Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 113 articles


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.

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.

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.

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Klemen Bedenčič MD, Martina Kavčič MD, Nataša Faganeli MD, Rene Mihalič MD, Blaž Mavčič MD, PhD, Jožica Dolenc PhD, Zlatka Bajc PhD, Rihard Trebše MD, PhD

Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions.

d -amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

Andrew J. Harmata PhD, Yun Ma PhD, Carlos J. Sanchez PhD, Katarzyna J. Zienkiewicz MS, Florent Elefteriou PhD, Joseph C. Wenke PhD, Scott A. Guelcher PhD

Infectious complications of musculoskeletal trauma are an important factor contributing to patient morbidity. Biofilm-dispersive bone grafts augmented with-amino acids (-AAs) prevent biofilm formation in vitro and in vivo, but the effects of-AAs on osteocompatibility and new bone formation have not been investigated.

Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA

Simon W. Young FRACS, Tim Roberts MBChB, Sarah Johnson BSc, James P. Dalton PhD, Brendan Coleman FRACS, Siouxsie Wiles PhD

In human TKA studies, intraosseous regional administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic administration. However, it is unclear if such high concentrations provide more effective prophylaxis.

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Paul Lichstein MD, MS, Sharlene Su BS, Hakan Hedlund MD, PhD, Gina Suh MD, William J. Maloney MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication.