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Orthopedic infection control

Daniel Pérez-Prieto, María E Portillo, Lluís Puig-Verdié, Albert Alier, Carlo Gamba, Pau Guirro, Santos Martínez-Díaz, Juan P Horcajada, Andrej Trampuz, Joan C Monllau
BACKGROUND: Culture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures. MATERIAL AND METHODS: An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital...
September 23, 2016: Diagnostic Microbiology and Infectious Disease
Zhaojun Jia, Peng Xiu, Pan Xiong, Wenhao Zhou, Yan Cheng, Shicheng Wei, Yufeng Zheng, Tingfei Xi, Hong Cai, Zhongjun Liu, Cai-Mei Wang, Wei-Ping Zhang, Zhi-Jiang Li
Restoring large-scale bone defects, where osteogenesis is slow while infections lurk, with biomaterials represents a formidable challenge in orthopedic clinics. Here, we propose a scaffold-based multipurpose anti-infection and bone repairing strategy to meet such restorative needs. To do this, personalized multifunctional titanium meshes were produced through an advanced additive manufacturing process and dual "TiO2‒poly(dopamine)/Ag (nano)" post modifications, yielding macroporous constructs with micro/nanoporous walls and nanosilver bullets immobilized/embedded therein...
October 5, 2016: ACS Applied Materials & Interfaces
Louise Kruse Jensen, Janne Koch, Bent Aalbaek, Arshnee Moodley, Thomas Bjarnsholt, Kasper Nørskov Kragh, Andreas Petersen, Henrik Elvang Jensen
Implant-associated osteomyelitis (IAO) is a common complication in orthopedic surgery. The aim of this study was to elucidate how deep IAO can go into the peri-implanted bone tissue within a week. The study was performed in a porcine model of IAO. A small steel implant and either 10(4) CFU/kg body weight of Staphylococcus aureus or saline was inserted into the right tibial bone of 12 pigs. The animals were consecutively killed on day 2, 4 and 6 following implantation. Bone tissue around the implant was histologically evaluated...
October 5, 2016: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Stephen King, Elizabeth S Roberts, Jonathan N King
BACKGROUND: Few pharmaceuticals are registered in cats for the management of post-operative pain and inflammation. The objective of this study was to assess the field efficacy and safety of an injectable formulation of the nonsteroidal anti-inflammatory drug robenacoxib in cats undergoing surgery. The study was a multi-center, prospective, randomized, masked, parallel-group, placebo-controlled clinical trial. A total of 349 cats were enrolled and underwent surgery comprising forelimb onychectomy, as an example of orthopedic surgery, plus either ovariohysterectomy or castration...
September 29, 2016: BMC Veterinary Research
Claire M McDaniel, Ryan W Churchill, Evan Argintar
Preoperative skin preparation with antimicrobial agents decreases the risk of surgical site infection, but concerns have been raised about the visibility of a common surgical preparatory agent (ChloraPrep; Becton, Dickinson & Co, Franklin Lakes, New Jersey), depending on skin pigmentation. Poor visibility may lead to failure to identify inadequately prepared skin, increasing the risk of surgical site infection. This study was conducted to determine whether different tints of ChloraPrep and different skin pigmentations affect the ability of orthopedic surgeons to identify the adequacy of skin preparation...
September 29, 2016: Orthopedics
Ying Yang, Haiyong Ao, Yugang Wang, Wentao Lin, Shengbing Yang, Shuhong Zhang, Zhifeng Yu, Tingting Tang
Infection is one of the major causes of failure of orthopedic implants. Our previous study demonstrated that nanotube modification of the implant surface, together with nanotubes loaded with quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan, HACC), could effectively inhibit bacterial adherence and biofilm formation in vitro. Therefore, the aim of this study was to further investigate the in vitro cytocompatibility with osteogenic cells and the in vivo anti-infection activity of titanium implants with HACC-loaded nanotubes (NT-H)...
2016: Bone Research
Sara J E Beishuizen, Rikie M Scholtens, Barbara C van Munster, Sophia E de Rooij
OBJECTIVES: To assess the association between serum S100B levels (a marker of brain damage), delirium, and subsequent cognitive decline. DESIGN: Substudy of a multicenter randomized controlled trial. SETTING: Surgical, orthopedic, and trauma surgery wards of two teaching hospitals. PARTICIPANTS: Individuals aged 65 and older (range 65-102) admitted for hip fracture surgery (N = 385). MEASUREMENTS: During hospitalization, presence of delirium was assessed daily...
September 19, 2016: Journal of the American Geriatrics Society
Quentin Flamant, Carlos Caravaca, Sylvain Meille, Laurent Gremillard, Jérôme Chevalier, Katia Biotteau-Deheuvels, Meinhard Kuntz, Rona Chandrawati, Inge K Herrmann, Christopher D Spicer, Molly M Stevens, Marc Anglada
: Due to their outstanding mechanical properties and excellent biocompatibility, zirconia-toughened alumina (ZTA) ceramics have become the gold standard in orthopedics for the fabrication of ceramic bearing components over the last decade. However, ZTA is bioinert, which hampers its implantation in direct contact with bone. Furthermore, periprosthetic joint infections are now the leading cause of failure for joint arthroplasty prostheses. To address both issues, an improved surface design is required: a controlled micro- and nano-roughness can promote osseointegration and limit bacterial adhesion whereas surface porosity allows loading and delivery of antibacterial compounds...
September 14, 2016: Acta Biomaterialia
Mohammadreza Golbakhsh, Mirmostafa Sadaat, Fatemeh Noughani, Ahmadreza Mirbolook, Amirmohammad Gholizadeh, Sadegh Abedi
BACKGROUND: Implant removal is a common procedure in orthopedic surgery which can be associated with many complications such as scar formation, hematoma, nerve injury, infection, and refracture. Indications for orthopedic implant removal have declined in recent years. Most studies have considered orthopedic hardware removal as an unnecessary procedure in the absence of severe complications such as nonunion. Some studies have reported the complications of orthopedic hardware removal to be 24% to 50% dependent on their types and locations as well as on other factors such as patient's condition and the orthopedist's experience...
May 2016: Trauma Monthly
Yuta Shiono, Ken Ishii, Shigenori Nagai, Hiroaki Kakinuma, Aya Sasaki, Haruki Funao, Tetsuya Kuramoto, Kenji Yoshioka, Hiroko Ishihama, Norihiro Isogai, Kenichiro Takeshima, Takashi Tsuji, Yasunori Okada, Shigeo Koyasu, Masaya Nakamura, Yoshiaki Toyama, Mamoru Aizawa, Morio Matsumoto
Whether Propionibacterium acnes (P. acnes) causes surgical-site infections (SSI) after orthopedic surgery is controversial. We previously reported that we frequently find P. acnes in intraoperative specimens, yet none of the patients have clinically apparent infections. Here, we tracked P. acnes for 6 months in a mouse osteomyelitis model. We inoculated P. acnes with an implant into the mouse femur in the implant group; the control group was treated with the bacteria but no implant. We then observed over a 6-month period using optical imaging system...
2016: Scientific Reports
J C M Langenberg, A R Thomas, J M W Donker, M M L van Rijen, J A J W Kluytmans, L van der Laan
INTRODUCTION: Surgical site infections (SSI) are a serious complication in vascular surgery which may lead to severe morbidity and mortality. Staphylococcus aureus nasal carriage is associated with increased risk for development of SSIs in central vascular surgery. The risk for SSI can be reduced by perioperative eradication of S. aureus carriage in cardiothoracic and orthopedic surgery. This study analyzes the relation between S. aureus eradication therapy and SSI in a vascular surgery population...
2016: PloS One
Farrin A Manian, Erik Kelly
BACKGROUND: Although total knee arthroplasty (TKA) is one of the most common orthopedic procedures, its association with subsequent acute bacterial skin and soft tissue infections (ABSSTIs) in the ipsilateral limb has not been studied. METHODS: This was a retrospective study of patients with prior unilateral TKA who were diagnosed with ABSSTI 4 weeks or more postoperatively in the absence of surgical site infection. The odds of ABSSTI in the TKA limb was compared to that of the contralateral "control" limb in the same patient in the presence or absence of local predisposing factors for ABSSTI in the lower extremities (e...
August 2016: American Journal of the Medical Sciences
Joshua Nyaribari Ondari, Moses Muia Masika, Richard Bwana Ombachi, John Ernest Ating'a
OBJECTIVE: To determine the difference in infection rate between 24h versus five days of prophylactic antibiotic use in management of Gustilo II open tibia fractures. DESIGN: Unblinded randomized control trial. SETTING: Accident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National Hospital (KNH). PATIENTS: The study involved patients aged 18-80 years admitted through accident and emergency department with Gustilo II traumatic open tibia fractures...
October 2016: Injury
Ying Yang, Hai-Yong Ao, Sheng-Bing Yang, Yu-Gang Wang, Wen-Tao Lin, Zhi-Feng Yu, Ting-Ting Tang
Titanium-based implants have been widely used in orthopedic surgery; however, failures still occur. Our in vitro study has demonstrated that gentamicin-loaded, 80 nm-diameter nanotubes possessed both antibacterial and osteogenic activities. Thus, the aim of this study was to further investigate the in vivo anti-infection effect of the titanium implants with gentamicin-loaded nanotubes. Thirty-six male Sprague Dawley rats were used to establish an implant-associated infection model. A volume of 50 μL Staphylococcus aureus suspension (1×10(5) CFU/mL) was injected into the medullary cavity of the left femur, and then the titanium rods without modification (Ti), titanium nanotubes without drug loading (NT), and gentamicin-loaded titanium nanotubes (NT-G) were inserted with phosphate-buffered saline-inoculated Ti rods as a blank control...
2016: International Journal of Nanomedicine
D Velázquez-Vélez, N Durán-Martínez, J A Peñafort-García, A Romero-Peña
More than 20% of the tarsometatarsal joint injuries (Lisfranc injuries) occur during motor vehicle accidents. This kind of trauma is infrequent and in 50% of cases closed reduction is used. A 18 year-old male patient sustained a high-energy trauma resulting in a Gustilo and Anderson III B open Lisfranc fracture dislocation of the left foot. Surgical debridement, open reduction and internal fixation, and immediate skin coverage were performed. The secondary complication rate may decrease with stringent treatment adherence and proper care of severe orthopedic injuries...
September 2015: Acta Ortopédica Mexicana
Frédérique Hovaguimian, Paul S Myles
BACKGROUND: Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. METHODS: The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients...
July 2016: Anesthesiology
Jiankang Song, Qiang Chen, Yang Zhang, Mani Diba, Eva Kolwijck, Jinlong Shao, John A Jansen, Fang Yang, Aldo R Boccaccini, Sander C G Leeuwenburgh
Orthopedic and dental implants are increasingly used in the medical field in view of their high success rates. Implant-associated infections, however, still occur and are difficult to treat. To combat these infections, the application of an active coating to the implant surface is advocated as an effective strategy to facilitate sustained release of antibacterial drugs from implant surfaces. Control over this release is, however, still a major challenge. To overcome this problem, we deposited composite coatings composed of a chitosan matrix containing gelatin nanospheres loaded with antibiotics onto stainless steel plates by means of the electrophoretic deposition technique...
June 8, 2016: ACS Applied Materials & Interfaces
David B McConda, Jonathan M Karnes, Therwa Hamza, Brock A Lindsey
Infection is a major cause of orthopedic implant failure. There are few studies assessing both tissue cell and bacterial adherence on common orthopedic implant materials in a co-culture environment. An in vitro co-culture model was created using K12 osteosarcoma cells and Staphylococcus aureus in a medium incubated over metal disks for 48 h. The results showed that, in the presence of S. aureus, there were fewer osteosarcoma cells attached to the disks for all substrata tested. There were significantly more osteosarcoma cells adhering to the cobalt chrome than the stainless steel and titanium disks...
July 2016: Biofouling
Juan A Constantino, María Delgado-Rastrollo, Miguel A Pacha-Olivenza, M Luisa González-Martín, Manuel Quiles, C Pérez-Giraldo, José M Bruque, Amparo M Gallardo-Moreno
BACKGROUND: Biomaterial-associated infections are one of the most important complications in orthopedic surgery. The main goal of this study was to demonstrate the in vivo bactericidal effect of ultraviolet (UV) irradiation on Ti6Al4V surfaces. MATERIALS AND METHODS: An experimental model of device-related infections was developed by direct inoculation of Staphylococcus aureus into the canal of both femurs of 34 rats. A UV-irradiated Ti6Al4V pin was press-fit into the canal by retrograde insertion in one femur and the control pin was inserted into the contralateral femur...
May 2, 2016: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Claudia Flores, Stephanie Degoutin, Feng Chai, Gwenael Raoul, Jean-Chritophe Hornez, Bernard Martel, Juergen Siepmann, Joel Ferri, Nicolas Blanchemain
Trauma and orthopedic surgery can cause infections as any open surgical procedures. Such complications occur in only1 to 5% of the cases, but the treatment is rather complicated due to bacterial biofilm formation and limited drug access to the site of infection upon systemic administration. An interesting strategy to overcome this type of complications is to prevent bacterial proliferation and biofilm formation via the local and controlled release of antibiotic drugs from the implant itself. Obviously, the incorporation of the drug into the implant should not affect the latter's biological and mechanical properties...
July 1, 2016: Materials Science & Engineering. C, Materials for Biological Applications
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