Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study
Abstract
:1. Introduction
2. Results and Discussion
2.1. Population
2.2. Treatment and Outcomes
2.3. Discussion
3. Conclusions
4. Materials and Methods
4.1. Study Design
4.2. Perioperative Treatment and Surgical Strategy
4.3. Statistical Analysis
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Antimicrobial Carrier | ALH | CS Beads |
---|---|---|
Composition | Hyaluronic acid and Poly-lactic acid | Calcium sulphate |
Method of preparation in operating room | Add chosen antibiotic (liquid and/or powder) and dilute according to proportion until gel consistency is obtained | Add chosen antibiotic (liquid and/or powder) and dilute according to proportion and wait for solidification |
Mode of application | Directly applied on plates, screws, nails, or prosthesis surfaces | Placed into bone cavities, intraarticular or subfascial |
Duration of antibiotic release | 24–72 h | Up to 30 days |
Intended use by manufacturer | Prevention of infection in fractures and joint replacement | To fill voids, defects, and gaps caused by surgery, cysts, tumours, osteomyelitis, and traumatic injury |
Described use by literature | Prevention of infection in fractures and joints replacement Reconstruction surgery for FRI OSE/TSE with cementless implant for PJI | OSE/TSE for PJI SSI Diabetic Foot Ulceration |
Total | DAPRI | DACRI | p-Value | |
---|---|---|---|---|
Years (mean ± SD) | 67.31 ± 10.79 | 66.86 ± 7.69 | 67.67 ± 12.18 | 0.8876 |
Sex | 0.6143 | |||
Male | 8 (50%) | 4 (57.15%) | 4 (44.44%) | |
Female | 8 (50%) | 3 (42.85%) | 5 (55.56%) | |
CCI (mean ± SD) | 3.06 ± 2.77 | 3.43 ± 3.69 | 2.78 ± 1.98 | 0.6572 |
ASA risk score (mean ± SD) | 2.25 ± 0.45 | 2.14 ± 0.37 | 2.33 ± 0.50 | 0.4180 |
Localization | 0.6143 | |||
Knee | 8 (50%) | 4 (57.15%) | 4 (44.44%) | |
Hip | 7 (43.75%) | 3 (42.85%) | 4 (44.44%) | |
Shoulder | 1 (6.25%) | 0 (0%) | 1 (11.12%) | |
Aetiology | 0.6143 | |||
Hematogenous | 8 (50%) | 4 (57.15%) | 4 (44.44%) | |
Postoperative | 8 (50%) | 3 (42.85%) | 5 (55.56%) | |
Days to diagnosis (mean ± SD) | 22.13 ± 9.08 | 23.86 ± 12.37 | 20.78 ± 5.93 | |
Micro-organisms | ||||
S. aureus | 7 (43.75%) | 3 (33.34%) | 4 (28.58%) | |
CoNS | 2 (12.50%) | 1 (11.11%) | 1 (7.14%) | |
E. coli | 3 (18.75%) | 1 (11.11%) | 2 (14.29%) | |
P. aeruginosa | 3 (18,75%) | 1 (11.11%) | 1 (7.14%) | |
A. baumanii | 1 (6.25%) | 1 (11.11%) | 0 (0%) | |
S. dysgalactiae | 1 (6.25%) | 0 (0%) | 1 (7.14%) | |
C. albicans | 1 (6.25%) | 0 (0%) | 1 (7.14%) | |
Others | 1 (6.25%) | 0 (0%) | 1 (7.14%) | |
Polymicrobial | 4 (25%) | 1 (11.11%) | 3 (21.43%) | |
Culture negative | 1 (6.25%) | 1 (11.11%) | 0 (0%) |
Total | DAPRI | DACRI | p-Value | |
---|---|---|---|---|
Local Antibiotics | ||||
Vancomycin | 2 (12.50%) | 0 (0%) | 2 (22.22%) | |
Gentamicin + Vancomycin | 10 (62.50%) | 6 (85.71%) | 4 (44.45%) | |
Meropenem + Vancomycin | 3 (18.75%) | 1 (14.29%) | 2 (22.22%) | |
Fluconazole | 1 (6.25%) | 0 (0%) | 1 (11,11%) | |
Outcomes | ||||
Infection controlled | 15 (93.75%) | 7 (100%) | 8 (88.89%) | 0.3624 |
Septic revision | 1 (6.25%) | 0 (0%) | 1 (11.11%) | |
CRP at last f-u (mg/L, mean ± SD) | 3.75 ± 3.73 | 4.99 ± 4.62 | 2.81 ± 2.91 | 0.2680 |
Follow-up duration (mean ± SD) | 26.12 ± 22.18 | 7.71 ± 1.80 | 40.44 ± 18.8 | 0.0007 |
Sex | Age (Years) | ASA | Localization | Postoperative/ Hematogenous | Days from Symptoms Onset/Surgery | Microbiology | Surgical Treatment | Local Antibiotic 1 | Local Antibiotic 2 | Length of Stay (Days) | ATB I.V. (Active Ingredients) | ATB os (Active Ingredients) | Infection Free at last F-U (Y/N) | CRP last F-U (mg/L) | F-U (Months) | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | F | 79 | 2 | knee | haematogenous | 26 | MSSA | DACRI | Gentamycin | Vancomycin | 19 | Rifampicin, Amikacin, Fosfomycin | Dalbavancin, Amoxi/Clav | Y | 5.90 | 17 |
2 | M | 40 | 2 | hip | postoperative | 13 | MRSA, Gram - | DACRI | Gentamycin | Vancomycin | 47 | Daptomycin, Meropenem, Colistin | Ciprofloxacin | Y | 4.36 | 16 |
3 | M | 64 | 2 | knee | haematogenous | 17 | CoNS, Streptococcus dysgalactiae | DACRI | Vancomycin | - | 11 | Ceftriaxone, Linezolid, Pip/Tazo | Amoxi/Clav | Y | 7.60 | 35 |
4 | F | 65 | 2 | shoulder | postoperative | 23 | MSSA | DACRI | Gentamycin | Vancomycin | 9 | Pip/Tazo, Daptomycin, Dalbavancin | Rifampicin | Y | 1.40 | 31 |
5 | F | 76 | 3 | knee | haematogenous | 26 | MSSA | DACRI | Gentamycin | Vancomycin | 23 | Daptomycin, Cefazolin | Rifampicin, Levofloxacin | Y | 0.00 | 28 |
6 | F | 78 | 3 | hip | postoperative | 12 | Gram -, others | DACRI | Vancomycin | Meropenem | 36 | Targosid, Meropenem, Tazocin | Ciprofloxacin, Amoxi/Clav | Y | 0.14 | 53 |
7 | F | 82 | 3 | knee | haematogenous | 18 | Gram - | DACRI | Vancomycin | Meropenem | 9 | Ertapenem, Dalbavancin | Levoxacin, Doxycicline | Y | 0.00 | 49 |
8 | M | 58 | 2 | hip | postoperative | 24 | Gram - | DACRI | Vancomycin | - | 8 | Vancomycin, Rifampicin | Rifampicin, Amoxi/Clav | Y | 2.80 | 64 |
9 | M | 67 | 2 | knee | postoperative | 28 | others | DACRI | Fluconazole | - | 4 | - | Fluconazole | N | 4.70 | 71 |
10 | F | 77 | 2 | hip | postoperative | 42 | Colture negative | DAPRI | Gentamycin | Vancomycin | 15 | Cefazolin | Rifampicin, Levofloxacin | Y | 5.00 | 7 |
11 | M | 67 | 3 | hip | postoperative | 25 | Gram - | DAPRI | Gentamycin | Vancomycin | 35 | Meropenem, Daptomycin, Gentamicin, Ceftriaxone | Ceftriaxone | Y | 3.30 | 11 |
12 | M | 65 | 2 | hip | postoperative | 30 | MSSA, others | DAPRI | Gentamycin | Vancomycin | 91 | Daptomycin, Cefepime, Cefiderocol, Daptomycin, Sulb/Amp, Colistin | - | Y | 0.06 | 9 |
13 | M | 66 | 2 | hip | haematogenous | 34 | Gram - | DAPRI | Gentamycin | Vancomycin | 15 | Meropenem | Ciprofloxacin | Y | 2.20 | 8 |
14 | F | 70 | 2 | knee | haematogenous | 15 | CoNS | DAPRI | Vancomycin | Meropenem | 16 | Daptomycin, Pip/Tazo | Amox/Clav | Y | 13.40 | 7 |
15 | M | 52 | 2 | knee | haematogenous | 13 | MSSA | DAPRI | Gentamycin | Vancomycin | 11 | Daptomycin, Ceftobiprole, Cefazolin | Rifampicin, Levofloxacin | Y | 11.2 | 6 |
16 | F | 71 | 2 | knee | haematogenous | 8 | MSSA | DAPRI | Gentamycin | Vancomycin | 23 | Daptomycin, Pip/Tazo | Rifampicin, Levofloxacin | Y | 6.00 | 6 |
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De Meo, D.; Martini, P.; Pennarola, M.F.; Guarascio, G.; Rivano Capparuccia, M.; Iaiani, G.; Candela, V.; Gumina, S.; Villani, C. Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study. Gels 2023, 9, 758. https://doi.org/10.3390/gels9090758
De Meo D, Martini P, Pennarola MF, Guarascio G, Rivano Capparuccia M, Iaiani G, Candela V, Gumina S, Villani C. Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study. Gels. 2023; 9(9):758. https://doi.org/10.3390/gels9090758
Chicago/Turabian StyleDe Meo, Daniele, Paolo Martini, Maria Francesca Pennarola, Giovanni Guarascio, Marco Rivano Capparuccia, Giancarlo Iaiani, Vittorio Candela, Stefano Gumina, and Ciro Villani. 2023. "Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study" Gels 9, no. 9: 758. https://doi.org/10.3390/gels9090758