Season of the year influences infection rates following total hip arthroplasty

Rosas, Samuel; Ong, Alvin; Buller, Leonard T.; Sabeh, Karim; Law, Tsun Yee; Hernández, Victor H.

doi:10.5312/wjo.v8.i12.895

Cited by 34 publications

(36 citation statements)

References 36 publications

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“…Staphylococcus aureus is the most common pathogen isolated from chronic osteomyelitis [4], with 50% of prosthetic joint infections caused by hardto-treat methicillin resistant S. aureus (MRSA) [2,5]. Despite advances in medical technology, the incidence of infection across all classes of orthopaedic subspecialties ranges from 0.1-30% [4] and rates of reinfection following revision surgery remain as high as 33% [6,7]. Further, the recurrence of S. aureus osteomyelitis following decades of quiescence and presumptive cure remains an important clinical problem [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Identification of Penicillin Binding Protein 4 (PBP4) as a critical factor for Staphylococcus aureus bone invasion during osteomyelitis in mice

et al. 2020

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Staphylococcus aureus infection of bone is challenging to treat because it colonizes the osteocyte lacuno-canalicular network (OLCN) of cortical bone. To elucidate factors involved in OLCN invasion and identify novel drug targets, we completed a hypothesis-driven screen of 24 S. aureus transposon insertion mutant strains for their ability to propagate through 0.5 μm-sized pores in the Microfluidic Silicon Membrane Canalicular Arrays (μSiM-CA), developed to model S. aureus invasion of the OLCN. This screen identified the uncanonical S. aureus transpeptidase, penicillin binding protein 4 (PBP4), as a necessary gene for S. aureus deformation and propagation through nanopores. In vivo studies revealed that Δpbp4 infected tibiae treated with vancomycin showed a significant 12-fold reduction in bacterial load compared to WT infected tibiae treated with vancomycin (p<0.05). Additionally, Δpbp4 infected tibiae displayed a remarkable decrease in pathogenic bone-loss at the implant site with and without vancomycin therapy. Most importantly, Δpbp4 S. aureus failed to invade and colonize the OLCN despite high bacterial loads on the implant and in adjacent tissues. Together, these results demonstrate that PBP4 is required for S. aureus colonization of the OLCN and suggest that inhibitors may be synergistic with standard of care antibiotics ineffective against bacteria within the OLCN.

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Section: Introductionmentioning

confidence: 99%

“…aureus (MRSA) [ 2 , 5 ]. Despite advances in medical technology, the incidence of infection across all classes of orthopaedic subspecialties ranges from 0.1–30% [ 4 ] and rates of reinfection following revision surgery remain as high as 33% [ 6 , 7 ]. Further, the recurrence of S .…”

Section: Introductionmentioning

confidence: 99%

Identification of Penicillin Binding Protein 4 (PBP4) as a critical factor for Staphylococcus aureus bone invasion during osteomyelitis in mice

et al. 2020

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“…Implant‐associated infections are considered very difficult to treat due to the need for complex surgical procedures and prolonged antibiotic therapy 2 . Rigorous intervention studies (i.e., the Surgical Care Improvement Project 3 ) have demonstrated that prosthetic joint infections (PJIs) complicate 0.1%–30% of total joint replacements, 4,5 and rates of recurrent or persistent infection following a two‐stage revision surgery are as high as 33% 6 . Most recently, an international registry of 192 bone infection patients (157 fracture‐related infections, 7 86 PJI, and 49 osteomyelitis) demonstrated a cure rate of only 62.1% at 1 year postoperation.…”

Section: Introductionmentioning

confidence: 99%

Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

Masters

Hao

Kenney

et al. 2020

Journal Orthopaedic Research

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Osteomyelitis is a devastating complication of orthopaedic surgery and commonly caused by Staphylococcus aureus (S. aureus) and Group B Streptococcus (GBS, S. agalactiae). Clinically, S. aureus osteomyelitis is associated with local inflammation, abscesses, aggressive osteolysis, and septic implant loosening. In contrast, S. agalactiae orthopaedic infections generally involve soft tissue, with acute lifethreatening vascular spread. While preclinical models that recapitulate the clinical features of S. aureus bone infection have proven useful for research, no animal models of S. agalactiae osteomyelitis exist. Here, we compared the pathology caused by these bacteria in an established murine model of implant-associated osteomyelitis. In vitro scanning electron microscopy and CFU quantification confirmed similar implant inocula for both pathogens (~10 5 CFU/pin). Assessment of mice at 14 days post-infection demonstrated increased S. aureus virulence, as S. agalactiae infected mice had significantly greater body weight, and fewer CFU on the implant and in bone and adjacent soft tissue (p < 0.05). X-ray, µCT, and histologic analyses showed that S. agalactiae induced significantly less osteolysis and implant loosening, and fewer large TRAP + osteoclasts than S. aureus without inducing intraosseous abscess formation. Most notably, transmission electron microscopy revealed that although both bacteria are capable of digesting cortical bone, S. agalactiae have a predilection for colonizing blood vessels embedded within cortical bone while S. aureus primarily colonizes the osteocyte lacuno-canalicular network. This study establishes the first quantitative animal model of S. agalactiae osteomyelitis, and demonstrates a vasculotropic mode of S. agalactiae infection, in contrast to the osteotropic behavior of S. aureus osteomyelitis.

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“…Musculoskeletal infections (MSKI) remain a devastating complication of orthopedic surgery, the majority of which are caused by Staphylococcus aureus , and in some regions over 50% of cases involve methicillin‐resistant S. aureus (MRSA) strains . Rigorous intervention studies (e.g., outcomes from the Surgical Care Improvement Project) have demonstrated that infection rates for elective surgery cannot be reduced below 1–2%, and failure rates of revision surgery are as high as 33% . In total, the costs for treatment of implant‐associated infection is projected to exceed $1.62 billion in the United States by 2020 …”

Section: The Significance Of Mski In Terms Of Incidence Current and mentioning

confidence: 99%

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

Schwarz

Parvızı

Gehrke

et al. 2019

Journal Orthopaedic Research

230

200

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Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to $150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite > 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable. ICM, International Consensus Meeting; MSKI, musculoskeletal infections; RW, research workgroup. * 2018 ICM RW consensus on the current and projected incidences of infection, and costs per patient, for all orthopedic subspecialties. These estimates, which were compiled from information were obtained from: (i) recent peer-reviewed publications, (ii) analysis of 2015 national administrative data using HCUPNet (https://hcupnet.ahrq.gov/#setup), and (iii) RW expertise. 998 SCHWARZ ET AL.

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Season of the year influences infection rates following total hip arthroplasty

Cited by 34 publications

References 36 publications

Identification of Penicillin Binding Protein 4 (PBP4) as a critical factor for Staphylococcus aureus bone invasion during osteomyelitis in mice

Identification of Penicillin Binding Protein 4 (PBP4) as a critical factor for Staphylococcus aureus bone invasion during osteomyelitis in mice

Distinct vasculotropic versus osteotropic features ofS. agalactiaeversusS. aureusimplant‐associated bone infection in mice

2018 International Consensus Meeting on Musculoskeletal Infection: Research Priorities from the General Assembly Questions

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