Etiology, prevention and treatment of infections after anterior cruciate ligament reconstruction

• Autores: Daniel Pérez Prieto
• Directores de la Tesis: Juan Carlos Monllau García (dir. tes.), Andrej Trampuz (dir. tes.), L. Puig-Verdié (dir. tes.)
• Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2018
• Idioma: español
• Tribunal Calificador de la Tesis: Salvador Navarro Soto (presid.), Oliviier Borens (secret.), Joao Espregueira Mendes (voc.)
• Programa de doctorado: Programa de Doctorado en Cirugía y Ciencias Morfológicas por la Universidad Autónoma de Barcelona
• Materias:
  • Ciencias médicas
    • Ciencias clínicas
      • Microbiología clínica
    • Cirugía
      • Cirugía ortopédica
      • Traumatología
• Enlaces
  • Tesis en acceso abierto en: TESEO
• Resumen

  • Infections after anterior cruciate ligament reconstruction (ACL-R) are complications with an incidence between 0,5% and 1,5% and can cause serious knee joint damage if a correct treatment is not applied. During last decade several studies about arthroscopic debridement efficacy and outcomes have been published. However, literature about the origin and prevention of ACL-R infections is scarce same as its antibiotic treatment.

    The present thesis is a compendium of three publications about the etiology, the prevention and the treatment of infections after ACL-R. The purposes are: to evaluate the ACL graft contamination as a source of infection; to evaluate the effectiveness of a 5mg/dl vancomycin solution to eradicate contamination and thus reduce infection’s rate; and finally, to evaluate the combination of levofloxacin and rifampicin as the optimal antibiotic treatment for staphylococcal infections.

    A contamination rate of 14% was observed during ACL graft harvesting and preparation, most of it due to staphylococci (71%). The soaking in a 5mg/dl vancomycin solution completely eradicates contamination. In clinical practice the presoaking of ACL graft in the vancomycin solution reduces infection rate from 1,8% to 0%. Finally the combination of oral levofloxacin and rifampicin (along with arthroscopic debridement) for a period of 6 weeks is an effective treatment for staphylococcal infections.

    The conclusions of the present thesis and its publications compendium are: 1) The ACL graft harvesting and preparation is a source of contamination that can lead to infection. 2) The vancomycin solution of 5mg/dl completely eradicates the aforementioned contamination and reduces ACL-R infection rate to 0%. 3) The combination of levofloxacin and rifampicin after arthroscopic debridement is the optimal antibiotic schedule for staphylococcal ACL-R infections.