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PJI prevention

John M Thompson, Vikram Saini, Alyssa G Ashbaugh, Robert J Miller, Alvaro A Ordonez, Roger V Ortines, Yu Wang, Robert S Sterling, Sanjay K Jain, Lloyd S Miller
BACKGROUND: The medical treatment of periprosthetic joint infection (PJI) involves prolonged systemic antibiotic courses, often with suboptimal clinical outcomes including increased morbidity and health-care costs. Oral and intravenous monotherapies and combination antibiotic regimens were evaluated in a mouse model of methicillin-resistant Staphylococcus aureus (MRSA) PJI. METHODS: Oral linezolid with or without oral rifampin, intravenous vancomycin with oral rifampin, intravenous daptomycin or ceftaroline with or without oral rifampin, oral doxycycline, or sham treatment were administered at human-exposure doses for 6 weeks in a mouse model of PJI...
April 19, 2017: Journal of Bone and Joint Surgery. American Volume
John Segreti, Javad Parvizi, Elie Berbari, Philip Ricks, Sandra I Berríos-Torres
Peri-prosthetic joint infection (PJI) is a severe complication of total joint arthroplasty that appears to be increasing as more of these procedures are performed. Numerous risk factors for incisional (superficial and deep) and organ/space (e.g., PJI) surgical site infections (SSIs) have been identified. A better understanding and reversal of modifiable risk factors may lead to a reduction in the incidence of incisional SSI and PJI. The Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recently updated the national Guideline for Prevention of Surgical Site Infection...
April 13, 2017: Surgical Infections
V Prendki, T Ferry, P Sergent, E Oziol, E Forestier, T Fraisse, S Tounes, S Ansart, J Gaillat, S Bayle, O Ruyer, F Borlot, G Le Falher, B Simorre, F-A Dauchy, S Greffe, T Bauer, E N Bell, B Martha, M Martinot, M Froidure, M Buisson, A Waldner, X Lemaire, A Bosseray, M Maillet, V Charvet, A Barrelet, B Wyplosz, M Noaillon, E Denes, E Beretti, M Berlioz-Thibal, V Meyssonnier, E Fourniols, L Tliba, A Eden, M Jean, C Arvieux, K Guignery-Kadri, C Ronde-Oustau, Y Hansmann, A Belkacem, F Bouchand, G Gavazzi, F Herrmann, J Stirnemann, A Dinh
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI...
April 4, 2017: European Journal of Clinical Microbiology & Infectious Diseases
Nicholas T Ting, Craig J Della Valle
BACKGROUND: Periprosthetic joint infection (PJI) remains one of the most challenging and devastating modes of failure after total hip and knee arthroplasties. Despite the profound urgency and impact of PJI on an individual and societal basis, historically, there have not been standardized definitions of and diagnostic algorithms for infection after total joint arthroplasty. METHODS: In a recent symposium, the American Academy of Hip and Knee Surgeons put forth a standardized approach to the prevention, diagnosis, and management of the patient with a suspected PJI...
March 2, 2017: Journal of Arthroplasty
Clare M McNally, Renuka Visvanathan, Sharon Liberali, Robert J Adams
BACKGROUND: Antibiotic prophylaxis before dental treatment is routinely recommended by orthopaedic surgeons to prevent prosthetic joint infection (PJI). This recommendation is at odds with current guidelines. METHODS: A postal survey of 9 checkbox or short-answer questions was completed by 633 orthopaedic surgeons. RESULTS: The majority of respondents (n = 186 of 260, 72%) believe that antibiotic prophylaxis is required indefinitely for dental treatment...
September 2016: Arthroplasty Today
S K Kunutsor, M R Whitehouse, A W Blom, A D Beswick
Accurate identification of individuals at high risk of surgical site infections (SSIs) or periprosthetic joint infections (PJIs) influences clinical decisions and development of preventive strategies. We aimed to determine progress in the development and validation of risk prediction models for SSI or PJI using a systematic review. We searched for studies that have developed or validated a risk prediction tool for SSI or PJI following joint replacement in MEDLINE, EMBASE, Web of Science and Cochrane databases; trial registers and reference lists of studies up to September 2016...
March 7, 2017: Epidemiology and Infection
Per Hviid Gundtoft, Alma Becic Pedersen, Claus Varnum, Søren Overgaard
BACKGROUND: Revision for prosthetic joint infection (PJI) has a major effect on patients' health but it remains unclear if early PJI after primary THA is associated with a high mortality. QUESTIONS/PURPOSES: (1) Do patients with a revision for PJI within 1 year of primary THA have increased mortality compared with patients who do not undergo revision for any reason within 1 year of primary THA? (2) Do patients who undergo a revision for PJI within 1 year of primary THA have an increased mortality risk compared with patients who undergo an aseptic revision? (3) Are there particular bacteria among patients with PJI that are associated with an increased risk of death? METHODS: This population-based cohort study was based on the longitudinally maintained Danish Hip Arthroplasty Register on primary THA performed in Denmark from 2005 to 2014...
February 24, 2017: Clinical Orthopaedics and related Research
Timothy L Tan, Miguel M Gomez, Michael M Kheir, Mitchell G Maltenfort, Antonia F Chen
BACKGROUND: Preoperative antibiotic prophylaxis remains one of the most important strategies for preventing periprosthetic joint infection (PJI). Current guidelines recommend giving universal antibiotic prophylaxis to all total joint arthroplasty patients regardless of their medical conditions or immune status; however, no studies have evaluated the individualizing of antibiotics. The aims of this study were (1) to determine if comorbidities influence the organism profile of PJIs, and (2) to investigate if the efficacy of two different perioperative antibiotics (cefazolin or vancomycin) for preventing PJI is affected by patient's comorbidities...
November 23, 2016: Journal of Arthroplasty
W J Metsemakers, R Kuehl, T F Moriarty, R G Richards, M H J Verhofstad, O Borens, S Kates, M Morgenstern
One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). IAFF may result in permanent functional loss or even amputation of the affected limb in patients who may otherwise be expected to achieve complete, uneventful healing. Over the past decades, the problem of implant related bone infections has garnered increasing attention both in the clinical as well as preclinical arenas; however this has primarily been focused upon prosthetic joint infection (PJI), rather than on IAFF...
September 11, 2016: Injury
David M Levy, Nathan G Wetters, Brett R Levine
Periprosthetic joint infection (PJI) is a rare but devastating complication of arthroplasty. Research has been dedicated to minimizing the incidence of PJI, leading to the development of a comprehensive perioperative approach. Multiple preoperative, intraoperative, and postoperative factors can increase patient risk. From medical management and skin sterilization to wound sterility and blood management, multiple issues must be considered in a well-rounded prevention protocol. In this literature review, we consolidate the current information that orthopedic surgeons can use to minimize PJI after total knee arthroplasty and total hip arthroplasty...
July 2016: American Journal of Orthopedics
Benjamin M Zmistowski, Jorge Manrique, Ripal Patel, Antonia F Chen
BACKGROUND: Irrigation and debridement with prosthetic retention (I&D) is an oft-utilized treatment option for PJI, despite its known limited success. While it is known that nearly half of all patients treated with I&D have recurrent infection, the organism persistence between infection events remains unreported. In addition, identifying those cases in which I&D routinely failed to eradicate the infection (not simply prevent recurrent infection) may allow improved patient selection for this less morbid procedure-a difficult task to date...
September 2016: Journal of Arthroplasty
Giuseppe Solarino, Antonella Abate, Giovanni Vicenti, Antonio Spinarelli, Andrea Piazzolla, Biagio Moretti
Periprosthetic joint infection (PJI) remains one of the most challenging complications after joint arthroplasty. Despite improvements in surgical techniques and in the use of antibiotic prophylaxis, it remains a major cause of implant failure and need for revision. PJI is associated with both human host-related and bacterial agent-related factors that can interact in all the phases of the procedure (preoperative, intraoperative and postoperative). Prevention is the first strategy to implement in order to minimize this catastrophic complication...
October 2015: Joints
Camelia E Marculescu, Tad Mabry, Elie F Berbari
Prosthetic joint infections (PJI), although rare, represent a serious complication of total joint arthroplasty as they pose not only a direct financial burden to the patient but also an indirect burden related to psychosocial impact that PJI incur on the patient. Treatment of PJI is complex and requires a combined surgical and medical approach. Patients are often subjected to multiple surgical procedures and prolonged courses of antimicrobial therapy. Therefore, all efforts should be directed toward maximizing the prophylactic measures in the peri-operative and post-operative phases in order to prevent the occurrence of surgical site infections...
April 2016: Surgical Infections
Emine Alp, Fatma Cevahir, Safiye Ersoy, Ahmet Guney
In this study, we aimed to evaluate the incidence and economic burden of prosthetic joint infections (PJIs) in a university hospital in a middle-income country. Surveillance data between April 2011 and April 2013 in the Orthopedic Surgery Department was evaluated. Patients (>16 years old) who had primary arthroplasty in Erciyes University were included in the study, and patients with preoperative infection were excluded. Patients were followed up during their stay in the hospital and during readmission to the hospital for PJI by a trained Infection Control Nurse...
July 2016: Journal of Infection and Public Health
Madhav Chowdhry, Antonia F Chen
BACKGROUND: Preventing post-surgical complications after total joint arthroplasty (TJA) is of great importance, and application of an appropriate wound dressing is necessary. Since no dressing encompasses all the parameters required for ideal wound healing, a comparison of the available dressing types can assist the surgeon to choose the best dressing after TJA. METHODS: Studies evaluating postoperative wound dressings after TJA were reviewed in order to assess the outcomes, complications and costs associated with dressing types...
October 2015: Annals of Translational Medicine
Aleeson Eka, Antonia F Chen
Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA). Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors. Medical risk factors, such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), preoperative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery...
September 2015: Annals of Translational Medicine
I J Banke, R von Eisenhart-Rothe, H M L Mühlhofer
BACKGROUND: Prosthetic joint infection (PJI) is challenging for patients and orthopedic surgeons and represents a great economic burden to the health care system. The growing number of primary and revision arthroplasty procedures in an aging society with demographic changes will increase the number of PJIs in the future. AIM: This article presents an overview of the epidemiology and prevention of PJI. METHOD: A selective literature review was performed focusing on evidence-based epidemiology, risk factors, and prevention of PJI...
December 2015: Der Orthopäde
Daniel D Skaar, Taehwan Park, Marc F Swiontkowski, Karen M Kuntz
BACKGROUND: Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. METHODS: The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA)...
November 2015: Journal of the American Dental Association
Jian'gang Cao, Jun Liu
OBJECTIVE: To summarize the recent progress in prevention of prosthetic joint infection (PJI) so as to provide clinical references. METHODS: The publications concerning the etiology and surgical management of PJI were reviewed, analyzed, and summarized. RESULTS: The prevention of PJI is related to preoperative, intraoperative, and postoperative aspects of PJI, comprehensive treatment is considered to be the most common method for PJI. CONCLUSION: These prevention strategies that may be utilized in all phases of perioperative care, a multifaceted approach to the patient undergoing total joint replacement will have the greatest positive effect...
February 2015: Chinese Journal of Reparative and Reconstructive Surgery
Zachary Jones, Amanda E Brooks, Zachary Ferrell, David W Grainger, Kristofer D Sinclair
Periprosthetic joint infection (PJI) following total knee arthroplasty is a globally increasing procedural complication. These infections are difficult to treat and typically require revision surgery. Antibiotic-loaded bone cement is frequently utilized to deliver antibiotics to the site of infection; however, bone cement is a nondegrading foreign body and known to leach its antibiotic load, after an initial burst release, at subtherapeutic concentrations for months. This work characterized a resorbable, antibiotic-eluting bone void filler designed to restore bone volume and prevent PJI...
August 31, 2015: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
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