Treatment Of Prosthetic Infections Research Articles

793. Rifabutin Use in Staphylococcal Prosthetic Material Infections: A Case Series

BackgroundBacterial biofilm formation is of clinical concern among patients with staphylococcal infections involving prosthetic material. While rifampin has in-vitro, animal and clinical data to support its adjunctive role in these types of infections, its potent induction of multiple cytochrome P450 enzymes and P-glycoprotein transport system proteins can pose significant drug-drug interactions. Rifabutin has comparable in-vitro anti-staphylococcal activity but less drug-drug interaction potential than rifampin. However, minimal clinical data exists to support rifabutin use as adjunctive treatment of prosthetic infections.MethodsThis case series describes 7 patients who received adjunctive rifabutin for staphylococcal prosthetic material infections between February 2018 and January 2021 at Massachusetts General Hospital. The primary outcome of infection recurrence was defined as need for surgical intervention for suspected or proven recurrence infection within 6 months after starting rifabutin therapy. Incidence of adverse effects was the main secondary outcome.ResultsMost patients (6/7) had methicillin-sensitive S. aureus (MSSA) and one patient had S. epidermidis infection. Three patients had spinal fusion hardware infection, one patient had hardware-associated spinal osteomyelitis/ diskitis with epidural abscess, two patients had prosthetic joint infection, and one patient had MSSA bacteremia with left ventricular assistance device involvement. All patients except one underwent surgical management prior to starting rifabutin. Infection recurrence was noted in one of seven patients who required surgical washout. Adverse events were uncommon (n=1 treatment-related nausea, n=1 leukopenia).ConclusionThis small case series suggests favorable outcomes with use of rifabutin instead of rifampin for staphylococcal infections with prosthetic material involvement.Disclosures Sandra B. Nelson, MD, UpToDate (Other Financial or Material Support, author)

PROSTHETIC INFECTION TREATMENT BY USING ANTIBIOTIC CEMENT SPACER WITH CUSTOM MOLD: 05 CASES REPORT

Background: According to statistical data of many countries in the wold, the more proportion of patients in hip replacement have, the more prosthetic infection have been treated. In Vietnam, treatment of prosthetic infection is often difficult beacause of antibiotic resistance, high cost treatment and difficult rehabilitation in post-surgery. Nowadays, there are many methods of treatment for prosthetic infected patients, using antibiotic cement spacer for prosthetic infection have applied in common of a lot of countries all over the wold. We report five cases hip prosthetic infection treatment by using antibiotic impregnated cement spacer with custom mold. Aim of study: Inform 05 cases hip prosthetic infection treatment by using antibiotic impregnated cement spacer with custom mold. Methods: Serial cases report. Key words: Prosthetic infection, Antibiotic cement spacer

Experimental study of the application of a new bone cement loaded with broad spectrum antibiotics for the treatment of bone infection

ObjectivesTo evaluate the in vivo behaviour of a new bone cement loaded with antibiotics, in a rabbit bone infection model. Material and methodsSixteen New Zealand rabbits divided into 4 groups were used, depending on the cement (commercial or experimental) and the antibiotic (vancomycin or linezolid) used to control a bone infection caused by Staphylococcus aureus. The commercial cement is Palacos® R and the experimental cement has been achieved by adding PLGA to the solid phase of Palacos® R cement. A novel histological staging method based on bone histoarchitecture has been used. This staging allows us a global vision of bone repair capacity, in the presence of modified cement, and also allows us to correlate the damage generated with the functionality of the tissue. ResultsThe degree of bone destructuration found depended on the type of cement and antibiotic, and was higher in the groups with commercial cement than in the experimental group (p<.01) and in the groups with linezolid with respect to vancomycin (p=.04) The percentage of macrophages varied exclusively depending on the antibiotic used, and was higher in the vancomycin groups (p=.04). DiscussionThe development of new formulations of bone cement that release more, and more prolonged, new generation antibiotics such as linezolid, present an in vivo behaviour superior to commercial cement, respecting the bone structure. This behaviour would have a clinical implication in fighting infections by increasingly resistant germs in the treatment of prosthetic infection.

Estudio experimental de la aplicación de un nuevo cemento óseo cargado con antibióticos de amplio espectro para el tratamiento de la infección ósea

ObjectivesTo evaluate the in vivo behaviour of a new bone cement loaded with antibiotics, in a rabbit bone infection model. Material and methodsSixteen New Zealand rabbits divided into 4 groups were used, depending on the cement (commercial or experimental) and the antibiotic (vancomycin or linezolid) used to control a bone infection caused by Staphylococcus aureus. The commercial cement is Palacos® R and the experimental cement has been achieved by adding PLGA to the solid phase of Palacos® R cement. A novel histological staging method based on bone histoarchitecture has been used. This staging allows us a global vision of bone repair capacity, in the presence of modified cement, and also allows us to correlate the damage generated with the functionality of the tissue. ResultsThe degree of bone destructuration found depended on the type of cement and antibiotic, and was higher in the groups with commercial cement than in the experimental group (P<.01) and in the groups with linezolid with respect to vancomycin (P=.04) The percentage of macrophages varied exclusively depending on the antibiotic used, and was higher in the vancomycin groups (P=.04). DiscussionThe development of new formulations of bone cement that release more, and more prolonged, new generation antibiotics such as linezolid, present an in vivo behaviour superior to commercial cement, respecting the bone structure. This behaviour would have a clinical implication in fighting infections by increasingly resistant germs in the treatment of prosthetic infection.

Prosthetic Hip Joint Infection: An Aluminium Mold for Intraoperative Production of Antibiotic-loaded Cement Hip Prostheses: 3 Cases Report

Introduction: To treat hip prosthetic infection, 2-stage revision, including removal and reimplantation, remains the standard treatment for prosthetic infection. Articulating cement spacer has been shown to provide better functional results after reimplantation. However, its cost as a manufactured product is not cheap and the choice of antibiotics is not flexible either. We designed an aluminium mold to make an antibiotic impregnated cement spacer, and replaced it between the first and the second stage. The current study was conducted to test their clinical efficacy.Case report: We report 3 cases of hip prosthetic infection treatment by using antibiotic impregnated cement spacer made by an aluminium mold. All patients presented to us in first 2-years postoperation and all had a deep infection. Three patients with infected total hip arthroplasties were treated with 2-stage revision using articulating spacers made by an aluminium mold and had a good result.Conclusion: Treating hip prosthetic infection with these articulating spacers eradicates infection effectively, improves the life quality before reimplantation and provides good final results without significant complications.

Alternatives in the treatment of prosthetic infection after the Bentall-de Bono operation

Method In case 1, three months after hospital discharge, a small fistula in the upper sternal scar was observed. When it was explored surgically, the fistula affected the superiorposterior part of the sternum and the pericardium was covering the prosthesis except in a small area over the left distal anastomosis of the dacron graft, which had a drop of pus. Cases 2 and 3 presented clear mediastinitis, with fever, leucocytosis and purulent effusion around the conduit, at 7 and 10 days after Bentall procedure. In case 1 s. Epidermidis was isolated and in cases 2 and 3 enterococci were cultured.

Effects of Vancomycin, Cefazolin and Test Conditions on the Wear Behavior of Bone Cement

Antibiotic cement has been recommended in the treatment of prosthetic infections. The purpose of this study was to investigate the mechanical behavioral changes in cement loaded with two antibiotics, vancomycin and cefazolin, in dry and liquid medium. Six groups and four study conditions were established according to the doses of antibiotic used and the ageing (immersion in phosphate buffered saline) of the samples. Properties evaluated were friction coefficient and wear. Samples in dry medium showed higher wears than in liquid. Antibiotic selection did not influence wear properties tested in dry conditions, however, in liquid medium, there were higher frictional coefficients and wear for cefazolin loaded cement after one week and for vancomycin and cefazolin after one month. The results suggest that antibiotic cements behave differently in liquid and that the molecular characteristics of antibiotics are essential for determining this influence.