Vancomycin prophylaxis in prosthetic joint surgery?

Yusuf, Erlangga; Croughs, P

doi:10.1016/j.cmi.2019.10.007

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…tibia and soft tissue envelope) in an ambulating model over a clinically relevant time. In the pilot study, plasma concentrations of VAN and GEN demonstrated levels consistent with values indicated in the literature for VAN prophylaxis (Yusuf and Croughs, 2020). C max values measured for the IM canal and fracture plate site were in the 10-100× MIC range for staphylococcal species, consistent with other reports (Gustafson et al, 2016;Khan et al, 2014;Liu et al, 2014;Selph and Carson, 2011) and with the most common organisms responsible for orthopaedic SSIs (Hickok and Shapiro, 2012).…”

Section: Antibiotic Delivery For Biofilmssupporting

confidence: 88%

In vitro investigations of Staphylococcus aureus biofilms in physiological fluids suggest that current antibiotic delivery systems may be limited

Isguven¹,

Fitzgerald²,

Delaney³

et al. 2022

eCM

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Orthopaedic surgical site infections, especially when a hardware is involved, are associated with biofilm formation. Clinical strategies for biofilm eradication still fall short. The present study used a novel animal model of long-bone fixation with vancomycin- or gentamicin-controlled release and measured the levels of antibiotic achieved at the site of release and in the surrounding tissue. Then, using fluids that contain serum proteins (synovial fluid or diluted serum), the levels of vancomycin or gentamicin required to substantially reduce colonising bacteria were measured in a model representative of either prophylaxis or established biofilms. In the in vivo model, while the levels immediately adjacent to the antibiotic release system were up to 50× the minimal inhibitory concentration in the first 24 h, they rapidly dropped. At peripheral sites, values never reached these levels. In the in vitro experiments, Staphylococcus aureus biofilms formed in serum or in synovial fluid showed a 5-10 fold increase in antibiotic tolerance. Importantly, concentrations required were much higher than those achieved in the local delivery systems. Finally, the study determined that the staged addition of vancomycin and gentamicin was not more efficacious than simultaneous vancomycin and gentamicin administration when using planktonic bacteria. On the other hand, for biofilms, the staged addition seemed more efficacious than adding the antibiotics simultaneously. Overall, data showed that the antibiotics’ concentrations near the implant in the animal model fall short of the concentrations required to eradicate biofilms formed in either synovial fluid or serum.

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Section: Antibiotic Delivery For Biofilmssupporting

confidence: 88%

In vitro investigations of Staphylococcus aureus biofilms in physiological fluids suggest that current antibiotic delivery systems may be limited

Isguven¹,

Fitzgerald²,

Delaney³

et al. 2022

eCM

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show abstract

“…However, the bacterial culture may be negative in some infection cases. In 23.2% of patients with PJI, no bacteria were detected despite clinical suspicion of an infection [25]. Given the disastrous consequences of SSI following joint and spine surgery, vancomycin was still continued until the clinical sign of infection was alleviated.…”

Section: Discussionmentioning

confidence: 99%

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

Wang

Jiang

2020

Preprint

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Background Despite vancomycin has been widely used in orthopedics, the details of vancomycin usage in orthopedics remains unknown. The purpose of the study was to evaluate the usage profile of intravenous vancomycin medication in orthopedics. Methods The medical records of inpatients receiving intravenous vancomycin medication from January 2015 to December 2019 in a single center of orthopedics department were retrospectively reviewed. The gender, age, diagnosis, surgical information, microbiological data, duration of vancomycin medication were collected. The related data were analyzed and compared between subgroups. Results A total of 258 cases receiving intravenous vancomycin medication (≥ 3 days) were enrolled. The mean age was 57.3 years. There were 141 cases in treatment and 117 in Prophylaxis group. The mean duration of vancomycin medication was 11.2 days. The duration was longer in Treatment than Prophylaxis group (14.8 versus 6.9 days, P < 0.05). The main reasons for treatment were PJI after TKA (46.7%) and THA (18.2%) in Joint subgroup and SSI after spine surgery (51.5%) for Spine subgroup. For prophylaxis usage, the main reasons were postoperative clinical suspicious infection. The bacteria responsible for infections in Treatment group were S. epidermidis (34.6%), S. aureus (31.8%), other Staphylococcus (12.1%), MRSA (7.5%), Streptococcus (7.5%), Enterococcus faecalis (3.7%) and Bacillus (2.8%). Conclusion Taken together, our research firstly revealed the treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics. It provides the different purposes, main causes, bacteriological data and medication duration for treatment and prophylaxis vancomycin usage in orthopedics.

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Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty — Superior Tissue Concentrations and Improved Efficiency

Harper

Park

Brozovich

et al. 2023

The Journal of Arthroplasty

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Vancomycin prophylaxis in prosthetic joint surgery?

Cited by 5 publications

References 12 publications

In vitro investigations of Staphylococcus aureus biofilms in physiological fluids suggest that current antibiotic delivery systems may be limited

In vitro investigations of Staphylococcus aureus biofilms in physiological fluids suggest that current antibiotic delivery systems may be limited

The treatment and prophylaxis usage profile of intravenous vancomycin medication in orthopedics

Otto Aufranc Award: Intraosseous Vancomycin in Total Hip Arthroplasty — Superior Tissue Concentrations and Improved Efficiency

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