Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Proceedings of the 2015 Musculoskeletal Infection Society 11 articles

Articles

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Knee Arthroplasty?

Bhaveen H. Kapadia MD, Peter L. Zhou BA, Julio J. Jauregui MD, Michael A. Mont MD

Many preventive methodologies seek to reduce the risk of surgical site infections after total knee arthroplasty (TKA), including the use of preoperative chlorhexidine baths and cloths. Although we have demonstrated in previous studies that this may be an efficacious method for infection prevention, our study was underpowered and we therefore set out to evaluate this with a larger sample size.

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

Bhaveen H. Kapadia MD, Julio J. Jauregui MD, Daniel P. Murray BA, Michael A. Mont MD

Periprosthetic hip infections are among the most catastrophic complications after total hip arthroplasty (THA). We had previously proven that the use of chlorhexidine cloths before surgery may help decrease these infections; hence, we increased the size of the previously reported cohort.

The Alpha-defensin Test for Periprosthetic Joint Infections Is Not Affected by Prior Antibiotic Administration

Alisina Shahi MD, Javad Parvizi MD, FRCS, Gregory S. Kazarian AB, Carlos Higuera MD, Salvatore Frangiamore MD, Joshua Bingham MD, Christopher Beauchamp MD, Craig Della Valle MD, Carl Deirmengian MD

Previous studies have demonstrated that the administration of antibiotics to patients before performing diagnostic testing for periprosthetic joint infection (PJI) can interfere with the accuracy of test results. Although a single-institution study has suggested that alpha-defensin maintains its concentration and sensitivity even after antibiotic treatment, this has not yet been demonstrated in a larger multiinstitutional study.

Antibiotic-tolerant Staphylococcus aureus Biofilm Persists on Arthroplasty Materials

Kenneth L. Urish MD, PhD, Peter W. DeMuth BS, Brian W. Kwan PhD, David W. Craft PhD, Dongzhu Ma PhD, Hani Haider PhD, Rocky S. Tuan PhD, Thomas K. Wood PhD, Charles M. Davis MD

The continued presence of biofilm may be one cause of the high risk of failure observed with irrigation and débridement with component retention in acute periprosthetic joint infection (PJI). There is a poor understanding of the role of biofilm antibiotic tolerance in PJI.

The ACS NSQIP Risk Calculator Is a Fair Predictor of Acute Periprosthetic Joint Infection

Nathaniel C. Wingert MD, James Gotoff BA, Edgardo Parrilla BA, BS, Robert Gotoff MD, Laura Hou MSc, Elie Ghanem MD

Periprosthetic joint infection (PJI) is a severe complication from the patient’s perspective and an expensive one in a value-driven healthcare model. Risk stratification can help identify those patients who may have risk factors for complications that can be mitigated in advance of elective surgery. Although numerous surgical risk calculators have been created, their accuracy in predicting outcomes, specifically PJI, has not been tested.

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Salvatore J. Frangiamore MD, Marcelo B. P. Siqueira MD, Anas Saleh MD, Thomas Daly MD, Carlos A. Higuera MD, Wael K. Barsoum MD

Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after first-stage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure.

Cathodic Voltage-controlled Electrical Stimulation Plus Prolonged Vancomycin Reduce Bacterial Burden of a Titanium Implant-associated Infection in a Rodent Model

Scott R. Nodzo MD, Menachem Tobias MS, Richard Ahn MD, Lisa Hansen MS, Nicole R. Luke-Marshall PhD, Craig Howard BS, Linda Wild MD, Anthony A. Campagnari PhD, Mark T. Ehrensberger PhD

Cathodic voltage-controlled electrical stimulation (CVCES) of titanium implants, either alone or combined with a short course of vancomycin, has previously been shown to reduce the bone and implant bacterial burden in a rodent model of methicillin-resistant(MRSA) implant-associated infection (IAI). Clinically, the goal is to achieve complete eradication of the IAI; therefore, the rationale for the present study was to evaluate the antimicrobial effects of combining CVCES with prolonged antibiotic therapy with the goal of decreasing the colony-forming units (CFUs) to undetectable levels.

Biofilm Antimicrobial Susceptibility Increases With Antimicrobial Exposure Time

Paulo Castaneda BSE, Alex McLaren MD, Gamuchirai Tavaziva, Derek Overstreet PhD

The antimicrobial concentration required to kill all the bacteria in a biofilm, known as the minimum biofilm eradication concentration (MBEC), is typically determined in vitro by exposing the biofilm to serial concentrations of antimicrobials for 24 hours or less. Local delivery is expected to cause high local levels for longer than 24 hours. It is unknown if longer antimicrobial exposures require the same concentration to eradicate bacteria in biofilm. Questions/purposes Does MBEC change with increased antimicrobial exposure time?

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Jaiben George MBBS, Grzegorz Kwiecien MD, Alison K. Klika MS, Deepak Ramanathan MBBS, Thomas W. Bauer MD, PhD, Wael K. Barsoum MD, Carlos A. Higuera MD

Frozen section histology is widely used to aid in the diagnosis of periprosthetic joint infection at the second stage of revision arthroplasty, although there are limited data regarding its utility. Moreover, there is no definitive method to assess control of infection at the time of reimplantation. Because failure of a two-stage revision can have serious consequences, it is important to identify the cases that might fail and defer reimplantation if necessary. Thus, a reliable test providing information about the control of infection and risk of subsequent failure is necessary.

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Timothy L. Tan MD, Bryan D. Springer MD, John A. Ruder MD, Michael R. Ruffolo MD, Antonia F. Chen MD, MBA

Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy.