Aim
Method
Swedish guidelines on antibiotic prophylaxis in arthroplasty surgery recommend cloxacillin in fixed doses that pay little attention to the patient's renal function and weight. Nevertheless, there are no studies on whether the resulting free prophylactic cloxacillin We performed a prospective two-centre study, measuring the free (active) cloxacillin concentrations in plasma throughout surgery, in patients subject to primary hip and knee prosthetic joint replacements, aiming at 100 patients per centre. To account for plasma-bone exposure differences, concentrations were considered adequate if twice the epidemiological cut-off value for cloxacillin concerning wild type Aim
Method
Dalbavancin is a lipoglycopeptide with a broad antimicrobial spectrum against Gram-positive bacteria and effect against microorganisms in biofilm in vitro. Its pharmacokinetic properties, with an exceptionally long half-life of approximately 300 hours, allow for simplified administration that may be of value in the long-term treatment of bone and joint infections, such as prosthetic joint infections (PJIs). Several case reports and case series with “off-lable” treatment with dalbavancin of PJIs exist, but the optimal dosing regimen remains to be defined. Therapeutic drug monitoring (TDM) is recommended for treatment with >2 doses of dalbavancin. In the absence of TDM, the Swedish national guidelines for bone and joint infections (2023, Twelve patients with PJI were treated with at least 6 doses of dalbavancin, of which the first two doses were 1500 mg and the following doses were 1000 every second week, and prospectively sampled biweekly for determination of serum concentrations (trough levels) of dalbavancin which was measured by liquid chromatography coupled to electrospray tandem mass spectrometry (LC-MS/MS). The renal function was also examined.Aim
Method
Prosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life, and high healthcare costs. In 2009 a nationwide, multidisciplinary infection control program was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%. The primary aim was to investigate whether the PRISS project reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis. We obtained data on patients undergoing primary THA in Sweden (n = 45,723 patients, 49,946 THAs), 2012–2014. Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks antibiotic consumption were reviewed to verify PJI diagnosis (n = 2240, 2569 THAs).Aim
Method
Dalbavancin is a novel second-generation lipoglycopeptide antibiotic with strong activity against many gram-positive bacteria and a prolonged half-life of 6–11 days. This allows a once-a-week intravenous application and therefore an outpatient intravenous therapy. Currently, only little is known about the use of Dalbavancin in Periprosthetic joint infection (PJI). The aim of this retrospective study, was to compare the outcome of hip and knee periprosthetic joint infections (PJI) in patients who received dalbavancin (DAL) with patients which was treated by standard of care antimicrobial agents (SoC). Between 02/2017 and 02/2020 a total of 89 (42 male/47 female) patients with PJI of the hip 56/89 (62.9%) and knee 33/89 (37.1%) who received at least one dosage of Dalbavancin were included. A 1:1 propensity-score (PS) matching between the DAL-group (n=89) and the SoC-group (n=89) was performed, using defined demographic covariates such as body-mass-index, age, sex, causative pathogens, knee or hip joint and infection after primary or revision surgery, surgical site infections, Charlson-comorbidity index and the types of infection (acute, late acute and chronic). Patient's demographics were analysed by our prospectively maintained institutional arthroplasty registry and PJI database. We analysed the outcome of the included patients evaluate the re-infection and re-revision rate and gave details about surgical management and the type of PJI with a minimum follow-up of one year.Aim
Methods
Implementation of new diagnostic methods (i.e. MALDI-TOF MS) has made it possible to identify coagulase-negative staphylococci (CoNS) to species level in routine practice. Further knowledge about clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different CoNS may both facilitate interpretation of microbiological findings and improve clinical algorithms. The aim of this study was clinical and microbiological characterization of PJIs caused by Staphylococcus capitis. Patients with PJIs caused by S. capitis (growth in ≥2 perioperative tissue samples, n=19, identified by MALDI-TOF MS) from three centres between 2005–2014 were included. Medical records were examined (n=16). Further characterization of S. capitis was performed; rep-PCR (Diversilab, BioMerieux), standard antibiotic susceptibility testing, GRD Etest and macromethod Etest for detection of heteroresistant subpopulations and microtitre plate assay for detection of biofilm production. Multi-drug resistant (MDR) S. capitis (R≥3 antibiotic groups) was detected in 5/19(26%) of isolates, 1/19(5%) were ciprofloxacin resistant and no isolates was rifampin resistant. Biofilm formation was present in 14/19(74%). The dendrograms created by rep-PCR showed two distinct clusters, including one that contained isolates from all centres, as well as the reference isolates. Furthermore, three additional clusters were identified, all of these mainly obtained from single centres. In two of these, MDR was highly prevalent. In one of these clusters, 4 of the 8 strictly monomicrobial infections were found. All of the PJIs were defined as either early postinterventional (10/16) or chronic (6/16). No late haematogenous infection was found. The highest CRP values were reported in monomicrobial infections. Wound healing disturbances was noted in 8/10 early postinterventional infections. Fever was absent in chronic infections, sinus tracts rare (1/6), while pain was a common symptom (5/6). S. capitis has the potential to cause PJIs, both by itself as well as part of a polymicrobial infection. The antibiotic susceptibility patterns were more favourable than has previously been reported in S. epidermidis isolated from PJIs(1). Clinical data suggests that PJIs caused by S. capitis were acquired perioperatively or in the early postoperative phase. The clustering found by rep-PCR together with data showing high prevalence of S. capitis in the air of operation rooms during prosthetic joint surgery(2) implicates that nosocomial spread might be present. Epidemiological surveillance may be of value in order to ensure early detection of nosocomial transmission. Grants were received from the research committees of Värmland County Council and Örebro University, Sweden.
