General Assembly, Prevention, Local Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Baeza, J.A.; Cury, Marco Bernardo; Fleischman, Andrew N.; Ferrando, Albert; Fuertes, M. Esteban; Goswami, Karan; Lidgren, Lars; Linke, Philip; Manrique, Jorge; Makar, Gabriel; McLaren, A. C.; Moriarty, T. Fintan; Ren, Qun; Vince, Kelly G.; Wahl, Peter; Webb, Jonathan; Winkler, Heinz; Witsø, Eivind; Young, Simon W.

doi:10.1016/j.arth.2018.09.056

Cited by 24 publications

(18 citation statements)

References 132 publications

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“…Time is, of course, associated with the development or maturation of the biofilm, which has consecutively decreasing treatment success rates (Burger et al, 1991;Marculescu et al, 2006;Vilchez et al, 2011;Fehring et al, 2013;Lora-Tamayo et al, 2013;Grammatopoulos et al, 2017a;Narayanan et al, 2018). Prolonged exposure to antibiotics at high concentrations may, however, overcome and even eradicate the matured biofilm (Post et al, 2017;Baeza et al, 2019). The required thresholds may be obtained for vancomycin with CaSO 4 as the carrier material for approximately 2 weeks, with concentrations remaining above usual MIC (minimal inhibitory concentration) for approximately 2 months (Wahl et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…It is soft and does not cause relevant third-body wear on prosthetic components (Heuberger et al, 2014), and it is compatible with many antibiotics (Wahl et al, 2018). Biofilm-active concentrations of vancomycin may be obtained locally for at least 2 weeks and with therapeutic release for some months (Post et al, 2017;Wahl et al, 2017;Baeza et al, 2019). The aim of this study was to compare the success rates of DAIR for PJI after THA with or without local antibiotic delivery with CaSO 4 as the carrier material.…”

Section: Introductionmentioning

confidence: 99%

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Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty – a retrospective study

Reinisch

Schläppi

Meier

et al. 2022

J. Bone Joint Infect.

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Abstract. Purpose: Debridement, antibiotics, and implant retention (DAIR) is an established treatment modality in periprosthetic joint infections (PJIs), but success rates vary. This study compared the success of DAIR for PJIs after a total hip arthroplasty (THA), with or without local antibiotic delivery with CaSO4 as the carrier material. Methods: A retrospective review of DAIR for PJIs after THA performed between 2010 and 2018, including 41 patients is conducted. A total of 27 patients were treated by DAIR with local antibiotics with CaSO4 as the carrier material, and 14 patients were treated by a standard DAIR. The endpoints were treatment failure, defined as the need for a reoperation, either a second DAIR or a prosthesis removal or exchange due to persistent or recurrent infection, the initiation of a long-term suppressive antibiotic treatment, or death related to infection. Results: Considering any reoperation as an outcome, 11 of 14 cases treated without AB-CaSO4 (79 %) and 4 of the 27 cases treated with AB-CaSO4 failed (15 %). Considering revision as an outcome, 9 out of 14 cases treated without AB-CaSO4 (64 %) and 4 of the 27 cases treated with AB-CaSO4 (15 %) failed. A Kaplan–Meier survival analysis showed that local antibiotic delivery with CaSO4 as the carrier material led to a significantly longer infection-free survival, considering any surgical revision (p<0.0001; hazard ratio 8.9 (95 % CI 2.8–28.2)) or revision with component exchange (p=0.0015; hazard ratio 5.6 (95 % CI 1.7–18.2)) as the endpoint. Conclusion: The addition of local antibiotics with CaSO4 as the carrier material to DAIR for PJIs after THA significantly increases success rates, such as infection-free survival, any reoperation, and revision with component exchange in particular.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty – a retrospective study

Reinisch

Schläppi

Meier

et al. 2022

J. Bone Joint Infect.

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“…We have always used a fixed antibiotic in cement, similar to other authors [ 38 ]. The concept is that the local antibiotic in cement is a prophylactic for new infections; it does not serve as treatment for the chronic infection [ 39 ], or for an acute infection during the 1-stage revision [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection

et al. 2021

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The objective of this study was to evaluate our preliminary results after changing our surgical strategy from 2-stage revision arthroplasty to 1-stage revision arthroplasty for patients with chronic knee periprosthetic joint infection. We conducted a prospective study of knee arthroplasty patients that had been diagnosed with chronic infection and treated using a 1-stage revision regardless of the traditional criteria applied for indication thereof. We evaluated two main variables: infection control and economic costs. The definitive diagnosis of infection of the revision was determined by using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated as average costs in USD, as described by Srivastava (2019), for 1-stage or 2-stage revisions. Eighteen patients were included in the study, and infection was controlled in 17 patients. The total economic savings for our hospital from these 18 patients amounted to USD 291,152. This clinical success has led to major changes in how our hospital approaches the treatment of chronically infected knee replacements, in addition to substantial economic advantages for the hospital.

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“…Currently, there is no evidence on the clinical efficacy of these devices without systemic antibiotic therapy [17]. Antibiotic coatings have the advantage of ensuring high concentrations of antibiotics locally, optimizing the pharmacodynamics of these drugs [18,19] and overcoming the issues of pharmacokinetics in the bone microenvironment [20].…”

Section: Discussionmentioning

confidence: 99%

“…Currently, one of the issues limiting the diffusion of coating prevention strategies is the lack of large randomized clinical trials that prove their effectiveness in the orthopedic field [17]. Additionally, numerous criticisms have been raised regarding the use of these devices, due to their high costs in the context of prevention.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study

et al. 2020

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Periprosthetic joint infections (PJIs) are a cause of frequent implant failure in revision hip replacement surgery. The purpose of this study is to evaluate the onset of early postoperative infections in patients who underwent hip surgery with cementless prostheses treated with an antibiotic loaded hydrogel on their surface, in addition to systemic prophylaxis, and compare them to a control group. The secondary objective was to evaluate the onset of any local and systemic adverse effects and interference with bone ingrowth processes and functional recovery. A retrospective observational study was conducted on patients who underwent revision hip surgery by performing a 1:1 match between patients treated with an antibiotic hydrogel (ALH) and the control patients. The incidence of PJIs was assessed with a minimum of six months follow-up. Seventeen patients treated with the ALH were compared with 17 patients from the control group. No PJIs were reported in the ALH group versus the six cases encountered in the control group (p < 0.0001). No significant differences were reported with regard to prosthetic osseointegration and functional results, nor were there side effects in the ALH group. Despite the low sample size, the use of on-site prophylaxis with ALH has proven effective and safe in reducing the risk of PJIs in patients with a high risk for infections. Further studies are needed to validate these results in other implant-related surgeries.

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General Assembly, Prevention, Local Antimicrobials: Proceedings of International Consensus on Orthopedic Infections

Cited by 24 publications

References 132 publications

Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty – a retrospective study

Local antibiotic treatment with calcium sulfate as carrier material improves the outcome of debridement, antibiotics, and implant retention procedures for periprosthetic joint infections after hip arthroplasty – a retrospective study

Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection

Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study

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