Introduction
The risk of knee arthroplasty infection and appropriateness of antibiotic treatment are not clearly established in patients with preoperative asymptomatic bacteriuria. It has been the ...purpose to analyze the prevalence of preoperative asymptomatic bacteriuria in knee arthroplasty patients, as well as the incidence of prosthetic joint infection in those with asymptomatic bacteriuria treated and not with specific antibiotics.
Patients and methods
This prospective study included 215 consecutive knee arthroplasty patients (73 ± 6 years, 168 females) with neither urinary symptoms nor perioperative urethral catheterization. A “clean-catch” urinalysis was obtained from all patients before surgery and an urine culture if urinalysis was abnormal. Asymptomatic bacteriuria was diagnosed if >100,000 colony-forming units/ml were cultured. Patients were treated (Group A) or not (Group B) with additional specific antibiotics for urine bacteria according to surgeon criteria. Minimum follow-up reached 48 months. No patient was lost to follow-up.
Results
Asymptomatic bacteriuria was diagnosed in 11/215 patients (5.1 %) (11/11 females), and four of these 11 were treated with specific antibiotics (Group A). Only one patient in Group A suffered a prosthesis infection along the first 3 months (1/125, 0.5 %), but bacteria cultured from the wound were absolutely different to those in urine culture. No patient in Group B suffered a prosthesis infection.
Conclusions
Asymptomatic bacteriuria presents a low prevalence. We have not found any case of arthroplasty infection from urinary focus in patients with asymptomatic bacteriuria whether they received or not specific antibiotics.
Um implantatassoziierte Infekte zu vermeiden, ist die konsequente prä- und postoperative Prophylaxe von allergrößter Bedeutung. Welche Möglichkeiten Ihnen als niedergelassener Arzt zur Verfügung ...stehen, z. B. präoperativ kompromisslos auf das Ausheilen von Infektionen zu achten, lesen Sie im nachfolgenden Beitrag.
Pantoea agglomerans is a rare isolate in orthopaedic patients. We describe the first case of an acute hip prosthetic joint infection (PJI) caused by Pantoea agglomerans. The microorganism was ...detected after sonication of the removed hip endoprosthesis.
Zusammenfassung
Hintergrund
Im Rahmen eines zweizeitigen septischen Knieprothesenwechsels wird bei ausgedehnten knöchernen Defekten nach Prothesenexplantation häufig eine temporäre Arthrodese ...mithilfe eines antibiotikahaltigen Polymethylmethacrylat v(PMMA)-Spacer vorgenommen. Eine gängige Methode stellt die Verwendung von konventionellen Stahl- oder Kohlefaserstangen dar, die über einen „Tube-to-tube“-Konnektor verbunden und anschließend gelenknah mit Knochenzement armiert werden.
Ziel der Arbeit
Da in der Behandlung periprothetischer Infektionen (PPI) der Oberflächenbesiedelung von Fremdmaterialien und der Biofilmbildung eine entscheidende Rolle zukommt, werden die Stahl- und Kohlefaserstangen hinsichtlich der bakteriellen Oberflächenadhäsion verglichen.
Material und Methode
Für die experimentelle Studie wurden Kohlefaser- und Stahlstäbe externer Fixateursysteme verwendet. Das Probenmaterial wurde in eine mit
Staphylococcus aureus
(
S. aureus
) angereicherte Trägersubstanz gelegt. Die adhärierenden Bakterien wurden sowohl mithilfe der Fluoreszenzmikroskopie als auch quantitativ nach Ultraschallablösung (Sonikation) im Ausstrich untersucht. Rasterelektronenmikroskopische (REM-)Bilder wurden angefertigt, um die Topografie der bakteriellen Adhäsionen zu analysieren.
Ergebnisse
Die Fluoreszenzmikroskopie zeigt eine gleichmäßige Oberflächenverteilung auf beiden Materialien. Die Betrachtung der REM-Aufnahmen belegt, dass bei Kohlefaserstäben die Ausrichtung des Keimwachstums in Faserrichtung verläuft, während sich bei den Stahlstangen eine willkürliche Anordnung findet. Mithilfe der Sonikation konnte kein signifikanter Mengenunterschied an adhärenten Erregern auf den beiden Materialien unter Verwendung des Wilcoxon-Tests (Signifikanzniveau
p
< 0,05) festgestellt werden.
Schlussfolgerung
Bei der Durchführung einer PMMA-armierten fixen Arthrodese können beide Materialien Anwendung finden, ohne Einbußen im Therapieerfolg zu befürchten. Unter ökonomischen Gesichtspunkten erscheint die Verwendung von Stahlstangen sinnvoll, da die Materialkosten deutlich geringer sind.
This study aims to assess the activity of solutions containing Povidone-Iodine (Pl) and Hydrogen Peroxide (H2O2) alone or combined on biofilm of different microbial species in the contest of ...periprosthetic joint infection.
Different antiseptic solutions were tested on 2-day-old biofilms of Gram-positive and Gram-negative bacteria and fungi at 1 and 3 minutes of exposure. The efficacy of these solutions was evaluated measuring the biofilm metabolic activity by XTT reduction assay. The anti-biofilm effect of 5%PI and 0.3%PI + 0.5%H2O2 was tested on 5-day-old biofilm using colony-forming unit (CFUs) counts and XTT reduction assay.
PI and H2O2 solutions showed a concentration-dependent anti-biofilm activity against all the strains except E. faecalis. PI at 5% was the most active solution against the 2-day-old biofilm of all test microorganisms. The 0,3%PI + 0,5%H₂O₂ solution had a significant effect on all strains only at 3 min. The 5%PI and 0,3%PI + 0,5%H₂O₂ effect was evaluated on 5-day-old biofilms. PI at 5% produced a significant reduction in metabolic activity for all test strains at both 1 and 3 minutes; 0.3%PI + 0.5%H₂O₂ caused a significant anti-biofilm activity against all Gram-positive strains after 3 minutes, with a greater metabolic activity reduction than 5% PI.
In the case of PJI by Gram-positive bacteria, 0.3% PI + 0.5% H₂O₂ could be used for wound irrigation for 3 minutes of exposure. In the case of PJI with a different etiological agent or PJI with unknown etiology, it’s advisable to use 5%PI for 1 minute of exposure.
Diagnosis of periprosthetic joint infection (PJI) is challenging as no perfect test for it exists. Often a combination of serological, synovial, microbiological, histological, and radiological ...investigations is performed that are expensive, invasive, and imperfect. Serum biomarkers are dependable diagnostic tools given the low-risk nature and ease of collecting blood that aid in the diagnosis of PJI. However, it must be noted they are not without limitations. This chapter will focus on current serological markers and their efficacy in diagnosing PJI. Routine workup for PJI involves the measurements of serum white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The combination of ESR and CRP is very effective to “rule out” PJI. Additional biomarkers such as IL-6, IL-4, TNF-alpha, procalcitonin, and siCAM1 have also shown value in the diagnosis of PJI. Scientific investigation continues to work toward a “gold standard” serum test for the diagnosis of PJI.
Implant‐associated osteomyelitis (IAOM) of long bones is a feared complication after bone fixation. Moreover, in fixation of open fractures, it may not be possible to close the wound directly. This ...results in a delay in covering the implant, which may increase the chance of early colonization of fracture implants and IAOM. Treatment concepts of IAOM and periprosthetic joint infection (PJI) are often considered to be similar. This chapter briefly discusses classification and risk factors, laboratory investigation, clinical presentation and imaging procedures of IAOM in detail. Virtually any bacterial or fungal agent can cause IAOM, including mycobacteria and fungi. Regarding therapeutic management, the duration of infection is the most relevant parameter to be considered. The goals of the therapeutic management of IAOM are consolidation of bone and cure of osteomyelitis. These goals must be fulfilled in a way that allows rehabilitation of the limb, including weight‐bearing and joint movement.
Several complications can be observed after joint replacement, including mechanical problems such as luxation, heterotopic ossification, aseptic loosening because of wear particles, or insufficient ...adaptation of the implant shape to the bone. The most feared complication, however, is periprosthetic joint infection (PJI), because it may lead to the loss of the device. This chapter presents the common features of periprosthetic joint infection (PJI). It discusses the pathogenesis, diagnostic algorithm, laboratory investigation and therapeutic management of PJI in detail. Traditionally, PJIs are classified as early, delayed, and late infections. Early and delayed infections are mainly exogenously acquired in the perioperative period, whereas most late PJIs are hematogenously acquired. Several laboratory parameters have been used to look for and to confirm PJI. Some of them are not sensitive enough and can therefore only be used as supportive arguments for PJI. The chapter finally discusses the errors in the management of PJI.
