Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study

Cutibacterium acnes; Infecció articular protèsica; Tractament quirúrgic i mèdicCutibacterium acnes; Infección articular protésica; Tratamiento quirúrgico y médicoCutibacterium acnes; Prosthetic joint infection; Surgical and medical treatmentThis retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.This work received no specific funding from the public, private, or not-for-profit sectors

Prosthetic shoulder joint infection by cutibacterium acnes: does rifampin improve prognosis? a retrospective, multicenter, observational study

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3–75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80–58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08–105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI

Prosthetic shoulder joint infection by Cutibacterium acnes: does rifampin improve prognosis? a retrospective, multicenter, observational study.

This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI

Eficiencia energética en la edificación: análisis regulatorio y caso práctico

[ES] Los gases de efecto invernadero como el CO2 y el NOx emitidos por el ser humano influyen de forma muy negativa en el entorno a medio y largo plazo. La sociedad es responsable de este problema, del que el sector de la construcción posee un peso específico a tener en cuenta y que sin duda será determinante para alcanzar una solución antes de que sea demasiado tarde. Los diferentes estamentos legislativos tienen la obligación moral de responder ante esta realidad, tomando cartas en el asunto dentro de sus competencias y atribuciones. Tanto la Unión Europea como España tienen una posición legislativa firme sobre la materia que se aborda en el presente trabajo, luchando contra el cambio climático desde hace lustros. De manera específica se aborda la posición normativa de la Comunitat Valenciana, que va en consonancia con lo determinado por Europa y España, como no podría ser de otra manera. Esa posición firme se ve reflejada sobre el sector de la construcción, del que este trabajo recoge un caso práctico, que desde hace años viene sufriendo una transformación profunda y que gracias a las diferentes normativas y ayudas logra el objetivo propuesto, que la transformación del sector sea una realidad asumible por la sociedad civil, siendo esta realmente la más interesada con el cambio[EN] Greenhouse gases such as CO2 and NOx emitted by humans have a very negative influence on the environment in the medium and long term. Society is responsible for this problem, of which the construction sector has a specific weight to consider and which will undoubtedly be decisive in reaching a solution before it is too late. The different legislative bodies have the moral obligation to respond to this reality, acting on the matter within their competencies and attributions. Both the European Union and Spain have a firm legislative position on the matter that is addressed in this paper, fighting against climate change for decades. In a specific way, the normative position of the Valencian Community is addressed, which is in line with what is determined by Europe and Spain, as it could not be otherwise. This firm position is reflected in the construction sector, of which this work includes a practical case, which for years has been undergoing a profound transformation and that thanks to the different regulations and aid achieves the proposed objective, that the transformation of the sector be a reality that can be assumed by civil society, which is really the one most interested in change.Auñón Lloréns, AÁ. (2020). Eficiencia energética en la edificación: análisis regulatorio y caso práctico. http://hdl.handle.net/10251/151262TFG

Molecular Diagnosis of Osteoarticular Implant-Associated Infection: Available Techniques and How We Can Use Them

Despite recent advances during the last few years, microbiological diagnosis of prosthetic joint infections remains a challenge. Molecular biology techniques have been developed to try to overcome this problem, and recently, many of them have become available for many laboratories. Some of them, especially commercial multiplex PCR-based assays and universal 16S rDNA homemade PCR assays, are now available in many laboratories. Moreover, new technologies have appeared, especially metagenomics and next-generation sequencing. These techniques have demonstrated their potential in many studies but appear to be experimental at present. A few studies have evaluated the possible use of these methods in the clinical routine, and a review of the critical aspects for the selection of a molecular method (accuracy, complexity, cost) was performed. Finally, a proposal for a protocol that includes molecular biology techniques was made according to the literature published in this field. In conclusion, molecular biology techniques are ready to be used in the clinical routine of a microbiology laboratory, but their use must be carried out in accordance with the many special characteristics of each laboratory. In all cases, the interpretation of the results must be conducted by a multidisciplinary team with experience in the management of these patients

Orthopedic Implant-Associated Infection by Multidrug Resistant <i>Enterobacteriaceae</i>

Introduction: Orthopedic implant-associated infections caused by multidrug-resistant Enterobacteriaceae are a growing challenge for healthcare providers due to their increasing incidence and the difficulties of medical and surgical treatment. Material and Methods: A retrospective observational study of all cases of multidrug resistant Enterobacteriaceae orthopedic implant-associated infection diagnosed in a tertiary European hospital from December 2011 to November 2017 was carried out. Clinical records were reviewed using a previously designed protocol. Data analysis was performed with IBM&#174; SPSS&#174;, version 22. Results: 25 patients met inclusion criteria. The infected implants included 10 prosthetic joints, seven osteosyntheses, six combinations of prosthetic joint and osteosynthesis material, and two spacers. Of the multidrug resistant Enterobacteriaceae obtained on culture, 12 were extended-spectrum beta-lactamase-producing Escherichia coli, three OXA-48-producing Klebsiella pneumoniae, nine extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and one extended-spectrum beta-lactamase-producing Proteus mirabilis. Combination antimicrobial therapy was employed in all cases but two. Overall, 16 (64%) patients underwent implant removal. The rate of infection control in the overall implant removal group was 100% compared to 33% in the implant retention group. A strong relationship between implant removal and infection control was observed (p = 0.001). Discussion: Implant removal is strongly associated with infection control. However, in some cases, patient age and comorbidity contraindicate hardware extraction. Potential objectives for future studies should be geared towards targeting the population in which debridement, antibiotic therapy, and implant retention can be used as a first-line therapeutic strategy with a reasonable probability of achieving infection control

Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery

Cement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal. The cement is removed piece by piece using a specifically designed device, without osteotomies or cortical windows

Staphylococcus aureus Prosthetic Joint Infection Is Prevented by a Fluorine- and Phosphorus¿Doped Nanostructured Ti-6Al-4V Alloy Loaded With Gentamicin and Vancomycin

Prosthetic joint infection (PJI) is one of the most devastating complications in orthopedic surgery. One approach used to prevent PJI is local antibiotic therapy. This study evaluates the antibiotic release, in vitro cytocompatibility and in vivo effectiveness in preventing PJI caused by Staphylococcus aureus (S. aureus) of the fluorine‐ and phosphorus‐doped, bottle‐shaped, nanostructured (bNT) Ti–6Al–4V alloy loaded with a mixture of gentamicin and vancomycin (GV). We evaluated bNT Ti–6Al–4V loading with a mixture of GV, measuring the release of these antibiotics using high‐performance liquid chromatography. Further, we describe bNT Ti–6Al–4V GV cytocompatibility and its efficacy against S. aureus using an in vivo rabbit model. GV was released from bNT Ti–6Al–4V following a Boltzmann non‐linear model and maximum release values were obtained at 240 min for both antibiotics. The cell proliferation of MCT3T3‐E1 osteoblastic cells significantly increased at 48 (28%) and 168 h (68%), as did the matrix mineralization (52%) of these cells and the gene expression of three of the most important markers related to bone differentiation (more than threefold for VEGF and BGLAP, and 65% for RunX) on bNT Ti–6Al–4V GV compared with control. In vivo study results show that bNT Ti–6Al–4V GV can prevent S. aureus PJI according to histopathological and microbiological results. According to our results, bNT Ti–6Al–4V loaded with a mixture of GV using the soaking method is a promising biomaterial with favorable cytocompatibility and osteointegration, demonstrating local bactericidal properties against S. aureus.Secretaría de Estado de Investigación, Desarrollo e Innovación. Grant Numbers: BES‐2014‐069007, MAT2013‐48224‐C2‐1‐R, MAT2013‐48224‐C2‐2‐R, MAT2017‐86163‐C2‐1‐

Staphylococcus aureus Prosthetic Joint Infection Is Prevented by a Fluorine‐ and Phosphorus‐Doped Nanostructured Ti–6Al–4V Alloy Loaded With Gentamicin and Vancomycin

La infección de prótesis articulares (PJI) es una de las complicaciones más devastadoras de la cirugía ortopédica. Un enfoque utilizado para prevenir la PJI es la terapia con antibióticos. En este artículo hemos evaluado la liberación de dos antibióticos: gentamicina y vancomicina cargados en capas de óxido anódico nanotubular dopado con flúor, así como su efecto bactericida en Staphylococcus aureus. Este método de carga se suma a las propiedades de las capas de óxido nanotubular dopado con flúor fabricadas en Ti-6Al-4V y, por lo tanto, se pueden obtener superficies con propiedades antibacterianas, biocompatibles, estimulantes de la integración tisular y bactericidas de espectro extendido, lo que permite una potenciación de la actividad bacteriológica de los antibióticos analizados. Supone un avance en cuanto a la administración de estos fármacos, incluyendo métodos tradicionales y modernos con el uso de nanopartículas, liposomas y otros vehículos de introducción de estos antibióticos en el organismo humano.Spanish Ministry of Economics and CompetitivenessDepto. de Química en Ciencias FarmacéuticasFac. de FarmaciaTRUEpu

Urine Aluminum Concentration as a Possible Implant Biomarker of Pseudomonas aeruginosa Infection Using a Fluorine- and Phosphorus-Doped Ti-6Al-4V Alloy with Osseointegration Capacity

Joint prosthesis failure is mainly related to aseptic loosening and prosthetic joint infections, both associated with high morbidity and a substantial cost burden for patients and health systems. The development of a biomaterial capable of stimulating bone growth while minimizing bacterial adhesion would reduce the incidence of prosthetic failure. Using an in vivo rabbit model, this study evaluates the osseointegration effect of the fluorine (F)- and phosphorus (P)-doped bottle-shaped nanostructured (bNT) Ti-6Al-4V alloy and effectiveness of monitoring urine aluminum concentration to determine the presence of Pseudomonas aeruginosa infection in Ti-6Al-4V implants. Unlike chemically polished (CP) Ti-6Al-4V alloy implants, bNT Ti-6Al-4V alloy implants promoted osseointegration and showed effectiveness as a biomaterial marker. The bNT Ti-6Al-4V alloy implants were associated with a twofold increase in bone thickness and up to 15% greater bone density compared to the CP alloy. Additionally, bNT Ti-6Al-4V alloy implants allowed for discrimination between P. aeruginosa-infected and noninfected animals for 15 days postoperatively, as indicated by the decrease of aluminum concentration in urine, while this difference was only appreciable over the first 7 days when CP Ti-6Al-4V alloy implants were used. Therefore, bNT Ti-6Al-4V alloys could have clinical applications by detecting the infection and by avoiding aseptic loosening.This study was funded by a grant from the Spanish Ministry of Economics and Competitiveness (MAT2017-86163-C2-1-R, MAT2013-48224-C2-2-R, and MAT2013-48224-C2-1-R). J.-J.A.C. is funded by an FPI grant from the same institution (BES-2014-069007). We wish to acknowledge Dr. Oliver Shaw for his help in revising the manuscript for aspects related to the English language. Part of this work was previously presented before the 28th European Congress of Clinical Microbiology and Infectious Diseases