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Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone...
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Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections

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

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 19722

Special Issue Editors

Prof. Dr. Ciro Villani

E-Mail Website
Guest Editor
1. Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Section of Orthopedics, Sapienza University of Rome, 00185 Rome, Italy
2. Department of Orthopaedics and Traumatology, Policlinico Umberto I University Hospital, 00161 Rome, Italy
3. M.I.T.O. Group (“Malattie Infettive in Traumatologia e Ortopedia” - Infectious Diseases in Traumatology and Orthopedics Surgery), Rome, Italy
Interests: primary and revision joint replacement; periprosthetic joint infections; pediatric orthopaedics; traumatology of the lower limb
Dr. Daniele De Meo

E-Mail Website
Guest Editor
1. Department of Orthopaedics and Traumatology, Policlinico Umberto I University Hospital, 00161 Rome, Italy
2. M.I.T.O. Group (“Malattie Infettive in Traumatologia e Ortopedia” - Infectious Diseases in Traumatology and Orthopedics Surgery), Rome, Italy
Interests: primary and revision joint replacement; periprosthetic joint infections; fracture-related infections; traumatology of the lower limb

Special Issue Information

Dear Colleagues,

Infections in traumatology and orthopaedics are an issue attracting growing interest. The specific problems of implant-related infections require dedicated surgical strategies and multidisciplinary teams and a long follow-up. The literature has shown that even with the right strategies, the risk of recurrence is high; identifying the causes and risk factors is an imperative challenge if we aim to reduce them. In order to reduce the incidence of infection and its recurrence, several risk reduction strategies have recently been developed with encouraging but poorly represented results.

The aim of this Special Issue is to gather the latest evidence on the recurrence of infection and its risk factors. Moreover, manuscripts that explore the topic of infection risk reduction strategies in pre-operative, intra-operative, and post-operative settings are particularly encouraged.

In particular, manuscripts dealing with the following topics are welcome:

- New enhanced strategies for antibiotic prophylaxis and therapy

- Preoperative infection risk reduction strategies

- Surgical debridement protocols and their results

- Local antimicrobial carriers or coatings

- Risk factors for recurrence or re-infection

- Epidemiological research on periprosthetic infections and fracture-related infections

- Management of recurrent periprosthetic infections and fracture-related infections.

Prof. Dr. Ciro Villani
Dr. Daniele De Meo
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 Infections (PJIs)
  • Fracture-Related Infections (FRIs)
  • biofilm
  • local antibiotics
  • antibiotic prophylaxis
  • antibacterial hydrogels
  • antibacterial coatings
  • debridement strategies
  • recurrence
  • risk reduction

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Published Papers (7 papers)

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14 pages, 417 KiB  
Article
Antimicrobial Stewardship for Outpatients with Chronic Bone and Joint Infections in the Orthopaedic Clinic of an Academic Tertiary Hospital, South Africa
by Mankoana A. Masetla, Pinky N. Ntuli, Veena Abraham, Brian Godman, Bwalya A. Witika, Steward Mudenda and Phumzile P. Skosana
Antibiotics 2023, 12(7), 1142; https://doi.org/10.3390/antibiotics12071142 - 1 Jul 2023
Cited by 6 | Viewed by 1968
Abstract
Bone and joint infections are associated with prolonged hospitalizations, high morbidity and complexity of care. They are difficult to treat, and successful therapy requires organism-specific antimicrobial therapy at high doses for a prolonged duration as recommended in standard treatment guidelines (STGs). Adherence to [...] Read more.
Bone and joint infections are associated with prolonged hospitalizations, high morbidity and complexity of care. They are difficult to treat, and successful therapy requires organism-specific antimicrobial therapy at high doses for a prolonged duration as recommended in standard treatment guidelines (STGs). Adherence to the treatment plan is equally important, which is enhanced with knowledge of the condition as well as appropriate antibiotics. Consequently, the aim of this study was to provide antimicrobial stewardship (AMS) services to outpatients with chronic bone and joint infections presenting to the orthopaedic clinic at a public South African tertiary hospital. A total of 44 patients participated in this study. Chronic osteomyelitis was diagnosed in 39 (89%) patients and septic arthritis in 5 (11%). The majority (43%) of infections were caused by Staphylococcus aureus followed by Pseudomonas aeruginosa (14%). Seventy-one antibiotics were prescribed at baseline with rifampicin prescribed the most (39%), followed by ciprofloxacin (23%). The majority (96%) of the antibiotics were not prescribed according to the South African STG; however, interventions were only needed in 31% of prescribed antibiotics (n = 71) since the STG only recommends empiric therapy directed against Staphylococcus aureus. Seventy-seven percent of the patients obtained a high self-reported adherence score at baseline. Consequently, there is a need to improve AMS in bone and joint infections to improve future care. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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21 pages, 4865 KiB  
Article
Fabrication and Characterisation of the Cytotoxic and Antibacterial Properties of Chitosan-Cerium Oxide Porous Scaffolds
by Lemiha Yildizbakan, Neelam Iqbal, Payal Ganguly, Eric Kumi-Barimah, Thuy Do, Elena Jones, Peter V. Giannoudis and Animesh Jha
Antibiotics 2023, 12(6), 1004; https://doi.org/10.3390/antibiotics12061004 - 3 Jun 2023
Cited by 8 | Viewed by 2357
Abstract
Bone damage arising from fractures or trauma frequently results in infection, impeding the healing process and leading to complications. To overcome this challenge, we engineered highly porous chitosan scaffolds (S1, S2, and S3) by incorporating 30 (wt)% iron-doped dicalcium phosphate dihydrate (Fe-DCPD) minerals [...] Read more.
Bone damage arising from fractures or trauma frequently results in infection, impeding the healing process and leading to complications. To overcome this challenge, we engineered highly porous chitosan scaffolds (S1, S2, and S3) by incorporating 30 (wt)% iron-doped dicalcium phosphate dihydrate (Fe-DCPD) minerals and different concentrations of cerium oxide nanoparticles (CeO2) (10 (wt)%, 20 (wt)%, and 30 (wt)%) using the lyophilisation technique. The scaffolds were specifically designed for the controlled release of antibacterial agents and were systematically characterised by utilising Raman spectroscopy, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray spectroscopy methodologies. Alterations in the physicochemical properties, encompassing pore size, swelling behaviour, degradation kinetics, and antibacterial characteristics, were observed with the escalating CeO2 concentrations. Scaffold cytotoxicity and its impact on human bone marrow mesenchymal stem cell (BM-MSCs) proliferation were assessed employing the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT) assay. The synthesised scaffolds represent a promising approach for addressing complications associated with bone damage by fostering tissue regeneration and mitigating infection risks. All scaffold variants exhibited inhibitory effects on bacterial growth against Staphylococcus aureus and Escherichia coli strains. The scaffolds manifested negligible cytotoxic effects while enhancing antibacterial properties, indicating their potential for reducing infection risks in the context of bone injuries. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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12 pages, 1182 KiB  
Article
Chronic Suppressive Antibiotic Treatment for Staphylococcal Bone and Joint Implant–Related Infections
by Giancarlo Ceccarelli, Beatrice Perciballi, Alessandro Russo, Paolo Martini, Francesco Marchetti, Marco Rivano Capparuccia, Giancarlo Iaiani, Silvia Fabris, Massimo Ciccozzi, Ciro Villani, Mario Venditti, Gabriella D’Ettorre and Daniele De Meo
Antibiotics 2023, 12(5), 937; https://doi.org/10.3390/antibiotics12050937 - 21 May 2023
Cited by 4 | Viewed by 2687
Abstract
Prosthetic joint infection (PJI) and fracture-related infection (FRI) are difficult-to-treat conditions in patients with severe comorbidity or significant surgical risk. In cases not eligible for standard strategy, debridement procedures with the retention of prosthesis or internal fixation device, combined with long-term antibiotic treatment [...] Read more.
Prosthetic joint infection (PJI) and fracture-related infection (FRI) are difficult-to-treat conditions in patients with severe comorbidity or significant surgical risk. In cases not eligible for standard strategy, debridement procedures with the retention of prosthesis or internal fixation device, combined with long-term antibiotic treatment and subsequent indefinite chronic oral antimicrobial suppression (COAS), can be the only reasonable choice. The aim of this study was to investigate the role of COAS and its follow-up in the management of these cases. We retrospectively analyzed a cohort of 16 patients with a follow-up of at least 6 months (mean age 75 yo, 9F, 7M, 11 PJI, 5 FRI). All microbiological isolates were tetracycline-susceptible staphylococci and for this reason a minocycline-based COAS was adopted after debridement and 3 months of antibiogram-guided antibiotic treatment. Patient monitoring was carried out on a clinical basis, with bimonthly execution of the inflammation indices and serial radiolabeled leukocyte scintigraphy (LS). The overall median time of COAS follow-up was 15 months (min 6–max 30). Moreover, 62.5% of patients were still taking COAS with no relapse after cure at the last evaluation available. Clinical failure with a relapse of the infection was observed in 37.5% of patients; interestingly, 50% of them had previously stopped COAS due to side effects of the antibiotic used. In the COAS follow-up, a combination of clinical, laboratory and LS evaluation seems to monitor the infection properly. COAS can be considered as an interesting approach in patients not suitable for standard treatments of PJI or FRI but it requires careful monitoring. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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11 pages, 744 KiB  
Article
Antibiotic-Loaded Coatings to Reduce Fracture-Related Infections: Retrospective Case Series of Patients with Increased Infectious Risk
by Daniele De Meo, Gianluca Cera, Roberta Pica, Fabiano Perfetti, Paolo Martini, Beatrice Perciballi, Giancarlo Ceccarelli, Pietro Persiani and Ciro Villani
Antibiotics 2023, 12(2), 287; https://doi.org/10.3390/antibiotics12020287 - 1 Feb 2023
Cited by 6 | Viewed by 2407
Abstract
Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious [...] Read more.
Local antibiotic delivery strategies have been increasingly employed for the prevention of fracture-related infections (FRIs). The aim of this study is to evaluate the efficacy and safety of antibiotic-coated implants in the prevention of FRIs after surgical treatment in patients with increased infectious risk. A retrospective observational study has been conducted on patients with upper and lower limb fractures treated with internal fixation or prosthetic replacements, using a gentamicin coated nail (CN) and/or antibiotic-loaded hydrogel applied to the implant of choice (ALH). The study included 37 patients (20 M, 17 F), with a mean age of 63 years. The mean estimated preoperative infectious risk score was 6.4%. ALH was used in 27 cases, tibial CNs were implanted in 4 cases, and both were employed in 6 cases. The antibiotics used locally were gentamicin in 72.97% of cases (27 patients) and a combination of gentamicin + vancomycin in 27.03% of cases (10 patients). Mean follow-up was 32 months. Only one case (2.94%) showed onset of FRI at 5 months after surgery. Local antibiotic prophylaxis by coating resulted in a reduction in the incidence FRI, as compared to the estimated preoperative risk. The use of ALH allows for the choice of antibiotic; however, the application of antibiotics seems more nonuniform when applied to a nail. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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10 pages, 476 KiB  
Article
Microbiological Trends and Antibiotic Susceptibility Patterns in Patients with Periprosthetic Joint Infection of the Hip or Knee over 6 Years
by Frank Sebastian Fröschen, Thomas Martin Randau, Alexander Franz, Ernst Molitor, Achim Hoerauf and Gunnar Thorben Rembert Hischebeth
Antibiotics 2022, 11(9), 1244; https://doi.org/10.3390/antibiotics11091244 - 13 Sep 2022
Cited by 8 | Viewed by 1908
Abstract
We sought to analyze trends of the causative pathogens and their antibiotic susceptibility patterns in patients with periprosthetic joint infections (PJI) of the hip and knee to get better insights and improve treatment. Retrospective evaluation of all consecutive patients with microbiological detection of [...] Read more.
We sought to analyze trends of the causative pathogens and their antibiotic susceptibility patterns in patients with periprosthetic joint infections (PJI) of the hip and knee to get better insights and improve treatment. Retrospective evaluation of all consecutive patients with microbiological detection of a causative pathogen at a tertiary endoprothetic referral center between January 2016 and December 2021 in Germany was performed. Overall, 612 different microorganisms could be detected in 493 patients (hip: n = 293; knee: n = 200). Evaluation did not show a change in the relative abundance of pathogens detected, with coagulase-negative staphylococci (n = 275; 44.9%) found frequently, followed by S. aureus (n = 86; 14.1%), Enterococcus species (n = 57; 9.3%), Streptococcus species (n = 48; 7.8%), and Gram-negative bacteria (n = 80; 13.1%). Evaluation of the antibiotic susceptibilities showed increasing rates of oxacillin-resistant coagulase-negative staphylococci (60.4%; 46.8–76.7%) and piperacillin-tazobactam-resistant Gram-negative bacteria (26.5%; 0–57.1%), although statistically not significant. Resistance of Gram-positive bacteria to vancomycin (<1%) and Gram-negative microorganisms to meropenem (1.25%) remained an exception. In summary, coagulase-negative staphylococci, as the most frequent pathogen, displayed a continuously high rate of oxacillin resistance. For the highest antimicrobial coverage in the case of an empiric therapy/unknown pathogen, vancomycin might be chosen. Level of evidence: IV. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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16 pages, 3951 KiB  
Article
Impact of High-Dose Anti-Infective Agents on the Osteogenic Response of Mesenchymal Stem Cells
by Jakob Hofmann, Sabrina Klingele, Uwe Haberkorn, Gerhard Schmidmaier and Tobias Grossner
Antibiotics 2021, 10(10), 1257; https://doi.org/10.3390/antibiotics10101257 - 16 Oct 2021
Cited by 8 | Viewed by 2276
Abstract
Treatment of infected nonunions and severe bone infections is a huge challenge in modern orthopedics. Their treatment routinely includes the use of anti-infective agents. Although frequently used, little is known about their impact on the osteogenesis of mesenchymal stem cells. In a high- [...] Read more.
Treatment of infected nonunions and severe bone infections is a huge challenge in modern orthopedics. Their treatment routinely includes the use of anti-infective agents. Although frequently used, little is known about their impact on the osteogenesis of mesenchymal stem cells. In a high- and low-dose set-up, this study evaluates the effects of the antibiotics Gentamicin and Vancomycin as well as the antifungal agent Voriconazole on the ability of mesenchymal stem cells to differentiate into osteoblast-like cells and synthesize hydroxyapatite in a monolayer cell culture. The osteogenic activity was assessed by measuring calcium and phosphate concentrations as well as alkaline phosphatase activity and osteocalcin concentration in the cell culture medium supernatant. The amount of hydroxyapatite was measured directly by radioactive 99mTechnetium-HDP labeling. Regarding the osteogenic markers, it could be concluded that the osteogenesis was successful within the groups treated with osteogenic cell culture media. The results revealed that all anti-infective agents have a cytotoxic effect on mesenchymal stem cells, especially in higher concentrations, whereas the measured absolute amount of hydroxyapatite was independent of the anti-infective agent used. Normed to the number of cells it can therefore be concluded that the above-mentioned anti-infective agents actually have a positive effect on osteogenesis while high-dose Gentamycin, in particular, is apparently capable of boosting the deposition of minerals. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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21 pages, 1082 KiB  
Perspective
Orthopaedic Implant-Associated Staphylococcal Infections: A Critical Reappraisal of Unmet Clinical Needs Associated with the Implementation of the Best Antibiotic Choice
by Milo Gatti, Simona Barnini, Fabio Guarracino, Eva Maria Parisio, Michele Spinicci, Bruno Viaggi, Sara D’Arienzo, Silvia Forni, Angelo Galano and Fabrizio Gemmi
Antibiotics 2022, 11(3), 406; https://doi.org/10.3390/antibiotics11030406 - 17 Mar 2022
Cited by 15 | Viewed by 5007
Abstract
Infections associated with orthopaedic implants represent a major health concern characterized by a remarkable incidence of morbidity and mortality. The wide variety of clinical scenarios encountered in the heterogeneous world of infections associated with orthopaedic implants makes the implementation of an optimal and [...] Read more.
Infections associated with orthopaedic implants represent a major health concern characterized by a remarkable incidence of morbidity and mortality. The wide variety of clinical scenarios encountered in the heterogeneous world of infections associated with orthopaedic implants makes the implementation of an optimal and standardized antimicrobial treatment challenging. Antibiotic bone penetration, anti-biofilm activity, long-term safety, and drug choice/dosage regimens favouring outpatient management (i.e., long-acting or oral agents) play a major role in regards to the chronic evolution of these infections. The aim of this multidisciplinary opinion article is to summarize evidence supporting the use of the different anti-staphylococcal agents in terms of microbiological and pharmacological optimization according to bone penetration, anti-biofilm activity, long-term safety, and feasibility for outpatient regimens, and to provide a useful guide for clinicians in the management of patients affected by staphylococcal infections associated with orthopaedic implants Novel long-acting lipoglycopeptides, and particularly dalbavancin, alone or in combination with rifampicin, could represent the best antibiotic choice according to real-world evidence and pharmacokinetic/pharmacodynamic properties. The implementation of a multidisciplinary taskforce and close cooperation between microbiologists and clinicians is crucial for providing the best care in this scenario. Full article
(This article belongs to the Special Issue Risk of Recurrence and Risk Reduction Strategies of Implant-Related Bone and Joint Infections)
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