Outcome of orthopedic implant infections due to different staphylococci

Abstract

In orthopedic implant infections, S. aureus is more virulent than CoNS. MRSA has the worst outcome and CoNS the best.

Remission rate of implant-related infections following revision surgery after fractures

“…Our remission rate is also higher than the 73 % published regarding young healthy individuals with ankle fractures [14] or the 72 % among 25 early staphylococcal infections following rigid internal fixation [9]. We cannot explain the exact reasons for the difference inasmuch as the duration of our antibiotic treatment was much shorter, while the distribution of the pathogens, the duration of follow-up and surgical approach were shared with other authors [5,16].…”

“…In our case-control study, remission rates of combined surgical and medical treatment of established implant infections after fracture management (128/139, 92 %) were significantly higher than for the treatment of chronic osteomyelitis [7] or arthroplasties [9,10], with remission rates ranging between 75 and 90 % in the literature [4]. Our remission rate is also higher than the 73 % published regarding young healthy individuals with ankle fractures [14] or the 72 % among 25 early staphylococcal infections following rigid internal fixation [9].…”

“…They rely on expert opinion with some indirect information from past animal studies or in vitro experiments [3,4]. Traditionally, a six-to 12-week course of antibiotic therapy is recommended [5,9,10,13,16], of which the first two to four weeks are usually given intravenously [1,11]. This general recommendation has been continuously challenged in recent years in favour of shorter antibiotic administration time with decreased parenteral regimen [7,10,11].…”

“…In the literature the duration of antimicrobial administration after implant removal, and the variables associated with remission, have been investigated thus far for arthroplastyassociated infections [5][6][7], but less for chronic osteomyelitis cases [3,8], and even less for fracture device-associated infections, the latter often with fewer than 30 episodes included per publication [9][10][11][12][13]. Theoretically, complete implant removal is the essential part of treatment, and therefore a relatively short period of antibiotic administration might be sufficient for sterilisation of superficial bone layers adjacent to the implant.…”

Infectious Dose Dictates the Host Response during Staphylococcus aureus Orthopedic-Implant Biofilm Infection

“…The often protracted period between prosthetic joint replacement and infectious complications suggests that prostheses may also be colonized following systemic bacterial infection. Since S. aureus biofilms are adept at circumventing immune-mediated clearance (6)(7)(8)(9) and are recalcitrant to antibiotic therapy, S. aureus PJIs have become increasingly difficult to treat (10)(11)(12)(13). Understanding the series of inflammatory events that occur during S. aureus PJI is a critical step toward identifying potential therapeutic targets.…”