Vancomycin Povidone-Iodine Protocol Improves Survivorship of Periprosthetic Joint Infection Treated With Irrigation and Debridement

Riesgo, Aldo M.; Park, Brian K.; Herrero, Christina; Yu, Stephen; Schwarzkopf, Ran; Iorio, Richard

doi:10.1016/j.arth.2017.10.044

Cited by 58 publications

(31 citation statements)

References 21 publications

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“…They can be used as adjunct therapy to treat difficult to eradicate infections, to reduce the duration of antibiotic use, and as primary treatment of infection. 7,10,11 Additionally, compared with antibiotics, PI 1.25% use has been recently reported to be noninferior as a treatment for bacterial keratitis. 7 The low cost, wide availability, and simple preparation of PI may make it useful as a primary therapy in resource-limited settings.…”

Section: Discussionmentioning

confidence: 99%

Povidone-iodine concentration and in vitro killing time of bacterial corneal ulcer isolates

et al. 2018

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Background-The concentration and dosing of povidone-iodine (PI) solution used in surgical site prophylaxis are variable. Prior in vitro work has demonstrated that dilute PI solutions (<1%) had greater bactericidal activity than stock solutions (10%). Studies using pathologic clinical isolates from the eye have yielded mixed results. The purpose of the current study was to evaluate the efficacy of different concentrations of PI on pathologic ocular surface isolates. Methods-We conducted an in vitro microbiology study using clinical isolates from corneal ulcers. Bacteria were recovered from trypticase soy agar with 5% sheep erythrocytes, chocolate agar, and thioglycollate broth media. A standardized concentration of each bacterial sample (1 × 10 8 cfu/ml) was exposed to various dilutions of PI. Quantitative cultures were performed to determine the number of organisms surviving PI exposure. Results-None of the isolates survived exposure to the PI 0.25% solution for 30 seconds. Micrococcus luteus and Staphylococcus aureus survived both 30-second and 1-minute exposure to PI 5% and 10%. The exposure time required to produce no growth was variable with concentrations of <0.25%. In some isolates, the 10% solution was faster than the more dilute solutions (0.1%, 0.05%). Conclusions-Our results are consistent with prior in vitro studies of PI, from nonocular sources, and suggest that PI has similar bactericidal action on pathologic bacteria from the ocular surface. In vitro exposure to dilute PI (0.25%) resulted in no growth after 30 seconds, whereas 10% and 5% solutions took longer to kill several of the isolates. Future investigations of PI use in ophthalmology as an antimicrobial agent should include the study of low-concentration PI (0.25%).

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Section: Discussionmentioning

confidence: 99%

Povidone-iodine concentration and in vitro killing time of bacterial corneal ulcer isolates

et al. 2018

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“…Such low cure rates are believed to occur in part due to surgeon variability in how surgical debridement is performed, but also due to current topical agents being ineffective in removing biofilm from metal and plastic implant surfaces [30]. Currently, administration of dilute betadine [31], chlorhexidine [32], and vancomycin powder [33] has all been separately advocated to improve irrigation and debridement treatment outcomes, but these effects have only been observed in retrospective case series. The limited quality of evidence and high degree of both morbidity and mortality obviate the need for novel methods of preventing and eradicating biofilm formation around artificial joint implants.…”

Section: Why Do Contemporary Treatments Fail?mentioning

confidence: 99%

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Taha

Abdelbary

Ross

et al. 2018

Curr Rev Musculoskelet Med

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Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides. Several promising treatment strategies for PJI are available to be tested further. The next requirement for most of the novel treatments is reproducing their effects in clinically representative animal models of PJI against clinical isolates of relevant bacteria.

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“…Also, in the implant-retaining treatment of early infection by irrigation, debridement and exchange of all modular components, it was shown that a combination of povidone-iodine and vancomycin increases the success rate of this procedure 16 .…”

mentioning

confidence: 99%

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

Matziolis

Brodt

Böhle

et al. 2020

Sci Rep

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Locally applied vancomycin is increasingly being used in primary hip and knee arthroplasty to reduce the risk of infection. Despite encouraging initial results, considerable debate remains on the basis of the data currently available. In particular, it has been unclear up to now whether local vancomycin is suitable to further reduce the risk of infection even if the rate of infection is already low (< 1%). In this monocentric retrospective cohort study, all primary total hip and knee arthroplasties performed between 2013 and 2018 were included. After a change in procedure at the hospital, 1 g vancomycin powder was applied intraarticularly before wound closure. The remaining perioperative procedure was constant over the investigation period. The follow-up was one year. The presence of an infection according to the currently valid MSIS criteria was defined as the endpoint. In patients with TKA two infections (0.3%) were observed under vancomycin prophylaxis in contrast to 44 infections (1.3%) in the control group (p = 0.033). In patients with THA two infections (0.5%) were observed under vancomycin prophylaxis and 48 infections (1.1%) in the control group without local vancomycin but this difference was statistically not significant. No wound complications requiring revision were observed as a result of the vancomycin. On the basis of the results of this study, intraarticular application of vancomycin powder in total hip and knee arthroplasty may be considered. Prospective randomized studies have to confirm this promising results prior a common recommendation. Level of Evidence III Retrospective cohort study. Infections after endoprosthetic hip or knee replacement, in spite of all perioperative improvements, are observed with an incidence of 1-2% 1-4. Despite the apparently low risk, efforts to further reduce the risk are sensible in light of the consequences for the patients concerned, with the potential for several follow-up operations and the often limited functional outcome. In spinal surgery, the reduction in the rate of infection through locally applied vancomycin was established more than 10 years ago and has been well documented by meta-analyses and animal experiments 5-8. The positive effect is set against minor complications caused in 0.3% of cases, mostly culture-negative seroma formation 9, so that it is even used successfully in children 10. Otte et al. were able to show that intrawound vancomycin powder lowers the infection rate after knee and hip arthroplasty from 1.6 to 0.5%, compared with a control group 11. In a subgroup analysis, the effect in revision operations was even greater, with a reduction of the infection rate from 3.9 to 0%. Patel et al. showed a reduction in the infection rate through vancomycin of 2.7-0.3% and determined a number needed to treat (NNT) of 47.5 12. Systemic side effects were not observed. The local application of vancomycin was assessed to be safe and cost-effective. Dial et al. observed a similar effect in primary hip arthroplasty, with a lowering of the infection rate...

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Vancomycin Povidone-Iodine Protocol Improves Survivorship of Periprosthetic Joint Infection Treated With Irrigation and Debridement

Cited by 58 publications

References 21 publications

Povidone-iodine concentration and in vitro killing time of bacterial corneal ulcer isolates

Povidone-iodine concentration and in vitro killing time of bacterial corneal ulcer isolates

New Innovations in the Treatment of PJI and Biofilms—Clinical and Preclinical Topics

Intraarticular vancomycin powder is effective in preventing infections following total hip and knee arthroplasty

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