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Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment...
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Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 54564

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Natividad Benito

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Guest Editor
1. Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau—Institut d\'Investigació Biomèdica Sant Pau, Barcelona, Spain
2. Departament of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
Interests: prevention; diagnosis and treatment of complex infections (bone and joint, endovascular, and central nervous system infections; health care-associated and multidrug-resistant infections; infections in immunocompromised patients)
Special Issues, Collections and Topics in MDPI journals
Dr. Óscar Murillo

E-Mail Website
Guest Editor
1. Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
2. Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
Interests: Nosocomial infections caused by multidrug-resistant microorganisms; Bone and joint infections; Foreign-body associated infections; Experimental models of biofilm-associated infections
Dr. Jaime Lora-Tamayo

E-Mail Website
Guest Editor
1. Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación“i+12” Hospital 12 de Octubre. Universidad Complutense de Madrid, Madrid, Spain
2. Bone and Joint Infection Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (GEIO-SEIMC), Madrid, Spain
Interests: Nosocomial infections; with particular interest in foreign body-associated infections; biofilm; bone and joint infections

Special Issue Information

Dear Colleagues,

Joint replacements are common and increasingly performed surgical procedures. The main indications for arthroplasties are to relieve pain and improve joint function in patients with advanced joint disease (mainly osteoarthritis), as well as to restore function in patients with fractures (typically femoral fractures in elderly patients). The most common joint replacements are the hip and knee, although virtually all extra-axial joints can be replaced. Prosthetic joint infections (PJI) are devastating complications with significant patient morbimortality and substantial healthcare and societal costs. While the percentage of PJIs in patients with arthroplasties could be considered low (1-3%), the increasing frequency of such procedures converts an apparently low risk into a substantial and increasing burden of infection. In most developed countries, PJI is considered a public health issue of major importance.

PJIs are a paradigm of extravascular biofilm-associated infection. The presence of biofilm influences and hinders all aspects of the prevention, diagnosis, and management of PJI. Infection eradication always requires surgery and antimicrobial therapy. Unlike other infections, however, the goal of PJI treatment is not only to eradicate infection, but also to relieve pain and maintain joint function, and not all of these outcomes are always possible in every patient. Strong collaboration between all medical and surgical specialists involved is a critical component of the care of patients with PJIs.

In this complex scenario, and in spite of the considerable amount of research performed in this field in recent decades, many unresolved questions remain about the prevention, diagnosis, treatment and outcome of PJIs; indeed, most recommendations in these areas are based on expert opinion due to the limitations of the available information. Nevertheless, these limitations also bring opportunities and the weaknesses of many of the available studies on PJI constitute a call to join forces in order to conduct well-designed international multidisciplinary studies.

This Special Issue aims to advance knowledge and expand our perspectives on the prevention, diagnosis, management, and outcome of PJIs.

Dr. Natividad Benito
Dr. Óscar Murillo
Dr. Jaime Lora-Tamayo
Guest Editors

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Keywords

  • prosthetic joint infection
  • arthroplasty infection
  • definition of prosthetic joint infection
  • prosthetic joint infection prevention
  • diagnosis of prosthetic joint infection
  • prosthetic joint infection management
  • antimicrobial therapy of prosthetic joint infection
  • surgical treatment of prosthetic joint infection
  • definition of successful treatment of prosthetic joint infection
  • prosthetic joint infection outcomes

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Published Papers (15 papers)

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Research

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16 pages, 64685 KiB  
Article
A New Antifungal-Loaded Sol-Gel Can Prevent Candida albicans Prosthetic Joint Infection
by Hugo Garlito-Díaz, Jaime Esteban, Aranzazu Mediero, Rafael Alfredo Carias-Cálix, Beatriz Toirac, Francisca Mulero, Víctor Faus-Rodrigo, Antonia Jiménez-Morales, Emilio Calvo and John Jairo Aguilera-Correa
Antibiotics 2021, 10(6), 711; https://doi.org/10.3390/antibiotics10060711 - 12 Jun 2021
Cited by 7 | Viewed by 3636
Abstract
Fungal PJI is one of the most feared complications after arthroplasty. Although a rare finding, its high associated morbidity and mortality makes it an important object of study. The most frequent species causing fungal PJI is C. albicans. New technology to treat [...] Read more.
Fungal PJI is one of the most feared complications after arthroplasty. Although a rare finding, its high associated morbidity and mortality makes it an important object of study. The most frequent species causing fungal PJI is C. albicans. New technology to treat this type of PJI involves organic–inorganic sol-gels loaded with antifungals, as proposed in this study, in which anidulafungin is associated with organophosphates. This study aimed to evaluate the efficacy of an anidulafungin-loaded organic–inorganic sol-gel in preventing prosthetic joint infection (PJI), caused by Candida albicans using an in vivo murine model that evaluates many different variables. Fifty percent (3/6) of mice in the C. albicans-infected, non-coated, chemical-polished (CP)-implant group had positive culture and 100% of the animals in the C. albicans-infected, anidulafungin-loaded, sol-gel coated (CP + A)-implant group had a negative culture (0/6) (p = 0.023). Taking the microbiology and pathology results into account, 54.5% (6/11) of C. albicans-infected CP-implant mice were diagnosed with a PJI, whilst only 9.1% (1/11) of C. albicans-infected CP + A-implant mice were PJI-positive (p = 0.011). No differences were observed between the bone mineral content and bone mineral density of noninfected CP and noninfected CP + A (p = 0.835, and p = 0.181, respectively). No histological or histochemical differences were found in the tissue area occupied by the implant among CP and CP + A. Only 2 of the 6 behavioural variables evaluated exhibited changes during the study: limping and piloerection. In conclusion, the anidulafungin-loaded sol-gel coating showed an excellent antifungal response in vivo and can prevent PJI due to C. albicans in this experimental model. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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13 pages, 643 KiB  
Article
Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study
by Helem H. Vilchez, Rosa Escudero-Sanchez, Marta Fernandez-Sampedro, Oscar Murillo, Álvaro Auñón, Dolors Rodríguez-Pardo, Alfredo Jover-Sáenz, Mª Dolores del Toro, Alicia Rico, Luis Falgueras, Julia Praena-Segovia, Laura Guío, José A. Iribarren, Jaime Lora-Tamayo, Natividad Benito, Laura Morata, Antonio Ramirez, Melchor Riera, Study Group on Osteoarticular Infections (GEIO) and the Spanish Network for Research in Infectious Pathology (REIPI)
Antibiotics 2021, 10(5), 475; https://doi.org/10.3390/antibiotics10050475 - 21 Apr 2021
Cited by 13 | Viewed by 4053
Abstract
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January [...] Read more.
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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7 pages, 401 KiB  
Communication
Risk Factors of Daptomycin-Induced Eosinophilic Pneumonia in a Population with Osteoarticular Infection
by Laura Soldevila-Boixader, Bernat Villanueva, Marta Ulldemolins, Eva Benavent, Ariadna Padulles, Alba Ribera, Irene Borras, Javier Ariza and Oscar Murillo
Antibiotics 2021, 10(4), 446; https://doi.org/10.3390/antibiotics10040446 - 16 Apr 2021
Cited by 15 | Viewed by 2390
Abstract
Background: Daptomycin-induced eosinophilic pneumonia (DEP) is a rare but severe adverse effect and the risk factors are unknown. The aim of this study was to determine risk factors for DEP. Methods: A retrospective cohort study was performed at the Bone and Joint Infection [...] Read more.
Background: Daptomycin-induced eosinophilic pneumonia (DEP) is a rare but severe adverse effect and the risk factors are unknown. The aim of this study was to determine risk factors for DEP. Methods: A retrospective cohort study was performed at the Bone and Joint Infection Unit of the Hospital Universitari Bellvitge (January 2014–December 2018). To identify risk factors for DEP, cases were divided into two groups: those who developed DEP and those without DEP. Results: Among the whole cohort (n = 229) we identified 11 DEP cases (4.8%) and this percentage almost doubled in the subgroup of patients ≥70 years (8.1%). The risk factors for DEP were age ≥70 years (HR 10.19, 95%CI 1.28–80.93), therapy >14 days (7.71, 1.98–30.09) and total cumulative dose of daptomycin ≥10 g (5.30, 1.14–24.66). Conclusions: Clinicians should monitor cumulative daptomycin dosage to minimize DEP risk, and be cautious particularly in older patients when the total dose of daptomycin exceeds 10 g. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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13 pages, 961 KiB  
Article
Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study
by Raquel Bandeira da Silva and Mauro José Salles
Antibiotics 2021, 10(3), 340; https://doi.org/10.3390/antibiotics10030340 - 23 Mar 2021
Cited by 17 | Viewed by 3511
Abstract
Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip [...] Read more.
Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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10 pages, 445 KiB  
Article
Intra-Articular Injections Prior to Total Knee Arthroplasty Do Not Increase the Risk of Periprosthetic Joint Infection: A Prospective Cohort Study
by Jérôme Grondin, Pierre Menu, Benoit Métayer, Vincent Crenn, Marc Dauty and Alban Fouasson-Chailloux
Antibiotics 2021, 10(3), 330; https://doi.org/10.3390/antibiotics10030330 - 21 Mar 2021
Cited by 11 | Viewed by 3692
Abstract
Periprosthetic joint infections (PJI) occur in 0.5 to 2.8% of total knee arthroplasties (TKA) and expose them to an increase of morbidity and mortality. TKA are mainly performed after failure of non-surgical management of knee osteoarthritis, which frequently includes intra-articular injections of corticosteroids [...] Read more.
Periprosthetic joint infections (PJI) occur in 0.5 to 2.8% of total knee arthroplasties (TKA) and expose them to an increase of morbidity and mortality. TKA are mainly performed after failure of non-surgical management of knee osteoarthritis, which frequently includes intra-articular injections of corticosteroids or hyaluronic acid. Concerning the potential impact of intra-articular injections on TKA infection, literature provides a low level of evidence because of the retrospective design of the studies and their contradictory results. In this prospective cohort study, we included patients after a total knee arthroplasty, at the time of their admission in a rehabilitation center, and we excluded patients with any prior knee surgery. 304 patients were included. Mean follow-up was 24.9 months, and incidence proportion of PJI was 2.6%. After multivariate logistic regression, male was the only significant risk factor of PJI (OR = 19.6; p = 0.006). The incidence of PJI did not differ between patients who received prior intra-articular injections and others, especially regarding injections in the last 6 months before surgery. The use of intra-articular injection remains a valid therapeutic option in the management of knee osteoarthritis, and a TKA could still be discussed. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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13 pages, 639 KiB  
Article
Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study
by Joan Gómez-Junyent, Jaime Lora-Tamayo, Josu Baraia-Etxaburu, Mar Sánchez-Somolinos, Jose Antonio Iribarren, Dolors Rodriguez-Pardo, Julia Praena-Segovia, Luisa Sorlí, Alberto Bahamonde, Melchor Riera, Alicia Rico, Mª Dolores del Toro, Laura Morata, Javier Cobo, Luis Falgueras, Natividad Benito, Elena Muñez, Alfredo Jover-Sáenz, Carles Pigrau, Javier Ariza and Oscar Murilloadd Show full author list remove Hide full author list
Antibiotics 2021, 10(2), 118; https://doi.org/10.3390/antibiotics10020118 - 26 Jan 2021
Cited by 9 | Viewed by 3056
Abstract
Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially [...] Read more.
Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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10 pages, 668 KiB  
Article
Long-Term Use of Tedizolid in Osteoarticular Infections: Benefits among Oxazolidinone Drugs
by Eva Benavent, Laura Morata, Francesc Escrihuela-Vidal, Esteban Alberto Reynaga, Laura Soldevila, Laia Albiach, Maria Luisa Pedro-Botet, Ariadna Padullés, Alex Soriano and Oscar Murillo
Antibiotics 2021, 10(1), 53; https://doi.org/10.3390/antibiotics10010053 - 8 Jan 2021
Cited by 19 | Viewed by 3332
Abstract
Background: To evaluate the efficacy and safety of long-term use of tedizolid in osteoarticular infections. Methods: Multicentric retrospective study (January 2017–March 2019) of osteoarticular infection cases treated with tedizolid. Failure: clinical worsening despite antibiotic treatment or the need of suppressive treatment. Results: Cases [...] Read more.
Background: To evaluate the efficacy and safety of long-term use of tedizolid in osteoarticular infections. Methods: Multicentric retrospective study (January 2017–March 2019) of osteoarticular infection cases treated with tedizolid. Failure: clinical worsening despite antibiotic treatment or the need of suppressive treatment. Results: Cases (n = 51; 59% women, mean age of 65 years) included osteoarthritis (n = 27, 53%), prosthetic joint infection (n = 17, 33.3%), and diabetic foot infections (n = 9, 18%); where, 59% were orthopedic device-related. Most frequent isolates were Staphylococcus spp. (65%, n = 47; S. aureus, 48%). Reasons for choosing tedizolid were potential drug-drug interaction (63%) and cytopenia (55%); median treatment duration was 29 days (interquartile range -IQR- 15–44), 24% received rifampicin (600 mg once daily) concomitantly, and adverse events were scarce (n = 3). Hemoglobin and platelet count stayed stable throughout treatment (from 108.6 g/L to 116.3 g/L, p = 0.079; and 240 × 109/L to 239 × 109/L, p = 0.942, respectively), also in the subgroup of cases with cytopenia. Among device-related infections, 33% were managed with implant retention. Median follow-up was 630 days and overall cure rate 83%; among failures (n = 8), 63% were device-related infections. Conclusions: Long-term use of tedizolid was effective, showing a better safety profile with less myelotoxicity and lower drug-drug interaction than linezolid. Confirmation of these advantages could make tedizolid the oxazolidinone of choice for most of osteoarticular infections. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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14 pages, 624 KiB  
Article
Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement
by Alba Rivera, Alba Sánchez, Sonia Luque, Isabel Mur, Lluís Puig, Xavier Crusi, José Carlos González, Luisa Sorlí, Aránzazu González, Juan Pablo Horcajada, Ferran Navarro and Natividad Benito
Antibiotics 2021, 10(1), 18; https://doi.org/10.3390/antibiotics10010018 - 27 Dec 2020
Cited by 9 | Viewed by 3011
Abstract
Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined [...] Read more.
Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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12 pages, 682 KiB  
Article
Tolerance of Prolonged Oral Tedizolid for Prosthetic Joint Infections: Results of a Multicentre Prospective Study
by Eric Senneville, Aurélien Dinh, Tristan Ferry, Eric Beltrand, Nicolas Blondiaux and Olivier Robineau
Antibiotics 2021, 10(1), 4; https://doi.org/10.3390/antibiotics10010004 - 23 Dec 2020
Cited by 14 | Viewed by 2516
Abstract
Objectives: Data on clinical and biological tolerance of tedizolid (TZD) prolonged therapy are lacking. Methods: We conducted a prospective multicentre study including patients with prosthetic joint infections (PJIs) who were treated for at least 6 weeks but not more than 12 weeks. Results: [...] Read more.
Objectives: Data on clinical and biological tolerance of tedizolid (TZD) prolonged therapy are lacking. Methods: We conducted a prospective multicentre study including patients with prosthetic joint infections (PJIs) who were treated for at least 6 weeks but not more than 12 weeks. Results: Thirty-three adult patients of mean age 73.3 ± 10.5 years, with PJI including hip (n = 19), knee (n = 13) and shoulder (n = 1) were included. All patients were operated, with retention of the infected implants and one/two stage-replacements in 11 (33.3%) and 17/5 (51.5%/15.2%), respectively. Staphylococci and enterococci were the most prevalent bacteria identified. The mean duration of TZD therapy was 8.0 ± 3.27 weeks (6–12). TZD was associated with another antibiotic in 18 patients (54.5%), including rifampicin in 16 cases (48.5). Six patients (18.2%) had to stop TZD therapy prematurely because of intolerance which was potentially attributable to TZD (n = 2), early failure of PJI treatment (n = 2) or severe anaemia due to bleeding (n = 2). Regarding compliance with TZD therapy, no cases of two or more omissions of medication intake were recorded during the whole TZD treatment duration. Conclusions: These results suggest good compliance and a favourable safety profile of TZD, providing evidence of the potential benefit of the use of this agent for the antibiotic treatment of PJIs. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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15 pages, 536 KiB  
Article
Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study
by Isabel Mur, Marcos Jordán, Alba Rivera, Virginia Pomar, José Carlos González, Joaquín López-Contreras, Xavier Crusi, Ferran Navarro, Mercè Gurguí and Natividad Benito
Antibiotics 2020, 9(12), 872; https://doi.org/10.3390/antibiotics9120872 - 5 Dec 2020
Cited by 11 | Viewed by 2355
Abstract
Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with [...] Read more.
Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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Review

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8 pages, 236 KiB  
Review
Suppressive Antibiotic Treatment in Prosthetic Joint Infections: A Perspective
by Javier Cobo and Rosa Escudero-Sanchez
Antibiotics 2021, 10(6), 743; https://doi.org/10.3390/antibiotics10060743 - 19 Jun 2021
Cited by 11 | Viewed by 4989
Abstract
The treatment of prosthetic joint infections (PJIs) is a complex matter in which surgical, microbiological and pharmacological aspects must be integrated and, above all, placed in the context of each patient to make the best decision. Sometimes it is not possible to offer [...] Read more.
The treatment of prosthetic joint infections (PJIs) is a complex matter in which surgical, microbiological and pharmacological aspects must be integrated and, above all, placed in the context of each patient to make the best decision. Sometimes it is not possible to offer curative treatment of the infection, and in other cases, the probability that the surgery performed will be successful is considered very low. Therefore, indefinite administration of antibiotics with the intention of “suppressing” the course of the infection becomes useful. For decades, we had little information about suppressive antibiotic treatment (SAT). However, due to the longer life expectancy and increase in orthopaedic surgeries, an increasing number of patients with infected joint prostheses experience complex situations in which SAT should be considered as an alternative. In the last 5 years, several studies attempting to answer the many questions that arise on this issue have been published. The aim of this publication is to review the latest published evidence on SAT. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
12 pages, 309 KiB  
Review
Dalbavancin for the Treatment of Prosthetic Joint Infections: A Narrative Review
by Luis Buzón-Martín, Ines Zollner-Schwetz, Selma Tobudic, Emilia Cercenado and Jaime Lora-Tamayo
Antibiotics 2021, 10(6), 656; https://doi.org/10.3390/antibiotics10060656 - 31 May 2021
Cited by 16 | Viewed by 5226
Abstract
Dalbavancin (DAL) is a lipoglycopeptide with bactericidal activity against a very wide range of Gram-positive microorganisms. It also has unique pharmacokinetic properties, namely a prolonged half-life (around 181 h), which allows a convenient weekly dosing regimen, and good diffusion in bone tissue. These [...] Read more.
Dalbavancin (DAL) is a lipoglycopeptide with bactericidal activity against a very wide range of Gram-positive microorganisms. It also has unique pharmacokinetic properties, namely a prolonged half-life (around 181 h), which allows a convenient weekly dosing regimen, and good diffusion in bone tissue. These features have led to off-label use of dalbavancin in the setting of bone and joint infection, including prosthetic joint infections (PJI). In this narrative review, we go over the pharmacokinetic and pharmacodynamic characteristics of DAL, along with published in vitro and in vivo experimental models evaluating its activity against biofilm-embedded bacteria. We also examine published experience of osteoarticular infection with special attention to DAL and PJI. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)

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10 pages, 948 KiB  
Perspective
Candida Periprosthetic Joint Infection: Is It Curable?
by Laura Escolà-Vergé, Dolors Rodríguez-Pardo, Pablo S. Corona and Carles Pigrau
Antibiotics 2021, 10(4), 458; https://doi.org/10.3390/antibiotics10040458 - 17 Apr 2021
Cited by 5 | Viewed by 3264
Abstract
Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. [...] Read more.
Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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6 pages, 238 KiB  
Perspective
Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges
by Dolors Rodríguez-Pardo, Laura Escolà-Vergé, Júlia Sellarès-Nadal, Pablo S. Corona, Benito Almirante and Carles Pigrau
Antibiotics 2021, 10(4), 429; https://doi.org/10.3390/antibiotics10040429 - 13 Apr 2021
Cited by 4 | Viewed by 2361
Abstract
We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely [...] Read more.
We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
9 pages, 1533 KiB  
Perspective
Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?
by Nora Renz, Andrej Trampuz and Werner Zimmerli
Antibiotics 2021, 10(2), 165; https://doi.org/10.3390/antibiotics10020165 - 5 Feb 2021
Cited by 27 | Viewed by 5148
Abstract
Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, [...] Read more.
Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, experimental data from animal models of foreign-body infections and clinical trials are reviewed. The risk for emergence of rifampin resistance and multiple drug interactions are emphasized. A recent randomized controlled trial (RCT) showing no beneficial effect of rifampin in patients with acute staphylococcal periprosthetic joint infection treated with prosthesis retention is critically reviewed and data interpreted. Given the existing strong evidence demonstrating the benefit of rifampin, the conduction of an adequately powered RCT with appropriate definitions and interventions would probably not comply with ethical standards. Full article
(This article belongs to the Special Issue Prosthetic Joint Infection: The Challenges of Prevention, Diagnosis and Treatment and Opportunities for Future Research)
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