The microbiology of the infected knee arthroplasty

Nickinson, R S J; Board, Tim; Gambhir, A K; Porter, Martyn; Kay, PR

doi:10.1007/s00264-009-0797-y

Cited by 102 publications

(93 citation statements)

References 26 publications

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“…As similar results have been reported in subsequent studies [7,24], CoNS must be considered an important pathogen for targeting in antimicrobial prophylaxis. Moreover, CoNS has been recognized as the predominant causative organism for prosthetic joint infections [20,21,28], and globally one of the most resistant [14,25]. Moran et al [20] reported that 47% of causative organisms for prosthetic joint infections were CoNS, 60% of which were methicillin-resistant, followed by MSSA.…”

Section: Discussionmentioning

confidence: 99%

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Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Antimicrobial prophylaxis is considered beneficial for preventing surgical-site infections in clean orthopaedic surgery. However, whether tissue concentrations of cefazolin achieve the minimum inhibitory concentration for the targeted contaminants have yet to be clarified. Questions/purposes We asked whether 2 g of cefazolin would enable effective serum and bone concentrations relative to the current minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococci and methicillin-sensitive Staphylococcus aureus. Patients and Methods We enrolled 43 patients (THA, n = 16; TKA, n = 27) scheduled for primary THAs and primary TKAs. Subjects were given 2 g of cefazolin intravenously before incision. One blood sample and two bone samples were collected from each subject before tourniquet deflation before any additional dose. All samples were assayed at the same laboratory. Minimum inhibitory concentration values were defined based on nationwide surveys. Results Mean (± standard deviation) serum concentration was 170.3 ± 51.3 lg/mL (range, 99.3-370.3 lg/mL). Mean bone concentration was 32.3 ± 15.2 lg/g (range, 11.4-70.0 lg/g) in THA, and 16.0 ± 10.4 lg/g (range, 6.3-46.3 lg/g) in TKA. All serum and bone concentrations exceeded the minimum inhibitory concentration for methicillin-sensitive S. aureus, but some serum levels were marginal and no bone levels exceeded the minimum inhibitory concentration for cefazolin-resistant coagulasenegative Staphylococcus. Conclusions Our data suggest intravenous administration of 2 g of cefazolin achieves the minimum inhibitory concentration for methicillin-sensitive S. aureus in serum and bone, but not the minimum inhibitory concentration for cefazolin-resistant coagulase-negative Staphylococcus in bone, resulting in a potential risk of deep surgical site infections in THAs and TKAs.

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Section: Discussionmentioning

confidence: 99%

“…Thus, they are clinically considered cefazolin resistant [27,34]. The existence of resistant CoNS seen on a patient's skin [30,37] and the resistance seen in CoNSinfected joints [20,21,28] therefore must be given serious consideration.…”

Section: Introductionmentioning

confidence: 99%

Are Bone and Serum Cefazolin Concentrations Adequate for Antimicrobial Prophylaxis?

Yamada

Matsumoto

Tokimura

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Because aminoglycosides meet all the requirements, they were considered the preferred antibiotics for this treatment approach [6,10,25,27,28,41]. Staphylococcus species are the principal bacterial family related to TKA or THA infections [13,23,29], therefore a possible increase in aminoglycoside resistance in staphylococci causing an infection is a concern, and potentially might impact the utility of classic aminoglycoside-impregnated cement spacers [3,5,13,29,35]. This suggests that the use of other antibiotics or combinations of antibiotics in bone cement could be more effective for elimination of infection.…”

Section: Discussionmentioning

confidence: 99%

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

Corona

Barro

Mendez

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known. Questions/purposesWe therefore sought to compare industrially prefabricated spacers containing either gentamicin or gentamicin and vancomycin with respect to (1) infection control, (2) complications, and (3) quality of life, pain, and patient satisfaction. Methods We performed a review of 51 patients with chronic infections treated at one center using either gentamicin or vancomycin and gentamicin-prefabricated spacers. The former were used exclusively from January 2006 until May 2009, and the latter from June 2009 until July 2011, and there was no overlap. We collected data on demographics, immunologic status (McPherson classification), prosthetic joint infection location, type of prosthesis, microbiologic results, and time between stages. We evaluated the primary outcome of infection control or recurrence after at least 12 months followup. We also recorded complications. Each patient completed a qualityof-life survey, VAS, and a self-administered satisfaction scale. Results The overall infection control rate was 83% after a mean followup of 35 months (range, 12.4-64.7 months). There were no differences between gentamicin and vancomycin and gentamicin spacers in terms of infection eradication (80 % versus 85 %, respectively; p = 0.73), nor in terms of complications, quality of life, pain, or satisfaction scores. Conclusions Prefabricated, antibiotic-loaded cement spacers has been proven effective for infection control in TKAs and THAs but with the numbers available, we did not find any differences between a gentamicin or vancomycin and gentamicin-prefabricated spacer, and therefore, we are unable to validate the superiority of the combination of vancomycin and gentamicin over gentamicin alone. Because of the higher costs involved with vancomycin and gentamicin spacers, and the potential risks of unselective use of

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“…Despite concerted efforts to reduce infection rates, the reported incidence after primary TKA persists between 0.86% and 2.5% [1,2,20,21]. Coagulasenegative staphylococci cause up to 49% of deep infections with evidence that the role of these organisms is increasing [1,2,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…[3]. CoNS causes up to 49% of TKA infections [20], and at our institution, over 68% of CoNS isolates have an MIC [ 32 ug/mL against cefazolin. Assuming distribution similar to the cephalosporins used in the study of Hoddinott et al [15], such isolates would therefore not be covered by the tissue concentrations seen with systemic dosing (11 ug/mL); tissue concentrations with regional dosing (88-133 ug/mL) would however provide effective prophylaxis against such isolates, suggesting the differences used in our power analysis are clinically relevant.…”

Section: Authorsmentioning

confidence: 99%