Systemic Safety of High-Dose Antibiotic-Loaded Cement Spacers after Resection of an Infected Total Knee Arthroplasty

Springer, Bryan D.; Lee, Gwo Chin; Osmon, Douglas R.; Haidukewych, George J.; Hanssen, Arlen D.; Jacofsky, David J.

doi:10.1097/01.blo.0000144476.43661.10

Cited by 246 publications

(141 citation statements)

References 30 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…Our results are consistent with other previously published reports on this subject [4,30,38] finding an increase in postoperative kidney injury with multiple antibiotic prophylaxis. Furthermore, our data also show the effect that hip and knee arthroplasty can have on patients.…”

Section: Discussionsupporting

confidence: 94%

“…Their results showed that the two antibiotic groups developed new-onset, transient renal impairment at a higher rate compared with the single antibiotic group (9% versus 2%, p \ 0.001) [4]. Additionally, others have reported AKI in patients undergoing treatment of prosthetic joint infections with vancomycin-impregnated cement spacers [34,38]. The precise mechanism leading to the cause of transient renal dysfunction is unclear, but potential causes may be included altered pharmacokinetics caused by the combination of antibiotics [34,38].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, others have reported AKI in patients undergoing treatment of prosthetic joint infections with vancomycin-impregnated cement spacers [34,38]. The precise mechanism leading to the cause of transient renal dysfunction is unclear, but potential causes may be included altered pharmacokinetics caused by the combination of antibiotics [34,38]. Consequently, a risk of routine vancomycin administration in patients undergoing elective primary THA or TKA is the development of postoperative AKI.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

104

View full text Add to dashboard Cite

Background With increasing prevalence of methicillinresistant Staphylococcus aureus (MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients. Questions/purposes The purpose of this study was to determine whether patients receiving antibiotic prophylaxis with cefazolin and vancomycin have a higher risk of postoperative acute kidney injury (AKI) compared with patients receiving cefazolin alone before elective primary hip and knee arthroplasty. We also aimed to compare severity and recovery of AKI in these two cohorts and to determine independent risk factors for AKI. Methods We retrospectively evaluated a series of 1828 patients undergoing primary hip and knee arthroplasty over a 2-year period who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1328) as perioperative antibiotic prophylaxis. During the study period, a perceived high prevalence of MRSA infections at our institution led some surgeons to add vancomycin to the prophylactic antibiotic regimen. The patient characteristics, case mix, and preoperative renal function and baseline creatinine clearance were similar between the two groups. We defined AKI according to the published Acute Kidney Injury Network (AKIN) criteria, and the risk of AKI in both groups was compared. We also compared the proportions of patients by AKIN severity stage and assessed recovery as defined by creatinine levels showing kidney function reaching 50% baseline. The American Society of Anesthesiologists (ASA) classification, preoperative chronic kidney disease, intraoperative fluid requirements, and estimated blood loss were recorded. We analyzed the data using a multivariate logistic regression model to identify potential independent risk factors, including dual antibiotic therapy. Results Patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone (13% versus 8%, p = 0.002). Dual-antibiotic prophylaxis also was associated with greater severity; patients in the dual antibiotic group had higher rates of Grade II and III acute kidney injury (3% versus 0%, p = 0.003). There was no difference in the rate of return to baseline renal function (2 ± 1.4 days versus 3 ± 3.4 days; mean difference, 0.5 days; 95% confidence interval [CI], À0.2 to 1.2 days; p = 0.155). Controlling for confounding variables, dual antibiotic prophylaxis (adjusted odds ratio [OR], 1.82; 95% CI, 1.25-2.64; p = 0.002), ASA class

show abstract

Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Courtney

Melnic

Zimmer

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

104

View full text Add to dashboard Cite

show abstract

“…Radical debridement, copious irrigation and systemic and local antibiotic therapy are essential to avoid recurrent infection [3,4,12,14,19,20,22], with the quality of the surgical debridement being the most important parameter for long-term success in its management. Dead space management by means of antibiotic beads has lowered the failure rates and also enables a staged reconstruction, if needed [7,8,11,21,23]. The Cierny-Mader (C-M) classification provides prognostic data and assists in the planning of the treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Kınık

Karaduman

2007

International Orthopaedics (SICO

View full text Add to dashboard Cite

Cierny-Mader (C-M) Type III osteomyelitis is defined as a localised lesion with both medullary and cortical involvement that is stable mechanically after debridement. The treatment of C-M Type III osteomyelitisis is difficult and requires a precise protocol to achieve a disease-free longterm follow-up. We report here the results of our study on 26 patients (19 men and 7 women; average age: 34.7 years) with C-M Type III osteomylelitis who were treated with radical debridement, irrigation, vancomycin-impregnated custom-made beads and culture-specific systemic antibiotics. Those patients with metaphyseal involvement were treated with deroofing of the cortex and debridement by means of a "trough" (16 patients); those with diaphyseal involvement were treated with both intramedullary reaming and debridement from a trough (ten patients). Antibiotic cement rods were used as an additional therapy in five patients with diaphyseal involvement. Recurrence developed in three patients and was attributed to inadequate debridement; all three patients were treated again in the same manner with success. The mean follow-up is currently 3.6 years (range: 2-6 years). All of the patients have normal clinical, radiographic and laboratory parameters, and all are ambulatory and have returned to their pretreatment level of activity or better. We conclude that C-M Type III chronic osteomyelitis can be safely treated with this protocol.Résumé L'ostéomyélite de type III Cierny-Mader (C-M) peut se définir comme une localisation de lésions localisées à la fois sur la médullaire et la corticale et qui reste stable sur le plan mécanique après mise à plat. Son traitement est difficile et demande un protocole précis. Pour cette étude, nous avons suivi les résultats de 26 patients (19 hommes et 7 femmes) dont l'âge moyen était de 34.7 ans, traités par mise à plat, irrigation, et billes de vancomycine. Dans les lésions métaphysaires, la mise à plat est réalisée à travers une fenêtre (16 patients), dans les lésions diaphysaires on réalise à la fois un alésage des lésions et une mise à plat par la fenêtre (10 patients). En addition aux billes de vancomycine, un ciment aux antibiotiques a été utilisé chez 5 patients avec lésions diaphysaires. Trois patients ont présenté une récidive secondaire à une mise à plat insuffisante. Tous ces patients ont été à nouveau traités de la même manière et avec succès. Le suivi moyen a été de 3.6 ans (2 à 6 ans) et aucun patient n'a présenté d'anomalie post-opératoire des différents paramètres clinique, radiographique et biologique. Les patients peuvent marcher et ont retrouvé leur activité d'avant le traitement. L'ostéomyé-lite chronique de type III de CM peut être traitée avec succès selon ce protocole.

show abstract

“…[14][15][16][24][25][26][27][28][29][30][31][32][33] The glycopeptide, vancomycin, which presents chemical characteristics similar to those of gentamicin, has been considered the drug of choice in infections caused by MRSA and S. epidermidis and its concentration in bone ranges from 15-35% of those seen in the serum, well above the minimum inhibitory concentration of 1 mg/mL for susceptible SA strains. 8 Various researchers have shown in vitro the excellent properties of the combination of gentamicin and vancomycin in PMMA with regard to their synergistic antimicrobial effect against Escherichia coli and E. faecalis, [25][26][27] enterococci, 34 and variable effect on SA, according to strain.…”

mentioning

confidence: 99%

Preliminary investigations on a new gentamicin and vancomycin‐coated PMMA nail for the treatment of bone and intramedullary infections: An experimental study in the rabbit

Giavaresi¹,

Borsari²,

Fini³

et al. 2008

Journal Orthopaedic Research

View full text Add to dashboard Cite

To evaluate a new gentamicin-vancomycin-impregnated (2:1) PMMA coating nail as a drug delivery device to treat bone and intramedullary infections, methicillin-resistant Staphylococcus aureus (MRSA) was used to induce femoral osteomyelitis in 20 New Zealand male rabbits. Four weeks after inoculum, the animals were submitted to debridement of infected femur canal, divided into four groups of five animals each and treated according to the following protocols: Group 1, insertion of a steel AISI316 intramedullary nail; Group 2, insertion of a gentamicin-vancomycin-impregnated PMMA nail; Group 3, no therapy; and Group 4 no fixation device and 1-week systemic antibiotic therapy with teicoplanin i.m. At 7 weeks after inoculum, the femurs were explanted sterilely. The radiological score showed that the lowest and best radiological score was observed in Group 2 that was significantly different from the other groups. The highest bacterial load in the femoral canal was found in Group 1, which was significantly different from Group 2 and Group 4 (p < 0.05). Histology showed that Group 2 produced a marked improvement (p < 0.005) of the bone injuries induced by the osteomyelitis in comparison with the other groups (Smeltzer score). The current findings showed that tested device might effectively lead to MRSA infection healing after surgical debridement and immediate implantation. Keywords: PMMA nail; gentamicin-vancomycin coating; intramedullary infections Bone and intramedullary infections are severe complications of fracture management (0-1% for closed fractures and 0-11% for open fractures) 1 and surgical repair (intramedullary nailing 2,3 and lengthening over nails with external fixation 4,5 ) of long bones. A prevalence of methicillin-resistant or gentamicin-resistant Staphyloccous aureus (SA) has been observed, and bone infection with methicillin-resistant SA (MRSA) has increased among patients with implanted orthopedic devices. The current management of these forms of osteomyelitis has two main aims: (a) to limit and resolve the infective process, by removing all foreign material (fixation device), followed by a meticulous debridement of the necrotic and infected area, and by administering systemically prolonged (4-6 weeks) high doses of antibiotics; 6-8 (b) to stabilize the fracture with alternative treatments, mainly external fixators, which are also not without complications. 1,9 The rationale for the long treatment time is based on the observation that revascularization of bone after debridement takes about 4 weeks. 10

show abstract

Systemic Safety of High-Dose Antibiotic-Loaded Cement Spacers after Resection of an Infected Total Knee Arthroplasty

Cited by 246 publications

References 30 publications

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

Cierny-Mader Type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics

Preliminary investigations on a new gentamicin and vancomycin‐coated PMMA nail for the treatment of bone and intramedullary infections: An experimental study in the rabbit

Contact Info

Product

Resources

About