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Antibiotics
Special Issues
Advances in Orthopedic Infection Management and Antibiotic Treatment
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Advances in Orthopedic Infection Management and Antibiotic Treatment

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 7998

Special Issue Editors

Dr. Carlo Perisano

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Guest Editor
Orthopedics and Trauma Surgery Unit, Department of Aging, Orthopedic and Rheumatologic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: trauma surgery; orthopedic; hip fracture; arthroplasty; osteoporosis; bone tumors
Special Issues, Collections and Topics in MDPI journals
Dr. Nicola Mondanelli

E-Mail Website
Guest Editor
Department of Medicine Surgery and Neurosciences, University of Siena, Siena, Italy
Interests: joint replacement; trauma surgery; bone stock; bone infection; bone tumor; intra-operative fracture; loose stem; post-operative fracture
Dr. Massimiliano Mosca

E-Mail Website
Guest Editor
U.O. Ortopedia Bentivoglio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Interests: foot and ankle; total ankle replacement; trauma; foot and ankle deformities; sports medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Infections in orthopedic and trauma surgery include surgical site infections, periprosthetic joint infections, fracture-related infections, and biomaterial- or implant-associated infections. In recent years, numerous efforts have focused on the research of early diagnostic markers or local infection sensors, implant coatings, and local antibiotics on the infection site. Despite this, infections still remain a major problem, a devastating complication, and above all, a treatment challenge for the orthopedic and trauma surgeon. The aim of this Special Issue is to collect studies on epidemiology and methods for the diagnosis, prevention, and treatment of infections of the musculoskeletal system.

All submission types, including original research manuscripts, short communications, reviews, and case reports, are appreciated.

Dr. Carlo Perisano
Dr. Nicola Mondanelli
Dr. Massimiliano Mosca
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

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

  • bone infection
  • surgical site infections
  • periprosthetic joint infections
  • fracture-related infections
  • coatings implant
  • osteomyelitis

Published Papers (7 papers)

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Research

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12 pages, 1161 KiB  
Article
Outcome and Predictors of Treatment Failure in Chronic Osteomyelitis Using Bioactive Glass Granules and Putty Formulations
by Adriana Macedo Dell’Aquila, Gabriela Nagy Baldy dos Reis, Gabriel Trova Cuba, Walter Hamilton de Castro Targa, José Carlos Bongiovanni, Thomas Stravinskas Durigon, Mauro José Salles and Fernando Baldy dos Reis
Antibiotics 2023, 12(12), 1720; https://doi.org/10.3390/antibiotics12121720 - 13 Dec 2023
Viewed by 790
Abstract
Background: The aim of this study is to evaluate the outcome of patients with cavitary chronic osteomyelitis undergoing adjuvant treatment with bioactive glass (BAG) S53P4 and identify the independent risk factors (RFs) for recurrence in 6- and 12-month patient follow-up. Methods: A retrospective, [...] Read more.
Background: The aim of this study is to evaluate the outcome of patients with cavitary chronic osteomyelitis undergoing adjuvant treatment with bioactive glass (BAG) S53P4 and identify the independent risk factors (RFs) for recurrence in 6- and 12-month patient follow-up. Methods: A retrospective, multicentre observational study conducted in tertiary specialised hospitals among patients undergoing the surgical treatment of chronic cavitary osteomyelitis using BAG-S53P4 in a granule and/or putty formulation to assess the clinical outcome and RFs for failure in 6- and 12-month patient follow-up. Results: Of the 92 and 78 patients with 6-month and 12-month follow-ups, infection was eradicated in 85.9% and 87.2%, respectively. In the 6-month follow-up, BAG-S53P4 in the granule formulation presented a greater risk of recurrence compared to the bioactive glass putty formulation or combined granules and putty (prevalence ratio (PR) = 3.04; confidence interval 95% [CI95%]: 1.13–10.52) and neoplasia (PR = 5.26; CI95%: 1.17–15.52). In the 12-month follow-up cohort of 78 patients, smoking (PR = 4.0; 95% CI: 1.03–15.52) and nonfermenting GNB infection (PR = 3.87; CI95%: 1.09–13.73) presented a greater risk of recurrence. Conclusions: BAG-S53P4 is a viable option for bone-void filling and the treatment of chronic cavitary osteomyelitis. Formulations of BAG with putty or in combination with granules showed better results. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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13 pages, 995 KiB  
Article
Early Staphylococcal Periprosthetic Joint Infection (PJI) Treated with Debridement, Antibiotics, and Implant Retention (DAIR): Inferior Outcomes in Patients with Staphylococci Resistant to Rifampicin
by Hannah K. Eriksson, Stergios Lazarinis, Josef D. Järhult and Nils P. Hailer
Antibiotics 2023, 12(11), 1589; https://doi.org/10.3390/antibiotics12111589 - 03 Nov 2023
Viewed by 929
Abstract
It is unknown how rifampicin resistance in staphylococci causing a periprosthetic joint infection (PJI) affects outcomes after debridement, antibiotics, and implant retention (DAIR). We thus aimed to compare the risk of relapse in DAIR-treated early PJI caused by staphylococci with or without rifampicin [...] Read more.
It is unknown how rifampicin resistance in staphylococci causing a periprosthetic joint infection (PJI) affects outcomes after debridement, antibiotics, and implant retention (DAIR). We thus aimed to compare the risk of relapse in DAIR-treated early PJI caused by staphylococci with or without rifampicin resistance. In total, 81 patients affected by early PJI were included, and all patients were treated surgically with DAIR. This was repeated if needed. The endpoint of relapse-free survival was estimated using the Kaplan–Meier method, and Cox regression models were fitted to assess the risk of infection relapse for patients infected with rifampicin-resistant bacteria, adjusted for age, sex, type of joint, and type of index surgery. In patients with rifampicin-resistant staphylococci, relapse was seen in 80% after one DAIR procedure and in 70% after two DAIR procedures. In patients with rifampicin-sensitive bacteria, 51% had an infection relapse after one DAIR procedure and 33% had an infection relapse after two DAIR procedures. Patients with rifampicin-resistant staphylococcal PJI thus had an increased adjusted risk of infection relapse of 1.9 (95% CI: 1.1–3.6, p = 0.04) after one DAIR procedure compared to patients with rifampicin-sensitive bacteria and a 4.1-fold (95% CI: 1.2–14.1, p = 0.03) increase in risk of infection relapse after two DAIR procedures. Staphylococcal resistance to rifampicin is associated with inferior outcomes after DAIR. These findings suggest that DAIR may not be a useful strategy in early PJI caused by rifampicin-resistant staphylococci. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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11 pages, 2031 KiB  
Article
A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone Cement
by Benedikt Paul Blersch, Michael Barthels, Philipp Schuster and Bernd Fink
Antibiotics 2023, 12(9), 1368; https://doi.org/10.3390/antibiotics12091368 - 25 Aug 2023
Cited by 1 | Viewed by 897
Abstract
Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate [...] Read more.
Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections. Methods: We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics—gentamycin and clindamycin—was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0–115.0) months. Results: Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%. Survival for any reason was significantly different between the types of revision (p = 0.026, Log-Rank-test), with lower survival rates after more complex surgical procedures. The 5-year survival rate with regard to revision for any reason was 91.3% [88.2–94.4%] and with regard to revision for PJI 98.2% [98.7–99.9%], respectively. Conclusion: The use of the dual-antibiotic-impregnated bone cement Copal G+C results in a lower rate of periprosthetic infections after aseptic knee prosthesis replacement than that reported in published prosthesis revisions using only one antibiotic in the bone cement. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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19 pages, 4248 KiB  
Article
Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study
by Chittawee Jiamton, Adinun Apivatgaroon, Saree Aunaramwat, Banchai Chawalitrujiwong, Chaiwat Chuaychoosakoon, Sitthiphong Suwannaphisit, Choen Jirawison, Chonlathan Iamsumang, Pinkawas Kongmalai, Pawaris Sukvanich, Pongtep Na Nakorn, Worawit Ongbumrungphan, Pawin Rattanasumrit, Suthee Tharakulphan, Thanachai Thongtanworapat, Faungchat Thammarakcharoen, Autcharaporn Srion, Jintamai Suwanprateeb and Bancha Chernchujit
Antibiotics 2023, 12(6), 1049; https://doi.org/10.3390/antibiotics12061049 - 15 Jun 2023
Cited by 1 | Viewed by 1905
Abstract
Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) [...] Read more.
Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) beads for chronic osteomyelitis treatment. A total of 62 patients were enrolled in this study. After radical surgical debridement, the bone defect was filled with three types of antibiotics (vancomycin or gentamicin or fosfomycin) impregnated HA beads. The follow-up period was 48 weeks. It was found that the success rate was approximately 98% with a re-infection in only one patient. Quality of life of all patients after treatment improved significantly over time. Systemic exposure to vancomycin and gentamicin after beads implantation was limited and high local antibiotics concentrations were found in wound drainage fluid at 24, 48 and 72 h. Blood biochemistry measurements did not show any nephrotoxic or hepatotoxic effects. 20 adverse events were reported, but 90% of the events were resolved without having to remove the beads and the patients recovered. Satisfactory outcomes were observed in terms of success rate, quality of life and adverse effect. nHA-ATB beads impregnated by vancomycin or gentamicin or fosfomycin could potentially be employed as an alternative product of choice for localized antibiotics delivery in chronic osteomyelitis treatment. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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Review

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19 pages, 4293 KiB  
Review
Diagnostics in Late Periprosthetic Infections—Challenges and Solutions
by Florian Hubert Sax, Marius Hoyka, Benedikt Paul Blersch and Bernd Fink
Antibiotics 2024, 13(4), 351; https://doi.org/10.3390/antibiotics13040351 - 11 Apr 2024
Viewed by 412
Abstract
The rising number of arthroplasties is combined with a rising number of periprosthetic joint infections, which leads to life-concerning consequences for the patients, including extended antibiotic treatment, further surgery and increased mortality. The heterogeneity of the symptoms and inflammatory response of the patients [...] Read more.
The rising number of arthroplasties is combined with a rising number of periprosthetic joint infections, which leads to life-concerning consequences for the patients, including extended antibiotic treatment, further surgery and increased mortality. The heterogeneity of the symptoms and inflammatory response of the patients due to, e.g., age and comorbidities and the absence of a single diagnostic test with 100% accuracy make it very challenging to choose the right parameters to confirm or deny a periprosthetic joint infection and to establish a standardized definition. In recent years, additional diagnostic possibilities have emerged primarily through the increasing availability of new diagnostic methods, such as genetic techniques. The aim of the review is to provide an overview of the current state of knowledge about the various tests, including the latest developments. The combination of different tests increases the accuracy of the diagnosis. Each physician or clinical department must select the tests from the available methods that can be best implemented for them in organizational and technical terms. Serological parameters and the cultivation of the samples from aspiration or biopsy should be combined with additional synovial tests to create an accurate figure for the failure of the prosthesis, while imaging procedures are used to obtain additional information for the planned therapeutic procedure. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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15 pages, 8412 KiB  
Review
Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature
by Marcos R. Gonzalez, Juan Pretell-Mazzini and Santiago A. Lozano-Calderon
Antibiotics 2024, 13(1), 25; https://doi.org/10.3390/antibiotics13010025 - 26 Dec 2023
Cited by 1 | Viewed by 1194
Abstract
Prosthetic joint infection (PJI) is the most common mode of failure of megaprostheses, yet the literature on the topic is scarce, and studies report conflicting data regarding the optimal treatment strategy. Patients with megaprostheses PJI are often immunosuppressed, and surgeons must balance the [...] Read more.
Prosthetic joint infection (PJI) is the most common mode of failure of megaprostheses, yet the literature on the topic is scarce, and studies report conflicting data regarding the optimal treatment strategy. Patients with megaprostheses PJI are often immunosuppressed, and surgeons must balance the trade-off between treatment efficacy and morbidity associated with the surgery aiming for infection eradication. Our review on megaprostheses PJI focuses on two axes: (1) risk factors and preventative strategies; and (2) surgical strategies to manage this condition. Risk factors were classified as either unmodifiable or modifiable. Attempts to decrease the risk of PJI should target the latter group. Strategies to prevent PJI include the use of silver-coated implants, timely discontinuation of perioperative antibiotic prophylaxis, and adequate soft tissue coverage to diminish the amount of dead space. Regarding surgical treatment, main strategies include debridement, antibiotics, implant retention (DAIR), DAIR with modular component exchange, stem retention (DAIR plus), one-stage, and two-stage revision. Two-stage revision is the “gold standard” for PJI in conventional implants; however, its success hinges on adequate soft tissue coverage and willingness of patients to tolerate a spacer for a minimum of 6 weeks. DAIR plus and one-stage revisions may be appropriate for a select group of patients who cannot endure the morbidity of two surgeries. Moreover, whenever DAIR is considered, exchange of the modular components should be performed (DAIR plus). Due to the low volume of megaprostheses implanted, studies assessing PJI should be conducted in a multi-institutional fashion. This would allow for more meaningful comparison of groups, with sufficient statistical power. Level of evidence: IV. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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Other

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11 pages, 3675 KiB  
Systematic Review
Antibiotic-Coated Intramedullary Nailing Managing Long Bone Infected Non-Unions: A Meta-Analysis of Comparative Studies
by Amirhossein Ghaseminejad-Raeini, Alireza Azarboo, Kasra Pirahesh, Amirmohammad Sharafi, Amir Human Hoveidaei, Basilia Onyinyechukwu Nwankwo, Abhijith Annasamudram and Janet D. Conway
Antibiotics 2024, 13(1), 69; https://doi.org/10.3390/antibiotics13010069 - 10 Jan 2024
Viewed by 1080
Abstract
Long bone infected non-unions are such an orthopedic challenge that antibiotic-coated intramedullary nailing (ACIN) has become a viable therapeutic option for their management. This study aims to provide a comprehensive assessment of the available data about the use of antibiotic-coated nailing in the [...] Read more.
Long bone infected non-unions are such an orthopedic challenge that antibiotic-coated intramedullary nailing (ACIN) has become a viable therapeutic option for their management. This study aims to provide a comprehensive assessment of the available data about the use of antibiotic-coated nailing in the treatment of long bone infected non-unions. Following the PRISMA guideline in this meta-analysis, a systematic literature search was conducted across major databases for studies evaluating ACIN in long bone infected non-unions. The primary outcome measures included union rates, infection control, complications and functional status. Five eligible studies encompassing 183 patients in total met the inclusion criteria. The meta-analysis revealed no difference in the union rate in the antibiotic-coated intramedullary nailing group compared to that of the control group (OR = 1.73 [0.75–4.02]). Antibiotic-coated intramedullary nailing demonstrated no association with higher infection eradication (OR = 2.10 [0.97–4.54]). Also, functional outcome measure was mostly not significantly different between ACIN and control interventions. According to this meta-analysis, compared to the management of controls, ACIN is neither linked to increased union rates nor decreased infection rates. The paucity of research on this topic emphasizes the continuous need for additional well-designed randomized controlled trials for the application of antibiotics-coated intramedullary nailing in long bone non-unions. Full article
(This article belongs to the Special Issue Advances in Orthopedic Infection Management and Antibiotic Treatment)
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