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Paul M Huddleston - One of the best experts on this subject based on the ideXlab platform.

  • Implant Sonication versus Tissue Culture for the Diagnosis of Spinal Implant Infection.
    Spine, 2020
    Co-Authors: Bayard C. Carlson, Jeremy T. Hines, William A. Robinson, Arjun S. Sebastian, Kerryl E. Greenwood-quaintance, Robin Patel, Paul M Huddleston
    Abstract:

    : MINI: We compared the sensitivity and specificity of peri-Implant tissue culture to the vortexing-sonication technique for the diagnosis of Spinal Implant infection (SII). Lower thresholds of sonicate fluid culture positivity showed increased sensitivity with maintained specificity. We recommend a threshold of 20 CFU/10 mL for sonicate culture positivity for the diagnosis of SII. STUDY DESIGN: This is a retrospective study comparing the diagnosis of Spinal Implant infection (SII) by peri-Implant tissue culture to vortexing-sonication of retrieved Spinal Implants. OBJECTIVE: We hypothesized that vortexing-sonication would be more sensitive than peri-Implant tissue culture. SUMMARY OF BACKGROUND DATA: We previously showed Implant vortexing-sonication followed by culture to be more sensitive than standard peri-Implant tissue culture for diagnosing of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods and evaluated thresholds for positivity for sonicate fluid for SII diagnosis. METHODS: We compared peri-Implant tissue culture to the vortexing-sonication technique which samples bacterial biofilm on the surface of retrieved Spinal Implants. We evaluated different thresholds for sonicate fluid positivity and assessed the sensitivity and specificity of the two culture methods for the diagnosis of SII. RESULTS: A total of 152 patients were studied. With more than 100 colony forming units (CFU)/10 mL as a threshold for sonicate fluid culture positivity, there were 46 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 65.2% and 79.6%; the specificities were 88.7% and 93.4%, respectively. With more than 50 CFU/10 mL as a threshold, there were 50 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 68.0% and 76.0%; the specificities were 92.2% for both methods. Finally, with more than or equal to 20 CFU/10 mL as a threshold, there were 52 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 69.2% and 82.7%; the specificities were 94.0% and 92.0%, respectively. CONCLUSION: Implant sonication followed by culture is a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, enhancing the clinical utility of Implant sonication. LEVEL OF EVIDENCE: 4.

  • Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P35. Implant sonication versus tissue culture for the detection of Spinal Implant infection
    The Spine Journal, 2018
    Co-Authors: Bayard C. Carlson, Jeremy T. Hines, William A. Robinson, Arjun S. Sebastian, Paul M Huddleston
    Abstract:

    BACKGROUND CONTEXT Diagnosing a Spinal Implant infection (SII) remains a challenge. We have previously shown that Implant sonication followed by culture is more sensitive than peri-Implant tissue culture for the microbiologic diagnosis of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods. PURPOSE To compare Implant sonication versus tissue culture for the detection of Spinal Implant infection. STUDY DESIGN/SETTING Restrospective case series. METHODS We compared peri-Implant tissue culture to the vortexing-bath sonication technique which samples bacterial biofilm on the surface of retrieved Spinal Implants. We established different thresholds for sonicate positivity and assessed the sensitivity and specificity of these culture methods for the diagnosis of SII. RESULTS A total of 153 patients were studied. With 100 colony forming units (CFU) as a threshold for sonicate culture positivity, there were 47 patients with SII. At this level, the sensitivites of peri-Implant tissue and sonicate fluid culture were 66.0% and 70.2% (p=.6); the specificities were 88.7% and 93.4%, respectively. With 50 CFU as a threshold, there were 51 patients with SII. The sensitivies of peri-Implant tissue and sonicate fluid culture were 68.6% and 76.5% (p=.47); the specificities were 92.2% for both methods. Finally, with 20 CFU as a threshold, there were 52 patients with SII. The sensitivies of peri-Implant tissue and sonicate fluid culture were 69.8% and 83.0% (p=.09); the specificities were 94.0% and 92.0%, respectively. CONCLUSIONS When compared to peri-Implant tissue culture, Implant sonication followed by culture remains a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, further enhancing the clinical utility of Implant sonication.

  • A Biofilm Approach to Detect Bacteria on Removed Spinal Implants
    Spine, 2010
    Co-Authors: Marta Fernandez Sampedro, Paul M Huddleston, Jayawant N Mandrekar, Douglas R Osmon, Kerryl E. Piper, Melissa J. Karau, Mark B. Dekutoski, Michael J. Yaszemski, Bradford L. Currier, Andrew Mcdowell
    Abstract:

    STUDY DESIGN: This is a prospective study comparing the diagnosis of Spinal Implant infection by conventional peri-Implant tissue culture with a technique which uses a combination of vortexing and bath sonication to dislodge bacteria growing as a biofilm on the surface of retrieved Spinal Implants.OBJECTIVE: We hypothesized that the biofilm-sampling technique would be more sensitive than peri-Implant tissue culture.SUMMARY OF BACKGROUND DATA: Culture of peri-Implant tissue is inaccurate for the diagnosis of orthopedic device-related infection; cultures taken from the Implant may be more sensitive. We have developed a technique which uses vortexing-bath sonication to sample bacterial biofilms on the surface of retrieved hip and knee Implants, and shown that it is more sensitive than peri-prosthetic tissue culture for the microbiologic diagnosis of prosthetic knee, hip, and shoulder infection.METHODS: We compared peri-Implant tissue culture to the vortexing-bath sonication technique which samples bacterial biofilm on the surface of retrieved Spinal Implants, for the diagnosis of Spinal Implant infection. In addition, we compared detection of Staphylococcus and Propionibacterium acnes by rapid cycle real-time polymerase chain reaction with culture of sonicate fluid.RESULTS: A total of 112 subjects were studied; 22 had Spinal Implant infection. The sensitivities of peri-Implant tissue and sonicate fluid culture were 73% and 91% (P = 0.046), and the specificities were 93% and 97%, respectively. P. acnes and coagulase-negative staphylococci were the most frequent microorganisms detected among subjects with Spinal Implant infection, with P. acnes detected in 56 and 45%, and coagulase-negative staphylococci detected in 31 and 40% of peri-Implant tissue and sonicate fluid cultures, respectively. Compared with the culture of sonicate fluid, polymerase chain reaction was 100 and 67% sensitive for the detection of culture-positive Staphylococcus and P. acnes Spinal Implant infection, respectively.CONCLUSION: Implant sonication followed by culture is more sensitive than peri-Implant tissue culture for the microbiologic diagnosis of Spinal Implant infection.

  • the management and outcome of Spinal Implant infections contemporary retrospective cohort study
    Clinical Infectious Diseases, 2007
    Co-Authors: Todd J Kowalski, Elie F Berbari, Paul M Huddleston, James M Steckelberg, Jayawant N Mandrekar, Douglas R Osmon
    Abstract:

    BACKGROUND: Spinal Implant infections provide unique diagnostic and therapeutic challenges. METHODS: We conducted a retrospective cohort study to evaluate risk factors for treatment failure in patients with early- and late-onset Spinal Implant infections at the Mayo Clinic (Rochester, MN) during 1994-2002. RESULTS: We identified 30 patients with early-onset Spinal Implant infection and 51 patients with late-onset Spinal Implant infection. Twenty-eight of 30 patients with early-onset infection were treated with debridement, Implant retention, and antimicrobial therapy. The estimated 2-year cumulative probability of survival free of treatment failure for patients with early-onset infection was 71% (95% confidence interval [CI], 51%-85%). Thirty-two of 51 patients with late-onset infection were treated with Implant removal. Their estimated 2-year cumulative probability of survival free of treatment failure was 84% (95% CI, 66%-93%). For patients with early-onset infections, receiving oral antimicrobial suppression therapy was associated with increased cumulative probability of survival (hazard ratio, 0.2; 95% CI, 0.1-0.7). For patients with late-onset infections, Implant removal was associated with increased cumulative probability of survival (hazard ratio, 0.3; 95% CI, 0.1-0.7). CONCLUSIONS: Early-onset Spinal Implant infections are successfully treated with debridement, Implant retention, and parenteral followed by oral suppressive antimicrobial therapy. Implant removal is associated with successful outcomes in late-onset infections.

Christine Coillard - One of the best experts on this subject based on the ideXlab platform.

  • in vivo biocompatibility testing of peek polymer for a Spinal Implant system a study in rabbits
    Journal of Biomedical Materials Research, 2002
    Co-Authors: Charles-h. Rivard, Souad Rhalmi, Christine Coillard
    Abstract:

    We are developing a new Spinal Implant system (SIS) without fusion (bone graft). This SIS is made from two materials, metal and polyetheretherketone (PEEK) polymer. The Food and Drug Administration recommended testing in vivo, in an animal model, whether the PEEK polymer could be used in a SIS without any harm of wear debris to the nervous tissue (Spinal cord and nerve roots). The objective was to evaluate the biological response of the Spinal cord and nerve roots (dura mater) to PEEK polymer particles. Twenty-four female New Zealand white rabbits were used. The rabbits were divided into three groups: test (n = 12), control (n = 9), and sham (n = 3). During the surgery, the test group received the PEEK particle injections (5 × 10 7 particles per site, lumbar and thoracic), while the control group re- ceived only the vehicle (0.9% saline solution). The sham group had the same surgical approach without injection. In each group, the rabbits were euthanized at 1, 4, and 12 weeks postsurgery. The macroscopic and semiquantitative histologic analyses of the Spinal cords (dura mater) showed normal vascularization and particle adherence to the con- nective tissue especially at the injection sites. Neither necro- sis nor swelling of the dura mater and nerve roots was ob- served. The PEEK polymer is harmless to the Spinal cord; thus it might be used as component in the Spinal Implant system. © 2002 Wiley Periodicals, Inc. J Biomed Mater Res 62: 488-498, 2002

  • In vivo biocompatibility testing of peek polymer for a Spinal Implant system: A study in rabbits
    Journal of Biomedical Materials Research, 2002
    Co-Authors: Charles-h. Rivard, Souad Rhalmi, Christine Coillard
    Abstract:

    We are developing a new Spinal Implant system (SIS) without fusion (bone graft). This SIS is made from two materials, metal and polyetheretherketone (PEEK) polymer. The Food and Drug Administration recommended testing in vivo, in an animal model, whether the PEEK polymer could be used in a SIS without any harm of wear debris to the nervous tissue (Spinal cord and nerve roots). The objective was to evaluate the biological response of the Spinal cord and nerve roots (dura mater) to PEEK polymer particles. Twenty-four female New Zealand white rabbits were used. The rabbits were divided into three groups: test (n = 12), control (n = 9), and sham (n = 3). During the surgery, the test group received the PEEK particle injections (5 x 10(7) particles per site, lumbar and thoracic), while the control group received only the vehicle (0.9% saline solution). The sham group had the same surgical approach without injection. In each group, the rabbits were euthanized at 1, 4, and 12 weeks postsurgery. The macroscopic and semiquantitative histologic analyses of the Spinal cords (dura mater) showed normal vascularization and particle adherence to the connective tissue especially at the injection sites. Neither necrosis nor swelling of the dura mater and nerve roots was observed. The PEEK polymer is harmless to the Spinal cord; thus it might be used as component in the Spinal Implant system.

Stephen D. Zoller - One of the best experts on this subject based on the ideXlab platform.

  • In vivo Mouse Model of Spinal Implant Infection
    Journal of Visualized Experiments, 2020
    Co-Authors: Benjamin V. Kelley, Stephen D. Zoller, Danielle Greig, Kellyn R. Hori, Nicolas Cevallos, Chad R. Ishmael, Peter P. Hsiue, Rishi Trikha, Troy Sekimura, Thomas Olson
    Abstract:

    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 x 103 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 Use of a Novel Antimicrobial Implant Coating in vivo to Prevent Spinal Implant Infection.
    Spine, 2020
    Co-Authors: Vishal Hegde, Howard Y. Park, Erik M. Dworsky, Stephen D. Zoller, Weixian Xi, Daniel Johansen, Amanda H. Loftin, Christopher D. Hamad, Tatiana Segura, Nicholas M. Bernthal
    Abstract:

    STUDY DESIGN: A controlled, interventional animal study OBJECTIVE.: Spinal Implant infection 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 Spinal Implant infection. SUMMARY OF BACKGROUND DATA: Current methods to minimize the frequency of Spinal Implant infection include: local antibiotic therapy (vancomycin powder), betadine irrigation, silver nanoparticles, and passive release from antibiotic-loaded cement (PMMA) 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 Spinal Implant infection. METHODS: A 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 Spinal Implant infection. Noninvasive bioluminescence imaging was used to quantify the bacterial burden, and Implant sonication was used to determine bacterial colony forming units from the Implant and surrounding bone and soft tissue. RESULTS: The PEG-PPS-vancomycin coating significantly lowered the infection burden from post-operative day (POD) 3 onwards (p 

  • the use of a novel antimicrobial Implant coating in vivo to prevent Spinal Implant infection
    Spine, 2020
    Co-Authors: Vishal Hegde, Howard Y. Park, Erik M. Dworsky, Stephen D. Zoller, Weixian Xi, Daniel Johansen, Amanda H. Loftin, Christopher D. Hamad, Tatiana Segura, Nicholas M. Bernthal
    Abstract:

    STUDY DESIGN: A controlled, interventional animal study OBJECTIVE.: Spinal Implant infection 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 Spinal Implant infection. SUMMARY OF BACKGROUND DATA: Current methods to minimize the frequency of Spinal Implant infection include: local antibiotic therapy (vancomycin powder), betadine irrigation, silver nanoparticles, and passive release from antibiotic-loaded cement (PMMA) 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 Spinal Implant infection. METHODS: A 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 Spinal Implant infection. Noninvasive bioluminescence imaging was used to quantify the bacterial burden, and Implant sonication was used to determine bacterial colony forming units from the Implant and surrounding bone and soft tissue. RESULTS: The PEG-PPS-vancomycin coating significantly lowered the infection burden from post-operative day (POD) 3 onwards (p < 0.05), while PEG-PPS-tigecycline only decreased the infection on POD 5-10 (p < 0.05). Colony-forming units (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 < 0.05). CONCLUSIONS: The biodegradable PEG-PPS coating demonstrates promise in decreasing bacterial burden and preventing Spinal Implant infection. The vancomycin coating outperformed the tigecycline coating in this model compared to prior work in arthroplasty models, highlighting the uniqueness of the para-Spinal infection microenvironment. LEVEL OF EVIDENCE: N/A.

  • multimodal imaging guides surgical management in a preclinical Spinal Implant infection model
    JCI insight, 2019
    Co-Authors: Stephen D. Zoller, Howard Y. Park, Christopher D. Hamad, Kellyn R. Hori, Tove Olafsen, Charles Zamilpa, Zachary D C Burke, Gideon W Blumstein, William Sheppard, Jenchieh Tseng
    Abstract:

    : 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.

  • combinatory antibiotic therapy increases rate of bacterial kill but not final outcome in a novel mouse model of staphylococcus aureus Spinal Implant infection
    PLOS ONE, 2017
    Co-Authors: Yan Hu, Vishal Hegde, Howard Y. Park, Erik M. Dworsky, Stephen D. Zoller, Daniel Johansen, Amanda H. Loftin, Christopher D. Hamad, George E Nelson, Kevin P Francis
    Abstract:

    Background Management of spine Implant infections (SII) are challenging. Explantation of infected Spinal hardware can destabilize the spine, but retention can lead to cord compromise and biofilm formation, complicating management. While vancomycin monotherapy is commonly used, in vitro studies have shown reduced efficacy against biofilm compared to combination therapy with rifampin. Using an established in vivo mouse model of SII, we aim to evaluate whether combination therapy has increased efficacy compared to both vancomycin alone and infected controls. Methods An L-shaped, Kirschner-wire was transfixed into the L4 spinous process of 12-week-old C57BL/6 mice, and inoculated with bioluminescent Staphylococcus aureus. Mice were randomized into a vancomycin group, a combination group with vancomycin plus rifampin, or a control group receiving saline. Treatment began on post-operative day (POD) 7 and continued through POD 14. In vivo imaging was performed to monitor bioluminescence for 35 days. Colony-forming units (CFUs) were cultured on POD 35. Results Bioluminescence peaked around POD 7 for all groups. The combination group had a 10-fold decrease in signal by POD 10. The vancomycin and control groups reached similar levels on POD 17 and 21, respectively. On POD 25 the combination group dropped below baseline, but rebounded to the same level as the other groups, demonstrating a biofilm-associated infection by POD 35. Quantification of CFUs on POD 35 confirmed an ongoing infection in all three groups. Conclusions Although both therapies were initially effective, they were not able to eliminate Implant biofilm bacteria, resulting in a rebound infection after antibiotic cessation. This model shows, for the first time, why histologic-based, static assessments of antimicrobials can be misleading, and the importance of longitudinal tracking of infection. Future studies can use this model to test combinations of antibiotic therapies to see if they are more effective in eliminating biofilm prior to human trials.

Charles-h. Rivard - One of the best experts on this subject based on the ideXlab platform.

  • in vivo biocompatibility testing of peek polymer for a Spinal Implant system a study in rabbits
    Journal of Biomedical Materials Research, 2002
    Co-Authors: Charles-h. Rivard, Souad Rhalmi, Christine Coillard
    Abstract:

    We are developing a new Spinal Implant system (SIS) without fusion (bone graft). This SIS is made from two materials, metal and polyetheretherketone (PEEK) polymer. The Food and Drug Administration recommended testing in vivo, in an animal model, whether the PEEK polymer could be used in a SIS without any harm of wear debris to the nervous tissue (Spinal cord and nerve roots). The objective was to evaluate the biological response of the Spinal cord and nerve roots (dura mater) to PEEK polymer particles. Twenty-four female New Zealand white rabbits were used. The rabbits were divided into three groups: test (n = 12), control (n = 9), and sham (n = 3). During the surgery, the test group received the PEEK particle injections (5 × 10 7 particles per site, lumbar and thoracic), while the control group re- ceived only the vehicle (0.9% saline solution). The sham group had the same surgical approach without injection. In each group, the rabbits were euthanized at 1, 4, and 12 weeks postsurgery. The macroscopic and semiquantitative histologic analyses of the Spinal cords (dura mater) showed normal vascularization and particle adherence to the con- nective tissue especially at the injection sites. Neither necro- sis nor swelling of the dura mater and nerve roots was ob- served. The PEEK polymer is harmless to the Spinal cord; thus it might be used as component in the Spinal Implant system. © 2002 Wiley Periodicals, Inc. J Biomed Mater Res 62: 488-498, 2002

  • In vivo biocompatibility testing of peek polymer for a Spinal Implant system: A study in rabbits
    Journal of Biomedical Materials Research, 2002
    Co-Authors: Charles-h. Rivard, Souad Rhalmi, Christine Coillard
    Abstract:

    We are developing a new Spinal Implant system (SIS) without fusion (bone graft). This SIS is made from two materials, metal and polyetheretherketone (PEEK) polymer. The Food and Drug Administration recommended testing in vivo, in an animal model, whether the PEEK polymer could be used in a SIS without any harm of wear debris to the nervous tissue (Spinal cord and nerve roots). The objective was to evaluate the biological response of the Spinal cord and nerve roots (dura mater) to PEEK polymer particles. Twenty-four female New Zealand white rabbits were used. The rabbits were divided into three groups: test (n = 12), control (n = 9), and sham (n = 3). During the surgery, the test group received the PEEK particle injections (5 x 10(7) particles per site, lumbar and thoracic), while the control group received only the vehicle (0.9% saline solution). The sham group had the same surgical approach without injection. In each group, the rabbits were euthanized at 1, 4, and 12 weeks postsurgery. The macroscopic and semiquantitative histologic analyses of the Spinal cords (dura mater) showed normal vascularization and particle adherence to the connective tissue especially at the injection sites. Neither necrosis nor swelling of the dura mater and nerve roots was observed. The PEEK polymer is harmless to the Spinal cord; thus it might be used as component in the Spinal Implant system.

Robin Patel - One of the best experts on this subject based on the ideXlab platform.

  • Implant Sonication versus Tissue Culture for the Diagnosis of Spinal Implant Infection.
    Spine, 2020
    Co-Authors: Bayard C. Carlson, Jeremy T. Hines, William A. Robinson, Arjun S. Sebastian, Kerryl E. Greenwood-quaintance, Robin Patel, Paul M Huddleston
    Abstract:

    : MINI: We compared the sensitivity and specificity of peri-Implant tissue culture to the vortexing-sonication technique for the diagnosis of Spinal Implant infection (SII). Lower thresholds of sonicate fluid culture positivity showed increased sensitivity with maintained specificity. We recommend a threshold of 20 CFU/10 mL for sonicate culture positivity for the diagnosis of SII. STUDY DESIGN: This is a retrospective study comparing the diagnosis of Spinal Implant infection (SII) by peri-Implant tissue culture to vortexing-sonication of retrieved Spinal Implants. OBJECTIVE: We hypothesized that vortexing-sonication would be more sensitive than peri-Implant tissue culture. SUMMARY OF BACKGROUND DATA: We previously showed Implant vortexing-sonication followed by culture to be more sensitive than standard peri-Implant tissue culture for diagnosing of SII. In this follow-up study, we analyzed the largest sample size available in the literature to compare these two culture methods and evaluated thresholds for positivity for sonicate fluid for SII diagnosis. METHODS: We compared peri-Implant tissue culture to the vortexing-sonication technique which samples bacterial biofilm on the surface of retrieved Spinal Implants. We evaluated different thresholds for sonicate fluid positivity and assessed the sensitivity and specificity of the two culture methods for the diagnosis of SII. RESULTS: A total of 152 patients were studied. With more than 100 colony forming units (CFU)/10 mL as a threshold for sonicate fluid culture positivity, there were 46 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 65.2% and 79.6%; the specificities were 88.7% and 93.4%, respectively. With more than 50 CFU/10 mL as a threshold, there were 50 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 68.0% and 76.0%; the specificities were 92.2% for both methods. Finally, with more than or equal to 20 CFU/10 mL as a threshold, there were 52 patients with SII. The sensitivities of peri-Implant tissue and sonicate fluid culture were 69.2% and 82.7%; the specificities were 94.0% and 92.0%, respectively. CONCLUSION: Implant sonication followed by culture is a sensitive and specific method for the diagnosis of SII. Lower thresholds for defining sonicate fluid culture positivity allow for increased sensitivity with a minimal decrease in specificity, enhancing the clinical utility of Implant sonication. LEVEL OF EVIDENCE: 4.

  • Topical vancomycin for treatment of methicillin-resistant Staphylococcus epidermidis infection in a rat Spinal Implant model
    Spine Deformity, 2020
    Co-Authors: Melissa J. Karau, Jayawant N Mandrekar, Robin Patel, Chenghao Zhang, Nicholas J. Kohrs, David A. Puleo, Andre J. Wijnen, Thomas G. Boyce, A. Noelle Larson, Todd A. Milbrandt
    Abstract:

    Study design Basic science. Objective Investigate the ability of local applicaiton of vancomycin, either in powder form or suspended within poly(lactic-co-glycolic acid) microspheres (MS), to treat infection using a rat Spinal model. Summary of background data Surgical site infections (SSIs) are a serious complication after spine surgery and are associated with high morbidity and mortality and often caused my coagulase negative staphylococci. A comprehensive approach to reduce SSIs has been recommended including the use of topical vancomycin. Animal and human studies have shown improved control of infection with local compared to systemic antibiotics. Methods K-wires seeded with methicillin-resistant Staphylococcus epidermidis RP62A (MRSE) were treated with vancomycin powder, carboxymethylcellulose sodium salt (CMC) (microsphere carrier), vancomycin powder, blank MS or vancomycin-loaded MS for 24 or 48 h in vitro after which bacteria were enumerated. In addition, a Spinal instrumentation model was developed in rats with a bacterial seeded K-wire Implanted into the right side of L4 and L5. Rats underwent no treatment or were treated locally with either vancomycin powder, blank MS or vancomycin-loaded MS. After 8 weeks, the K-wire, bone, soft tissue and wire fastener were cultured and results analyzed. Results Vancomycin powder and vancomycin-loaded MS resulted in significantly fewer bacteria remaining in vitro than did CMC. Vancomycin powder- treated animals’ cultures were significantly lower than all other groups ( P