Prosthetic joint infections, biomarkers and antibiotic stewardship

Saeed, Kordo (2020) Prosthetic joint infections, biomarkers and antibiotic stewardship. University of Southampton, Doctoral Thesis, 150pp.

Record type: Thesis (Doctoral)

Abstract

Infection, microbiology, diagnostics, antibiotic stewardship and infection prevention/control are interweaving matters, one benefit from the other and all advance each other.

The complex nature of medical sciences and the advances in medical, surgical, cancer care and technologies currently available, particularly in the western world, means population live longer. However in certain cases, these advances result in increased susceptibility to infection that needs novel diagnostics as well as the provision of excellent antimicrobial and infection prevention programmes to treat, prevent spread as well as limit or prevent the rise of antimicrobial resistance.

A good example is joint replacement (Arthroplasty), the majority of which are successful. Not only do they provide pain relief, restore function and independence, but also improve the patients’ quality of life. Prosthetic (or periprosthetic) joint infection (PJI) or arthroplasty associated infections (AAI) which is defined as infection involving the joint prosthesis and adjacent tissue are rare, although the effect on patients and health economy can be detrimental in the era of rising antimicrobial resistance.

An accurate diagnosis of PJI remains a challenging clinical problem. Despite aggressive investigations, the distinction between PJI and other causes of joint failure, such as aseptic loosening, can frequently be convoluted even among experts in the field. Chapters one and two of this thesis will review diagnostic tests in PJI including the original application of novel biomarkers in the synovial fluid as well as the application of specific polymerase chain reaction (PCR) technology. Chapter three aims to highlight the issues of antimicrobial resistance through original research into novel strains of methicillin resistant Staphylococcus aureus (MRSA) and a review on hidden resistances associated with S. aureus, an organism that is associated with bone and joint infections including PJI. Finally in chapter four, my aim was to provide further insights through application of biomarkers into antibiotic decision making process and stewardship programmes and specific novel application in antibiotic delivery in PJI.

This thesis is the result of research and publication over the past ten years. It is mainly intended for infection specialists, antimicrobial pharmacists and orthopaedic surgeons, aiming to provide professionals with insight to these novel applications and technologies, encourage collaborative work among these multidisciplinary teams, and generating more research questions and future studies.