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TropicalMed
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Orthopedic-Related Infections: Current Concepts and Future Perspectives
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Orthopedic-Related Infections: Current Concepts and Future Perspectives

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (23 December 2022) | Viewed by 21337

Special Issue Editors

Dr. Daniel Pérez-Prieto

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Guest Editor
Department of Orthopaedic Surgery, Hospital del Mar, Passeig Marítim 25–29, Barcelona, Spain
Interests: periprosthetic-joint infections; osteomyelitis; fracture-related infections; biofilm
Dr. Joan Gómez-Junyent

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Guest Editor
Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Pg. Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain
Interests: infectious diseases; biofilms; prosthetic joint infections; orthopedic-related infections; bacteremia

Special Issue Information

Dear Colleagues,

Bone and joint surgical procedures are among the most frequent operations performed in hospitals, for a wide variety of clinical conditions, including osteoarthritis or trauma. Such orthopedic procedures have proven to significantly improve patients’ quality of life and pain along with preserving function. Infection constitutes one of the most feared complications of such orthopedic surgery, resulting in significant morbidity and mortality.

Orthopedic-related infections are a huge issue in health care systems. They require both surgical and antimicrobial treatment and a long hospital stay. In addition, some cases need several operations including orthopedic and plastic surgery. The presence of bacterial biofilm in inert bone structures or foreign devices presents a huge challenge in the global management of orthopedic-related infections.

In this context, antimicrobial therapy represents a key step in assuring the best possible outcomes but often requires high doses and extended periods of time. Antimicrobial combinations exhibiting additive or synergistic effects may also play a role in treating these infections. Local antimicrobials are also often employed. Therefore, close collaboration between orthopedic surgeons, infectious disease specialists, microbiologists and pharmacologists is crucial when managing orthopedic-related infections.

In this complex scenario, and in spite of the considerable amount of research performed in this field in recent decades, many unresolved questions remain; indeed, most recommendations in these areas are based on expert opinions due to the limitations of the available information. Nevertheless, these limitations and the weaknesses of many of the available studies on orthopedic-related infections constitute a call to join forces to conduct well-designed, international, multidisciplinary studies.

This Special Issue aims to advance knowledge and expand our perspectives on orthopedic-related infections. 

Dr. Daniel Pérez-Prieto
Dr. Joan Gómez-Junyent
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 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

  • Orthopedic-related infection
  • Orthopedic-related infection treatment
  • Orthopedic-related infection management
  • Antimicrobial therapy in orthopedic-related infection
  • Antibiotic elution
  • Antibiotic-loaded bone cement
  • Antibiotic resistance
  • Antibiotic pharmacokinetics

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Published Papers (6 papers)

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Research

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10 pages, 436 KiB  
Article
Therapeutic Drug Monitoring of Vancomycin Concentrations for the Management of Bone and Joint Infections: An Urgent Need
by Laura Rio-No, Luisa Sorli, Alba Arderiu-Formenti, Marta De Antonio, Lucas Martorell, Isaac Subirana, Lluis Puig, Albert Alier, Joan Gómez-Junyent, Daniel Pérez-Prieto and Sonia Luque
Trop. Med. Infect. Dis. 2023, 8(2), 113; https://doi.org/10.3390/tropicalmed8020113 - 13 Feb 2023
Viewed by 2646
Abstract
Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug [...] Read more.
Vancomycin is used for the treatment of bone and joint infections (BJI), but scarce information is available about its pharmacokinetic/pharmacodynamic (PK/PD) characteristics. We aimed to identify the risk factors associated with the non-achievement of an optimal PK/PD target in the first therapeutic drug monitoring (TDM). Methods: A retrospective study was conducted in a tertiary hospital from January 2020 to January 2022. Patients with BJI and TDM of vancomycin on day 2 of treatment were included. Initial vancomycin fixed doses (1 g every 8 h or 12 h) was decided by the responsible doctors. According to TDM results, dosage adjustments were performed. An AUC24h/MIC < 400 mg × h/L, between 400 and 600 mg × h/L and >600 mg × h/L, were defined as suboptimal, optimal and supratherapeutic, respectively. Patients were grouped into these three categories. Demographic, clinical and PK characteristics were compared between groups. Nephrotoxicity at the end of treatment was assessed. Results: A total of 94 patients were included: 22 (23.4%), 42 (44.7%) and 30 (31.9%) presented an infratherapeutic, optimal and supratherapeutic PK/PD targets, respectively. A younger age and initial vancomycin dose <40 mg/kg/day were predictive factors for achieving a suboptimal PK/PD target, while older age, higher serum-creatinine and dose >40 mg/kg/day were associated with overexposure. The nephrotoxicity rate was 22.7%. More than 50% of patients did not achieve an optimal PK/PD. Considering age, baseline serum-creatinine and body weight, TDM is required to readily achieve an optimal and safe exposure. Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)
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8 pages, 551 KiB  
Article
A Detailed Analysis of Clinical Features and Outcomes of Patients with Pyogenic Spondylodiscitis Presenting without Axial Back Pain
by Luigi Aurelio Nasto, Massimo Fantoni, Valerio Cipolloni, Luca Piccone, Enrico Pola and Alfredo Schiavone Panni
Trop. Med. Infect. Dis. 2021, 6(2), 54; https://doi.org/10.3390/tropicalmed6020054 - 20 Apr 2021
Cited by 4 | Viewed by 3099
Abstract
Study design: Retrospective analysis of a single institution prospective, longitudinal database of spinal pyogenic infections. Diagnosis of pyogenic spondylodiscitis (PS) can be challenging. Although presenting symptoms are often non-specific, acute non-remitting axial back pain is the most striking feature. Nevertheless, several authors have [...] Read more.
Study design: Retrospective analysis of a single institution prospective, longitudinal database of spinal pyogenic infections. Diagnosis of pyogenic spondylodiscitis (PS) can be challenging. Although presenting symptoms are often non-specific, acute non-remitting axial back pain is the most striking feature. Nevertheless, several authors have reported on the uncommon occurrence of patients with PS without axial back pain. The aim of this study was to characterize presenting symptoms, causative agents, comorbidities, and treatment outcomes of patients presenting with painless pyogenic spondylodiscitis. A total of 214 patients diagnosed with PS were reviewed; patients were divided into two groups: patients presenting with no axial back pain (no pain group, n = 16), and patients presenting with axial back pain (control group, n = 198). Analyzed data comprised general demographics, presenting symptoms, comorbidities, spinal infection location, and amount of spinal involvement. While average age (62.4 vs. 65.0) and sex distribution was similar between the two groups, a significant diagnostic delay was noted in the control group (53 vs. 17 days, p < 0.001). Patients in the no pain group were more likely IV drug abusers or have had liver failure/cirrhosis. Anatomic distribution (i.e., cervical vs thoracolumbar) of the infection did not differ between the two groups, but a higher number of post-surgical infections was noted in the no pain group (37.5 vs. 15.6%, p = 0.026). E. coli and Pseudomonas spp. were more commonly seen in no pain group patients, and mortality was also higher in this group (12.5 vs. 6.0%, p = 0.004). Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)
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Review

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9 pages, 262 KiB  
Review
What’s New in the Diagnosis of Periprosthetic Joint Infections: Focus on Synovial Fluid Biomarkers
by Giuseppe Solarino, Davide Bizzoca, Lorenzo Moretti, Giovanni Vicenti, Andrea Piazzolla and Biagio Moretti
Trop. Med. Infect. Dis. 2022, 7(11), 355; https://doi.org/10.3390/tropicalmed7110355 - 7 Nov 2022
Cited by 14 | Viewed by 2269
Abstract
Periprosthetic joint infections are some of the leading causes of revision prosthetic surgery, accounting for 25% of failed total knee replacements and 15% of failed total hip replacements. The search for a biomarker that, together with clinical and radiological findings, could improve the [...] Read more.
Periprosthetic joint infections are some of the leading causes of revision prosthetic surgery, accounting for 25% of failed total knee replacements and 15% of failed total hip replacements. The search for a biomarker that, together with clinical and radiological findings, could improve the management of such patients is currently a significant challenge for orthopaedic surgeons. Synovial fluid is a viscous and mucinous substance produced by the synovium, a specialized connective tissue that lines diarthrodial joints. Synovial fluid is an ultrafiltrate of plasma but also contains proteins secreted from the surrounding tissues, including the articular cartilage and synovium. Therefore, synovial fluid represents a source of disease-related proteins that could be used as potential biomarkers in several articular diseases. Based on these findings, the study of synovial fluid has been gaining increasing importance in recent years. This review aims to assess the accuracy and the limitations of the most promising synovial fluid biomarkers—i.e., Alpha-Defensin, Leukocyte Esterase, C-Reactive Protein, Interleukin-6, Calprotectin, Presepsin and Neopterin—in the diagnosis of PJI. Special attention will be given to emerging synovial biomarkers, which could soon be important in diagnosing PJIs. Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)

Other

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6 pages, 1000 KiB  
Case Report
Acute Hematogenous Periprosthetic Hip Infection by Gemella morbillorum, Successfully Treated with Debridement, Antibiotics and Implant Retention: A Case Report and Literature Review of Osteoarticular Gemella morbillorum Infections
by Albert Pardo-Pol, Daniel Pérez-Prieto, Albert Alier, Lucas Ilzarbe, Lluïsa Sorlí, Lluis Puig, Santos Martínez-Díaz and Joan Gómez-Junyent
Trop. Med. Infect. Dis. 2022, 7(8), 191; https://doi.org/10.3390/tropicalmed7080191 - 18 Aug 2022
Cited by 1 | Viewed by 2199
Abstract
Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as [...] Read more.
Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as endocarditis, meningitis or brain abscesses, and very rarely can cause osteoarticular infections. Herein, a case report of an acute hematogenous prosthetic hip infection caused by Gemella morbillorum, successfully treated with a DAIR and beta-lactam antibiotic therapy, is presented. We provide a literature review of the other orthopedic-related infections caused by this microorganism. Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)
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8 pages, 1236 KiB  
Case Report
One-Stage Hip Revision Arthroplasty Using Megaprosthesis in Severe Bone Loss of The Proximal Femur Due to Radiological Diffuse Osteomyelitis
by Roy Gonzalez, Ernesto Muñoz-Mahamud and Guillem Bori
Trop. Med. Infect. Dis. 2022, 7(1), 5; https://doi.org/10.3390/tropicalmed7010005 - 31 Dec 2021
Cited by 2 | Viewed by 3384
Abstract
Managing substantial proximal and/or distal femoral bone defects is one of the biggest challenges in chronic hip periprosthetic joint infection. Most authors use two-stage arthroplasty with a temporary antibiotic-loaded cement spacer for the management of these patients. In this study, we show our [...] Read more.
Managing substantial proximal and/or distal femoral bone defects is one of the biggest challenges in chronic hip periprosthetic joint infection. Most authors use two-stage arthroplasty with a temporary antibiotic-loaded cement spacer for the management of these patients. In this study, we show our experience with one-stage exchange arthroplasty in managing severe bone defects due to radiological-extensive proximal femoral osteomyelitis. Two patients were included in the study. They showed radiological-extensive proximal femoral osteomyelitis, and they were treated with one-stage exchange arthroplasty using megaprosthesis. Diffuse osteomyelitis was confirmed in both cases; in one case, the histology was compatible with osteomyelitis, and the other case had a positive culture identified in a bone sample. At a minimum of a four-year follow-up, the patients did not reveal any clinical, radiological or laboratory signs of infection. In conclusion, one-stage exchange arthroplasty and megaprosthesis is an option for the treatment of chronic hip periprosthetic joint infection associated with radiological-diffuse proximal femoral osteomyelitis. Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)
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6 pages, 234 KiB  
Viewpoint
Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)
by Pier Francesco Indelli, Stefano Ghirardelli, Ferdinando Iannotti, Alessia Maria Indelli and Gennaro Pipino
Trop. Med. Infect. Dis. 2021, 6(2), 91; https://doi.org/10.3390/tropicalmed6020091 - 28 May 2021
Cited by 8 | Viewed by 5636
Abstract
Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. [...] Read more.
Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles. Full article
(This article belongs to the Special Issue Orthopedic-Related Infections: Current Concepts and Future Perspectives)
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