens, such as Pseudomonas aeruginosa, though with greater variability. Exposure to antibiotics of any class significantly decreased the degree of thermal shock required for reliable mitigation, including at subclinical concentration. These combined treatments reduced biofilm population more than the sum of thermal and chemical treatments alone, demonstrating synergism, while also indicating a critical population drop of ∼4.5 log10 beyond which the biofilms typically became non-viable.

Contemporary multimodal approach to diagnosis and treatment of vascular graft and endograft infections.

Vascular graft and endograft infections (VGEIs) are a feared complication because of their morbidity, cost, and mortality. Despite broad and varying strategies, as well as limited evidence, societal guidelines do exist. The objective of this review was to supplement current guidelines with emerging and multimodal techniques for treatment. An electronic search was performed using PubMed with specific search terms from 2019 to 2022 in which VGEIs were described or analyzed in the carotid, thoracic aorta, abdominal, or lower extremity arteries. A total of 12 studies were collected from the electronic search. Articles describing all of the anatomic areas were present. The incidence of VGEIs depends on the anatomic location, varying from <1% to 18%. Gram-positive bacteria are the most common organism. Referral of patients with VGEIs to centers of excellence is paramount, as is pathogen identification, preferably from direct sampling techniques. The MAGIC (Management of Aortic Graft Infection Collaboration) criteria have been endorsed for all VGEIs and validated for aortic VGEI. They are well supplemented with additional diagnostic techniques. Treatment must be individualized, although the goal should be the removal of infected material with appropriate revascularization. VGEIs remain a devastating complication, despite changing or improving medical surgical techniques in vascular surgery. Prophylactic measures, early diagnosis, and patient-specific therapy remain the cornerstones of treatment for this feared complication.

One-stage revision hip arthroplasty for infection using primary cementless stems as first-line implants: About 35 cases.

INTRODUCTION: During infected total hip arthroplasty revisions (THAR), the need for systematic antibiotic cementation remains undefined. HYPOTHESIS: Implantation of a primary cementless stem as first-line implant in 1-stage septic THAR provides results as good as those from a stem cemented with antibiotics in terms of infection resolution. MATERIALS AND METHODS: We retrospectively examined 35 patients operated on for septic THAR with Avenir® cementless stem placement - between 2008 and 2018 at Besançon University Hospital - with a minimum follow-up of 2 years to define healing in the absence of infectious recurrence. Clinical outcomes were assessed using the Harris, Oxford, and Merle D'Aubigné scores. Osseointegration was analyzed by the Engh radiographic score. RESULTS: The median follow-up was 5±2.6 years (2-11). The infection was cured in 32 of 35 (91.4%) patients. The median scores of the following were: Harris 77/100, Oxford 47.5/60 and Merle d'Aubigné 15/18. Of 32 femoral stems, 31 (96.8%) had radiographically stable osseointegration. Age greater than 80 years was a risk factor for failure to cure the infection during septic THAR. DISCUSSION: A primary cementless stem as first-line implant plays a role in 1-stage septic THAR. It confers good results in terms of infection resolution and stem integration in the setting of loss of femoral bone substances rated Paprosky 1. LEVEL OF EVIDENCE: IV; retrospective case series.

Epidemiología de las infecciones post osteosíntesis detectadas por baño de ultrasonido en el Servicio de Traumatología del Hospital Universitario de Caracas / Post osteosinthesis infections epidemiology by ultrasound bath in the trauma service of the University Hospital of Caracas

El objetivo de este trabajo es determinar la epidemiología de la infección post osteosíntesis a través de cultivos de fluidos sonicados en los pacientes del Hospital Universitario de Caracas en el período comprendido entre noviembre 2021-noviembre 2022. Se realizó un estudio observacional de tipo, serie de casos, a través de la revisión de historias médicas de todos los casos que acudieron con diagnóstico de infección post osteosíntesis a fin de determinar cuál agente causal fue el más común, factores de riesgo asociados y tratamiento de elección. Se incluyeron 10 pacientes, 70% de sexo masculino y edad promedio de 40,6±17,9 años. Los gérmenes aislados en el cultivo convencional fueron el SAMS, SAMR, Enterobacter cloacae, Staphylococcus coagulasa negativo (10,0% cada uno), el 60,0% de los cultivos en esta modalidad fueron negativos, en el cultivo de fluidos por baño de ultrasonido, el germen más frecuente fue el SAMR en el 30% de los casos, seguido del SAMS con 20%, en menor medida un caso de Staphylococcus coagulasa negativo y una infección polimicrobiana compuesta por K. pneumoniae, E. cloacae y Enterococo sp. El tratamiento médico consistió en antibioticoterapia vía endovenosa, se realizó de acuerdo al antibiograma obtenido del cultivo, el más empleado fue la cefazolina en 30% (en casos de SAMS), seguido de la vancomicina + meropenem y la vancomicina aislada en 20%. Todos los pacientes cumplieron tratamiento al menos por 4 semanas con evolución satisfactoria(AU)

The objective of this work is to determine the epidemiology of post-osteosynthesis infection through sonicated fluid cultures in patients at the Hospital Universitario de Caracas in the period between November 2021 and November 2022. An observational study of type, series of cases, through the review of the medical records of all the cases that presented with a diagnosis of post-osteosynthesis infection in order to determine which causative agent was the most common, associated risk factors and treatment of choice. 10 patients were included, 70% male and mean age 40.6 ± 17.9 years. The germs isolated in the conventional culture were SAMS, SAMR, Enterobacter cloacae, coagulase-negative Staphylococcus (10.0% each), 60.0% of the cultures in this modality were negative, in the culture of fluids by bath of On ultrasound, the most frequent germ was MRSA in 30% of cases, followed by SAMS with 20%, to a lesser extent a case of coagulase-negative Staphylococcus and a polymicrobial infection made up of K. pneumoniae, E. cloacae and Enterococcus sp. The medical treatment consisted of intravenous antibiotic therapy, it was carried out according to the antibiogram obtained from the culture, the most used was cefazolin in 30% (in cases of SAMS), followed by vancomycin + meropenem and vancomycin alone in 20%. All patients complied with treatment for at least 4 weeks with satisfactory evolution(AU)

Microbiological Profi le of Periprosthetic Knee Infections in a Brazilian Unified Health System Hospital Specialized in Highly Complex Orthopedic Surgeries / Perfil microbiológico das infecções periprotéticas do joelho em um hospital do Sistema Único de Saúde especializado em cirurgias ortopédicas de alta complexidade

Abstract Objective We studied the microbiological profile of periprosthetic knee infections treated in a Brazilian tertiary hospital. Methods The study included all patients undergoing revision surgery for total knee arthroplasty (RTKA) between November 2019 and December 2021, with a diagnosis of periprosthetic infection confirmed per the 2018 International Consensus Meeting (ICM) criteria. Results Sixty-two patients had a periprosthetic joint infection (PJI) per the 2018 ICM criteria. Cultures were monomicrobial in 79% and polymicrobial in 21% of cases. The most frequent bacterium in microbiological tissue and synovial fluid cultures was Staphylococcus aureus, observed in 26% of PJI patients. Periprosthetic joint infection with negative cultures occurred in 23% of patients. Conclusion Our results show the following: i) a high prevalence of Staphylococcus as an etiological agent for knee PJI; ii) a high incidence of polymicrobial infections in early infections; iii) the occurrence of PJI with negative cultures in approximately one fourth of the subjects.

Resumo Objetivo Identificar o perfil microbiológico das infecções periprotéticas do joelho tratadas em um hospital terciário brasileiro. Métodos Todos os pacientes submetidos à cirurgia de revisão de artroplastia total do joelho (RATJ), no período compreendido entre novembro de 2019 e dezembro de 2021, e que tiveram o diagnóstico de infecção periprotética confirmado de acordo com critérios do International Consensus Meeting (ICM) 2018, foram incluídos no estudo. Resultados Sessenta e dois pacientes foram diagnosticados com infecção periprotética (IAP) pelos critérios do International Consensus Meeting 2018. Culturas monomicrobianas foram identificadas em 79% e polimicrobianas em 21% dos casos. A bactéria mais frequentemente identificada nas culturas microbiológicas de tecidos e líquido sinovial foi o Staphylococcus aureus, presente em 26% dos pacientes com infecção periprotética. Infecções periprotéticas com culturas negativas ocorreram em 23% dos pacientes. Conclusão Nossos resultados evidenciam: i) alta prevalência de bactérias do gênero Staphylococcus como causadores da IAP do joelho; ii) a alta incidência de infecções polimicrobianas nas infecções precoces e iii) IAP com culturas negativas ocorre em, aproximadamente, um quarto dos pacientes.

The Antimicrobial Activity of Micron-Thin Sol-Gel Films Loaded with Linezolid and Cefoxitin for Local Prevention of Orthopedic Prosthesis-Related Infections.

Orthopedic prosthesis-related infections (OPRI) are an essential health concern. OPRI prevention is a priority and a preferred option over dealing with poor prognosis and high-cost treatments. Micron-thin sol-gel films have been noted for a continuous and effective local delivery system. This study aimed to perform a comprehensive in vitro evaluation of a novel hybrid organic-inorganic sol-gel coating developed from a mixture of organopolysiloxanes and organophosphite and loaded with different concentrations of linezolid and/or cefoxitin. The kinetics of degradation and antibiotics release from the coatings were measured. The inhibition of biofilm formation of the coatings against Staphylococcus aureus, S. epidermidis, and Escherichia coli strains was studied, as well as the cell viability and proliferation of MC3T3-E1 osteoblasts. The microbiological assays demonstrated that sol-gel coatings inhibited the biofilm formation of the evaluated Staphylococcus species; however, no inhibition of the E. coli strain was achieved. A synergistic effect of the coating loaded with both antibiotics was observed against S. aureus. The cell studies showed that the sol-gels did not compromise cell viability and proliferation. In conclusion, these coatings represent an innovative therapeutic strategy with potential clinical use to prevent staphylococcal OPRI.

Image-guided synovial biopsy with a focus on infection.

Image-guided biopsy of the synovium is a relatively uncommon but safe procedure with a high-diagnostic yield in the correct clinical scenario. Whilst surgical and arthroscopic techniques are still commonly performed and remain the gold standard, they are more invasive, expensive and not widely available. Ultrasound and X-ray-guided synovial biopsy are being increasingly performed by radiologists to diagnose both native and periprosthetic joint infection (PJI) to guide surgical and microbiological management. The purpose of this review article is to present the historical background to synovial biopsy particularly related to potential joint infection, including common and uncommon pathogens encountered, sampling techniques and pitfalls, focusing mainly on its role in PJI and its role in patient pathways and decision-making within a joint infection multi-disciplinary framework.

Case Series of Silver Oxide-Containing Hydroxyapatite Coating in Antibacterial Cementless Total Hip Arthroplasty: Clinical Results of 50 Cases at 5-Year Follow-Up.

Background: Prosthetic joint infection, which is caused by implant treatment, is a severe complication. Consequently, silver-containing hydroxyapatite (Ag-HA)-coated implants have been developed to prevent prosthetic joint infection by combining Ag with HA. The Ag-HA-coated total hip prosthesis, which combines the antibacterial activity of Ag and the osteoconductivity of HA, is the first antibacterial cementless total hip prosthesis worldwide. This study aimed to evaluate the short-term outcomes of total hip arthroplasty (THA) with Ag-HA-coated implants. Methods: Overall, 50 hips with various disabling hip diseases and postoperative infection risks that underwent a primary THA using an Ag-HA total hip prosthesis were enrolled. The patients included 37 women (41 hips) and 8 men (9 hips), and the mean age at the time of surgery was 77 years. The clinical outcomes and hip function before and at 5 years postoperatively were measured using the Japanese Orthopaedic Association hip score. Implant stability was assessed, and postoperative complications were also examined. Results: The Japanese Orthopaedic Association score increased in all cases and improved from 41 to 86 points after the THA (P < .001). Radiography revealed no implant failure. Dislocation and deep vein thrombosis also occurred in 1 case each. However, there were no adverse reactions associated with Ag, and argyria was not observed in any case. Additionally, none of the patients experienced infection following the surgery. Conclusions: Silver-containing hydroxyapatite-coated implants significantly enhanced patients' daily activities without any adverse effects on the human body attributed to Ag, and they are expected to reduce postoperative infections.