Gram‐Negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment

Hsieh, Pang‐Hsin; Lee, Mel S.; Hsu, Kuo-Yao; Chang, Yu‐Han; Shih, Hsin-Nung; Ueng, Steve Wen–Neng

doi:10.1086/605593

Cited by 241 publications

(197 citation statements)

References 17 publications

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“…Although several studies, including the present study, have demonstrated that MRSA is reduced in patients with vancomycin, no studies to our knowledge have observed a reduced rate of Gram-positive organism. This finding can likely be explained by the narrower coverage of vancomycin compared with cefazolin and is important because infection with organisms other than Gram-positives such as atypical organisms and Gramnegative infection has been associated with poor treatment outcomes [10,17]. Because of the potential for narrower coverage, another antibiotic can be added such as cefazolin or teicoplanin, which is commonly done in Europe, or monotherapy with antibiotics of broader coverage such as aztreonam, levofloxacin, or clindamycin.…”

Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy. Questions/purposes (1) Are patients who receive vancomycin alone for penicillin allergy at greater odds of developing surgical site infection (SSI) as compared with patients who receive cefazolin for prophylaxis before total joint arthroplasty (TJA) without a patient-reported allergy? (2) What organism profile is associated with vancomycin monotherapy?Methods We performed a retrospective study of 10,391 primary TJAs performed between 2005 and 2014 at two institutions with a minimum of 1-year followup. Patients reporting penicillin or cephalosporin allergy were electronically queried from the anesthesia note. The odds of deep SSI and causative organisms were compared using multivariate analysis between b-lactam-allergic patients receiving vancomycin and nonallergic patients receiving cefazolin. Results After controlling for potential confounders, including comorbidities, we found that vancomycin alone did not affect the odds of deep SSI development (adjusted odds ratio [OR], 0.98; 95% confidence interval [CI], 0.67-1.43; p = 0.907). Although the overall odds of deep SSI were not different for patients receiving vancomycin versus cefazolin, we found that vancomycin was associated with a reduced risk of infection with Gram-positive organisms (adjusted OR, 0.25 [CI,; p = 0.003) and antibiotic-resistant organisms (adjusted OR, 0.10 [CI,

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Section: Discussionmentioning

confidence: 99%

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tan

Springer

Ruder

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…In the last few decades, treatment of these infections has become more difficult, mainly because S. aureus develops mechanisms of resistance to the antibiotics used in the treatments [36,37]. While for the Gram-negative, the most tested was E. coli, which, despite the reduced number in the cause of this type of infection, is a relevant group in clinical practice, presenting a difficulty in its treatment [38].…”

Section: Biomaterials -Physics and Chemistry -New Editionmentioning

confidence: 99%

Tuned Hydroxyapatite Materials for Biomedical Applications

Vieira¹,

Vieira²,

Silva³

et al. 2018

Biomaterials - Physics and Chemistry - New Edition

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Hydroxyapatite stands out between biomaterials due to its properties of osteoconduction and osteoinduction, being adequate to be used in bone grafts. The high stability and flexibility of the structure allows for several biomedical applications, for example, the use as polysaccharide based on the scaffold formulations and the cationic substitutions occurring through the doping of the material using metals, which may enhance biological characteristics, such as improving the action of combating bacterial infections in situ. This study was a research of articles and patents, without and with time restriction (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), which contain information about hydroxyapatite in the tissue engineering, biomedical, doped with cerium and its properties of antibacterial activity.There were also searches of products and companies that commercialize these types of materials aimed at tissue engineering area. Scopus was used for searched of articles and were EPO, USPTO, and INPI used for patents, and to search for products and companies were used search engines. Few papers were found to associate all the keywords, but the ones found are recent works, thus showing a new area with potential to be investigated.

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“…They found that conservative treatment of Gram-negative infection by debridements was associated with a lower success rate than treating Gram-positive arthroplasty infections (27 vs 47% remission). However, this difference vanished when a twostage exchange was performed [10].…”

Section: Introductionmentioning

confidence: 96%

“…P. aeruginosa accounts for an absolute minority of all osteoarticular pathogens [1], and most reports are either case series involving around 20-30 cases [9][10][11][12][13] or even less [14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Moreover, these reports subsume P. aeruginosa under other Gram-negative pathogens [9,12,13,19], including anaerobes [10,28], and lack adjustment for case mix [9,10,19,21]. Often, outcome comparisons of osteoarticular infections due to P. aeruginosa with Gram-positive pathogens are almost non-existent [10,28].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, these reports subsume P. aeruginosa under other Gram-negative pathogens [9,12,13,19], including anaerobes [10,28], and lack adjustment for case mix [9,10,19,21]. Often, outcome comparisons of osteoarticular infections due to P. aeruginosa with Gram-positive pathogens are almost non-existent [10,28]. Hsieh et al retrospectively compared arthroplasty infections due to Gram-positive pathogens to the same infections due to Gram-negative pathogens.…”

Section: Introductionmentioning

confidence: 99%

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Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

Seghrouchni

Delden

Dominguez

et al. 2011

International Orthopaedics (SICOT)

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Purpose Osteoarticular infections due to methicillinsusceptible Staphylococcus aureus (MSSA) or its methicillin-resistant variant (MRSA) are feared due to treatment failures. According to clinical experience, Pseudomonas aeruginosa may reveal less long-term remission than S. aureus. Methods A case-controlled study comparing outcomes of osteoarticular infections due to P. aeruginosa vs S. aureus was performed at Geneva University Hospitals. Results A total of 111 S. aureus (including 37 MRSA) and 20 P. aeruginosa osteoarticular infections were analysed in 131 patients: arthroplasties (n=38), fracture fixation devices (n=56), native joint arthritis (n=7) and osteomyelitis without implant (n=30). The median active follow-up time was 4 years. The patients underwent a median number of two surgical interventions for P. aeruginosa infections compared to two for S. aureus (two for MRSA), while the median duration of antibiotic treatment was 87 days for P. aeruginosa and 46 days for S. aureus infections (58 days for MRSA) (all p>0.05). Overall, Pseudomonas-infected patients tended towards a lower remission rate than those infected with S. aureus (12/20 vs 88/111; p=0.06). This was similar when P. aeruginosa was compared with MRSA alone (12/20 vs 30/37; p=0.08). In multivariate logistic regression analyses adjusting for case mix, odds ratios (OR) for remission were as follows: P. aeruginosa vs S. aureus [OR 0.4, 95% confidence interval (CI) 0.1-1.2], number of surgical interventions (OR 0.6, 95% CI 0.5-1.0) and duration of antibiotic treatment (OR 1.0, 95% CI 1.0-1.0). Conclusions Despite a similar number of surgical interventions and longer antibiotic treatment, osteoarticular infections due to P. aeruginosa tended towards a lower remission rate than infections due to S. aureus in general or MRSA in particular.

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Gram‐Negative Prosthetic Joint Infections: Risk Factors and Outcome of Treatment

Cited by 241 publications

References 17 publications

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Tuned Hydroxyapatite Materials for Biomedical Applications

Remission after treatment of osteoarticular infections due to Pseudomonas aeruginosa versus Staphylococcus aureus: a case-controlled study

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