Antibiotic treatment of Gram-positive bone and joint infections

Abstract

Gram-positive organisms, particularly staphylococci and streptococci, are responsible for the majority of bone and joint infections. Treatment of these infections can be difficult, usually involving a prolonged course of antibiotics, often with surgical intervention. The selection of antibiotics depends on sensitivity profile, patient tolerance and long-term goals, e.g. cure or suppression, but there are few randomized controlled trials in patients comparing efficacy of different antibiotics. Different degrees of bone penetration and clinical outcome for specific antibiotics, e.g. the beta-lactams, clindamycin and quinolones, have been described, although the methodology in these studies is not standardized and findings cannot always be applied directly to patients. The effect of attaining minimum serum bactericidal concentrations in patients has also been studied but this is no longer routinely recommended in clinical practice. Comparative clinical trials are few but have demonstrated efficacy of oral fluoroquinolones in combination with either rifampicin or fusidic acid for selected Gram-positive infections. In the past decade, increasingly resistant organisms, e.g. methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci have been recognized as causes of orthopaedic infection. Individual case reports describe successful treatment using the newer antibiotics, e.g. linezolid and quinupristin/dalfopristin, but results of clinical trials are awaited.

Simulated Antibiotic Exposures in an In Vitro Hollow-Fiber Infection Model Influence Toxin Gene Expression and Production in Community-Associated Methicillin-Resistant Staphylococcus aureus Strain MW2

“…Clindamycin and linezolid, although less active after the first dose, displayed improved and sustained activity over 72 h. All of these antibiotics demonstrate good outcomes in the treatment of complicated skin and skin structure infections, the predominant infection type in CA-MRSA (38). Interestingly, linezolid and clindamycin, both antibiotics with high tissue penetration in patients with clinical doses (15,17), were the most effective in reducing inoculum burden at the end of exposure in this study.…”

Silver-loaded nanotubular structures enhanced bactericidal efficiency of antibiotics with synergistic effect in vitro and in vivo

“…However, antibiotic resistance and biofilm formation are challenging the drug efficiency, resulting in an extended antibiotic therapy than a usual 6-week antibiotic administration. 4 Although gram-positive Staphylococcus aureus remains as one of the main pathogens leading to implant infection, the emerging methicillin-resistant Staphylococcus aureus (MRSA) and gram-negative bacteria are making the scenario more complex. MRSA is resistant to all β-lactam antibiotics that share structural similarity with methicillin.…”

Suppressive Oral Antibiotics in Orthopaedic Prosthetic Joint Infections

“…14 The IDSA suggests the use of rifampin following Staphylococcal prosthetic joint infection for three months following total hip arthroplasty and six months following total knee arthroplasty. 3 Rifampin must be used in combination with other antibiotics to prevent resistance.…”