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Periprosthetic Joint Infections: Pathomechanism, Diagnostics and Novel Treatment Options

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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Drug Discovery, Development and Delivery".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 12675

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Special Issue Editor

Dr. Jochen Hofstaetter

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Guest Editor

1. 2nd Department, Orthopaedic Hospital Vienna Speising, Vienna, Austria
2. Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna Speising, Vienna, Austria
Interests: arthroplasty; infection

Special Issue Information

Dear Colleagues,

Periprosthetic joint infection (PJI) following total hip or knee arthroplasty is a serious complication with high morbidity and mortality. It has a reported incidence rate of up to 2% in primary cases and up to 15% in revision cases. Due to the expected increase in the number of primary and revision arthroplasties performed over the next few decades, a subsequent dramatic increase in PJIs is also anticipated. Unfortunately, significant progress in the prevention and treatment of PJIs has not yet been achieved. Therefore, research efforts to improve clinical results in this area are urgently needed. PJI is a complex, multifactorial, interdisciplinary problem. The aim of this Special Issue is to illustrate the complexity of PJI, and contributions focusing on the following topics are welcome:

Prevention of PJI in hip and knee arthroplasty
Polymicrobial infections, antimicrobial resistance, low grade infections
Biofilm
Novel approaches in diagnosis and treatment

The focus of Biomedicine is directed towards genetic mechanisms and molecular and pathological characteristics and their translation to medicine.

Dr. Jochen Hofstaetter
Guest Editor

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Keywords

Arthroplasty
Infection
Synovial fluid
Biofilm

Published Papers (4 papers)

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Research

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15 pages, 2188 KiB

Open AccessArticle

Antibacterial and Anti-Biofilm Activity of Omega-3 Polyunsaturated Fatty Acids against Periprosthetic Joint Infections-Isolated Multi-Drug Resistant Strains

by Débora C. Coraça-Huber, Stephan Steixner, Alexander Wurm and Michael Nogler

Biomedicines 2021, 9(4), 334; https://doi.org/10.3390/biomedicines9040334 - 26 Mar 2021

Cited by 15 | Viewed by 2726

Abstract

Background: Implantable medical devices, such as prosthetics, catheters, and several other devices, have revolutionized medicine, but they increase the infection risk. In previous decades, commercially available antibiotics lost their activity against coagulase-negative Staphylococci (CoNS) and several other microorganisms. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are the two major omega-3 polyunsaturated fatty acids (ω-3 PUFAs) with antimicrobial properties. Materials and Methods: In this study, we tested the EPA and the DHA for its antibacterial and anti-biofilm activity in vitro against Staphylococcus epidermidis, Staphylococcus aureus, and different CoNS as reference strains and isolated from patients undergoing orthopedic treatment for implant infections. The tests were carried out with the strains in planktonic and biofilm form. Cytotoxicity assay was carried out with EPA and DHA using human gingival fibroblasts HGF-1. Results: The highest concentration of EPA and DHA promoted the complete killing of S. epidermidis 1457 and S. aureus ATCC 25923 in planktonic form. The fatty acids showed low activity against P. aeruginosa. EPA and DHA completely killed or significantly reduced the count of planktonic bacteria of the patient isolated strains. When incubated with media enriched with EPA and DHA, the biofilm formation was significantly reduced on S. epidermidis 1457 and not present on S. aureus ATCC 25923. The reduction or complete killing were also observed with the clinical isolates. The pre-formed biofilms showed reduction of the cell counting after treatment with EPA and DHA. Conclusion: In this study, the ω-3 PUFAs EPA and DHA showed antimicrobial and anti-biofilm activity in vitro against S. aureus, S. epidermidis, and P. aeruginosa, as well as against multi-drug resistant S. aureus and CoNS strains isolated from patients undergoing periprosthetic joint infections (PJI) treatment. Higher concentrations of the fatty acids showed killing activity on planktonic cells and inhibitory activity of biofilm formation. Although both substances showed antimicrobial activity, EPA showed better results in comparison with DHA. In addition, when applied on human gingival fibroblasts in vitro, EPA and DHA showed a possible protective effect on cells cultured in medium enriched with ethanol. Further studies are required to confirm the antimicrobial activity of EPA and DHA against multi-drug resistant strains and pan-drug resistant strains. Full article

(This article belongs to the Special Issue Periprosthetic Joint Infections: Pathomechanism, Diagnostics and Novel Treatment Options)

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Review

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11 pages, 662 KiB

Open AccessReview

PMMA Bone Cement: Antibiotic Elution and Mechanical Properties in the Context of Clinical Use

by Sebastian Philipp von Hertzberg-Boelch, Martin Luedemann, Maximilian Rudert and Andre F. Steinert

Biomedicines 2022, 10(8), 1830; https://doi.org/10.3390/biomedicines10081830 - 29 Jul 2022

Cited by 14 | Viewed by 2348

Abstract

This literature review discusses the use of antibiotic loaded polymethylmethacrylate bone cements in arthroplasty. The clinically relevant differences that have to be considered when antibiotic loaded bone cements (ALBC) are used either for long-term implant fixation or as spacers for the treatment of periprosthetic joint infections are outlined. In this context, in vitro findings for antibiotic elution and material properties are summarized and transferred to clinical use. Full article

(This article belongs to the Special Issue Periprosthetic Joint Infections: Pathomechanism, Diagnostics and Novel Treatment Options)

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19 pages, 367 KiB

Open AccessReview

Serum Inflammatory Biomarkers in the Diagnosis of Periprosthetic Joint Infections

by Irene K. Sigmund, Stephan E. Puchner and Reinhard Windhager

Biomedicines 2021, 9(9), 1128; https://doi.org/10.3390/biomedicines9091128 - 01 Sep 2021

Cited by 25 | Viewed by 3646

Abstract

Accurate preoperative diagnosis of periprosthetic joint infections (PJIs) can be very challenging, especially in patients with chronic PJI caused by low-virulence microorganisms. Serum parameters, such as serum C-reactive protein (CRP) or the erythrocyte sedimentation rate (ESR), are—among other diagnostic test methods—widely used to distinguish septic from aseptic failure after total hip or knee arthroplasty and are recommended by the AAOS in the preoperative setting. However, they are systemic parameters, and therefore, unspecific. Nevertheless, they may be the first and occasionally the only preoperative indication, especially when clinical symptoms are lacking. They are easy to obtain, cheap, and are available worldwide. In the last decade, different novel serum biomarkers (percentage of neutrophils, neutrophils to lymphocytes ratio, platelet count to mean platelet volume ratio, fibrinogen, D-Dimer, Il-6, PCT) were investigated to find a more specific and accurate serum parameter in the diagnosis of PJI. This article reviews the diagnostic value of established (serum CRP, ESR, WBC) and ‘novel’ serum inflammatory biomarkers (fibrinogen, D-dimer, interleukin-6 (IL-6), procalcitonin, percentage of neutrophils (%N), neutrophils to lymphocytes ratio (NLR), platelet count to mean platelet volume ratio (PC/mPV)) for the preoperative diagnosis of periprosthetic joint infections. Full article

(This article belongs to the Special Issue Periprosthetic Joint Infections: Pathomechanism, Diagnostics and Novel Treatment Options)

13 pages, 717 KiB

Open AccessReview

Predictive Antibiotic Susceptibility Testing by Next-Generation Sequencing for Periprosthetic Joint Infections: Potential and Limitations

by Lukas Lüftinger, Ines Ferreira, Bernhard J. H. Frank, Stephan Beisken, Johannes Weinberger, Arndt von Haeseler, Thomas Rattei, Jochen G. Hofstaetter, Andreas E. Posch and Arne Materna

Biomedicines 2021, 9(8), 910; https://doi.org/10.3390/biomedicines9080910 - 29 Jul 2021

Cited by 11 | Viewed by 3081

Abstract

Joint replacement surgeries are one of the most frequent medical interventions globally. Infections of prosthetic joints are a major health challenge and typically require prolonged or even indefinite antibiotic treatment. As multidrug-resistant pathogens continue to rise globally, novel diagnostics are critical to ensure appropriate treatment and help with prosthetic joint infections (PJI) management. To this end, recent studies have shown the potential of molecular methods such as next-generation sequencing to complement established phenotypic, culture-based methods. Together with advanced bioinformatics approaches, next-generation sequencing can provide comprehensive information on pathogen identity as well as antimicrobial susceptibility, potentially enabling rapid diagnosis and targeted therapy of PJIs. In this review, we summarize current developments in next generation sequencing based predictive antibiotic susceptibility testing and discuss potential and limitations for common PJI pathogens. Full article

(This article belongs to the Special Issue Periprosthetic Joint Infections: Pathomechanism, Diagnostics and Novel Treatment Options)

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