[Translated article] Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case-control study with 1151 arthroplasties.

BACKGROUND AND OBJECTIVE: Vancomycin powder (VP) has been positively used in spinal surgery to reduce the rate of infections. Hardly any data have been published on hip and knee joint replacement surgery, and its usefulness is questioned. Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications. METHODS: Primary hip (THA) and knee (TKA) arthroplasties were reviewed, performed by five surgeons in one hospital centre, between 2017 and 2018. One gram of VP was used on the implant prior to surgical closure based on the surgeon's preferences. With a 5-year follow-up in which the infection rate and local complications were analysed. RESULTS: One thousand one hundred and fifty-one arthroplasties were performed, 748 were TKA and 403 were THA. Nine patients were diagnosed with prosthetic infection, of which five received VP and four did not (p=0.555). Likewise, another 15 patients suffered wound complications, of which 11 received VP and 4 did not (p=0.412). There were no differences, either, in the rest of the complications depending on the use or not of VP (p=0.101). Likewise, the number of patients who needed reintervention was similar (p=0.999). No systemic complications were detected due to the use of VP. CONCLUSIONS: It has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee, so we cannot recommend its use.

Bionic Nanocoating of Prosthetic Grafts Significantly Reduces Bacterial Growth.

Prosthetic materials are a source of bacterial infections, with significant morbidity and mortality. Utilizing the bionic "Lotus effect," we generated superhydrophobic vascular prostheses by nanocoating and investigated their resistance to bacterial colonization. Nanoparticles were generated from silicon dioxide (SiO2), and coated vascular prostheses developed a nanoscale roughness with superhydrophobic characteristics. Coated grafts and untreated controls were incubated with different bacterial solutions including heparinized blood under mechanical stress and during artificial perfusion and were analyzed. Bioviability- and toxicity analyses of SiO2 nanoparticles were performed. Diameters of SiO2 nanoparticles ranged between 20 and 180 nm. Coated prostheses showed a water contact angle of > 150° (mean 154 ± 3°) and a mean water roll-off angle of 9° ± 2°. Toxicity and viability experiments demonstrated no toxic effects of SiO2 nanoparticles on human induced pluripotent stem cell-derived cardiomyocytes endothelial cells, fibroblasts, and HEK239T cells. After artificial perfusion with a bacterial solution (Luciferase+ Escherichia coli), bioluminescence imaging measurements showed a significant reduction of bacterial colonization of superhydrophobic material-coated prostheses compared to that of untreated controls. At the final measurement (t = 60 min), a 97% reduction of bacterial colonization was observed with superhydrophobic material-coated prostheses. Superhydrophobic vascular prostheses tremendously reduced bacterial growth. During artificial perfusion, the protective superhydrophobic effects of the vascular grafts could be confirmed using bioluminescence imaging.

Time to consider blunt needles for implant surgery? A systematic review and meta-analysis shows that blunt suture needles reduce glove perforation.

BACKGROUND: Despite a recent Cochrane Review demonstrating blunt suture needles are safer for surgeons, the use of blunt suture needles has not become widely adopted. In the 'Implant Era', with the value of medical implant companies to surpass $145 billion by 2027, should we re-examine the use of blunt suture needles, especially to reduce infection in implant surgery? We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) assessing whether blunt suture needles reduce risks to surgeons and patients. METHODS: A systematic review and meta-analysis was performed per PRISMA guidelines. PubMed, Cochrane and EMBASE databases were searched for RCTs. Dichotomous variables were pooled as risk ratios (RR) and associated 95% confidence intervals (CI) using the MH method. Random or fixed effects modelling use was based on statistical heterogeneity (I2). RESULTS: 14 RCTs were identified with 2488 patients. The RCTs included laparotomies, caesarean sections, episiotomies, and orthopaedic surgeries. Blunt suture needles when compared with sharp needles resulted in a significant reduction in glove perforation; RR: 0.47, 95% CI [0.37 to 0.60] and needlestick injuries, RR: 0.50, 95% CI [0.26 to 0.97]. Sharp needles caused more wound infections, but the result was not statistically significant; RR: 2.73, 95% CI [0.54 to 13.76], p 0.22. Surgeon's satisfaction decreased with blunt needles compared with sharp (RR: 1.22, 95% CI [1.09 to 1.37]). CONCLUSION: Blunt suture needles are safer than sharp needles for surgeons and likely reduce risks to patients. This, however, comes at the cost of decreased ease of use. The authors recommend the routine use of blunt suture needles, especially in implant surgery.

Vancomycin powder in the prevention of infection in primary knee and hip arthroplasty: Case-control study with 1151 arthroplasties. / Vancomicina en polvo en la prevención de la infección en artroplastia primaria de rodilla y cadera: estudio de casos y controles con 1.151 artroplastias.

BACKGROUND AND OBJECTIVE: Vancomycin powder (VP) has been positively used in spinal surgery to reduce the rate of infections. Hardly any data have been published on hip and knee joint replacement surgery, and its usefulness is questioned. Our objective was to investigate the effectiveness of VP in reducing prosthetic infection and its possible complications. METHODS: Primary hip (THA) and knee (TKA) arthroplasties were reviewed, performed by five surgeons in one hospital center, between 2017 and 2018. 1g of VP was used on the implant prior to surgical closure based on the surgeon's preferences. With a 5-year follow-up in which the infection rate and local complications were analyzed. RESULTS: One thousand one hundred and fifty one arthroplasties were performed, 748 were TKA and 403 were THA. Nine patients were diagnosed with prosthetic infection, of which five received VP and four did not (P=.555). Likewise, another 15 patients suffered wound complications, of which 11 received VP and 4 did not (P=.412). There were no differences, either, in the rest of the complications depending on the use or not of VP (P=.101). Likewise, the number of patients who needed reintervention was similar (P=.999). No systemic complications were detected due to the use of VP. CONCLUSIONS: It has not been possible to demonstrate that the use of VP reduces the rates of prosthetic infection in the hip and knee, so we cannot recommend its use.

Contribution of Sonication to the Identification of Megaprosthesis Infection in Culture Negative Oncologic Patient.

Conventional central osteosarcoma mainly affects the metaphysis of long bones in young people. The use of megaprostheses in oncological patients has increased in recent years. However, this type of surgery is not exempt from complications, with infections being the most common. In recent years, the presence of biofilm-forming bacteria has increased. Biofilm characteristics allow bacteria to resist hostile environmental conditions. The application of long wave ultrasound (process known as sonication) on the rescued inert material before culture interrupts the biofilm and generates a significantly higher recovery of bacterial growth compared to conventional tissue culture. We present the case of a 12-year-old patient with osteosarcoma of the femur, who, after surgery, developed a prosthetic infection detected by sonication, with negative soft tissue culture.

Dalbavancin as suppressive antibiotic therapy in patients with prosthetic infections: efficacy and safety.

Suppressive antibiotic therapy (SAT) is a strategy to alleviate symptoms and/or to reduce the progression of an infection when other treatment options cannot be used. Dalbavancin, due to its prolonged half-life, enables (bi) weekly dosing. Here, we report our multicenter real-life clinical experience with dalbavancin used as SAT in patients with prosthetic joint or vascular infections. Medical records of all adult patients with documented vascular or orthopedic chronic prosthetic infections, who received dalbavancin as SAT between 2016 and 2018 from four Spanish hospitals were reviewed for inclusion. Descriptive analysis of demographic characteristics, Charlson Comorbidity index, Barthel index, isolated pathogens and indication, concomitant antibiotic use, adverse events, and clinical outcome of SAT were performed. Eight patients were eligible for inclusion, where six patients had prosthetic vascular infections (aortic valve) and two patients had knee prosthetic joint infections. The most common pathogens were methicillin-susceptible Staphylococcus aureus and Enterococcus faecium. All patients had a history of prior antibiotic treatment for the prosthetic infection [median duration of antibiotic days 125 days (IQR, 28-203 days)]. The median number of dalbavancin doses was 29 (IQR, 9-61) and concomitant antibiotic use (n = 5, 62.5%). Clinical success was reported in 75% (n = 6) of patients. Adverse events were reported in two patients (mild renal and hepatic impairment). The median estimated cost savings due to the avoided hospital days was €60185 (IQR, 19,916-94984) per patient. Despite the limitations of our study, this preliminary data provides valuable insight to support further evaluation of dalbavancin for SAT in patients with prosthetic infections in the outpatient setting when alternative treatments are not feasible.

Linfocele persistente tras tratamiento de isquemia aguda en paciente con bloqueo linfático tras radioterapia / Persistent lymphocele after treatment of acute ischemia in a patient with lymphatic blockade after radiation therapy

Introducción: los linfoceles son una complicación poco frecuente en cirugía vascular, pero pueden representarun gran riesgo en pacientes con material protésico. Caso clínico: presentamos el caso de un varón de 82 años sometido hace 43 a radioterapia por un linfoma noHodgkin que presenta un gran linfocele en contacto con material protésico tras una intervención de revasculari-zación urgente. Se realiza tratamiento escleroterápico con espuma de polidocanol al 3% sin conseguir resultadosatisfactorio, por lo que se decide la sustitución del material protésico por autólogo y mioplastia de sartorio. Discusión: a pesar del fracaso con la escleroterapia de la cavidad, en gran medida debido al gran bloqueo linfáti-co crónico, consideramos esta opción la de elección en casos de linfocele por su baja complejidad, invasividad yexcelente relación riesgo/beneficio.(AU)

Background: lymphoceles are a rare complication in vascular surgery but can represent a great risk in patientswith prosthetic material. Case report: we present the case of an 82-year-old man who underwent radiotherapy 43 years ago for non-Hodg-kin lymphoma who presented a large lymphocele in contact with prosthetic material after an urgent revasculari-zation. Sclerotherapy treatment with 3% polidocanol foam was performed without achieving satisfactory resultsfor what we chose replace the prosthetic with autologous material and sartorius myoplasty. Discussion: despite the failure with sclerotherapy of the cavity, largely due to the great chronic lymphatic blockage,we consider this option the choice in cases of lymphocele due to its low complexity, invasiveness and excellentrisk/benefit ratio..(AU)

A Retrospective Analysis of the Association Between Male Facial Hair and the Incidence of Peri-Prosthetic Infections.

Background: The wearing of male facial hair has been undergoing something of a renaissance for a number of years, with medical colleagues in the surgical disciplines being no exception. Meanwhile, there are a few reports in the literature that beards might have an increased bacterial colonization. This study aims to determine if wearing a beard leads to an increased rate of infection in total hip or knee arthroplasty. Patients and Methods: A retrospective analysis was performed on 20,394 primary hip and knee replacements that were implanted at a single university hospital. The rate of infections that occurred within one year after surgery and the surgeons performing the surgery were recorded. The surgeons were classified into clean-shaven and beard wearers. The beard wearers were further classified by individual facial hair styles, namely a moustache, chin beard, round beard, or full beard. Results: The overall rate of surgical site infections 365 days after surgery is 0.75%. There was no statistically significant association between surgical site infection and the presence of facial hair (p = 0.774) or specific beard types (p = 0.298). Conclusions: The results presented in this study show no differences in infection rates across different facial hair styles of male surgeons.

Rat model of recalcitrant prosthetic joint infection using biofilm inocula.

Prosthetic joint infection (PJI) is a rare but devastating complication of joint arthroplasty. Biofilm formation around the prosthesis confers tolerance to antibiotics so that treatment is challenging. Most animal models of PJI use planktonic bacteria to establish the infection which fails to reproduce the pathology of chronic infection. We aimed to establish a rat model of Staphylococcus aureus PJI in male Sprague-Dawley rats using biofilm inocula and demonstrate its tolerance to frontline antibiotics. Pilot studies indicated that infection could be introduced to the knee joint by a biofilm-coated pin but that handling the prosthetic without disturbing the biofilm was difficult. We, therefore, developed a pin with a slotted end and used a miniature-biofilm reactor to develop mature biofilm in this niche. These biofilm-laden pins consistently produced infection of the bone and joint space. Treatment with high dose cefazolin, 250 mg/kg, starting the day of surgery reduced or cleared pin-adherent bioburden within 7 days, however when escalation from 25 to 250 mg/kg cefazolin treatment was delayed for 48 h, rats were unable to clear the infection. To track infections, we used bioluminescent bacteria, however, the bioluminescent signal did not accurately track the degree of infection in the bone and joint space as the signal did not penetrate the bone. In conclusion, we demonstrate that using a custom prosthetic pin, we can generate biofilm in a specific niche using a novel bioreactor setup and initiate a rat PJI that rapidly develops tolerance to supra-clinical doses of cefazolin.

Low Morbidity Anatomical Revascularisation for an Infected Aorto-Bifemoral Graft Using a Staged Hybrid Procedure.

A 66-year-old woman presented with a right femoral false aneurysm following an aortobifemoral bypass for lifestyle-limiting claudication. A computed tomography (CT) angiogram revealed features of complete aortobifemoral graft infection. A two-stage procedure was performed. The first hybrid stage involved the excision of only the femoral components and covered stenting of the aortic stump, along with recanalization of bilateral native iliac systems. The second stage, six weeks later, involved aortic stent and graft explant via midline laparotomy with aortic bovine pericardium patch repair (LeMaitre Vascular Inc, Burlington, Massachusetts). Follow-up imaging demonstrated no residual infection, and the patient remained without complication at the 12-month follow-up. This novel approach utilizes hybrid surgical techniques and modern bioprosthetic material to safely manage an infected aortobifemoral bypass graft.

Validez clínica de la histología intraoperatoria en el diagnóstico de la infección protésica / Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection

Antecedentes y objetivo: Diferentes autores han puesto de manifiesto la utilidad del análisis histológico en el diagnóstico de la infección protésica; sin embargo, todavía hoy, su validez clínica es motivo de controversia. El objetivo del presente manuscrito es describir y analizar la validez clínica del análisis histológico en el diagnóstico de infección protésica en el paciente sometido a un recambio protésico de cadera o rodilla. Material y métodos: Se presenta un estudio retrospectivo que incluye 133 recambios protésicos de cadera y rodilla realizados en nuestro centro entre 2008 y 2020. Se realizó un análisis estadístico descriptivo, bivariado y se determinó la validez clínica del análisis histológico. Resultados: La validez clínica del análisis histológico ofreció una sensibilidad del 48%, una especificidad del 91%, un valor predictivo positivo del 55% y un valor predictivo negativo del 88%. Conclusiones: La determinación de la validez clínica del análisis histológico pone de manifiesto una especificidad elevada. Dicho análisis supone una herramienta diagnóstica apropiada para detectar pacientes sanos, con ausencia de infección.(AU)

Background and aim: Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyze the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement. Material and methods: We present a retrospective study including 133 hip and knee prosthetic replacements performed in our center between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined. Outcomes: The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%. Conclusions: The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.(AU)

[Translated article] Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection / Validez clínica de la histología intraoperatoria en el diagnóstico de la infección protésica

Background and aim: Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyze the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement. Material and methods: We present a retrospective study including 133 hip and knee prosthetic replacements performed in our center between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined. Outcomes: The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%. Conclusions: The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.(AU)

Antecedentes y objetivo: Diferentes autores han puesto de manifiesto la utilidad del análisis histológico en el diagnóstico de la infección protésica; sin embargo, todavía hoy, su validez clínica es motivo de controversia. El objetivo del presente manuscrito es describir y analizar la validez clínica del análisis histológico en el diagnóstico de infección protésica en el paciente sometido a un recambio protésico de cadera o rodilla. Material y métodos: Se presenta un estudio retrospectivo que incluye 133 recambios protésicos de cadera y rodilla realizados en nuestro centro entre 2008 y 2020. Se realizó un análisis estadístico descriptivo, bivariado y se determinó la validez clínica del análisis histológico. Resultados: La validez clínica del análisis histológico ofreció una sensibilidad del 48%, una especificidad del 91%, un valor predictivo positivo del 55% y un valor predictivo negativo del 88%. Conclusiones: La determinación de la validez clínica del análisis histológico pone de manifiesto una especificidad elevada. Dicho análisis supone una herramienta diagnóstica apropiada para detectar pacientes sanos, con ausencia de infección.(AU)

Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection. / Validez clínica de la histología intraoperatoria en el diagnóstico de la infección protésica.

BACKGROUND AND AIM: Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyze the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement. MATERIAL AND METHODS: We present a retrospective study including 133 hip and knee prosthetic replacements performed in our center between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined. OUTCOMES: The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%. CONCLUSIONS: The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.

[Translated article] Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection.

BACKGROUND AND AIM: Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyse the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement. MATERIAL AND METHODS: We present a retrospective study including 133 hip and knee prosthetic replacements performed in our centre between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined. OUTCOMES: The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%. CONCLUSIONS: The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.

Is Instillational Topical Negative Pressure Wound Therapy in Peri-Prosthetic Infections of the Breast Effective? A Pilot Study.

Peri-prosthetic breast infections pose a risk of severe complications after breast implant surgery. The need to remove the breast implant, control the infection and perform additional surgical procedures are the consequences. Reimplantation of an alloplastic implant is only appropriate after an infection-free interval. In this retrospective cohort study, we investigated the effectiveness of negative pressure wound treatment with instillation and dwell time (NPWTi-d) on peri-prosthetic breast infections in combination with implant removal and antibiotic therapy. Twelve patients treated with NPWTi-d due to breast implant infection were included in the study. The bacterial burden was analyzed using wound swabs before and after NPWTi-d. Additionally, laboratory values were determined before NPWTi-d and immediately before wound closure. A total of 13 peri-prosthetic breast infections in 12 patients were treated using implant removal and NPWTi-d. In 76.9% (n = 10) of the cases, the patients had undergone alloplastic breast reconstruction following cancer-related mastectomy, whereas 23.1% (n = 3) of the patients had undergone breast augmentation for cosmetic reasons. The bacterial burden in the breast pocket decreased statistically significant after implant removal and NPWTi-d. No shift from Gram-positive to Gram-negative bacteria was observed. Inflammatory markers rapidly decreased following treatment. NPWTi-d had a positive impact on the healing process after peri-prosthetic breast infections, leading to a decrease in bacterial burden within the wounds and contributing to uneventful healing. Therefore, secondary reimplantation of breast prostheses might be positively influenced when compared to conventional implant removal and simple secondary closure. Further studies are required to conclusively establish the beneficial long-term effects of using NPWTi-d for the treatment of peri-prosthetic breast infections.

Epididymo-Orchitis and Pelvic Abscess in a Patient With Inflatable Penile Prosthesis.

This report discusses a case of a 79-year-old male with a urethral injury following implantation of an inflatable penile prosthesis, leading to frequent urinary tract infections. The patient presented with scrotal pain and swelling, as well as abdominal and suprapubic tenderness and rebound. He was diagnosed with epididymo-orchitis, penile prosthetic infection, and pelvis abscess, and was treated with cephalexin. The patient was admitted for urology consultation and had an uneventful hospital stay.

Reduction in Operating Room Airborne Particle Burden and Time-Dependent Contamination of Sterile Instrument Trays With the Use of a Novel Air Filtration System.

Introduction Postoperative infections represent a substantial burden to patients and healthcare systems. To improve patient care and reduce healthcare expenditures, interventions to reduce surgical infections must be employed. The crystalline C-band ultraviolet (UV-C) air filtration technology (Aerobiotix Inc., Miamisburg, OH, USA) has been designed to reduce airborne bioburden through high-quality filtration and germicidal irradiation. The purpose of this study was to assess the ability of a novel UV-C air filtration device to reduce airborne particle counts and contamination of surgical instrument trays in an operating room (OR) setting. Materials and methods Thirty sterile instrument trays were opened in a positive-air-flow OR. The trays were randomly assigned to one of two groups (UV-C or control, n=15 per group). In the UV-C group, the UV-C filtration device was used and in the control, it was not. All trays were opened with the use of a sterile technique and left exposed in the OR for four hours. Air was sampled by a particle counter to measure the numbers of 5µm and 10µm particles. Culture specimens were obtained from the trays to assess for bacterial contamination. Outcome data were collected at 30-minute intervals for the duration of the four-hour study period. Results Use of the UV-C device resulted in statistically significant reductions in the numbers of 5µm (average of 64.9% reduction when compared with the control, p<0.001) and 10µm (average of 65.7% reduction when compared with the control, p<0.001)-sized particles detectable in the OR. There was no significant difference in the overall rates of contamination (33.3% in the control group vs. 26.7% in the UV-C group, p=1.0) or the time to contamination (mean survival of 114 minutes in the control group vs. 105 minutes in the UV-C group, p=0.72) of surgical instrument trays with the use of the UV-C device. Conclusions The results demonstrate that the UV-C filtration device can successfully reduce airborne bioburden in standard ORs, suggesting that it may have the potential to reduce the risk for wound and hardware infections. Further clinical trials are necessary to better determine the effect of this air filtration system on postoperative infection rates.

Prevention of Orthopedic Prosthetic Infections Using Evidence-Based Surgical Site Infection Care Bundles: A Narrative Review.

Background: The number of primary/revision total joint replacements (TJR) are expected to increase substantially with an aging population and increasing prevalence of comorbid conditions. The 30-day re-admission rate, in all orthopedic specialties, is 5.4% (range, 4.8%-6.0%). A recent publication has documented that the surgical site infection (SSI) infection rate associated with revision total knee (rTKR, 15.6%) and revision total hip (rTHR, 8.6%) arthroplasties are four to seven times the rate of the primary procedures (2.1%-2.2%). These orthopedic infections prolong hospital stays, double re-admissions, and increase healthcare costs by a factor of 300%. Methods: A search of PubMed/MEDLINE, EMBASE and the Cochrane Library publications, which reported the infection risk after TKR and THR, was undertaken (January 1, 1995 to December 31, 2021). The search also included documentation of evidence-based practices that lead to improved post-operative outcomes. Results: The evidence-based approach to reducing the risk of SSI was grouped into pre-operative, peri-operative, and post-operative periods. Surgical care bundles have existed within other surgical disciplines for more than 20 years, although their use is relatively new in peri-operative orthopedic surgical care. Pre-admission chlorhexidine gluconate (CHG) showers/cleansing, staphylococcal decolonization, maintenance of normothermia, wound irrigation, antimicrobial suture wound closure, and post-operative wound care has been shown to improve clinical outcome in randomized controlled studies and meta-analyses. Conclusions: Evidence-based infection prevention care bundles have improved clinical outcomes in all surgical disciplines. The significant post-operative morbidity, mortality, and healthcare cost, associated with SSIs after TJR can be reduced by introduction of evidence-based pre-operative, intra-operative, and post-operative interventions.

Orthopedic infections due to Trichosporon species: Case series and literature review.

Reports of orthopedic fungal infections caused by Trichosporon species are extremely scarce, thus we aimed to describe a case series and review the cases published in the literature. Patients were retrospectively included if a previous culture of bone, joint, or soft tissues had resulted positive for Trichosporon species along with a clinical diagnosis of an orthopedic infection. Eight patients were included with diverse orthopedic conditions, most of them cases of osteomyelitis. The main isolated species was Trichosporon asahii. All patients were treated with antifungals, mainly voriconazole, and surgical management, resulting in high rates of clinical improvement and low associated mortality.

Reports of orthopedic infections caused by Trichosporon species are scarce. We described a case series of orthopedic infections caused by Trichosporon species and reviewed the previous published cases in the literature. We observed a high rate of clinical improvement and a low associated mortality.