Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

Rottier, Wouter; Seidelman, Jessica; Wouthuyzen-Bakker, Marjan

doi:10.1186/s42836-023-00169-4

Cited by 21 publications

(11 citation statements)

References 45 publications

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“…Considering the current literature, the authors clearly recommend antibiotic treatment intervals longer than 14 days, as described in this study. However, it must also be critically noted that there is still no conclusive evidence that long treatment intervals of 12 weeks and more are associated with better outcomes than shorter intervals (e.g., 6 weeks) [ 11 , 51 , 52 ]. Furthermore long treatment intervals of antibiotics can be associated with an increased occurrence of adverse events [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

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Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

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Section: Discussionmentioning

confidence: 99%

“…Surgical options described include debridement, antibiotics and implant retention (DAIR) with modular component exchange, and one- and two-stage prosthesis exchange [ 5 , 9 ]. Antibiotic treatment is an important non-surgical component in PJI treatment [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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“…Biofilme können sich sowohl auf metallischen, keramischen als auch auf Kunststoff-Anteilen von Endoprothesen ausbilden. Die im ausgereiften protektiven Biofilm eingebetteten pathogenen Mikroorganismen weisen aufgrund von pheno-und genotypischen Veränderungen verminderte Empfindlichkeiten auf und sind damit für medikamentöse Therapiekonzepte nicht mehr suffizient zugänglich [5]. Innerhalb von Stunden auf Implantatoberflächen entstehende bakterielle Biofilme reifen unbehandelt in der Regel in den folgenden Wochen aus.…”

Section: Diagnostikunclassified

Periprothetische Infektionen – operatives und medikamentöses Management

Stiehler

2024

Orthopädie und Unfallchirurgie up2date

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“…Identification of bacteria, both in acute and chronic infections, is only possible by culturing intra-articular swabs. Treatment steps (medication and surgery) are often taken without knowing the details of the infecting bacteria [ 13 ] and there is a high probability of negative cultures (~ 20%) [ 8 ]. Despite these shortcomings of identification, the majority of positive cultures comprise gram-positive microorganisms Staphylococcus aureus ( SA ) and Staphylococcus epidermidis ( SE ) (60–70% [ 14 ]).…”

Section: Introductionmentioning

confidence: 99%

Synergistic use of anti-inflammatory ketorolac and gentamicin to target staphylococcal biofilms

Sekar,

Gil,

Tierney

et al. 2024

J Transl Med

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Background While antibiotics remain our primary tools against microbial infection, increasing antibiotic resistance (inherent and acquired) is a major detriment to their efficacy. A practical approach to maintaining or reversing the efficacy of antibiotics is the use of other commonly used therapeutics, which show synergistic antibacterial action with antibiotics. Here, we investigated the extent of antibacterial synergy between the antibiotic gentamicin and the anti-inflammatory ketorolac regarding the dynamics of biofilm growth, the rate of acquired resistance, and the possible mechanism of synergy. Methods Control (ATCC 12600, ATCC 35984) and clinical strains (L1101, L1116) of Staphylococcus aureus and Staphylococcus epidermidis with varying antibiotic susceptibility profiles were used in this study to simulate implant-material associated low-risk and high-risk biofilms in vitro. The synergistic action of gentamicin sulfate (GS) and ketorolac tromethamine (KT), against planktonic staphylococcal strains were determined using the fractional inhibitory concentration measurement assay. Nascent (6 h) and established (24 h) biofilms were grown on 316L stainless steel plates and the synergistic biofilm eradication activity was determined and characterized using adherent bacteria count, minimum biofilm eradication concentration (MBEC) measurement for GS, visualization by live/dead imaging, scanning electron microscopy, gene expression of biofilm-associated genes, and bacterial membrane fluidity assessment. Results Gentamicin-ketorolac (GS-KT) combination demonstrated synergistic antibacterial action against planktonic Staphylococci. Control and clinical strains showed distinct biofilm growth dynamics and an increase in biofilm maturity was shown to confer further resistance to gentamicin for both ‘low-risk’ and ‘high-risk’ biofilms. The addition of ketorolac enhanced the antibiofilm activity of gentamicin against acquired resistance in staphylococcal biofilms. Mechanistic studies revealed that the synergistic action of gentamicin–ketorolac interferes with biofilm morphology and subverts bacterial stress response altering bacterial physiology, membrane dynamics, and biofilm properties. Conclusion The results of this study have a significant impact on the local administration of antibiotics and other therapeutic agents commonly used in the prevention and treatment of orthopaedic infections. Further, these results warrant the study of synergy for the concurrent or sequential administration of non-antibiotic drugs for antimicrobial effect.

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Antimicrobial treatment of patients with a periprosthetic joint infection: basic principles

Cited by 21 publications

References 45 publications

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Periprothetische Infektionen – operatives und medikamentöses Management

Synergistic use of anti-inflammatory ketorolac and gentamicin to target staphylococcal biofilms

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