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Peri-implant infection is one of the biggest threats to the success of dental implant. Existing coatings on titanium surfaces exhibit rapid decrease in antibacterial efficacy, which is difficult to promisingly prevent peri-implant infection. Herein, we report an N-halamine polymeric coating on titanium surface that simultaneously has long-lasting renewable antibacterial efficacy with good stability and biocompatibility. Our coating is powerfully biocidal against both main pathogenic bacteria of peri-implant infection and complex bacteria from peri-implantitis patients. More importantly, its antibacterial efficacy can persist for a long term (e.g., 12~16 weeks) in vitro, in animal model, and even in human oral cavity, which generally covers the whole formation process of osseointegrated interface. Furthermore, after consumption, it can regain its antibacterial ability by facile rechlorination, highlighting a valuable concept of renewable antibacterial coating in dental implant. These findings indicate an appealing application prospect for prevention and treatment of peri-implant infection., Infection is a major problem for dental implants with current antibacterial coatings losing efficacy quickly. Here, the authors report on the N-halamine polymeric coating of titanium implants to create a long-lasting renewable antibacterial layer and demonstrate application in vivo.

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.

Recently, dental implants have had the most important role in oral rehabilitation. Peri-implantitis is considered a common complication of dental implants. Adjacent natural teeth with untreated endodontic pathology may be a potential risk for implant placement. Retrograde/periapical peri-implantitis (RPI), the inverting of the progress direction of peri-implantitis. Radiographically, it is characterized by signs of periapical bone loss and normal coronal osteointegration of the implant; and its prevalence is closely associated with endodontic lesions of adjacent teeth. Another novel separate disease entity is known as the endodontic peri-implant defects (endo-implant defects), manifesting as the peri-implant marginal bone loss due to endodontic pathology of adjacent teeth, to which endodontists and implantologists are supposed to attach great importance. This current study presented two cases of different types of peri-implant infection in which conducting proper intervention to the endodontic lesions of adjacent teeth resulted in full radiographic and clinical resolution of peri-implant defects.

We report the first published case of Prototheca wickerhamii breast implant infection. This occurred after mastectomy, chemotherapy, radiotherapy, breast reconstruction, implant revisions and breast seroma aspirations and was preceded by polymicrobial infection. Definitive treatment required implant removal and intravenous liposomal amphotericin B. The management of breast prosthesis infections is discussed., Highlights • Clinical update on breast implant infections. • Algae can cause chronic infections that persist despite broad-spectrum therapy. • Consider removal of prostheses to assist with source control. • Biofilm-active agents are useful adjuncts in prosthetic infections. • Adherence to principles of surgical site infection prevention is recommended.

Even till now, nothing much has been done to explore the inflammation and prevention of the same around the implants placed, hence the aim of this study was to evaluate factor associated with dentist knowledge, attitude along with practice in preventing peri-implant diseases. This was a descriptive, cross-sectional, questionnaire based study carried within Dental professionals of Patna city. Stratified random sampling technique was the sampling method utilized in this study. The survey was conducted among 132 dentists. A questionnaire was framed by using google forms. Most of dental professionals were having fair knowledge {61(46.21%)}, positive attitude {61 (46.21%)} and poor practice (47.72%)} towards prevention of Peri-implant diseases. On application of Chi-square test, it was found that knowledge of study participants was significantly (0.05*) associated with gender, average duration of doing Implant surgery while attitude was significantly (0.05*) associated with age and degree. It was concluded that knowledge was fair; attitude was positive and despite this practice was poor regarding the prevention of Peri-Implant diseases among Dental professionals. Factors associated with knowledge, attitude and practice of study participants was gender, average duration of doing Implant surgery, age and degree.

Acute postoperative infections after surgical interventions on the spinal column are associated with prolonged treatment duration, poor patient outcomes, and a high socioeconomic burden. In the field of joint replacement, guidelines have been established with recommendations for the diagnosis and treatment of such complications, but in spinal surgery there are no definitions permitting distinction between early and late infections and no specific instructions for their management. Various factors increase the risk of acute postoperative infection, including blood transfusions, leakage of cerebrospinal fluid, urinary tract infection, injury of the dura mater, an American Society of Anesthesiologists (ASA) score >2, obesity, diabetes mellitus, and surgical revision. We suggest defining all infections occurring within the first 4 weeks after spinal surgery as early infections. The symptoms are pain at rest, on motion, and/or pressure pain, abnormal warmth, local erythema, circumscribed swelling of the wound, and newly occurring secretion. Together with laboratory parameters such as C-reactive protein (CRP) and leukocytes, a central role is played by imaging in the form of magnetic resonance imaging (MRI), although diagnosis can be hampered by the presence of postoperative fluid collections such as edema or hematoma or by artifacts from an implant. Once an infection has been confirmed, immediate wound revision with debridement and rinsing (sodium hypochlorite) is essential. Intraoperatively it may prove advantageous to use jet lavage and administer vancomycin. We recommend leaving the implant in place in cases of acute postoperative infection. Patients who are not conditional for surgery can first receive antibiotic suppression treatment before surgery at a later date. In such cases initial computed tomography (CT)-guided aspiration or drain insertion can take place.

Titanium implants have been widely used in bone tissue engineering for decades. However, orthopedic implant-associated infections increase the risk of implant failure and even lead to amputation in severe cases. Although TiO2 has photocatalytic activity to produce reactive oxygen species (ROS), the recombination of generated electrons and holes limits its antibacterial ability. Here, we describe a graphdiyne (GDY) composite TiO2 nanofiber that combats implant infections through enhanced photocatalysis and prolonged antibacterial ability. In addition, GDY-modified TiO2 nanofibers exert superior biocompatibility and osteoinductive abilities for cell adhesion and differentiation, thus contributing to the bone tissue regeneration process in drug-resistant bacteria-induced implant infection., Infection is a growing issue in artificial implants and has become an area of significant interest. Here, the authors report on graphdiyne titanium dioxide composite nanofibres with enhanced photocatalytic reactive oxygen species generation and osteoinductive properties, demonstrated in infected implant models.

Objectives The presence of postinstrumentation back pain in patients after undergoing spinal surgery is a well established phenomenon. So too is the presence of infection, both overt and subclinical which can be a source of pain. The accurate assessment of infection in patients with spinal implants in situ and no overt radiological or biochemical abnormalities frequently presents a diagnostic challenge. We present our experience spanning 5 years of using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (18F FDG PET)-computed tomography (CT) scans to aid the diagnostic process in treating presumed low-grade chronic implant infection. Methods We undertook a retrospective analysis of all patients with spinal implants in place who were referred for 18F FDG PET-CT imaging over a 5-year period. All available images, case notes and laboratory results were reviewed. Results Data pertaining to 49 patients were analysed, with infection diagnosed on 18F FDG PET-CT in 24 (45%) of those sent for scanning. Fifteen patients in the cohort underwent revision surgery, and 11 of whom had been diagnosed as infected on PET-CT. Confirmation of infection with positive microbiological sampling occurred in 8/11 giving a positive predictive value of 0.72 in our series. Conclusion We present a real-world experience of using 18F FDG PET-CT as a diagnostic tool in the evaluation of patients with chronic pain after undergoing spinal implantation. We have found PET-CT to be a promising modality and would recommend multicentre collaboration to ensure reproducibility across more centres.

Orthopaedic implant use increases infection risk. Implant infection risk can be explained by the "race for the surface" concept, where there is competition between host-cell integration and bacterial colonisation. Although generally accepted, the temporal dynamics have not been elucidated in vivo. Using a bilateral intramedullary rat model, Staphylococcus aureus was injected into the tail vein either immediately after or 1, 3 and 7 d following implant placement. This allowed assessment of the temporal interplay between bacterial colonisation and host-cell adhesion by uncoupling implant placement and bacterial challenge. 2 weeks following inoculation, animals were anaesthetised, euthanised and implants and tissues harvested for bacterial enumeration. To assess host participation in implant protection, additional animals were not inoculated but euthanised at 1, 3 or 7 d and the host cells adhered to the implant were evaluated by flow cytometry and microscopy. As time between implant placement and bacterial challenge increased, infection rate and bioburden decreased. All implants had measurable bioburden when challenged at day 1, but only two implants had recoverable bacteria when inoculated 7 d after implant placement. This protection against infection corresponded to a shift in host cell population surrounding the implant. Initially, cells present were primarily non-differentiated stem cells, such as bone marrow mesenchymal stem cells, or immature haematopoietic cells. At day 7, there was a mature monocyte/macrophage population. The present study illustrated a direct relationship between host immune cell attachment and decrease in bacterial colonisation, providing guidance for antimicrobial release devices to protect orthopaedic implants against bacterial colonisation.

Biofilm can protect bacteria from immune attacks and antibiotic inhibition, and bacterial biofilm hosted in implanted materials and medical devices is a serious threat for modern medical system. He...

Staphylococcus aureus (S. aureus) biofilm is the major cause of failure of implant infection treatment that results in heavy social and economic burden on individuals, families, and communities. Planktonic S. aureus attaches to medical implant surfaces where it proliferates and is wrapped by extracellular polymeric substances (EPS), forming a solid and complex biofilm. This provides a stable environment for bacterial growth, infection maintenance, and diffusion, and protects the bacteria from antimicrobial agents and the immune system of the host. Macrophages are an important component of the innate immune system, and resist pathogen invasion and infection through phagocytosis, antigen presentation, and cytokine secretion. The persistence, spread, or clearance of infection is determined by interplay between macrophages and S. aureus in the implant infection microenvironment. In this review, we discuss the interactions between S. aureus biofilm and macrophages, including the effects of biofilm-related bacteria on the macrophage immune response, roles of myeloid-derived suppressor cells during biofilm infection, regulation of immune cell metabolic patterns by the biofilm environment, and immune evasion strategies adopted by the biofilm against macrophages. Finally, we summarize the current methods that support macrophage mediated removal of biofilms and emphasize the importance of considering multi-dimensions and factors related to implant associated infection such as immunity, metabolism, the host, and the pathogen when developing new treatments.

Introduction: Silicone tube implantation in lymphoedema reduces symptoms by improving fluid drainage. Although there are descriptions of implant host reaction that can be misdiagnosed as graft infections these are scarce. Report: A 34 year old female with lymphoedema of the lower limb, underwent silicone tube implantation. Ten months after surgery, the patient presented with fever and dermatolymphangioadenitis of the limb. Ultrasound suggested an abscess surrounding the tubes. Clinical improvement was achieved after a 6-day cycle of meropenem. She was discharged under oral cefuroxime and clindamycin for one week. After 1 month, CT-angiography was performed showing only residual inflammation surrounding the tubes, the patient was asymptomatic and limb diameter was normal. Conclusion: Sudden onset and improvement of the patient’s condition after a short cycle of antibiotics without the need of tube removal supports a host-like reaction rather than an actual infection. Doctors should be aware of such complications avoiding unnecessary procedures., Portuguese Journal of Cardiac Thoracic and Vascular Surgery, Vol. 30 No. 2 (2023): Apr-Jun

Background Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance. Our goals were to describe management of implant infections with broad-spectrum antibiotics, review treatment related adverse events, and report on outcomes of therapy. Patients and methods A retrospective review was carried out to identify patients who were treated with intravenous (IV) antibiotics for periprosthetic infection. Patient characteristics, surgical details, and antibiotic therapy-related adverse events were collected. Eventual outcome related to expander/implant salvage was noted. Results A total of 101 patients (111 treatment episodes) were identified. Mean duration of antibiotic treatment was 18 days (range, 1-40 days). The most commonly used parenteral treatment was a combination of daptomycin with piperacillin-tazobactam (65%) or an alternative agent (16%). Fifty-nine percent of treatment episodes resulted in salvage of the expander or implant. Thirty-five percent treatment episodes were associated with 1 or more adverse events: diarrhea (12.6%), rash (10%), vaginal candidiasis (3.6%), agranulocytosis/neutropenic fever (3.6%), nausea (3.6%), urinary complaint (0.9%), myositis (0.9%), headache (0.9%), vascular line occlusion (1.8%), deep vein thrombosis (1.8%), and finger numbness (0.9%). No patients developed Clostridium difficile colitis. Five episodes (4%) needed discontinuation of antibiotics because of severe adverse events. The prosthesis was explanted in 3 of the cases of discontinued treatment. Conclusions Our findings show favorable outcomes and well-tolerated adverse effects with broad-spectrum parenteral antibiotherapy for periprosthetic infection. However, every effort should be made to deescalate therapy by narrowing the spectrum or limiting the duration, to minimize adverse events and development of bacterial resistance. Treating surgeons need to carefully weigh benefits of therapy and be aware of potential complications that might necessitate discontinuation of treatment.

Introduction: Early implant infection and failure can be addressed by either implant maintenance or immediate replacement and bone regeneration at the defect site. Methods: In this study, six patients with chronic sinusitis at the implant site were treated with implant removal and curettage to remove the infected and inflamed soft tissue. A new implant was immediately screwed into the same socket, and a Guided Bone Regeneration (GBR) procedure was performed to regenerate the lost bone at the site. After the patients underwent the second surgery, the sinusitis disappeared, and new bone formed around the implant, achieving good implant stability. Conclusion: The implant was loaded, and no complaints were reported during the follow-up period. Chronic implant infection treated with implant removal and immediate replacement plus GBR resulted in stable new implants with new bone formation.

Purpose: To report a case of delayed implant infection with Cutibacterium acnes (C. acnes, previously known as Propionibacterium acnes) 30 years after silicone sheet orbital floor implant.Methods: Case report with orbital imaging.Results: A 61-year-old male with a history of traumatic orbital floor fracture right eye (OD) repaired using a silicone sheet orbital floor implant 30 years prior, presented with 6 months of painless blepharoptosis and diplopia OD. On examination, there was 3 mm right upper eyelid blepharoptosis and hyperglobus. There was no globe proptosis, dysmotility, or compression and no cutaneous erythema, hyperthermia, discharge, or tenderness to palpation. Orbital magnetic resonance imaging (MRI) revealed a cystic mass in the inferior orbit in the region of the floor implant, measuring 25 mm in diameter and 10 mm in thickness. By MRI, T1-weighted images revealed a hypointense signal within the mass and T2-weighted images showed hyperintense signal with a flat hypointensity centrally representing the floor implant. Microbiologic cultures grew C. acnes.Conclusions: C. acnes can manifest several decades after placement of an orbital prosthetic implant, leading to delayed infection.

The main purpose of spinal fixation is to provide conditions for vertebral fusion at the level of injury. Bone fusion is associated with many factors including stability of injured segment, restoration of the anterior support column, condition of the bone tissue and other aspects. The timing of bone formation can be affected by soft tissue inflammation at the site of the rods of the external fixation system. Peri-implant infection is reported to occur in 0.7-20 % of cases with external transpedicular fixation. The timing of the complication and the dependence of the frequency of the occurrence on the patient's treatment strategy are debatable. Another topical issue is the study of the consequences of peri-implant infection with the need to establish the validity of the assumption about the effect of peri-implant infection on the rate of bone formation using a clinical model. This would allow the findings to be used for new methods of treatment considering the risk of possible complications, giving preference to low-traumatic semi-closed methods of spine fixation. Nevertheless, external transpedicular fixation is practical for open spinal injury or significant vertebral displacement with the need of significant reduction efforts to be applied. The purpose was to explore the effect of soft tissue inflammation on the timing of bone formation with spinal fusion surgery using different surgical methods of treatment of uncomplicated spinal fractures. Material and methods The review included 111 patients with uncomplicated fractures of the lower thoracic and lumbar spine. Based on a retrospective analysis the participants were assigned to three groups depending on the presence/absence of peri-implant infection and the timing of the occurrence: 81 patients experienced no complications, 16 had serous-purulent inflammation of soft tissues at the site of the rods of the external fixation device that developed on average after 20 days with 14 patients seen with pin tract infection after 2 months of anterior fusion surgery and failed bone formation. Results Peri-implant infection rate was found to be higher with external fixation (14.4 %) than that with anterior fusion surgery (12.6 %). The complication rate was 1.85 times less with one-stage surgical treatment as compared to two-stage treatment. Peri-implant infection developed later (after 21‑63 days) with one-stage treatment as compared with two-stage procedure (after 12-24 days). Infection associated with the external fixation led to increase in timing of bone formation by 6-7 %, by 2-4 weeks on average. Bone formation failed in 35 % of cases (p < 0.0002) due to peri-implant inflammation caused by Staphylococcus aureus, as the common pathogen and the bacteria detected resulted in ineffective antibacterial therapy. Immunological parameters (IgM and haptoglobin) were quantified to assess the risk of peri-implant infection. Discussion Peri-implant infection rate associated with external transpedicular fixation was shown to be comparable with the previously obtained data. Sharply defined notions were reported earlier to differentiate between infectious peri-implant osteolysis and mechanical loosening. We compared the data on the duration of bone formation and the timing of peri-implant infection and developed a model that with high sensitivity (73 %) and specificity (100 %) allowed description of cases with impaired osteogenesis. Changes in some immunological parameters (immunoglobulins, acute-phase proteins) were shown to affect both bone formation and stability of bone fixation.

Surface treatment of metallic implants plays a crucial role in orthopedics and orthodontics. Metallic implants produce side-effects such as physical, chemical/electro-chemical irritations, oligodynamic/catalytic and carcinogenic effects. These effects cause bacterial infections and account for huge medical expenses. Treatment for these infections comprises repeated radical debridement, replacement of the implant device and intravenous or oral injection antibiotics. Infection is due to the presence of bacteria in the patient or the surrounding environment. The antibiotic-based medication prevents prophylaxis against bacterial colonization, which is an emphatic method that may otherwise be catastrophic to a patient. Therefore, preventive measures are essential. A coating process was developed with its drug infusion and effect opposing biofilms. Modification in the medical implant surface reduces the adhesion of bacterial and biofilms, the reason behind bacterial attachment. Other polymer-based and nanoparticle-based carriers are used to resolve implant infections. Therefore, using an implant coating is a better approach to prevent infection due to biofilm.

A two-day-old female Warmblood foal (70 kg) presented with a closed, displaced Salter-Harris type-II fracture of the proximal physis of the left hind first phalanx. For fracture repair four 4.5 mm cortical screws and wire in a figure-of-8 pattern were applied on the lateral and medial aspect of the phalanx, respectively. A 4.5 mm cortical screw was additionally inserted in lag-fashion to engage the lateral metaphyseal spike. Three days postoperatively, medial axis deviation and implant infection were noted and revision surgery was performed. Previous implants were removed and two 4.5 mm transphyseal cortical lag-screws were placed in proximolateral-distomedial and dorsoproximal-plantarodistal direction. Postoperatively, the fracture healed rapidly and the implants were removed 6 weeks later. Nineteen months after implant removal the horse did not show any sign of lameness, despite a shortening of the proximal phalanx compared to the contralateral limb. In cases of postoperative implant instability and infection, implant removal often becomes necessary. However, new implants cannot be placed safely in the previous location. To avoid this problem, this report describes an alternative approach for screw positioning in case of previous implant infection in a Salter-Harris type-II fracture of the proximal physis of the first phalanx.

Recently, dental implants have had the most important role in oral rehabilitation. Peri-implantitis is considered a common complication of dental implants. Adjacent natural teeth with untreated endodontic pathology may be a potential risk for implant placement. Retrograde/periapical peri-implantitis (RPI), the inverting of the progress direction of peri-implantitis. Radiographically, it is characterized by signs of periapical bone loss and normal coronal osteointegration of the implant; and its prevalence is closely associated with endodontic lesions of adjacent teeth. Another novel separate disease entity is known as the endodontic peri-implant defects (endo-implant defects), manifesting as the peri-implant marginal bone loss due to endodontic pathology of adjacent teeth, to which endodontists and implantologists are supposed to attach great importance. This current study presented two cases of different types of peri-implant infection in which conducting proper intervention to the endodontic lesions of adjacent teeth resulted in full radiographic and clinical resolution of peri-implant defects.

An 11-year-old male neutered Yorkshire Terrier was presented with a cervical mass that developed a draining tract. Aside from the dysphagia reported by the owner, his neurologic exam was normal. Three years prior, the patient was diagnosed with an atlantoaxial subluxation that was ventrally stabilized with polymethylmethacrylate (PMMA) and self-tapping titanium screws. There were no postoperative complications until presenting with the cervical mass and dysphagia. Computerized tomography (CT) of the cervical spine confirmed caudal migration of the PMMA and screws with an abscess surrounding the implant. A surgical explant of the PMMA and screws was performed without complication. The atlantoaxial joint remained normally aligned on postoperative radiographs. Cultures of the implant grew Streptococcus bovis. He was treated with cephalexin (22 mg/kg PO BID) for 30 days. At the time of his one-month recheck, he was swallowing normally with no neurologic deficits. He remains normal at the time of this report (17 months later). This case reports a successful explant of a chronic atlantoaxial implant infection.

Postoperative spinal implant infection (PSII) is a commonly found and serious complication after instrumented spinal surgery. Whereas early-onset PSII usually can be diagnosed by clinical symptoms, the diagnosis of late-onset PSII can be often made only by examination of intraoperatively collected samples. The treatment of PSII consists of surgical and antibiotic therapy schemes. In case of early PSII, the retention of spinal implants is a feasible option, whereas late PSII is usually treated by one-staged exchange of the spinal implants. Radical debridement of surrounding tissue should be performed in any case of PSII. The antibiotic treatment depends on either the implants can be removed or need to be retained or exchanged, respectively. If the causative pathogens are sensitive for biofilm-active antibiotic agents, the duration of antibiotic treatment amounts to 12 weeks with retention of spinal implants. In case of problematic pathogens, the application of antibiotics needs to be prolonged for an individual duration. Antibiotic treatment should always be initiated with an intravenous application for at least 2 weeks.

Background: Evidence suggests the renin-angiotensin system (RAS) plays key immunomodulatory roles. In particular, angiotensin-converting enzyme (ACE) has been shown to play a role in antimicrobial host defense. ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) are some of the most commonly prescribed medications, especially in patients undergoing invasive surgery. Thus, the current study assessed the immunomodulatory effect of RAS-modulation in a preclinical model of implant infection.Methods:In vitro antimicrobial effects of ACEi and ARBs were first assessed. C57BL/6J mice subsequently received either an ACEi (lisinopril; 16 mg/kg/day), an ARB (losartan; 30 mg/kg/day), or no treatment. Conditioned mice blood was then utilized to quantify respiratory burst function as well as Staphylococcus aureus Xen36 burden ex vivo in each treatment group. S. aureus infectious burden for each treatment group was then assessed in vivo using a validated mouse model of implant infection. Real-time quantitation of infectious burden via bioluminescent imaging over the course of 28 days post-procedure was assessed. Host response via monocyte and neutrophil infiltration within paraspinal and spleen tissue was quantified by immunohistochemistry for F4/80 and myeloperoxidase, respectively.Results: Blood from mice treated with an ACEi demonstrated a decreased ability to eradicate bacteria when mixed with Xen36 as significantly higher levels of colony forming units (CFU) and biofilm formation was appreciated ex vivo (p < 0.05). Mice treated with an ACEi showed a higher infection burden in vivo at all times (p < 0.05) and significantly higher CFUs of bacteria on both implant and paraspinal tissue at the time of sacrifice (p < 0.05 for each comparison). There was also significantly decreased infiltration and respiratory burst function of immune effector cells in the ACEi group (p < 0.05).Conclusion: ACEi, but not ARB, treatment resulted in increased S. aureus burden and impaired immune response in a preclinical model of implant infection. These results suggest that perioperative ACEi use may represent a previously unappreciated risk factor for surgical site infection. Given the relative interchangeability of ACEi and ARB from a cardiovascular standpoint, this risk factor may be modifiable.

Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection.This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period.In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation.There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.EINFüHRUNG: Revisionsarthroplastik mit Megaimplantaten ist mit einer hohen Komplikationsrate verbunden. Insbesondere eine Infektion ist eine schwerwiegende Komplikation der Revisionsarthroplastik von Hüft- und Kniegelenken und wird in der Literatur mit einer durchschnittlichen Rate von 18% (zwischen 3% und 36%) bei Megaimplantaten angegeben. Diese Studie wurde durchgeführt, um die Strategie der Behandlung der Infektion von Mega-Endoprothesen der unteren Extremitäten in der Kohorte unseres Patienten zu analysieren, insbesondere die Behandlung chronischer Infektionen.Diese ist eine retrospektive Studie, die sich mit den Ergebnissen der Behandlung von periprothetischen Infektionen von Megaimplantaten der unteren Extremität befasst. Von September 2013 bis September 2019 wurden in unserer Klinik 212 Patienten mit 220 modularen Mega-Endoprothesen der unteren Extremitäten behandelt. Als Reinfektion oder Rezidiv definierten wir ein klinisch und mikrobiologisches Rezidiv lokaler periprothetischer Gelenkinfektionen nach antibiotikafreier Periode.In dieser Studie wurden 200 von 220 Fällen untersucht. Die durchschnittliche Nachbeobachtungszeit betrug ca. 18 Monate (6 Monate bis 6 Jahre). In 26 Fällen (13%) traten Endoprotheseninfektionen nach Implantation von Megaimplantaten auf. Diese Gruppe umfasste 2 frühe Infektionen (innerhalb der ersten 4 Wochen) und 24 chronische Infektionen (zwischen 10 Wochen und 6 Jahren nach der Implantation). 19 der 26 identifizierten Infektionsfälle (73,1%) gehören zur Gruppe der Patienten, die aufgrund eines schweren Knochenverlusts nach Explantation endoprothetischer Komponenten aufgrund einer früheren periprothetischen Gelenkinfektion operiert wurden. Die verbleibenden 7 Fälle mit Infektion umfassten 4 Fälle nach Behandlung einer periprothetischen Fraktur, 2 Fälle nach Behandlung einer aseptischen Lockerung und einen Fall nach Tumorresektion. Alle Infektionen wurden chirurgisch behandelt. In allen Fällen überschritt die Dauer der kontinuierlichen Antibiotikabehandlung 6 Wochen nicht. Beide Fälle mit einer frühen Infektion wurden jeweils durch Austausch von Polyethylen-Inlays und Durchführung eines Debridements mit Lavage (2 Fälle) behandelt. In 2 (7,7%) Fällen mit chronischer Infektion wurde ein einzeitiger Wechsel durchgeführt. In allen verbleibenden Fällen mit chronischer Infektion (22 Fälle; 84,6%) wurde vor der Reimplantation eine Explantation aller Komponenten und eine vorübergehende Implantation von Zementabstandshaltern durchgeführt.Radikales chirurgisches Debridement und Lavage in Verbindung mit einer systemischen Antibiotikatherapie sind die wichtigsten therapeutischen Instrumente in allen Fällen periprothetischer Infektionen. Die Managementstrategien variieren je nach Art der Infektion, den isolierten Mikroben und dem klinischen Schweregrad der Infektion. Weitere Studien sind erforderlich, um die Managementstrategien für solche Infektionen zu standardisieren. Es ist jedoch nicht ungewöhnlich, dass Kompromisse aufgrund des besonderen Zustands des Einzelnen eingegangen werden.

Breast implant-associated infections (BIAIs) are the primary complication following placement of breast prostheses in breast cancer reconstruction. Given the prevalence of breast cancer, reconstructive failure due to infection results in significant patient distress and health care expenditures. Thus, effective BIAI prevention strategies are urgently needed. This study tests the efficacy of one infection prevention strategy: the use of a triple antibiotic pocket irrigant (TAPI) against Staphylococcus aureus, the most common cause of BIAIs. TAPI, which consists of 50,000 U bacitracin, 1 g cefazolin, and 80 mg gentamicin diluted in 500 mL of saline, is used to irrigate the breast implant pocket during surgery. We used

Background: Animal models are used to guide management of periprosthetic implant infections. No adequate model exists for periprosthetic shoulder infections, and clinicians thus have no preclinical tools to assess potential therapeutics. We hypothesize that it is possible to establish a mouse model of shoulder implant infection (SII) that allows noninvasive, longitudinal tracking of biofilm and host response through in vivo optical imaging. The model may then be employed to validate a targeting probe (1D9-680) with clinical translation potential for diagnosing infection and image-guided debridement.Methods: A surgical implant was press-fit into the proximal humerus of c57BL/6J mice and inoculated with 2 mu L of 1 x 10(3) (e3), or 1 x 10(4) (e4), colony-forming units (CFUs) of bioluminescent Staphylococcus aureus Xen-36. The control group received 2 mu L sterile saline. Bacterial activity was monitored in vivo over 42 days, directly (bioluminescence) and indirectly (targeting probe). Weekly radiographs assessed implant loosening. CFU harvests, confocal microscopy, and histology were performed.Results: Both inoculated groups established chronic infections. CFUs on postoperative day (POD) 42 were increased in the infected groups compared with the sterile group (P Discussion: Given bone destruction in the e4 group, a longitudinal, noninvasive mouse model of SII and chronic osteolysis was produced using e3 of S aureus Xen-36, mimicking clinical presentations of chronic SII.Conclusion: The development of this model provides a foundation to study new therapeutics, interventions, and host modifications. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Spine implant infections portend poor outcomes as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. The purpose of this method is to describe a novel mouse model of spinal implant infection (SII) that was created to provide an inexpensive, rapid, and accurate in vivo tool to test potential therapeutics and treatment strategies for spinal implant infections. In this method, we present a model of posterior-approach spinal surgery in which a stainless-steel k-wire is transfixed into the L4 spinous process of 12-week old C57BL/6J wild-type mice and inoculated with 1 × 10(3) CFU of a bioluminescent strain of Staphylococcus aureus Xen36 bacteria. Mice are then longitudinally imaged for bioluminescence in vivo on post-operative days 0, 1, 3, 5, 7, 10, 14, 18, 21, 25, 28, and 35. Bioluminescence imaging (BLI) signals from a standardized field of view are quantified to measure in vivo bacterial burden. To quantify bacteria adhering to implants and peri-implant tissue, mice are euthanized and the implant and surrounding soft tissue are harvested. Bacteria are detached from the implant by sonication, cultured overnight and then colony forming units (CFUs) are counted. The results acquired from this method include longitudinal bacterial counts as measured by in vivo S. aureus bioluminescence (mean maximum flux) and CFU counts following euthanasia. While prior animal models of instrumented spine infection have involved invasive, ex vivo tissue analysis, the mouse model of SII presented in this paper leverages noninvasive, real time in vivo optical imaging of bioluminescent bacteria to replace static tissue study. Applications of the model are broad and may include utilizing alternative bioluminescent bacterial strains, incorporating other types of genetically engineered mice to contemporaneously study host immune response, and evaluating current or investigating new diagnostic and therapeutic modalities such as antibiotics or implant coatings.

The human oral cavity is an entrance to the digestive system and provides a habitat for bacteria. A microbiota is formed by a variety of bacterial species on the soft and hard tissues in the oral cavity, and is a community in which bacteria interact with each other. However, among the hundreds of bacterial species within a microbiota, only a limited number of species have been considered to be involved in oral infectious diseases such as dental caries and periodontitis. On the other hand, with the development of next-generation high-throughput sequencing technology, the activities and interactions of multiple bacterial species within a microbiota are being focused on in recent bacteriological research studies. In this chapter, the bacteriological aspect of peri-implantitis will be highlighted, especially with a focus on its polymicrobial nature. We will then present our research for the microbiota in peri-implantitis lesions, and discuss future perspectives of polymicrobial peri-implant infection.

Femur is the most fractured long bone in the body that often necessitates surgical fixation. One of the most challenging complications in trauma surgery is infection after fracture fixation (IAFF). Herein we presented A 39 years old male drug addict , he underwent close reduction and internal fixation right femur fracture on 2013 with no follow up in primary hospital.On July 2017 he presented to our hospital with a history of pain in his right thigh, the clinical examination showed a sinus discharge fromrightthigh, he was controlled by irrigation and debridement and inserting of antibiotics tens nail. He was followed up by X-ray scanning. On August 2018 patient presented with broken plate and fibula graft, after removal of broken plate and application of double plate for right femur fracturethe X-ray scan show callus formation. Keywords: Surgical treatment, Orthopedic, Implant, Infection, Femur, Fracture.

Using ultrasound luminescent chemical imaging (ULCI) technique we imaged changes in the luminescence spectra of the ultrasound luminescent film modulated by a pH sensitive dye coating in different pH environments through a light scattering media. Our results show that high resolution images can be obtained through scattering media, and that the ultrasound luminescent film could be modulated by the pH sensitive dye.

The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopaedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery.

Background With a reported rate of 0.7–20%, postoperative spinal implant infection (PSII) is one of the most common complications after spine surgery. While in arthroplasty both haematoma formation and perioperative blood loss have been identified as risk factors for developing periprosthetic joint infections and preoperative anaemia has been associated with increased complication rates, literature on the aetiology of PSII remains limited. Methods We performed a matched-pair analysis of perioperative haemoglobin (Hb) and haematocrit (Hct) levels in aseptic and septic spine revision surgeries. 317 patients were included, 94 of which were classified as septic according to previously defined criteria. Patients were matched according to age, body mass index, diabetes, American Society of Anesthesiologists score and smoking habits. Descriptive summaries for septic and aseptic groups were analysed using Pearson chi-squared for categorical or Student t test for continuous variables. Results Fifty patients were matched and did not differ significantly in their reason for revision, mean length of hospital stay, blood transfusion, operating time, or number of levels operated on. While there was no significant difference in preoperative Hb or Hct levels, the mean difference between pre- and postoperative Hb was higher in the septic group (3.45 ± 1.25 vs. 2.82 ± 1.48 g/dL, p = 0.034). Conclusions We therefore show that the intraoperative Hb-trend is a predictor for the development of PSII independent of the amount of blood transfusions, operation time, number of spinal levels operated on and hospital length of stay, which is why strategies to reduce intraoperative blood loss in spine surgery need to be further studied.

Implant related infection is relatively unusual in surgery to the hand and distal upper limb. When such infections occur, the consequences can be devastating. We review the latest guidance and research on the prevention, diagnosis, and management of implant-associated infections in the hand and distal upper limb.

In this study, gentamicin loaded collagen I/hyaluronic acid multilayers modified titanium coating (TC-AA(C/H)6-G) was fabricated via a layer-by-layer (LBL) covalent immobilization method. The drug releasing properties of collagen I/Hyaluronic acid (Col-I/HA) multilayers and the effect of loaded gentamicin on the antibacterial properties and cytocompatibility of modified TC were investigated. The gentamicin release assay indicated that the Col-I/HA multilayers modified TC exhibited agreeable drug-loading amount (537.22 ± 29.66 µg of gentamicin) and controlled-release performance (240 h of sustained release time). TC-AA(C/H)6-G revealed satisfactory antibacterial activity and inhibited the colonization and biofilm formation of S. aureus. Fortunately, the functions of hMSCs on TC-AA(C/H)6-G did not affected by the loaded gentamicin, and TC-AA(C/H)6-G could improve the adhesion, proliferation and osteogenic differentiation of cells, as well as TC-AA(C/H)6. In vivo animal study indicated that TC-AA(C/H)6-G could effectively control intramedullary cavity infection caused by S. aureus and prevent bone destruction.

Titanium (Ti) implant-associated infections are a challenge in orthopedic surgery, for which a series of antibacterial coatings have been designed and fabricated to reduce the risk of bacterial contamination. Herein, we created a degradable three-layer sandwich-type coating to achieve long-term antibacterial effects while simultaneously reconstructing the local immune microenvironment. The vancomycin (Van)-loaded vaterite coating constitutes the outer and inner layers, whereas Interleukin-12 (IL-12)-containing liposomes embedded in sodium alginate constitutes the middle layer. Van, released from the vaterite, demonstrated a favorable and rapid bactericidal ability against the representative methicillin-sensitive S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) strains. The released IL-12 exhibited the desired immune reconstitution abilities, actively facilitating defenses against subsequent bacterial invasions. Furthermore, the biocompatibility and cell-binding feature of the multifunctional coating was beneficial for achieving solid interface intergradation. Overall, the benefits of the three-layer sandwich-type coating, including the convenient fabrication process, efficient antimicrobial activity, fast immune remodeling property, fine cell-binding feature, and biodegradability, highlight its promising translational potential in preventing implant infection. STATEMENT OF SIGNIFICANCE: To prevent titanium implant infections, researchers have designed various antibacterial coatings. However, most of these coatings focused only on killing the invading bacteria over a limited postoperative period. However, the local immune microenvironment is compromised during surgery. Local immune deflection impedes the ability of the local immune defenses to clear bacteria and limits immune memory building from active defense against long-term subsequent bacterial invasions. Furthermore, these coatings are usually nondegradable and differ substantially from bone components, thereby impairing the integration of the coating and bone interface and generating concerns about implant stability and bacterial contamination. In this work, we synthesized a degradable coating that provides sustained antibacterial activity, promotes immune reconstitution, and simultaneously achieves solid bone integration.

Study design A randomized complete block animal spinal implant infection model with internal control. Objective The aim of this study was to develop a spinal implant animal infection model to simulate postoperative gram-negative wound infection. Summary of background data Implant-associated surgical site infections (SSIs) remain a dreaded complication of spinal surgery. Currently, over 30% of all spine SSIs are secondary to gram-negative bacteria. Traditional animal models have utilized gram-positive inoculums to simulate postoperative infection, but there exists no model in the literature for gram-negative infection in the setting of spinal instrumentation. Methods Five New Zealand white female rabbits underwent simulated partial laminectomies and implantation of a 5 mm titanium wire adjacent to the spinous processes of vertebra T4, T9, L1, and L6 to mimic posterior spinal instrumentation. The second site, T9, was used as the sterile internal control sites, while all other sites were challenged with varying inoculums of Escherichia coli (EC American Type Culture Collection 25922): 10, 10, 10, 10, and 10 Colony Forming Units (CFU). The rabbits were sacrificed 4 days postoperatively and bacterial loads were assayed from the implants and surrounding tissue. Results No evidence for infection was observed in any of the sterile control sites. The lowest inoculum of E. coli (10 CFU) did not produce a reliable infection. Inoculation with 10 CFU created a consistent soft tissue infection, but inconsistent infection on implants. Inoculation with 10 CFU was required to consistently produce both soft tissue and implant infection. Conclusion Consistent soft tissue and implant infection was produced with inoculation of 10 CFU of E. coli. Gram-negative infections represent greater than 30% of all spinal SSIs, and this animal model can reliably reproduce such infections with spinal instrumentation that can guide future development of anti-infective therapies. Level of evidence 2.

BACKGROUND CONTEXT Recent studies have indicated that allogenic blood transfusions are a risk-factor for surgical site infections (SSI) after orthopedic surgery. Previously, our lab observed that blood transfusions promoted a soft-tissue infection as opposed to an implant infection using our mouse model of spine implant infection with gram-positive (GP) Staphylococcus aureus. It is unknown if similar effects will be seen with gram-negative Pseudomonas aeruginosa. PURPOSE To examine how blood transfusions affect GP vs GN bacterial SSI using a mouse model of spine implant infection. STUDY DESIGN/SETTING Not applicable. PATIENT SAMPLE Not applicable. OUTCOME MEASURES Not applicable. METHODS Eight- to 12-week-old C57BL/6 mice were used in this experiment. To model a spine implant infection, a stainless-steel k-wire was surgically placed in the L4 spinous process and inoculated with either a bioluminescent strain of Staphylococcus aureus (Xen36) or a bioluminescent strain of Pseudomonas aeruginosa (Xen41). All mice were transfused immediately postoperatively and on postoperative day (POD) 1 with 200 microliters of blood or saline (no blood group). In vivo bioluminescent imaging (BLI) was used to quantify bacterial burden postoperatively. Mice were sacrificed at the end of the experiment (POD28) and paraspinal tissue and spine implants were collected and used to obtain colony-forming units (CFUs). RESULTS All infected mice demonstrated increased BLI signal compared to sterile controls. From POD3 to POD7, S. aureus infected mice that received blood transfusions had higher average BLI signal compared to the mice that received no blood. From POD3 to POD7, P. aeruginosa infected mice that received blood transfusions had lower average BLI signal compared to the mice that received no blood. CFU analysis revealed no difference in the soft-tissue infection rates between the S. aureus and the P. aeruginosa infected mice that received blood transfusions (93% vs 100% respectively, p=0.3218). CFU analysis revealed a significant difference in the spine implant infection rates between the S. aureus and the P. aeruginosa infected mice that received blood transfusions (40% vs 100% respectively, p=0.0006). CONCLUSIONS As we continue to learn more about spine implant infections, one essential concept that is becoming clearer is that not all biofilm-mediated implant infections are the same. For instance, both GP and GN bacteria can form biofilms and cause chronic infection, but our findings suggest that these two groups of bacteria react differently to the same stimulus (blood transfusion) in the context of biofilm-mediated implant infections. We believe that our results warrant additional similar in-vivo studies which will continue to clarify the intricate pathophysiology behind spine implant infections and prevent the gross over-simplification of a complex clinical problem. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Author(s): Hegde, Vishal; Park, Howard Y; Dworsky, Erik; Zoller, Stephen D; Xi, Weixian; Johansen, Daniel O; Loftin, Amanda H; Hamad, Christopher D; Segura, Tatiana; Bernthal, Nicholas M | Abstract: Study designA controlled, interventional animal study.ObjectiveSpinal implant infection (SII) is a devastating complication. The objective of this study was to evaluate the efficacy of a novel implant coating that has both a passive antibiotic elution and an active-release mechanism triggered in the presence of bacteria, using an in vivo mouse model of SII.Summary of background dataCurrent methods to minimize the frequency of SII include local antibiotic therapy (vancomycin powder), betadine irrigation, silver nanoparticles, and passive release from antibiotic-loaded poly(methyl methacrylate) cement beads, all of which have notable weaknesses. A novel implant coating has been developed to address some of these limitations but has not been tested in the environment of a SII.MethodsA biodegradable coating using branched poly(ethylene glycol)-poly(propylene sulfide) (PEG-PPS) polymer was designed to deliver antibiotics. The in vivo performance of this coating was tested in the delivery of either vancomycin or tigecycline in a previously established mouse model of SII. Noninvasive bioluminescence imaging was used to quantify the bacterial burden, and implant sonication was used to determine bacterial colony-forming units (CFUs) from the implant and surrounding bone and soft tissue.ResultsThe PEG-PPS-vancomycin coating significantly lowered the infection burden from postoperative day 3 onwards (P l 0.05), whereas PEG-PPS-tigecycline only decreased the infection on postoperative day 5 to 10 (P l 0.05). CFUs were lower on PEG-PPS-vancomycin pins than PEG-PPS-tigecycline and PEG-PPS pins alone on both the implants (2.4 × 10, 8.5 × 10, and 1.0 × 10 CFUs, respectively) and surrounding bone and soft tissue (1.3 × 10, 4.8 × 10, and 5.4 × 10 CFUs, respectively) (P l 0.05).ConclusionThe biodegradable PEG-PPS coating demonstrates promise in decreasing bacterial burden and preventing SII. The vancomycin coating outperformed the tigecycline coating in this model compared to prior work in arthroplasty models, highlighting the uniqueness of the paraspinal infection microenvironment.Level of evidenceN/A.

Chronic periodontitis progression may go through phases of remission and exacerbation. The possibility of periodontal pathogens translocating from infected periodontal sites to peri-implant sites has been reported. Additionally, a history of periodontal disease seems to be a risk factor for peri-implantitis. The present case reports a flare-up of chronic periodontitis concomitant with an episode of peri-implant infection on a documented stable implant site. Periodontal infection was managed nonsurgically by scaling root planing and antibiotic treatment. Peri-implant infection was treated by open-flap debridement and implant surface decontamination. A remarkable regeneration on the peri-implant defect occurred steadily over a 3-year period, leading to a full regeneration of the site relying exclusively on the individual healing resources.

Spine implant infections portend disastrous outcomes, as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. Current imaging modalities can detect anatomical alterations and anomalies but cannot differentiate between infection and aseptic loosening, diagnose specific pathogens, or delineate the extent of an infection. Herein, a fully human monoclonal antibody 1D9, recognizing the immunodominant staphylococcal antigen A on the surface of Staphylococcus aureus, was assessed as a nuclear and fluorescent imaging probe in a preclinical model of S. aureus spinal implant infection, utilizing bioluminescently labeled bacteria to confirm the specificity and sensitivity of this targeting. Postoperative mice were administered 1D9 probe dual labeled with 89-zirconium (89Zr) and a bars represent SEM dye (NIR680) (89Zr-NIR680-1D9), and PET-CT and in vivo fluorescence and bioluminescence imaging were performed. The 89Zr-NIR680-1D9 probe accurately diagnosed both acute and subacute implant infection and permitted fluorescent image-guided surgery for selective debridement of infected tissue. Therefore, a single probe could noninvasively diagnose an infection and facilitate image-guided surgery to improve the clinical management of implant infections.