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Antibiotics
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Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection
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Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (31 October 2024) | Viewed by 12052

Special Issue Editors

Prof. Dr. Éric M. Senneville

E-Mail Website
Guest Editor
Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, Nord-Pas-de-Calais, France
Interests: antibiotic therapy; bone and joint infections; diabetic foot infections; prosthetic joint infections
Special Issues, Collections and Topics in MDPI journals
Dr. Olivier Robineau

E-Mail Website
Guest Editor
Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Tourcoing, 59200 Tourcoing, Nord-Pas-de-Calais, France
Interests: antibiotic therapy; bone and joint infections; diabetic foot infections; prosthetic joint infections; vascular graft infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Osteomyelitis and periprosthetic joint infections (PJIs) have gained interest in the last decades not only because of their growing prevalence but also because it is a perfect example of the importance of the collaboration of different specialists to treat these difficult-to-treat infections. While the surgical part of the management of such infections is based on general rules generally well admitted, it is not the case for the antimicrobial part. Indeed, the numerous antimicrobial agents including new antibiotics and the emergence of new conceptual ways of treating these biofilm-associated infections result in a huge number of potential antimicrobial regimens. Except for the rifampin-fluoroquinolone combinations in the case of staphylococcal PJIs, and fluoroquinolones in the case of Gram-negative bacilli PJIs, the other combinations have not been assessed by well-designed studies. Recent studies have highlighted the potential role of persistent bacteria in the recurrence of osteomyelitis which might result in another possible way to fight against this issue. Suppressive antimicrobial therapy is used by some teams but it still needs clarification in its definition and modalities of administration. The question of both duration and oral administration of antimicrobial therapy for osteomyelitis (including diabetic foot osteomyelitis) and PJIs has been addressed in recent well-designed studies. This Special Issue seeks manuscript submissions that further our understanding of antimicrobial therapy for osteomyelitis and PJIs. Submissions on new antimicrobial approaches especially bacteriophages, prevention of recurrence, and innovative antimicrobial regimens are especially encouraged.

Prof. Dr. Éric M. Senneville
Dr. Olivier Robineau
Guest Editors

Manuscript Submission Information

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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 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

  • osteomyelitis
  • diabetic foot osteomyelitis
  • periprosthetic joint infections
  • antimicrobial therapy
  • recurrence
  • persistence
  • biofilm

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Published Papers (6 papers)

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Research

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11 pages, 792 KiB  
Article
A Comparison of Causative Pathogens in Bone and Prosthetic Joint Infections: Implications for Antimicrobial Therapy
by Annalise Unsworth, Bernadette Young, Matthew Scarborough and Martin McNally
Antibiotics 2024, 13(12), 1125; https://doi.org/10.3390/antibiotics13121125 (registering DOI) - 23 Nov 2024
Abstract
Background: The microbiological profile of bone and joint infections is important for determining the empiric choice of both systemic and local antimicrobial therapy. This study assessed whether there was a difference in the bacterial species that were isolated on culture in osteomyelitis [...] Read more.
Background: The microbiological profile of bone and joint infections is important for determining the empiric choice of both systemic and local antimicrobial therapy. This study assessed whether there was a difference in the bacterial species that were isolated on culture in osteomyelitis (OM), fracture-related infection (FRI) or prosthetic joint infection (PJI). This was a retrospective, observational cohort study of patients who had surgical intervention for PJI or OM or FRI with a positive microbial culture between 2019 and 2022. Methods: Data including patient demographics, the site of injury, JS-BACH score, organism classification and antibiotic resistance to vancomycin and gentamicin were extracted from the medical records. Results: A total of 440 patients were included in this study: 163 patients with osteomyelitis, 109 with fracture-related infection with fixation implants and 168 with prosthetic joint infection. The patients with PJI were older, more likely to be female and had a higher BMI and ASA score compared to those with OM. Patients with PJI were more likely to have a higher JS-BACH score and more complex infections. Staphylococcus aureus was the most commonly isolated organism in all three groups. It was more frequently isolated in osteomyelitis than in PJI (p = 0.016). In both osteomyelitis and FRI, after Staphylococcus aureus, the next most common organisms were Gram-negatives, whilst for PJIs, the most commonly isolated organisms were Staphylococcus aureus, followed by coagulase-negative Staphylococci and then Streptococcus species. The rates of other organisms were broadly similar between the three groups. When adjusted for confounders, including symptom duration, JS-BACH score, the location of injury, age and BMI, there was no statistically significant difference in the presence of Staphylococcus aureus (OR = 0.765; 95% CI 0.633–1.232; p = 0.465) or polymicrobial infection (OR = 1.175; 95% CI 0.803–1.721; p = 0.407). Conclusions: Causative pathogens are similar across bone and joint infections and are independent of the presence of prosthetic material. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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13 pages, 966 KiB  
Article
Microbiology of Prosthetic Joint Infections: A Retrospective Study of an Italian Orthopaedic Hospital
by Virginia Suardi, Daniele Baroni, Abdelrahman Hosni Abdelhamid Shahein, Valentina Morena, Nicola Logoluso, Laura Mangiavini and Antonio Virgilio Pellegrini
Antibiotics 2024, 13(5), 399; https://doi.org/10.3390/antibiotics13050399 - 26 Apr 2024
Viewed by 1441
Abstract
The most frequent cause of periprosthetic infections (PJIs) is intraoperative contamination; hence, antibiotic prophylaxis plays a crucial role in prevention. Modifications to standard prophylaxis can be considered if there is a high incidence of microorganisms resistant to current protocols. To date, very few [...] Read more.
The most frequent cause of periprosthetic infections (PJIs) is intraoperative contamination; hence, antibiotic prophylaxis plays a crucial role in prevention. Modifications to standard prophylaxis can be considered if there is a high incidence of microorganisms resistant to current protocols. To date, very few studies regarding microbial etiology have been published in Italy. In this single-center, retrospective study conducted at IRCCS Ospedale Galeazzi-Sant’Ambrogio in Milan, we analyzed hip, knee, and shoulder PJIs in patients undergoing first implantation between 1 January 17 and 31 December 2021. The primary aim was to derive a local microbiological case history. The secondary aim was to evaluate the adequacy of preoperative antibiotic prophylaxis in relation to the identified bacteria. A total of 57 PJIs and 65 pathogens were identified: 16 S. aureus, 15 S. epidermidis, and 10 other coagulase-negative staphylococci (CoNS), which accounted for 63% of the isolations. A total of 86.7% of S. epidermidis were methicillin-resistant (MRSE). In line with other case reports, we found a predominance of staphylococcal infections, with a lower percentage of MRSA than the Italian average, while we found a high percentage of MRSE. We estimated that 44.6% of the bacteria isolated were resistant to cefazolin, our standard prophylaxis. These PJIs could be prevented by using glycopeptide alone or in combination with cefazolin, but the literature reports conflicting results regarding the adequacy of such prophylaxis. In conclusion, our study showed that in our local hospital, our standard antibiotic prophylaxis is ineffective for almost half of the cases, highlighting the importance of defining specific antibiotic guidelines based on the local bacterial prevalence of each institution. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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10 pages, 676 KiB  
Article
Outcome of Irrigation and Debridement with Topical Antibiotic Delivery Using Antibiotic-Impregnated Calcium Hydroxyapatite for the Management of Periprosthetic Hip Joint Infection
by Hiroki Wakabayashi, Masahiro Hasegawa, Yohei Naito, Shine Tone and Akihiro Sudo
Antibiotics 2023, 12(5), 938; https://doi.org/10.3390/antibiotics12050938 - 21 May 2023
Cited by 1 | Viewed by 1671
Abstract
We assessed the clinical results of irrigation and debridement (I&D) with antibiotic-impregnated calcium hydroxyapatite (CHA) as a novel antibiotic delivery system for the treatment of prosthetic-joint-associated infection (PJI) after total hip arthroplasty (THA). Thirteen patients (14 hips) treated with I&D for PJI after [...] Read more.
We assessed the clinical results of irrigation and debridement (I&D) with antibiotic-impregnated calcium hydroxyapatite (CHA) as a novel antibiotic delivery system for the treatment of prosthetic-joint-associated infection (PJI) after total hip arthroplasty (THA). Thirteen patients (14 hips) treated with I&D for PJI after THA at our institution between 1997 and 2017 were retrospectively evaluated. The study group included four men (five hips) and nine women, with an average age of 66.3 years. Four patients (five hips) had symptoms of infection within less than 3 weeks; however, nine patients had symptoms of infection over 3 weeks. All patients received I&D with antibiotic-impregnated CHA in the surrounding bone. In two hips (two cups and one stem), cup and/or stem revision were performed with re-implantation because of implant loosening. In ten patients (11 hips), vancomycin hydrochloride was impregnated in the CHA. The average duration of follow-up was 8.1 years. Four patients included in this study died of other causes, with an average follow-up of 6.7 years. Eleven of thirteen patients (12 of 14 hips) were successfully treated, and no signs of infection were observed at the latest follow-up. In two patients (two hips) for whom treatment failed, infection was successfully treated with two-stage re-implantation. Both patients had diabetes mellitus and symptoms of infection over 3 weeks. Eighty-six percent of patients were successfully treated. No complications were observed with this antibiotic-impregnated CHA. I&D treatment with antibiotic-impregnated CHA produced a higher rate of success in patients with PJI after THA. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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Review

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17 pages, 537 KiB  
Review
Appropriate Duration of Antimicrobial Treatment for Prosthetic Joint Infections: A Narrative Review
by Jaime Lora-Tamayo, Mikel Mancheño-Losa, María Ángeles Meléndez-Carmona, Pilar Hernández-Jiménez, Natividad Benito and Oscar Murillo
Antibiotics 2024, 13(4), 293; https://doi.org/10.3390/antibiotics13040293 - 23 Mar 2024
Viewed by 3942
Abstract
Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment [...] Read more.
Prosthetic joint infections are considered difficult to treat they needing aggressive surgery and long antimicrobial treatments. However, the exact duration of these therapies has been established empirically. In the last years, several studies have explored the possibility of reducing the length of treatment in this setting, with conflicting results. In this narrative review, we critically appraise the published evidence, considering the different surgical approaches (implant retention [DAIR] and one-step and two-step exchange procedures) separately. In patients managed with DAIR, usually treated for at least 12 weeks, a large, randomized trial failed to show that 6 weeks were non-inferior. However, another randomized clinical trial supports the use of 8 weeks, as long as the surgical conditions are favorable and antibiotics with good antibiofilm activity can be administered. In patients managed with a two-step exchange procedure, usually treated during 6 weeks, a randomized clinical trial showed the efficacy of a 4-week course of antimicrobials. Also, the use of local antibiotics may allow the use of even shorter treatments. Finally, in the case of one-step exchange procedures, there is a trend towards reducing the length of therapy, and the largest randomized clinical trial supports the use of 6 weeks of therapy. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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Other

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11 pages, 580 KiB  
Perspective
The Role of Next-Generation Sequencing (NGS) in the Relationship between the Intestinal Microbiome and Periprosthetic Joint Infections: A Perspective
by Salvatore Gioitta Iachino, Federica Scaggiante, Claudia Mazzarisi and Christian Schaller
Antibiotics 2024, 13(10), 931; https://doi.org/10.3390/antibiotics13100931 - 1 Oct 2024
Viewed by 935
Abstract
Periprosthetic joint infections are still a challenge in orthopedics and traumatology. Nowadays, genomics comes to the aid of diagnosis and treatment, in addition to traditional methods. Recently, a key role of the intestinal microbiota has been postulated, and great efforts are aimed at [...] Read more.
Periprosthetic joint infections are still a challenge in orthopedics and traumatology. Nowadays, genomics comes to the aid of diagnosis and treatment, in addition to traditional methods. Recently, a key role of the intestinal microbiota has been postulated, and great efforts are aimed at discovering its interconnection, which shows to be at different levels. Firstly, the gut microbiome influences the immune system through the gut-associated lymphoid tissue (GALT). A balanced microbiome promotes a strong immune response, which is essential to prevent all local and systemic infections, including PJI. Thus, a dysbiosis, i.e., the disruption of this system, leads to an imbalance between the various strains of microorganisms co-existing in the gut microbiome, which can result in a weakened immune system, increasing susceptibility to infections, including PJI. Additionally, the dysbiosis can result in the production of pro-inflammatory mediators that enter the systemic circulation, creating a state of chronic inflammation that can compromise the immune system’s ability to fend off infections. Furthermore, the microbiome maintains the integrity of the gut barrier, preventing the translocation of harmful bacteria and endotoxins into the bloodstream; dysbiosis can compromise this protective “wall”. In addition, the gut microbiome may harbor antibiotic-resistance genes; during antibiotic treatment for other infections or prophylaxis, these genes may be transferred to pathogenic bacteria, making the treatment of PJI more difficult. In this complex landscape, next-generation sequencing (NGS) technology can play a key role; indeed, it has revolutionized the study of the microbiome, allowing for detailed and comprehensive analysis of microbial communities. It offers insights into the functional potential and metabolic capabilities of the microbiome, studies the collective genome of the microbiome directly from environmental samples sequencing DNA without isolating individual organisms, analyzes the RNA transcripts to understand gene expression and functional activity of the microbiome, analyzes the RNA transcripts to understand gene expression and functional activity of the microbiome, investigates the metabolites produced by the microbiome and studies the entire set of proteins produced by the microbiome. NGS technology, the study of the micromyoma and its implications in the field of orthopedic trauma are innovative topics on which few publications are yet to be found in the international scientific literature. The costs are still high, the focus of research is maximum, and it will certainly change our approach to infections. Our study is an up-to-date review of the hot topic application of NGS in the study and investigation of periprosthetic infections and the microbiome. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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9 pages, 2247 KiB  
Case Report
Ceftazidime-Avibactam as Osteomyelitis Therapy: A Miniseries and Review of the Literature
by Alessandro Mancuso, Luca Pipitò, Raffaella Rubino, Salvatore Antonino Distefano, Donatella Mangione and Antonio Cascio
Antibiotics 2023, 12(8), 1328; https://doi.org/10.3390/antibiotics12081328 - 17 Aug 2023
Cited by 1 | Viewed by 3072
Abstract
Bone and joint infections (BJIs) caused by multidrug-resistant gram-negative bacteria are becoming a concern due to limited therapeutic options. Although not approved for these indications, an ever-growing amount of evidence supports the efficacy and safety of ceftazidime–avibactam as a therapy for osteomyelitis and [...] Read more.
Bone and joint infections (BJIs) caused by multidrug-resistant gram-negative bacteria are becoming a concern due to limited therapeutic options. Although not approved for these indications, an ever-growing amount of evidence supports the efficacy and safety of ceftazidime–avibactam as a therapy for osteomyelitis and prosthetic joint infections. Here, we present three cases of difficult-to-treat resistant Pseudomonas aeruginosa osteomyelitis that were successfully treated with ceftazidime–avibactam alone or in combination therapy with fosfomycin and amikacin. Ceftazidime–avibactam was prescribed at a daily dose of 2.5 g every 8 h for 42 days in all cases. One potential drug-related adverse effect was observed, i.e., Clostridioides difficile infection, which occurred after fourteen days of treatment with ceftazidime–avibactam. Full article
(This article belongs to the Special Issue Antimicrobial Therapeutics for Bone and Periprosthetic Joint Infection)
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