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Prevention and Antibiotic Treatment of Periprosthetic Joint Infection

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 5434

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Special Issue Editors

Dr. Pablo Sanz-Ruíz

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Guest Editor

Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
Interests: alpha defensin; arthroplasty; hip replacement; anti-bacterial agents; osteomyelitis; vancomycin

Dr. Javier Vaquero

E-Mail Website
Guest Editor

General University Gregorio Maranon Hospital, Madrid, Spain
Interests: alpha defensin; arthroplasty; hip replacement; anti-bacterial agents; osteomyelitis; vancomycin

Special Issue Information

Dear Colleagues,

PJI is a devasting complication after joint replacement. Different surgical treatments have been proposed, such as radical debridement and one- or two-stage or even resection arthroplasty with different antibiotic protocols (short duration, long duration, suppression treatment, etc.). Multiple authors have shown excellent results with different protocols, with close to 90% success. However, more recently, some evidence has found much lower success rates, below 65%. This lower success rate with the high morbimortality observed in these patients and the higher cost of different treatment options determined that the best way to increase success is to avoid PJI. Different alternatives have been suggested to be useful in decreasing infection risk after joint replacement, such as preoperative optimization, systemic antibiotics, antibiotic-loaded bone cement, local antibiotic carriers different from bone cement, antiseptic-coated sutures, or active postsurgical dressing, among others. The purpose of this Special Issue is share different options for PJI prophylactic and treatment as well as other pertinent information to readers to facilitate decisions regarding which options are better for their daily work.

Dr. Pablo Sanz-Ruíz
Dr. Javier Vaquero
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

periprosthetic joint infection PJI
antibiotic loaded bone cement ALBC
one stage
two stages
suppression therapy
systemic antibiotic
PJI prophylaxis

Published Papers (4 papers)

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Research

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8 pages, 605 KiB

Open AccessArticle

How Useful Is Preoperative Aspiration before Revision of Unicompartmental Knee Prostheses Because of Osteoarthritis in the Other Compartments?

by Benedikt Paul Blersch, Florian Hubert Sax and Bernd Fink

Antibiotics 2024, 13(4), 361; https://doi.org/10.3390/antibiotics13040361 - 15 Apr 2024

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Abstract

Aim: Periprosthetic joint infections (PJIs) of unicompartmental knee arthroplasties (UKAs) can lead to secondary osteoarthritis of the other compartments. The objective of this study was to identify the frequency of PJIs in cases of UKA with progressed secondary osteoarthritis and the result of septic one-stage revision in these cases to verify the value of preoperative aspiration in cases of secondary osteoarthritis of UKA. Methods: We retrospectively reviewed 97 patients with a unicompartmental arthroplasty who underwent revision surgery to a total knee arthroplasty (TKA) between January 2013 and March 2021 because of subsequent osteoarthritis. Preoperative aspiration and sample collection during the revision surgery were employed to identify potential periprosthetic joint infections (PJIs). The post-revision period was monitored for septic complications over an average duration of 55.7 ± 25.2 months (24–113). Results: PJIs were identified in 5.2% of cases through preoperative aspiration. In all instances of PJIs, a one-stage septic revision was performed, and notably, none of these cases experienced septic complications during the follow-up period. Conclusions: Preoperative aspiration is essential in order to exclude the presence of a PJI before performing revision surgery of UKA due to secondary osteoarthritis. Full article

(This article belongs to the Special Issue Prevention and Antibiotic Treatment of Periprosthetic Joint Infection)

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10 pages, 1659 KiB

Open AccessArticle

In Vitro Efficacy of Dalbavancin as a Long-Acting Anti-Biofilm Agent Loaded in Bone Cement

by Mar Sánchez-Somolinos, Marta Díaz-Navarro, Antonio Benjumea, José Matas, Javier Vaquero, Patricia Muñoz, Pablo Sanz-Ruíz and María Guembe

Antibiotics 2023, 12(9), 1445; https://doi.org/10.3390/antibiotics12091445 - 13 Sep 2023

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Abstract

Based on previous studies by our group in which we demonstrated that dalbavancin loaded in bone cement had good elution capacity for the treatment of biofilm-related periprosthetic infections, we now assess the anti-biofilm activity of dalbavancin and compare it with that of vancomycin over a 3-month period. We designed an in vitro model in which we calculated the percentage reduction in log cfu/mL counts of sonicated steel discs contaminated with staphylococci and further exposed to bone cement discs loaded with 2.5% or 5% vancomycin and dalbavancin at various timepoints (24 h, 48 h, 1 week, 2 weeks, 6 weeks, and 3 months). In addition, we tested the anti-biofilm activity of eluted vancomycin and dalbavancin at each timepoint based on a 96-well plate model in which we assessed the percentage reduction in metabolic activity. We observed a significant decrease in the dalbavancin concentration from 2 weeks of incubation, with sustained anti-biofilm activity up to 3 months. In the case of vancomycin, we observed a significant decrease at 1 week. The concentration gradually increased, leading to significantly lower anti-biofilm activity. The percentage reduction in cfu/mL counts was higher for dalbavancin than for vancomycin at both the 2.5% and the 5% concentrations. The reduction in log cfu/mL counts was higher for S. epidermidis than for S. aureus and was particularly more notable for 5% dalbavancin at 3 months. In addition, the percentage reduction in metabolic activity also decreased at 3 months in 5% dalbavancin and 5% vancomycin, with more notable values recorded for the latter. Full article

(This article belongs to the Special Issue Prevention and Antibiotic Treatment of Periprosthetic Joint Infection)

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10 pages, 1389 KiB

Open AccessArticle

The Prophylactic Effect of Single vs. Dual Antibiotic-Loaded Bone Cement against Periprosthetic Joint Infection Following Hip Arthroplasty for Femoral Neck Fracture: An Analysis of the German Arthroplasty Registry

by Dominik Szymski, Nike Walter, Paula Krull, Oliver Melsheimer, Siegmund Lang, Alexander Grimberg, Volker Alt, Arnd Steinbrück and Markus Rupp

Antibiotics 2023, 12(4), 732; https://doi.org/10.3390/antibiotics12040732 - 8 Apr 2023

Cited by 1 | Viewed by 1765

Abstract

Background: Antibiotic-loaded bone cement in arthroplasties is currently experiencing increased usage. Therefore, single and double antibiotic-loaded bone cements are commercially available and used in orthopedic surgery. The aim of this investigation was to compare the clinical use of single compared to dual antibiotic-loaded bone cement for implant fixation after femoral neck fracture. Further infection rates were to be compared in (partial) arthroplasty for the treatment of femoral neck fracture for both treatment options. Methods: On the basis of the German Arthroplasty Registry (EPRD), all cases of femoral neck fracture treated with hemiarthroplasty (HA), or total hip arthroplasty (THA) with single and dual antibiotic-loaded bone cement, were included into the data analysis. The infection risk was compared using Kaplan-Meier estimates. Results: In total, 26,845 cases (HA 76.3%–THA: 23.7%) with femoral neck fracture were included. Within recent years, an increasing usage of dual antibiotic-loaded cement in Germany, with a current proportion of 7.30% in arthroplasty procedures for femoral neck fracture treatment, has been observed. In patients treated with HA, the proportion of dual antibiotic-loaded cement was 7.86%, while in those treated with THA, 5.46% of all prostheses were fixated with a two antibiotic component cement. For all arthroplasty procedures using single antibiotic-loaded bone cement after six months 1.8%, after one year 1.9%, and after five years 2.3%, of the cases failed due to periprosthetic joint infection (PJI), while in the same time period, in cases with dual antibiotic-loaded bone cement 1.5%, 1.5% and 1.5% suffered from infection (p = 0.34). A infection rate of 1.1% after HA with dual antibiotic-loaded bone cement was reported, compared to a 2.1% infection rate whilst using single antibiotic-loaded bone cement after five years (p = 0.098). The number required for treatment when using HA was 91. Conclusions: The use of dual antibiotic-loaded bone cement is increasingly used in arthroplasty procedures after femoral neck fractures. It demonstrates a reduction of PJI after HA and seems, therefore, to be a useful method for the prevention of infection, especially in patients with increased risk factors for PJI. Full article

(This article belongs to the Special Issue Prevention and Antibiotic Treatment of Periprosthetic Joint Infection)

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Review

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24 pages, 2028 KiB

Open AccessReview

Engineering 3D-Printed Advanced Healthcare Materials for Periprosthetic Joint Infections

by Iván Yuste, Francis C. Luciano, Brayan J. Anaya, Pablo Sanz-Ruiz, Almudena Ribed-Sánchez, Elena González-Burgos and Dolores R. Serrano

Antibiotics 2023, 12(8), 1229; https://doi.org/10.3390/antibiotics12081229 - 25 Jul 2023

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Abstract

The use of additive manufacturing or 3D printing in biomedicine has experienced fast growth in the last few years, becoming a promising tool in pharmaceutical development and manufacturing, especially in parenteral formulations and implantable drug delivery systems (IDDSs). Periprosthetic joint infections (PJIs) are a common complication in arthroplasties, with a prevalence of over 4%. There is still no treatment that fully covers the need for preventing and treating biofilm formation. However, 3D printing plays a major role in the development of novel therapies for PJIs. This review will provide a deep understanding of the different approaches based on 3D-printing techniques for the current management and prophylaxis of PJIs. The two main strategies are focused on IDDSs that are loaded or coated with antimicrobials, commonly in combination with bone regeneration agents and 3D-printed orthopedic implants with modified surfaces and antimicrobial properties. The wide variety of printing methods and materials have allowed for the manufacture of IDDSs that are perfectly adjusted to patients’ physiognomy, with different drug release profiles, geometries, and inner and outer architectures, and are fully individualized, targeting specific pathogens. Although these novel treatments are demonstrating promising results, in vivo studies and clinical trials are required for their translation from the bench to the market. Full article

(This article belongs to the Special Issue Prevention and Antibiotic Treatment of Periprosthetic Joint Infection)

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