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1.
Medicine (Baltimore) ; 99(15): e19735, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282732

RESUMO

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.


Assuntos
Candida albicans/isolamento & purificação , Prótese Articular/microbiologia , Osteoartrite/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/cirurgia , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Fluconazol/uso terapêutico , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/cirurgia , Osteoartrite/complicações , Prevalência , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
2.
Orthop Clin North Am ; 51(2): 141-146, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138852

RESUMO

Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges from 2% to 4% in primary procedures as opposed to nearly 20% in revisions. The challenges that arise here include mainly diagnostic uncertainty, management in immunocompromised patients, recurrent infection, infection around a well-fixed implant, and substantial bone loss, and require careful preoperative assessment and well-defined management plans. This article summarizes recent developments in the diagnosis and management of this increasingly prevalent issue specifically focusing on outcomes following debridement, antibiotics, and implants retention and one-stage revision procedures.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Antibacterianos/uso terapêutico , Biomarcadores/análise , Desbridamento , Remoção de Dispositivo , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/microbiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reino Unido
3.
Artigo em Inglês | MEDLINE | ID: mdl-32033480

RESUMO

The bio-engineering technologies of medical devices through nano-structuring and coating was recently proposed to improve biocompatibility and to reduce microbial adhesion in the prevention of implantable device-related infections. Our aim was to evaluate the ability of new nano-structured and coated materials to prevent the adhesion and biofilm formation, according to the American Standard Test Method ASTM-E2647-13. The materials composition was determined by X-ray Fluorescence and Laser Induced Breakdown Spectroscopy. Silver release was evaluated by Inductively Coupled Plasma Mass Spectrometry analysis. The gene expression levels of the Quorum Sensing Las and Rhl system were evaluated by the ΔΔCt method. The Log bacterial density (Log CFU/cm2) on TiAl6V4 was 4.41 ± 0.76 and 4.63 ± 1.01 on TiAl6V4-AgNPs compared to 2.57 ± 0.70 on CoCr and 2.73 ± 0.61 on CoCr-AgNPs (P < 0.0001, A.N.O.V.A.- one way test). The silver release was found to be equal to 17.8 ± 0.2 µg/L after the batch phase and 1.3 ± 0.1 µg/L during continuous flow. The rhlR gene resulted in a 2.70-fold increased expression in biofilm growth on the silver nanoparticles (AgNPs) coating. In conclusion, CoCr showed a greater ability to reduce microbial adhesion, independently of the AgNPs coating. The silver release resulted in promoting the up-regulation of the Rhl system. Further investigation should be conducted to optimize the effectiveness of the coating.


Assuntos
Resinas Acrílicas/farmacologia , Antibacterianos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Biofilmes/efeitos dos fármacos , Prótese Articular/microbiologia , Nanopartículas Metálicas/administração & dosagem , Prata/farmacologia , Resinas Acrílicas/administração & dosagem , Prata/administração & dosagem
4.
Eur J Orthop Surg Traumatol ; 30(2): 313-321, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578679

RESUMO

INTRODUCTION: Prosthetic joint infection (PJI) remains one of the major challenges facing orthopaedic surgeons. There is a paucity of evidence on non-operative management of PJI. We present the results of prolonged antibiotic suppression therapy (PSAT) in PJI from a single centre. METHODS: A retrospective study was performed. Twenty-six patients were included. Two patients were excluded due to the lack of follow-up data. Failure was defined as admission for sepsis from the joint or amputation. RESULTS: Average age was 72 years (range 35-93). Mean Charlson co-morbidity index was 4.3. Mean follow-up was 3.2 years (range 1.3-5.7). Staphylococcal species were isolated in 11 cases (44%) (MRSA 1, MSSA 5, Staph. epidermidis 4 and Staph Pasteuri 1). Other bacteria included E. Coli (2), Streptococci spp. (3), Propionebacterium acnes (1) and Pseudomonas aeruginosa (1). Four cases were polymicrobial infection (16%), and no organisms were identified in two cases (8%). Candida albicans was identified in one case. All cases of bacterial infection were treated with prolonged oral doxycycline or amoxicillin. Twenty patients (80%) received 6 weeks of intravenous antibiotics prior to commencing prolonged oral antibiotics. Two patients experienced persistent symptoms and required amputation (both TKA). Two patients experienced sepsis but were treated successfully with IV antibiotics alone. The success rate of PSAT was 84% (21/25) successful at an average 3.2-year follow-up. DISCUSSION AND CONCLUSION: Prolonged suppressive antibiotic therapy is a viable option for the management of PJI with a low incidence of complications.


Assuntos
Antibacterianos/uso terapêutico , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Administração Intravenosa , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Humanos , Prótese Articular/microbiologia , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Sepse/prevenção & controle
5.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(9): 588-591, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189576

RESUMO

INTRODUCCIÓN: Existe un creciente aumento de las infecciones de prótesis articular (IPA) por bacterias resistentes a las cefalosporinas utilizadas en la profilaxis quirúrgica. La sustitución de estas por glucopéptidos no ha demostrado mejorar los resultados pero sí su asociación. MÉTODOS: Estudio comparativo de la asociación de teicoplanina y cefazolina antes de la cirugía de artroplastia frente a cefazolina sola de un grupo control previo. RESULTADOS: En el periodo control hubo 16 IPA de 585 cirugías, mientras que en el grupo de intervención fueron 6 de 579 (incidencia 2,7% vs. 1,03%; RR 0,4, p = 0,04). En el grupo control, 11 de las infecciones fueron causadas por bacterias grampositivas frente a 4 en el de intervención (1,8% vs. 0,7%, p = 0,08). CONCLUSIONES: La adición de teicoplanina a cefazolina en la profilaxis de la cirugía de artroplastia se asoció a una reducción de la incidencia de IPA, a expensas de un descenso de las causadas por grampositivos


INTRODUCTION: There is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. METHODS: Comparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. RESULTS: During the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, P = .04). In control group, 11 of the infections were caused by Gram-positive bacteria versus 4 in the intervention group (1.8% vs. 0.7%, P = .08). CONCLUSIONS: The addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria


Assuntos
Humanos , Feminino , Idoso , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/prevenção & controle , Prótese Articular/microbiologia , Antibioticoprofilaxia , Teicoplanina/administração & dosagem , Cefazolina/administração & dosagem , Fatores de Risco
7.
Int J Infect Dis ; 82: 86-88, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30880125

RESUMO

Judging by the small number of published cases, periprosthetic joint infections (PJI) caused by Mycoplasma species are regarded as unusual. This is not surprising as special growth conditions are necessary for diagnosis and therefore the laboratory must be informed of any clinical suspicion. However, surgeons are generally not aware of the risk factors associated with certain microorganisms causing an infection. Our laboratory therefore decided to adopt a new strategy: first, to address specific questions concerning the medical history of the patient and second, to make diagnosis of rare and fastidious microorganisms part of routine investigation, even if detailed information is not available.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Mycoplasma/diagnóstico , Mycoplasma hominis/isolamento & purificação , Osteoartrite/diagnóstico , Hiperplasia Prostática/complicações , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Doxiciclina/uso terapêutico , Evolução Fatal , Humanos , Prótese Articular/microbiologia , Articulações/microbiologia , Levofloxacino/uso terapêutico , Masculino , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/tratamento farmacológico , Infecções por Mycoplasma/microbiologia , Mycoplasma hominis/genética , Osteoartrite/complicações , Osteoartrite/tratamento farmacológico , Osteoartrite/microbiologia , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia
8.
Knee ; 26(2): 444-450, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30711216

RESUMO

BACKGROUND: With advancements in manufacturing technology, custom orthopedic implants have become commercially available. A new concern with these implants is what to do when custom heat-sensitive components are contaminated. While intraoperative decontamination protocols for dropped autograft tissue have been described, no literature describes an intraoperative protocol for decontaminating one-of-a-kind polyethylene implants. The purpose of this work is to describe and evaluate polyethylene decontamination protocols using materials found in the average operating suite that could be used intraoperatively. METHODS: Sixteen custom polyethylene inserts were contaminated with potting soil and processed in one of four protocols: 1) hydrogen peroxide, 2) chlorhexidine gluconate, 3) povidone-iodine, or 4) control. Following processing, the implants were cultured with swabs or sonication. Each implant was evaluated with one aerobic, one anaerobic, and one fungal culture. RESULTS: All cultures from implants processed with both the chlorhexidine and povidone-iodine protocols were negative. One colony of Ralstonia species was isolated on the aerobic culture from one of the implants processed with hydrogen peroxide. The remainder of the cultures from implants processed with the hydrogen peroxide protocol were negative. All of the cultures for each culture modality from all of the control implants were positive with florid proliferation. CONCLUSION: In the rare situation that a custom polyethylene insert becomes contaminated intraoperatively, the surgeon should consider all salvage options. Chlorhexidine and povidone-iodine decontamination protocols eliminated bacterial growth following culture swabs or sonicate taken from the contaminated polyethylene inserts while hydrogen peroxide failed in one case to completely eradicate growth.


Assuntos
Protocolos Clínicos/normas , Descontaminação/normas , Desinfetantes/administração & dosagem , Contaminação de Equipamentos , Fômites/microbiologia , Prótese Articular/microbiologia , Materiais Biocompatíveis , Incrustação Biológica , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Descontaminação/métodos , Humanos , Peróxido de Hidrogênio/administração & dosagem , Polietileno , Povidona-Iodo/administração & dosagem , Desenho de Prótese
9.
Orthop Traumatol Surg Res ; 105(3): 473-477, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30612953

RESUMO

BACKGROUND: Bacterial adhesion depends on surface materials. Recently it was suggested that ceramic-on-ceramic bearings could be less prone to infection than other bearings. We examined the possibility that porous alumina ceramic could be less susceptible to bacterial adhesion. HYPOTHESIS: As hydroxyl groups (OH) on material surface are a major factor governing the surface properties (for example: adsorption, first non-specific step of bacterial adhesion), we hypothesized that alumina had lower OH group density than other material. Thus, we asked (i) if bacterial adhesion was lower on alumina than on titanium alloy, stainless steel and polyethylene and (ii) if OH group density was also lower on alumina. MATERIAL AND METHODS: We performed (i) in vitro bacterial cultures on porous alumina, titanium, stainless steel and polyethylene using Staphylococcus aureus and Pseudomonas aeruginosa, known to adhere to surfaces. Bacterial cultures were done 3 times in duplicate for each material and each strain. Colony Forming Units (CFU) per cm2 were measured; (ii) Neutral red reagent helped obtaining OH density estimates using spacer arms. UV-visible spectrophotometry method with Neutral red test, reproduced twice for each surface, provided µg/cm2 measurements of OH density. RESULTS: There was significantly less P. aeruginosa adherent on porous alumina (2.25×104 CFU/cm2) than on titanium (4.27×105 CFU/cm2, p=0.01), on stainless steel (2.44×105 CFU/cm2, p=0.02) and on polyethylene (7.29×105 CFU/cm2, p<0.001). S. aureus was significantly less adherent on porous alumina (3.22×105 CFU/cm2) than on polyethylene (5.23×106 CFU/cm2, p=0.01), but there was no difference with titanium (1.64×106 CFU/cm2, p=0.08) and stainless steel (1.79×106 CFU/cm2, p=0.1). There was significantly lower Neutral red grafted on porous alumina (0.09µg/cm2) than on titanium (8.88µg/cm2, p<0.0001), on stainless steel (39.8µg/cm2, p=0.002) and on polyethylene (4.5µg/cm2, p<0.01). However, no correlation was found between bacterial adherence and OH group density. DISCUSSION: Bacterial adherence on porous alumina was lower than on other bearings. Although there were less surface OH groups on porous alumina, we failed establishing a statistical correlation between bacterial adherence and OH group density. LEVEL OF EVIDENCE: IV, in vitro study.


Assuntos
Óxido de Alumínio/química , Aderência Bacteriana , Cerâmica/química , Ligas/química , Humanos , Prótese Articular/microbiologia , Polietileno/química , Porosidade , Desenho de Prótese , Pseudomonas aeruginosa/fisiologia , Aço Inoxidável/química , Staphylococcus aureus/fisiologia , Propriedades de Superfície , Titânio/química
11.
J Clin Microbiol ; 57(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30541933

RESUMO

Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.


Assuntos
Artroplastia/efeitos adversos , Prótese Articular/microbiologia , Técnicas Microbiológicas/métodos , Infecções Relacionadas à Prótese/diagnóstico , Reoperação , Sonicação/métodos , Manejo de Espécimes/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
12.
J Clin Microbiol ; 57(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30429253

RESUMO

We previously demonstrated that shotgun metagenomic sequencing can detect bacteria in sonicate fluid, providing a diagnosis of prosthetic joint infection (PJI). A limitation of the approach that we used is that data analysis was time-consuming and specialized bioinformatics expertise was required, both of which are barriers to routine clinical use. Fortunately, automated commercial analytic platforms that can interpret shotgun metagenomic data are emerging. In this study, we evaluated the CosmosID bioinformatics platform using shotgun metagenomic sequencing data derived from 408 sonicate fluid samples from our prior study with the goal of evaluating the platform vis-à-vis bacterial detection and antibiotic resistance gene detection for predicting staphylococcal antibacterial susceptibility. Samples were divided into a derivation set and a validation set, each consisting of 204 samples; results from the derivation set were used to establish cutoffs, which were then tested in the validation set for identifying pathogens and predicting staphylococcal antibacterial resistance. Metagenomic analysis detected bacteria in 94.8% (109/115) of sonicate fluid culture-positive PJIs and 37.8% (37/98) of sonicate fluid culture-negative PJIs. Metagenomic analysis showed sensitivities ranging from 65.7 to 85.0% for predicting staphylococcal antibacterial resistance. In conclusion, the CosmosID platform has the potential to provide fast, reliable bacterial detection and identification from metagenomic shotgun sequencing data derived from sonicate fluid for the diagnosis of PJI. Strategies for metagenomic detection of antibiotic resistance genes for predicting staphylococcal antibacterial resistance need further development.


Assuntos
Bactérias/isolamento & purificação , Biologia Computacional/métodos , Análise de Dados , Prótese Articular/microbiologia , Metagenômica/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Sensibilidade e Especificidade , Sonicação/métodos , Manejo de Espécimes/métodos , Adulto Jovem
13.
Eur J Clin Microbiol Infect Dis ; 38(2): 245-252, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30430376

RESUMO

Despite low sensitivity, culture of periprosthetic tissue (PPT) specimens on agars and in broths has traditionally been used for the detection of causative microorganisms in patients suspected for prosthetic joint infection (PJI). The aim of this study was to evaluate the added diagnostic value of culturing PPT in blood culture bottles (BCB) over the conventional combination of standard agar and broth alone. This prospective cohort study was conducted over a 12-month period and included consecutive patients undergoing revision arthroplasty. Overall, 113 episodes from 90 subjects were studied; 45 subjects (50.0%) met the Infectious Diseases Society of America (IDSA) criteria for PJI, of whom the majority (75.6%) had an acute infection. Sensitivity and specificity of culture were assessed using IDSA criteria for PJI as gold standard. Although the increase in sensitivity from 84.44 (CI 70.54; 93.51) to 93.33% (81.73; 98.60) was not significant, added diagnostic value of culturing PPT in BCBs was demonstrated by the significantly higher number of detected pathogens in culture sets with BCBs compared to culture without BCBs (61 pathogens in conventional set versus 89 when BCBs were included for 57 PJI episodes, P = <0.0001). In 17 (29.8%) episodes, microorganisms were cultured from BCBs only, and in 9 (52.9%) of these episodes, virulent pathogens were found. This study demonstrates that PPT culture in BCBs leads to isolation of additional microorganisms, both virulent and low-virulent, which were not cultured with use of agars and broths alone. Isolation of additional causative microorganisms has serious consequences for the treatment strategy in PJI.


Assuntos
Bactérias/isolamento & purificação , Técnicas de Cultura/métodos , Prótese Articular/microbiologia , Técnicas Microbiológicas/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/patologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia , Técnicas de Cultura/instrumentação , Humanos , Prótese Articular/efeitos adversos , Estudos Prospectivos , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Sensibilidade e Especificidade , Fatores de Tempo
14.
Clin Orthop Relat Res ; 477(2): 461-466, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30418277

RESUMO

BACKGROUND: One of the most commonly identified pathogens responsible for orthopaedic implant infection is Staphylococcus epidermidis, which can form biofilms on surfaces. Currently, orthopaedic implants made of various surface materials are available, each with features influencing osseointegration, biocompatibility, and adherence of bacteria to the surface, which is the first step in biofilm formation. The aim of this experimental study was to investigate the effect of a high tribologic-resistant 2.5-µm zirconium nitride top coat on an antiallergic multilayer ceramic-covered cobalt-chromium-molybdenum surface on the formation of S. epidermidis biofilm compared with other commonly used smooth and rough orthopaedic implant surface materials. QUESTIONS/PURPOSES: (1) When evaluating the surfaces of a cobalt-chromium-molybdenum (CoCrMo) alloy with a zirconium (Zr) nitride coating, a CoCrMo alloy without a coating, titanium alloy, a titanium alloy with a corundum-blasted rough surface, and stainless steel with a corundum-blasted rough surface, does a Zr coating reduce the number of colony-forming units of S. epidermidis in an in vitro setting? (2) Is there quantitatively less biofilm surface area on Zr-coated surfaces than on the other surfaces tested in this in vitro model? METHODS: To determine bacterial adhesion, five different experimental implant surface discs were incubated separately with one of 31 different S. epidermidis strains each and subsequently sonicated. Twenty test strains were obtained from orthopaedic patients undergoing emergency hip prosthesis surgeries or revision of implant infection and 10 further strains were obtained from the skin of healthy individuals. Additionally, one reference strain, S. epidermidis DSM 3269, was tested. After serial dilutions, the number of bacteria was counted and expressed as colony-forming units (CFUs)/mL. For biofilm detection, discs were stained with 0.1% Safranin-O for 15 minutes, photographed, and analyzed with computer imaging software. RESULTS: The lowest bacterial count was found in the CoCrMo + Zr surface disc (6.6 x 10 CFU/mL ± 4.6 x 10 SD) followed by the CoCrMo surface (1.1 x 10 CFU/mL ± 1.9 x 10 SD), the titanium surface (1.36 x 10 CFU/mL ± 1.8 x 10 SD), the rough stainless steel surface (2.65 x 10 CFU/mL ± 3.8 x 10 SD), and the rough titanium surface (2.1 x 10 CFU/mL ± 3.0 x 10 SD). The mean CFU count was lower for CoCrMo + Zr discs compared with the rough stainless steel surface (mean difference: 2.0 x 10, p = 0.021), the rough titanium alloy surface (mean difference: 1.4 x 10, p = 0.002), and the smooth titanium surface (mean difference: 7.0 x 10, p = 0.016). The results of biofilm formation quantification show that the mean covered area of the surface of the CoCrMo + Zr discs was 19% (± 16 SD), which was lower than CoCrMo surfaces (35% ± 23 SD), titanium alloy surface (46% ± 20 SD), rough titanium alloy surface (66% ± 23 SD), and rough stainless steel surface (58% ± 18 SD). CONCLUSIONS: These results demonstrate that a multilayer, ceramic-covered, CoCrMo surface with a 2.5-µm zirconium nitride top coat showed less S. epidermidis biofilm formation compared with other surface materials used for orthopaedic implants. CLINICAL RELEVANCE: CoCrMo with a 2.5-µm zirconium nitride top coat seems to be a promising surface modification technology able to reduce bacterial attachment on the surface of an implant and, hence, may further prevent implant infection with S. epidermidis biofilm formation.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Materiais Revestidos Biocompatíveis/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle , Staphylococcus epidermidis/efeitos dos fármacos , Zircônio/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Prótese Articular/microbiologia , Teste de Materiais , Desenho de Prótese , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/crescimento & desenvolvimento , Propriedades de Superfície
15.
Biomed Res Int ; 2018: 1067413, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30426000

RESUMO

In a retrospective study the association of the production of extracellular DNA (eDNA) in biofilms of clinical staphylococcal isolates from 60 patients with prosthetic joint infection (PJI) and the clinical outcome were investigated. Data from a previous study on eDNA production determined in 24-hour biofilms of staphylococcal isolates (Staphylococcus aureus n=30, Staphylococcus epidermidis n=30) was correlated with the patients' clinical outcome after 3 and 12 months. Statistical analysis was performed using either the Spearman's rank correlations test or the t-test. eDNA production of S. epidermidis in 24-hour biofilms correlated with the patients' outcome 'not cured' after 12 months. For S. aureus no such correlation was detected. Thus, eDNA may be a virulence factor of S. epidermidis. Quantification of eDNA production as a surrogate marker for biofilm formation might be a potential predictive marker for the management of PJI.


Assuntos
Biofilmes , DNA Bacteriano/metabolismo , Prótese Articular/microbiologia , Infecções Estafilocócicas/metabolismo , Staphylococcus aureus , Fatores de Virulência/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Staphylococcus aureus/fisiologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade , Staphylococcus epidermidis/fisiologia
16.
APMIS ; 126(8): 678-684, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30168623

RESUMO

The aim of this study was to test the hypothesis that Staphylococcus epidermidis isolated from prosthetic joint infections (PJIs) differs from S. epidermidis isolated from normal flora in terms of its capacity to induce activation of caspase-1 and release of IL-1ß in human neutrophils. The amount of active caspase-1 was determined over 6 h by detecting Ac-YVAD-AMC fluorescence in human neutrophils incubated with S. epidermidis isolates from PJIs (ST2) or normal flora. The amount of IL-1ß was detected by ELISA in neutrophil supernatants after 6 h of incubation. Mean IL-1ß release was lower after incubation with S. epidermidis from PJIs compared to isolates from normal flora, but no statistically significant difference was found in active caspase-1. Substantial inter-individual differences in both active caspase-1 and IL-1ß were noted. These results suggest that evasion of innate immune response, measured as reduced capacity to induce release of IL-1ß from human neutrophils, might be involved in the predominance of ST2 in S. epidermidis PJIs, but that other microbe-related factors are probably also important.


Assuntos
Interleucina-1beta/genética , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/imunologia , Caspase 1/genética , Caspase 1/imunologia , Técnicas de Cocultura , Regulação da Expressão Gênica , Humanos , Evasão da Resposta Imune , Interleucina-1beta/imunologia , Prótese Articular/microbiologia , Neutrófilos/imunologia , Neutrófilos/microbiologia , Neutrófilos/patologia , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/patologia , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/patologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade
17.
BMC Genomics ; 19(1): 714, 2018 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-30261842

RESUMO

BACKGROUND: Prosthetic joint infections are clinically difficult to diagnose and treat. Previously, we demonstrated metagenomic sequencing on an Illumina MiSeq replicates the findings of current gold standard microbiological diagnostic techniques. Nanopore sequencing offers advantages in speed of detection over MiSeq. Here, we report a real-time analytical pathway for Nanopore sequence data, designed for detecting bacterial composition of prosthetic joint infections but potentially useful for any microbial sequencing, and compare detection by direct-from-clinical-sample metagenomic nanopore sequencing with Illumina sequencing and standard microbiological diagnostic techniques. RESULTS: DNA was extracted from the sonication fluids of seven explanted orthopaedic devices, and additionally from two culture negative controls, and was sequenced on the Oxford Nanopore Technologies MinION platform. A specific analysis pipeline was assembled to overcome the challenges of identifying the true infecting pathogen, given high levels of host contamination and unavoidable background lab and kit contamination. The majority of DNA classified (> 90%) was host contamination and discarded. Using negative control filtering thresholds, the species identified corresponded with both routine microbiological diagnosis and MiSeq results. By analysing sequences in real time, causes of infection were robustly detected within minutes from initiation of sequencing. CONCLUSIONS: We demonstrate a novel, scalable pipeline for real-time analysis of MinION sequence data and use of this pipeline to show initial proof of concept that metagenomic MinION sequencing can provide rapid, accurate diagnosis for prosthetic joint infections. The high proportion of human DNA in prosthetic joint infection extracts prevents full genome analysis from complete coverage, and methods to reduce this could increase genome depth and allow antimicrobial resistance profiling. The nine samples sequenced in this pilot study have shown a proof of concept for sequencing and analysis that will enable us to investigate further sequencing to improve specificity and sensitivity.


Assuntos
Bactérias/classificação , Prótese Articular/microbiologia , Metagenômica/métodos , Análise de Sequência de DNA/métodos , Bactérias/genética , Bactérias/isolamento & purificação , DNA Bacteriano/análise , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Nanoporos , Projetos Piloto , Reprodutibilidade dos Testes
18.
PLoS One ; 13(8): e0202639, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30125299

RESUMO

BACKGROUND: The definition criteria and clinical characteristics of implant-associated infection (IAI) caused by Cutibacterium (formerly Propionibacterium) spp. are poorly known. We analyzed microbiologically proven Cutibacterium orthopedic IAI in a prospective cohort. METHODS: Patients with periprosthetic joint infections (PJI) and fixation device-associated infections (FDAI) caused by Cutibacterium spp. were prospectively included. IAI was defined by significant growth of Cutibacterium spp. and presence of at least one non-microbiological criterion for infection. The McNemar's chi-squared or binomial test was used to compare the performance of diagnostic tests. RESULTS: Of 121 patients with Cutibacterium IAI, 62 patients (51%) had PJI and 59 (49%) had FDAI. 109 infections (90%) were caused by C. acnes and 12 (10%) by C. avidum. The median time from implantation until diagnosis of infection was 15.7 months (interquartile range, 5-46.5 months). Clinical local signs were present in 30 patients (28%) and radiological implant loosening in 64 patients (63%). Culture sensitivity of sonication fluid was 84%, of peri-implant tissue 84% and of synovial or peri-implant fluid 56% after 14 days of incubation. CONCLUSION: Cutibacterium IAI was diagnosed late in the disease course and presented with subtle signs. Prolonged culture incubation and implant sonication improved the poor performance of conventional microbiological tests. Due to lack of reliable diagnostic tests, Cutibacterium remains difficult to detect making the diagnosis challenging.


Assuntos
Artrite Infecciosa/microbiologia , Equipamentos Ortopédicos/microbiologia , Propionibacteriaceae/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/fisiopatologia , Feminino , Humanos , Prótese Articular/microbiologia , Masculino , Pessoa de Meia-Idade , Propionibacteriaceae/patogenicidade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/fisiopatologia
19.
Biomed Res Int ; 2018: 6278012, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30112408

RESUMO

Background: Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI. Hypothesis: The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones. Study Design: It is systematic review with level of evidence 3. Methods: EMBASE, MEDLINE, and the Cochrane Library were searched electronically in January 2018. All studies regarding CN PJI of the hip or knee published in English or German with a minimum of 10 patients were included. Afterwards, the authors performed a descriptive analysis of diagnosis and treatment outcome. Result: Eight studies were identified that met the inclusion criteria. The incidence of CN PJI in the hip or knee ranged from 7% to 42 %. The included studies were pooled to give an overall incidence rate estimate of 11 % [95% confidence interval (CI): 10-12] based on a random-effects model. The most common surgical intervention was the two-stage revision of prosthesis with 283 patients. Postoperatively, the majority of patients received vancomycin as the antibiotic treatment, alone or in combination with other antibiotics. The rate of succesfully treated infections varied from 85% to 95 % in all included studies. The two-stage exchange arthroplasty had the best outcome, based on the infection-free survival rate of 95%, five years after treatment. Conclusions: We conclude that CN PJI have the same or even better results than culture-positive infections. Nonetheless, a standardized diagnostic protocol and evidence-based treatment strategies for CN PJI should be implemented for further studies.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Prótese Articular/microbiologia , Prognóstico
20.
Clin Orthop Relat Res ; 476(8): 1645-1654, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30020150

RESUMO

BACKGROUND: Alpha defensin was proposed as a new biomarker in synovial fluid for the diagnostic workup of failed joint prostheses. To our knowledge, no comparative study of the performance of the quantitative enzyme-linked immunosorbent assay (ELISA) and qualitative lateral flow alpha defensin test has been reported. QUESTIONS/PURPOSES: (1) Using the proposed European Bone and Joint Infection Society (EBJIS) criteria for defining periprosthetic joint infection (PJI), is there a difference in the diagnostic accuracy of quantitative ELISA and qualitative lateral flow alpha defensin tests? (2) Is there a difference in the performance of the two alpha defensin tests when using three definition classification systems (Musculoskeletal Infection Society [MSIS], Infectious Diseases Society of America [IDSA], and proposed EBJIS)? METHODS: In this retrospective study of samples collected earlier as part of a related longitudinal study, we included patients in whom aspiration of the prosthetic hip or knee was performed as routine investigation before every revision arthroplasty. Between October 2016 and April 2017, a total of 73 patients were eligible for inclusion. As a result of an insufficient fluid volume for analysis (< 5 mL), two patients were excluded. Among the 71 patients in the final analysis, 54 had a knee and 17 a hip arthroplasty. Using the proposed EBJIS criteria, PJI was diagnosed in 22 patients (31%) and aseptic failure in 49 (69%). The alpha defensin ELISA and lateral flow tests were performed in synovial fluid. Patients were classified as having PJI or aseptic failure using the MSIS, the IDSA, and the proposed EBJIS criteria. Sensitivity and specificity of ELISA and the lateral flow alpha defensin test were calculated. Based on receiver operating characteristic analysis, area under the curve values were compared. RESULTS: When measured against the proposed EBJIS criteria, the sensitivity of alpha defensin ELISA and the lateral flow test was low and not different from one another with the numbers available at 50% (95% confidence interval [CI], 31%-69%) and 46% (95% CI, 27%-65%; p = 0.857), respectively, whereas both methods showed high specificity (98% [95% CI, 88%-100%]; p = 1.000). For sensitivity, the highest values were seen when compared against the MSIS criteria (ELISA: 85% [95% CI, 56%-97%], lateral flow: 77% [95% CI]; p = 0.871), intermediate with IDSA criteria (ELISA: 73% [95% CI, 48%-89%], lateral flow: 67% [95% CI]; p = 0.867), and lowest with proposed EBJIS criteria (ELISA: 50% [95% CI, 31%-69%], lateral flow: 46% [95% CI]; p = 0.763). Specificity, however, was high regardless of the criteria used, where ELISA and lateral flow produced results that were not different (MSIS: 98% [95% CI, 90%-100%], IDSA: 98% [95% CI, 90%-100%], EBJIS: 98% [95% CI, 88%-100%]; p = 1.000). The area under the curve of alpha defensin ELISA and the lateral flow test was similar, regardless of the definition criteria used (EBJIS: p = 0.566; IDSA: p = 0.425; MSIS: p = 0.339). CONCLUSIONS: There is no difference between the quantitative and qualitative alpha defensin test for confirmation of PJI, irrespective of applied definition criteria. Having the advantage of providing results within 10 minutes without the need for a laboratory facility, the qualitative test may be of interest in the intraoperative setting, however, at a cost of higher test expense. LEVEL OF EVIDENCE: Level I, diagnostic study.


Assuntos
Artrite Infecciosa/diagnóstico , Artroplastia de Substituição/efeitos adversos , Ensaio de Imunoadsorção Enzimática/estatística & dados numéricos , Infecções Relacionadas à Prótese/diagnóstico , alfa-Defensinas/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/microbiologia , Biomarcadores/análise , Feminino , Humanos , Prótese Articular/microbiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Líquido Sinovial/química
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