Effectiveness of intra-articular vancomycin in preventing prosthetic joint infections in hip and knee arthroplasty: A systematic review and meta-analysis of RCT's

Review

Author: Machinski, Elcio ; da Silva Oliveira Filho, André Richard ; Varone, Bruno Butturi ; Leal, Daniel Peixoto ; Conde, Rodrigo Arruda ; Gobbi, Riccardo Gomes ; da Cruz, Vinícius Furtado ; Helito, Camilo Partezani

IntroductionThis study aimed to evaluate the effectiveness and safety of intra-articular vancomycin powder in reducing prosthetic joint infections (PJIs) in primary hip and knee arthroplasty through a meta-analysis of randomized controlled trials (RCTs).MethodsA research in Pubmed, Embase and Cochrane databases was performed to identify randomized clinical trials comparing intra-articular vancomycin use to conventional antibiotic prophylaxis in total hip or knee arthroplasty patients, assessing postoperative infection rates, adverse drug reactions, and venous thrombotic events. Statistical analysis was performed using R (RStudio 2024.04.2), and heterogeneity was assessed with the I² test.ResultsA total of 1485 patients from five randomized clinical trials were included, with 737 receiving intra-articular vancomycin. The infection rate was 0.54 % in the intervention group and 1.73 % in the control group (RR 0.37; 95 % CI 0.02-8.95; p = 0.369; I² = 49 %), showing no statistically significant difference between the groups. Adverse reactions to the glycopeptide were reported in six cases (0.8 %) in the intervention group compared to four cases (0.5 %) in the control group (RR 1.50; 95 % CI 1.50-150; p = 0.001; I² = 0 %). Regarding thrombotic events, there was one case in 647 patients in the intervention group and three cases in 660 patients in the control group (RR 0.45; 95 % CI 0.03-7.02; p = 0.169; I² = 0 %).ConclusionAlthough no significant difference was found, the intervention group showed a trend toward lower infection rates. Additional RCTs with larger sample sizes are required to confirm these findings.Trial registrationThe prospective registration of the meta-analysis was conducted on PROSPERO in July 2024 with the protocol number 565988.

01 May 2025·International Journal of Biological Macromolecules

Polystyrene microplastic exposure induces selective accumulation of antibiotic resistance genes in gut microbiota and its potential health risks

Article

Author: Huang, Haining ; Huang, Qiansheng ; Avellán-Llaguno, Ricardo David ; Li, Minghui ; Chen, Guoyou ; Chen, Jinsheng ; Ye, Guozhu

As emerging pollutants, antibiotic resistance genes (ARGs) and microplastics threaten the environment and human health. Gut microbiota is a hotspot for ARG emergence and spread. However, effects of microplastic exposure on the emergence and spread of gut microbial ARGs are unclear. Therefore, metagenomics was used to characterize polystyrene microplastics (PS)-induced ARG alterations in rat gut microbiota and their health risks, and to identify key ARG hosts and pathways as intervention targets. We found that PS exposure not only induced selective accumulation of glycopeptide and aminoglycoside ARGs, but also promoted mobility risks of glycopeptide and macrolide-lincosamide-streptogramin ARGs in gut microbiota. Metagenomic reassembly identified microbes belonging to Firmicutes (particularly order Clostridiales, such as speices Lachnospiraceae bacterium 3-1 and MD335) as major ARG hosts. Meanwhile, genera Enterococcus, Clostridioides and Streptococcus were main ARG hosts among human pathogens. Furthermore, glycopeptide and aminoglycoside ARGs were highly correlated with VanS/VanR signaling and its regulatory pathways of vancomycin resistance and peptidoglycan metabolism, amino sugar and nucleotide sugar metabolism, and CpxR signaling and its regulatory remodeling of cell envelope peptidoglycans and proteins in gut microbiota upon PS exposure. This study provides novel insights and intervention targets involved in PS-induced changes in gut microbial ARGs and their health risks.

01 May 2025·Infection Control & Hospital Epidemiology

High prevalence of multidrug-resistant bacteria on patient medical file surfaces at five critical care units in Kampala, Uganda: an explanatory sequential mixed-methods study

Article

Author: Mujugira, Andrew ; Izudi, Jonathan ; Okoboi, Stephen ; Kyamulabi, Margaret

AbstractIntroduction:Intensive care units (ICUs) and high-dependency units (HDUs) care for critically ill patients, many of whom have multi-drug-resistant (MDR) bacteria. We investigated the prevalence and distribution of MDR bacteria on the surfaces of patient medical files in three ICUs and two HDUs in Kampala.Method:We conducted a cross-sectional study that used simple random sampling to select patient medical files through unique codes recorded in a health information electronic system. MDR was defined as laboratory confirmation of the WHO priority pathogens following the 33rd edition of the Clinical Laboratory Standards Institute on Antimicrobial Susceptibility testing guidelines for antibiotic susceptibility interpretation. Quantitative data was descriptively analyzed, while qualitative was thematically analyzed.Results:Six of 33 files (18.2%) had MDR bacteria on their surfaces. Contamination was significantly associated with the type of medical diagnosis (p=0.014) and the file storage location (p=0.010). The MDR pathogens identified were Fastidious Acinetobacter (5/33; 15.2%) and methicillin-resistant Staphylococcus aureus (1/33; 3%).Conclusion:Nearly one in five patient medical files in ICUs and HDUs were contaminated with MDR bacteria. Most contaminated files belonged to patients treated with aminoglycoside or glycopeptide-based regimens.

100 Deals associated with Glycopeptide (ProtoKinetix)

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Indication	Highest Phase	Country/Location	Organization	Date
Dystrophy, Macular	Phase 1	United States	Protokinetix, Inc.	09 Jun 2022

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