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Infection Rates Between Standard Antibiotics and MRSA-Targeted Perioperative Antibiotic Regimen in Orthopedic Surgery.
Contexts in source publication
Context 1
... patients were MRSA carriers, but the number of MRSA carriers allocated to each group is unknown [73]. The overall PJI rate in carriers between the intervention group and nonintervention group was small (3.4 vs 4.3%; Table 1) [73]. ...Context 2
... the five studies, four studies used vancomycin as an alternative to cefazolin [75e77,79], whereas De Lucas- Villarrubia et al. (2004) administered teicoplanin instead [78]. In contrast to the previous studies mentioned, all five studies reported a significant reduction in infection rates in patients who were given alternative antibiotics after screening compared with those who received standard protocols (Table 1) [75e79]. ...Similar publications
Background:
Methicillin-resistant coagulase-negative Staphylococci (MRCoNS) is regarded as the repository of mecA gene for methicillin-resistant Staphylococcus aureus (MRSA) and may develop methicillin-susceptible Staphylococcus aureus (MSSA) to MRSA. Therefore, we aimed to explore whether MRCoNS carriage is a risk factor of MRSA colonization. Phe...
Citations
... To our knowledge, only a few studies [5] have directly investigated septic complications rate following single-stage cTHA, and no clear guidelines or recommendations 2 of 9 concerning infection screening prior to cTHA in patients with hardware in situ are available [8]. Remarkably, the last consensus meeting in 2018 did not provide a univocal answer concerning this topic [9,10] nor evidence to change perioperative antibiotic prophylaxis [11]. ...
Background:
Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up.
Methods:
This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded.
Results:
One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found.
Conclusions:
Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.
... Визначаючи список високорейтингових журналів, ми використали «Scimago Journal & Country Rank», в якому журнали ранжовані не лише за імпакт-фактором, а й за індексом Scimago Journal Rank (SJR) [6]. SJR-індекс -інтегральний показ-ник, який враховує, крім імпакт-фактора журналу, його престиж і вплив. ...
... Пошук проведено на сайті Scimago Journal & Country Rank [6], який започатковано в 1999 році. Під час пошуку задавали такі параметри: рейтинги журналів (Journal Rankings), у пункті предметних категорій (Subject categories) визначали рубрику «Ортопедія та спортивна медицина» (Orthopaedics & Sports Medicine), яка складається з 270 журналів. ...
Мета: уточнити статус української травматології та ортопедії як науки шляхом аналізу кількості та тематики публікацій українських ортопедів в зарубіжних наукових журналах з урахуванням цитованості.Методи: проаналізовано публікації (січень 1999 – березень 2020 р.) вітчизняних ортопедів-травматологів в електронній наукометричній базі даних Scopus і у всіх журналах рубрики «Orthopaedics and Sports Medicine» з рейтингу Scimago Journal & Country Rank (SJ & CR). Пошук проведено з першого випуску кожного журналу.Результати: роботи українських вчених у галузі «Ортопедія і травматологія» опубліковані в 10 із 270 наукових журналів (SJ & CR): квартиль Q1 — 4, Q2 — 5, Q3 — 1. Тематика публікацій: 36,3 % із травматології, 27, 2 % — вертебрології й артропластики, 9,1 % — епідеміології. У базі даних Scopus знайдено 23 доктори наук за фахом «Травматологія та ортопедія», які мають 2 і більше публікацій (авторів з індексом Хірша 0 не враховували). Установи України за їх кількістю розподілилися так: ДУ «ІПХС ім. проф. М. І. Ситенка НАМН » — 7 вчених, ДУ« ІТО НАМН » — 4, Національна медична академія післядипломної освіти імені П. Л. Шупика — 2, ДУ« Інститут геронтології ім. Д. Ф. Чеботарьова НАМН України » — 2, інші — по одному.Висновки: публікацій українських вчених у журналах рубрики «Ортопедія і травматологія» на сайті SJ & CR за період 1999–2019 рр. лише 11. У НБД Scopus опубліковано набагато більше робіт, проте не всі з них є цитованими, що відображає індекс Хірша авторів. Готуючи статтю до друку, слід ураховувати, що найбільш цитованими виявилися публікації, де автори наводять методичні рекомендації (guidelines), результати багатоцентрових досліджень, клінічних випробувань, вивчення нових матеріалів для використання в ортопедії і травматології. Також цитованість праць підвищується в разі оприлюднення їх в журналах квартилей Q1 і Q2.
... Another proposed alternative is to modify preoperative antibiotic prophylaxis by either adding glycopeptides or replacing cephalosporins with glycopeptides [32][33][34]. A recently published document from the International Consensus for PJI recommends using vancomycin or teicoplanin instead of cephalosporins in MRSA carriers, although it is acknowledged that there is only a moderate consensus due to a lack of high-quality studies [35]. The use of glycopeptides has been reported to be cost-effective in scenarios with a MRSA prevalence of as low as 3 % [11]. ...
Introduction. Nasal and skin colonization by methicillin-resistant Staphylococcus aureus (MRSA) are linked to a higher incidence
of infection after total joint replacement. The prevalence of colonization is poorly defined in Latin American countries.
Aim. The aim of the present study was to determine the prevalence of MRSA colonization in the nostrils and groin using real- time polymerase chain reaction (RT-PCR) in patients undergoing total hip arthroplasty (THA).
Methodology. In this cross-sectional study, 146 patients undergoing THA between December 2015 and March 2017 in a tertiary- care university-affiliated hospital in Chile were screened for MRSA colonization before the procedure using RT-PCR indepen- dently in the nostrils and groin. Risk factors for colonization were documented.
Results. Seven of the 146 (5%) patients undergoing THA were carriers of MRSA in the nostrils and/or the groin. Recent antibiotic use was identified as a risk factor for colonization, OR=4.86 [95 % confidence interval (CI): 1.56–13.96]. Patients reporting at least one of the seven surveyed risk factors had an OR of 2.39 (95 % CI: 0.37–25.77) for colonization. MRSA colonization frequency was twofold higher in the groin as opposed to the nostrils (P=0.014).
Conclusion. Five percent of the patients undergoing THA were identified as carriers of MRSA. Recent antibiotic use is a relevant risk factor for MRSA colonization in patients undergoing primary total hip arthroplasty.
... Cerrahi dren kullanılması, antibiyotiği uzun kullanmak için bir gerekçe değildir. [62] Dental girişimler sonrası teorik olarak geçici bakteriyemi riski mevcuttur ve protezin hematojen yolla bu bakteriyemiden etkilenmesi ihtimal dahilindedir. Ancak yapılan çalışmalarda, dental girişim öncesi profilaksi alan ve almayan hastalarda enfeksiyon riski bakımında fark saptanmamıştır. ...
... Sefazolin >70 kg hastalarda minimum inhibitör konsantrasyonu yakalamak için minimum 2 gram uygulanmalıdır. [62] Sefuroksim ikinci jenerasyon sefalosporindir ve gram negatif bakterilere daha geniş bir etki gösterir. Penisilin alerjisi olan hastaların çoğunluğu sefalosporini tolere edebilir. ...
... Anafilaktoid bir reaksiyon geçirmemişse, ameliyathanede sefalosporin test dozu verilebilir. [62] Penisiline veya diğer beta laktam antibiyotiklere anafilaktoid bir reaksiyon geçirmiş olan hastalarda klindamisin (600-900 mg, i.v.) veya vankomisin (1 g, i.v.) kullanılabilir. Klindamisinin oral biyoyararlanımı yüksektir ancak kemiğe penetrasyonu düşüktür ve bakteriyostatiktir. ...
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.
Case:
We report the case of a patient with consecutive infections with several multidrug-resistant agents-including carbapenem-resistant strains of Klebsiella pneumoniae among others-from a surgical wound infection after lumbar spine fusion, only successfully treated after the resort to novel antibiotics (ceftazidime-avibactam) in combination therapy.
Conclusions:
Multidrug resistance has become a major challenge in today's medicine. Care should be taken to avoid their emergence, but when present, a multidisciplinary approach is mandatory to ensure clinically up-to-date treatment choices. Multimodal antibiotic schemes tend to show the most promising results, with which successful infection resolution can still be achieved.
While there are numerous non-patient related factors that may help reduce infection risk, the proper use of prophylactic antibiotic is most responsible for reducing infection. The role of prophylactic antibiotics is to reduce early PJI which is accomplished by having adequate antibiotic tissue levels at the time of skin incision. The goal of this section of the symposium is to review current antibiotic recommendations, how to manage patients with a self-reported penicillin allergy, review the use of dual antibiotics, discuss the use of antibiotics in the outpatient total joint setting, as well as very briefly discuss the administration of intra-osseous antibiotics in knee replacement surgery.
In a rabbit model of methicillin-resistant S. aureus prosthetic joint infection, prophylaxis with AZD6389*-a combination of three monoclonal antibodies targeting alpha-hemolysin, bicomponent cytotoxins (LukSF/LukED/HlgAB/HlgCB), and clumping factor A-resulted in significant reductions in joint swelling, erythema, intra-articular pus, and bacterial burden in synovial tissues and biofilm-associated prosthetic implants when compared with isotype-matched control IgG. Targeting specific staphylococcal virulence factors could thus have potential clinical utility for prevention of prosthetic joint infection.
