Microbial Persistence, Replacement and Local Antimicrobial Therapy in Recurrent Bone and Joint Infection

Abstract

We report microbiological results from a cohort of recurrent bone and joint infection to define the contributions of microbial persistence or replacement. We also investigated for any association between local antibiotic treatment and emerging antimicrobial resistance. Microbiological cultures and antibiotic treatments were reviewed for 125 individuals with recurrent infection (prosthetic joint infection, fracture-related infection, and osteomyelitis) at two UK centres between 2007 and 2021. At re-operation, 48/125 (38.4%) individuals had an organism from the same bacterial species as at their initial operation for infection. In 49/125 (39.2%), only new species were isolated in culture. In 28/125 (22.4%), re-operative cultures were negative. The most commonly persistent species were Staphylococcus aureus (46.3%), coagulase-negative Staphylococci (50.0%), and Pseudomonas aeruginosa (50.0%). Gentamicin non-susceptible organisms were common, identified at index procedure in 51/125 (40.8%) and at re-operation in 40/125 (32%). Gentamicin non-susceptibility at re-operation was not associated with previous local aminoglycoside treatment (21/71 (29.8%) vs. 19/54 (35.2%); p = 0.6). Emergence of new aminoglycoside resistance at recurrence was uncommon and did not differ significantly between those with and without local aminoglycoside treatment (3/71 (4.2%) vs. 4/54 (7.4%); p = 0.7). Culture-based diagnostics identified microbial persistence and replacement at similar rates in patients who re-presented with infection. Treatment for orthopaedic infection with local antibiotics was not associated with the emergence of specific antimicrobial resistance.

Hybrid Organic–Inorganic Biomaterials as Drug Delivery Systems: A Molecular Dynamics Study of Quercetin Adsorption on Amorphous Silica Surfaces

“…The concentrations at the site of infection using wearable sensors are crucial. Locally targeted treatment of bone and joint infections using carriers containing antibiotics is a common practice today [10][11][12][13][14][15][16][17][18][19]. Organic/inorganic silica-based biomaterials capable of encapsulating the drug for in situ release after implantation also represent an increasingly attractive field for a good response to antibiotic resistance [20][21][22][23][24].…”

Optimal selection of specimens for metagenomic next-generation sequencing in diagnosing periprosthetic joint infections

“…Periprosthetic joint infection (PJI) stands as one of the most catastrophic and challenging complications following total joint arthroplasty (TJA) ( Gallo, 2020 ; Rietbergen et al., 2016 ). Rapid and accurate identification of pathogenic bacteria is crucial for determining the appropriate surgical approach and for selecting effective antibacterial drugs ( Hersh et al., 2019 ; Young et al., 2023 ). Although widely used for diagnosing PJI, traditional blood tests like C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell counts (WBC) struggle to identify the causative organism ( Nodzo et al., 2015 ).…”