- MeSH
- antibakteriální látky aplikace a dávkování farmakologie terapeutické užití MeSH
- dexamethason terapeutické užití MeSH
- diagnostické zobrazování metody MeSH
- diferenciální diagnóza MeSH
- klinické laboratorní techniky metody MeSH
- lidé MeSH
- nozokomiální pneumonie farmakoterapie MeSH
- oxygenoterapie MeSH
- pneumonie * diagnóza farmakoterapie klasifikace MeSH
- rentgendiagnostika hrudníku metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
PURPOSE OF THE STUDY Infections of joint replacements represent one of the most serious problems in contemporary orthopedics. The joint infections treatment is usually multimodal and involves various combinations of drug delivery and surgical procedures. The aim of this study was to evaluate and compare the bacteriostatic and bactericidal properties of the most common antibiotic carriers used in orthopedic surgery: bone cements mixed with antibiotic and porous calcium sulfate mixed with antibiotic. MATERIAL AND METHODS Three commercial bone cements (Palacos®, Palacos® R+G, Vancogenx®) and commercial porous sulfate (Stimulan®) were prepared with a known concentration of vancomycin (a glycopeptide antibiotic). Specifically, for the purpose of our study, the testing specimens were prepared to release 0, 1, 2, 4, 8, 16, 32, 64, 128, 256, and 512 mg of vancomycin into 1 liter of solution. The specimens with increasing amount of antibiotic were placed in a separate tubes containing 5 mL of Mueller-Hinton broth inoculated with a suspension (0.1 m, McFarland 1) of the reference strain CCM 4223 Staphylococcus aureus to evaluate their bacteriostatic properties (broth dilution method). After this initial incubation and evaluation of the broth dilution method, an inoculum from each tube was transferred onto blood agar plates. After another 24-hour incubation under the same conditions, we evaluated the bactericidal properties (agar plate method). As many as 132 of independent experiments were performed (4 specimens × 11 concentrations × 3 repetitions = 132). RESULTS The bacteriostatic properties of all investigated samples were excellent, perhaps with the exception of the first bone cement (Palacos®). The sample Palacos® started to exhibit bacteriostatic properties at concentrations ≥ 8 mg/mL, while all other samples (Palacos R+G®, Vancogenx®, and Stimulan®) were bacteriostatic in the whole concentration range starting from 1 mg/mL. The bacteriocidic properties did not show such clear trends, but correlated quite well with different properties of the investigated samples during mixing - the most homogeneous samples seemed to exhibit the best and the most reproducible results. DISCUSSION The reliable and reproducible comparison of ATB carriers is a difficult task. The situation is complicated by high numbers of local antibiotic carriers on the market, numerous antibiotics used, and differences in clinical trials at different laboratories. Simple in vitro testing of bacteriostatic and bacteriocidic properties represents a simple and efficient approach to the problem. CONCLUSIONS The study confirmed that the two most common commercial systems used in the orthopedic surgery (bone cements and porous calcium sulfate) prevent bacterial growth (bacteriostatic effect), but they may not be 100% efficient in complete elimination of bacteria (bacteriocidic effect). The scattered results in the case of bacteriocidic tests seemed to be connected with the homogeneity of ATB dispersion in the systems and with the lower reproducibility of the employed agar plate method. Key words: local release of antibiotics; bone cements; calcium sulfate; antimicrobial susceptibility.
- MeSH
- agar MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- kostní cementy farmakologie terapeutické užití MeSH
- lidé MeSH
- ortopedické výkony * MeSH
- ortopedie * MeSH
- polymethylmethakrylát chemie MeSH
- reprodukovatelnost výsledků MeSH
- síran vápenatý MeSH
- vankomycin farmakologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Periprosthetic joint infections in total knee arthroplasty (TKA) represent one of the most limiting factors of implantation. Frequency of this complication is up to 2.5% in primary implantation. Revision TKA with the use of DAIR (Debridement, Antibiotics and Implant Retention) procedure is a widely accepted method in treating infection, but the indication criteria have not been clearly defined as yet. The lack of uniformity prevails also with respect to the surgical technique and the importance of respective techniques for successful treatment. The purpose of this study was to evaluate the factors affecting the twoyear survival of TKA after treating the infection by DAIR. MATERIAL AND METHODS We conducted a monocentric retrospective analysis involving 52 cases of infected TKA managed with DAIR in the period between 2007 and 2016. The evaluation took into account such factors as the sex, age, history of revision surgery for aseptic or septic reasons, and pathogens. The patients were divided into groups based on the McPherson criteria. As to the procedure, we monitored the effect of administered antibiotics, time interval between the manifestation of symptoms of TKA infection and surgery, exchange of modular parts, and use of pulse lavage, continual lavage, local antibiotic carrier, or combination of these techniques. Treatment failure was defined as persistent infection and transition to chronic suppressive antibiotic therapy or need for revision surgery of the respective joint due to recurrent infection of TKA, or death directly associated with the treatment of infected TKA in the follow-up period of 2 years after DAIR. The R software (Team Development Core, 2017) was used to carry out the statistical analysis. The target variable was the failure at two years after surgery. The Generalized Linear Model (GLM) was used for the binary dependent variable - the socalled logistic model with a logit link function. RESULTS 32 of 52 patients (61.5%) were successfully treated, of whom 18 women (62.1%) and 14 men (60.9%). The effect of causative agent, administered antibiotics, polyethylene insert exchange, McPherson score or history of revision surgery of the respective joint for aseptic reasons was not confirmed. The history of revision surgery for infection of the affected joint had a strong negative impact on treatment success, 10 of 13 (76.9%) implants failed as against 10 of 39 (25.6%) implants with negative history of infection. The mean time from surgery to the manifestation of infection was 5.9 weeks (0.5-47.5). When surgery was performed within 2 weeks from the manifestation of infection, 1 of 15 (6.7%) cases failed. In case of a later surgery, 19 of 37 (51.4%) cases failed. As concerns the used surgical technique, 60% (9/15) failure was reported in case of the combination of pulse lavage and continual lavage, 36.4% (4/11) in case of the combination of pulse lavage and local antibiotic carrier, 25% (4/16) in case of separate continual lavage, and 66.7% (2/3) in case of continual lavage with local antibiotic carrier. DISCUSSION The importance of individual factors in revision surgery of periprosthetic joint infections of TKA remains unclear. The world literature indicates as a major negative effect the time factor, the positive history of infection of the affected implant, or other previous revision surgery for aseptic reasons. Ambiguous results are achieved in assessing the effect of the pathogen, administered antibiotics or presence of fistula, the statistical significance of which has not been confirmed in our study. Questionable is also the importance of individual surgical techniques. CONCLUSIONS DAIR is a suitable method in treating infections of stable TKA without the history of revision surgery for infection. The surgery should be performed within 2 weeks from the manifestation of symptoms. Key words: debridement, antibiotics, infection, implant retention, total knee arthroplasty.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- debridement MeSH
- infekce spojené s protézou * chirurgie MeSH
- lidé MeSH
- míra přežití MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- antibakteriální látky aplikace a dávkování terapeutické užití MeSH
- bakteriální léková rezistence MeSH
- fluorochinolony * aplikace a dávkování klasifikace terapeutické užití MeSH
- lékové interakce MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- směrnice pro lékařskou praxi MeSH
Volba antibiotik v prostředí narůstající rezistence původců bakteriálních infekcí vyžaduje vysoce zodpovědný přístup. Důvodem je jak dosažení spolehlivého účinku, tak i prevence dalšího šíření rezistence. Nezbytným podkladem pro empirické podání jsou aktuální přehledy rezistence, optimálně pak identifikace a stanovení citlivosti konkrétního patogena pro cílenou léčbu. Výběr vhodných přípravků pro léčbu komunitních infekcí (uroinfekcí) by měl respektovat národní doporučení, terapie nemocničních infekcí pak vycházet z lokálních epidemiologických podmínek. Pro léčbu infekcí vyvolaných multirezistentními mikroorganismy je perspektivních v současné době několik přípravků (ceftolozan/tazobaktam, ceftazidim/avibaktam, pivmecilinam).
In the setting of increasing resistance in the causative agents of bacterial infections, the choice of antibiotics requires a highly responsible approach. The reasons for this are both achieving a reliable effect and preventing further spread of resistance. Current reviews of resistance are an essential basis for empirical administration, optimally followed by identification and susceptibility testing of a particular pathogen for targeted therapy. The selection of appropriate drugs for treating community-acquired infections (urinary infections) should respect national guidelines, and the treatment of hospital-acquired infections should be adapted to local epidemiological conditions. Several drugs have recently shown promise in treating infections caused by multiresistant microorganisms (ceftolozane/tazobactam, ceftazidime/avibactam, pivmecillinam).
- MeSH
- antibakteriální látky MeSH
- infekce močového ústrojí terapie MeSH
- lidé MeSH
- mnohočetná bakteriální léková rezistence MeSH
- nemocnice MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- klostridiové infekce * diagnóza prevence a kontrola terapie MeSH
- kongresy jako téma * MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
