1. After a patient undergoes MRSA decolonization, is there a need to re-screen the patient?
2. Are light handles a source of contamination during orthopedic procedures?
3. Are there any concerns regarding the use of joint registries or administrative databases to conduct infection studies?
4. Are there any genetic factors that predispose patients to SSI/PJI or predict the success of the treatment for SSI/PJI?
5. a) Do underweight patients (low BMI) have a higher risk of SSI/PJI following orthopedic procedures? b) If yes, does increasing the body mass index in underweight patients reduce the risk of SSI/PJI?
6. Can a biomaterial surface be modified to dispel bacterial adherence and biofilms? What are the potential concerns in modifying implant surfaces to combat biofilms?
7. Can ceftriaxone be utilized as an alternative to cefazolin in the treatment of orthopedic infections caused by MSSA ? If so, what dosing is recommended?
8. Can fresh frozen allograft be used as a carrier to deliver local antibiotics during revision arthroplasty?
9. Can immunotherapy and immunoprophylaxis be used to prevent biofilm formation and implant-associated infections?
10. Can isolated local antibiotic delivery ever be effective in the treatment of musculoskeletal infections?
11. Can regional anesthesia be administered to patients with orthopedic infections?
12. Do antibacterial-coated sutures reduce the risk of subsequent SSI/PJI?
13. Do antibiotic coatings on implants reduce the rate of SSI/PJI?
14. Do antiplatelet drugs need to be withheld pre-operatively to reduce the risk for subsequent SSI/PJI?
15. Do patients need to refrain from getting the surgical incision wet or submerged in water to prevent SSI/PJI? If so, for how long postoperatively?
16. Does a patient with a colostomy have an increased risk for SSI/PJI?
17a. Does a prior arthroscopy of the hip joint increase the risk of a subsequent SSI/PJI in patients undergoing elective total hip arthroplasty?
17b. Does a prior arthroscopy of the knee increase the risk of a subsequent SSI/PJI in patients undergoing elective arthroplasty?
18. Does a prior surgical procedure (with or without retained hardware) in the same joint as the arthroplasty increase the risk of subsequent SSI/PJI? If so, what can be done to reduce the risk of SSI/PJI?
19. Does a prolonged hospitalization prior to elective total joint arthroplasty increase the risk of subsequent SSI/PJI?
20. Does addition of topical antibiotics (polymyxin and/or bacitracin) to irrigation solution offer additional antibacterial properties?
21. Does additional skin cleansing after draping have a role in reduction of SSI/PJI?
22. Does allogeneic blood transfusion increase the risk of SSI/PJI?
23. Do bacteria form biofilm on the surface of cement spacer in a similar fashion to a metallic implant?
24. Does bacteriophage technology have a role in treating multi-resistant PJI?
25. Does bariatric surgery reduce the risk of SSI/PJI in patients with obesity?
26. Does changing gloves during prolonged operations reduce the risk of SSI/PJI? If so, how frequently should gloves be changed during the procedure?
27. Does changing surgical gowns during prolonged operations reduce the risk of SSI/PJI? If so, how frequently should gowns be changed during the procedure?
28. Does changing the electrocautery tip during surgery reduce the rate of subsequent SSI/PJI?
29. Does current tobacco use increase the risk of SSI/PJI recurrence?
30. Does human immunodeficincy virus (HIV) predispose patients to SSI/PJI? If so, what optimization should be undertaken prior to operating on patients with HIV?
31. Does liver disease (hepatitis C, cirrhosis) predispose patients to SSI/PJI? If so, what optimization should be undertaken prior to operating on patients with hepatitis C?
32. Does Mycobacterium tuberculosis form a biofilm on implants?
33. Does operative time affect the risk of SSI/PJI?
34. Does perioperative normothermia affect the rate of subsequent SSI/PJI?
35. Does placement of patients with an infection in private hospital rooms decrease the risk of subsequent SSI/PJI for patients undergoing orthopedic procedures?
36. Does poor dental hygiene increase the risk of subsequent SSI/PJI? If yes, is there a role for obtaining dental clearance in patients with poor dental hygiene to reduce the risk of SSI/PJI?
37. Does preoperative skin cleansing at home prior to orthopedic surgery have a role in reduction of subsequent SSI/PJI?
38. Does preoperative swabbing of sinus tract have a role in isolation of the infecting organism?
39. Does pre-operative urinary tract infection (symptomatic and asymptomatic) increase the risk for subsequent SSI/PJI?
40. Does prior SSI/PJI of a joint increase the risk of subsequent infection in another joint? If so, should elective arthroplasty of the joint be withheld in patients with active or treated PJI of another joint?
41. Does prior use of antibiotics influence the accuracy of tests used to diagnose PJI?
42. Does routine screening for diabetes and glycemic control reduce the risk of SSI/PJI?
43. Does strict adherence to not wearing OR attire outside the hospital or outside the restricted OR area reduce the risk of SSI/PJI?
44. Does surgical preparation of the skin on the whole limb instead of a partial limb reduce the rate of SSI/PJI?
45. Does surgical skin preparation starting from the surgical site, proximal portion of the extremity, or distal portion of the extremity affect the rate of SSI/PJI?
46. Does the local administration of vancomycin powder to wound during surgery reduce the risk of subsequent SSI/PJI? If so, what are the risk factors associated with its use?
47. Does the MRSA/MRSE colonization status of OR personnel affect the hospital's rate of SSI/PJI?
48. Does the number of individuals in the operating room affect the rate of SSI/PJI? If so, what strategies should be implemented to reduce traffic in the operating room?
49. Does the operating room temperature affect the rate of subsequent SSI/PJI?
50. Does the presence of anxiety/depression and mood disorders increase the risk of SSI/PJI? If so, what are the considerations that should be implemented to reduce the risk of SSI/PJI?
51. Does the presence of exposed facial hair (beard and mustache) on any OR staff or surgeon influence the rate of SSI/PJI in patients undergoing orthopedic procedures?
52. Does the presence of other implants from a prior surgery in the affected joint alter the perioperative antibiotic prophylaxis?
53. Does the presence of prior projectile missile/bullet fragments in a joint predispose the patient to a higher risk of subsequent SSI/PJI? If so, what should be done to reduce the risk of SSI/PJI?
54. Does the presence of skin lesions (i.e. boils, grazes, folliculitis, etc) in the proximity of the surgical site or distant from the surgical site predispose patients to SSI/PJI? If so, is it necessary for patients with these skin lesions to undergo treatment prior to elective total joint arthroplasty?
55. Does the pressure of the pusaltile delivery mechanism for irrigation fluid influence the efficacy of the irriation solution to eradicate infecting organisms in the wound?
56. Does the risk of SSI/PJI increase when the surgeon performing the arthroplasty has an upper respiratory infection?
57. Does shoe wear (i.e. OR dedicated shoes, uncovered outside shoes, covered outside shoes) of the surgeon and operating room staff affect the rate of SSI/PJI in patients undergoing orthopedic procedures?
58. Does the size of an implant (volume) used during orthopedic procedures influence the incidence of subsequent SSI/PJI?
59. Does the technique, duration, or agent used for a surgical hand scrub by surgeon and the OR personnel alter the patient's risk of SSI/PJI?
60. Does the timescale of biofilm formation differ between bacterial species? If so, what is the timescale for common causative organisms?
61. Does the type of anesthesia (general vs. neuraxial) influence the risk of subsequent SSI/PJI?
62. Does the type of cap worn by the OR personnel matter?
63. Does the type of organism (i.e. Fungi, P. acnes, S. aureus) influence the thresholds for serum and synovial markers in acute and chronic PJI?
64. Does the type of surgical drape (disposable vs non-disposable) used affect the risk of subsequent SSI/PJI in patients undergoing orthopedic surgery?
65. Does the type of surgical gown (disposable or reusable) used by the OR personnel affect the rate of subsequent SSI/PJI in patients undergoing orthopedic procedures?
66. Does the type of venous thromboembolic (VTE) prophylaxis influence the risk of SSI/PJI in patients undergoing orthopedic procedures?
67. Does the type of wound closure (technique and material) affect the incidence of subsequent SSI/PJI?
68. Does the use of a splash basin increase contamination of instruments and the rate of subsequent SSI/PJI in patients undergoing orthopedic procedures?
69. Does the use of a urinary catheter during orthopedic surgery increase the risk of subsequent SSI/PJI?
70. Does the use of C-arm intraoperatively increase the risk for subsequent SSI/PJI in patients undergoing orthopedic procedures?
71. Does the use of cloth or impervious stockinettes aroud the ankle and extremity affect the rate of subsequent SSI/PJI in patients undergoing orthopedic procedures?
72. Does the use of forced air warming during orthopedic procedures increase the risk of subsequent SSI/PJI?
73. Does the use of incise draping reduce the incidence of SSI/PJI? Is there a differnec in efficacy between incise drapes?
74. Does the use of laminar flow in the operating room reduce the risk of subsequnt SSI/PJI in patients undergoing orthopedic procedures?
75. Does the use of occlusive strips at the sleeves of the surgical gowns reduce the risk of SSI/PJI?
76. Does the use of recent technologies (navigation, robots, etc.) influence the incidence of SSI/PJI after orthopedic procedures?
77. Does the use of surgical drains increase the risk of subsequent SSI/PJI?
78. Does the use of topical incisional sealants (i.e. integuseal, dermabond, etc) reduce the incidence of subsequent PJI/SSI in patients undergoing orthopedic procedures?
79a. Does the use of tranexamic acid reduce blood loss and need for allogeneic blood transfusion during primary total joint arthroplasty?
79b. Does the use of tranexamic acid reduce blood loss and need for allogeneic blood transfusion during revision total joint arthroplasty?
80. Does the use of tranexamic acid reduce the incidence of SSI/PJI following orthopedic procedures?
81. Does the use of UV light decontamination in the operating room reduce the risk of subsequent SSI/PJI in patients undergoing orthopedic procedures?
82. Does vitamin D deficiency increase the risk of subsequent SSI/PJI in patients undergoing orthopedic procedures?
83. For patients awaiting organ transplant who need elective arthroplasty, should the arthroplasty be done before or after the organ transplant?
84. Has the profile of organisms causing SSI/PJI following orthopedic procedures changed over recent years?
85. How should a patient with a symptomatic pre-operative urinary tract infection (UTI) be managed prior to undergoing elective joint arthroplasty?
86. How should divergent results between intraoperative tissue cultures and sonication of the prosthesis be managed?
87. How should synovial fluid sample be sent (via laboratory vacuum tube, syringe, blood culture tubes, etc) for culture to increase the culture yield?
88. In patients with prior septic arthritis what strategies should be undertaken to minimize the risk of subsequent SSI/PJI?
89. Is early mobilization after orthopedic procedures associated with an increased risk of wound drainage or SSI/PJI?
90. Is it necessary for a patient to postpone having an invasive dental procedure after TJA?
91. Is it safe to perform a neuraxial anesthesia in patients with active musculoskeletal infection?
92. a) Is preoperative anemia a risk factor for SSI/PJI? b) If so, what optimization can be done to increase the hemoglobin concentration? c) Does an increased preoperative hemoglobin concentration decrease postoperative SSI/PJI?
93. Is pre-operative MRSA deconolonization effective at reducing SSI/PJI in patuents undergoing orthopedic procedures? If so, is pre-operative MRSA decolonization cost-effective?
94. Is routine urinary screening indicated prior to elective TJA? If so, how should asymptomatic bacteriuria be treated prior to undergoing elective joint arthroplasty?
95. Is the biofilm on orthopedic implant surface permeable to neutrophils and macrophages in vivo? Are these intrinsic immune cells capable of engulfing and killing bacteria?
96. Is the mapping of biofilm to a particular component or anatomical location an important consideration in management of implant related infections?
97. Is there a difference in the bioavailability of vancomycin when administered through the intravenous route or intraosseous regional route in TKA?
98. Is there a distinct microbiome in the joints?
99. Is there a link between opioid consumption and an increased risk for SSI/PJI?
100. Is there a method to detect sessile microorganisms (organisms with biofilm) that have resulted in an infection following orthopedic procedures?
101. Is there a role for administration of erythropoetin, hemotinics, or other agents for patients with orthopedic infections?
102. Is there a role for banning all handheld devices/mobile phones in the operating room?
103. Is there a role for procalcitonin blood test in the diagnosis of SSI/PJI in orthopaedic patients?
104. Is there a role for routine acid-fast bacilli (AFB) and fungal testing in suspected SSI/PJI cases?
105. Is there a role for the use of antibiotic-loaded carriers (calcium sulfate/phosphate) in treatment of SSI/PJI?
106. Is there evidence that interference with bacterial communication by blocking quorum sensing molecules can minimize biofilm formation in vivo?
107. Is thrombocytosis associated with an increased risk of SSI/PJI in patients undergoing orthopedic procedures?
108. Should routine dental clearance be obtained prior to total joint arthroplasty (hip/knee/shoulder/ankle)?
109. Should early postoperative infection and acute hematogenous infection be treated and managed differently?
110. Should extended (beyond 24 hours) antibiotic prophylaxis be administered to patients with surgical drain in place?
111. Should patients wear a mask and a surgical cap in the operating room to reduce the risk of subsequent SSI/PJI?
112. a) Should patients with a penicillin or cephalosporin allergies routinely undergo allergy testing, sensitization, or a test dose before administering alternative antibiotic prophylaxis? B) What is the best choice of prophylactic antibiotic when the patient is allergic to penicillin/cephalosporins?
113. Should perioperative antibiotics be withheld prior to obtaining an intra-operative aspirate and/or tissue samples for culture in suspected infected revision total joint arthroplasty cases?
114. Should PJI cases be referred to a regional center to improve the outcome of treatment and and decrease cost?
115. Should PJI caused by P. acnes be treated the same as other bacterial causes of PJI?
116. Should skin hair around a planned surgical incision be removed? If so, what is the best method and timing of removal?
117. Should suction tips be regularly changed during surgery? If so, how frequently?
118. Should suction tips enter the intramedullary canal during orthopedic surgery?
119. Should surgeons and personnel in the OR wear a mask and a cap in the operating room?
120. Should the knife blade be changed after skin incision for deep dissection?
121. Should unusual organisms (e.g. Treponema spp., Corynebacteria spp.) identified through molecular or genetic testing be treated the same as the usually infecting organisms?
122. What antibiotic therapy and duration should be used in SSI/PJI caused by Mycobacterium tuberculosis?
123. What antiseptics can be used to prevent biofilm formation?
124. What are the indications for dual perioperative antibiotic prophylaxis in patients undergoing orthopedic procedures? What are the optimal combination antibiotics?
125. a) What upper body mass index threshold is associated with an increased risk of SSI/PJI? b) Does implementation of these cut-offs reduce the incidence of SSI/PJI?
126. What endogenous biological and cellular activities of the human host (e.g. anti-inflammatory, immune surveillance) can be amplified as an efficient antimicrobial strategy?
127. What immune system enhancing strategies can be employed to reduce the risk of SSI/PJI?
128. What intraoperative findings during surgical management of orthopedic infections need to be communicated with the ID specialist?
129. What is the best diagnostic method for identifying a P. acnes SSI/PJI?
130. What is the definition of a sinus tract?
131. What is the definition of implant “colonization” vs implant-related infection?
132. What is the definition of persistent wound drainage?
133. What is the diagnostic accuracy of intra-operative Gram stain for the diagnosis of SSI/PJI?
134. What is the diagnostic accuracy of MRI for osteomyelitis in the presence and absence of implants?
135. What is the life cycle of biofilm and the mechanism of its maturation?
136. What is the Minimum Biofilm Eradication Concentration (MBEC) of infective agents?
137. What is the most accurate marker for assessing glycemic control that best predicts SSI/PJI?
138. What is the most effective antibiotic in the treatment of P. acnes PJI?
139. What is the most effective perioperative prophylactic antibiotic (agent, route and number of doses) in patients undergoing primary total joint arthroplasty to reduce the risk of subsequent SSI/PJI?
140. What is the optimal antibiotic for perioperative prophylaxis in patients who are MRSA carriers and undergoing orthopedic procedures?
141. What is the optimal choice and duration of antibiotic therapy in polymicrobial PJI/SSI?
142. What is the optimal delivery method (bulb vs pulsatile vs pouring in) for the irrigation solution being used in orthopedic procedures?
143. What is the optimal irrigation solution (type, volume, frequency) to be used during clean elective orthopedic procedures?
144. What is the optimal methodology for obtaining intra-operative cultures?
145. What is the optimal time for culture processing of tissue or synovial aspirate samples? How long should routine cultures be kept before declared negative?
146. What is the preferred type of sample (tissue, fluid, etc) for molecular analysis in diagnosis of orthopedic infections?
147. What is the recommended standardized laboratory culture protocol to minimize differences between medical centers?
148. What is the recommended time interval that would divide acute and chronic PJI (four weeks, 90 days, etc)?
149. What is the relevance of Minimum Inhibitory Concentration (MIC) of infecting organisms in biofilm-mediated chronic infection?
150. What is the role for vacuum-assisted incisional dressings in orthopedic patients?
151. What is the role of prophylactic antibiotics for invasive procedures (dental, GI, urologic, etc) in the presence of an arthroplasty component to prevent subsequent PJI?
152. What is the role of the microbial synergy in polymicrobial infections?
153. What is the threshold for HbA1C that is predictive of subsequent SSI/PJI in patients undergoing orthopedic procedures?
154. What method(s) is available to verify the microbiological cleanliness of the operating room?
155. What methods can be utilized to increase diagnostic yield of microbiological culture in SSI/PJI?
156a. What methods can the FDA and other regulatory bodies use to evaluate the efficacy of novel anti-infective technologies?
156b. What are some of the emerging pre-clinical methods for evaluating novel antimicrobial technologies?
157. What methods for MRSA/MSSA decolonization exist? What are the benefits and risks associated with the use of each?
158. What modifiable and non-modifiable host factors contribute to an increased risk of SSI/PJI?
159. What novel diagnostic techniques are effective in detecting biofilm infections?
160. What patient factors (allergy status, weight, etc) should be utilized to alter the choice of perioperative antibiotic prophylaxis?
161. What pre-surgical skin preparation is most effective in reducing the risk of SSI/PJI in patients undergoing orthopedic procedures?
162. What quality of life (QOL) measures should be used when determining the functional outcomes of PJI treatment?
163. What serum test(s) have the best diagnostic accuracy? Does the combination of any number of tests increase the diagnostic accuracy?
164. What surface properties favor biofilm formation?
165. What surgical dressing (i.e. occlusive, silver impregnated, dry gauze) is associated with a lower risk of SSI/PJI in patients undergoing orthopedic procedures?
166. What systemic antibiotic therapies should be used in patients with SSI/PJI caused by resistant organisms?
167. When should instrument trays be opened during surgery to minimize the risk of contamination?
168. When should sterile surgical dressings be removed and how frequently should subsequent dressings be changed following orthopedic procedures?
169. Which antifungal agents are heat stable and what dose of these agents should be used in cement spacers for fungal PJI?
170. Which patient-specific factors (i.e. inflammatory arthritis, immunocompromised state) influence the thresholds for serum and synovial markers in acute and chronic PJI?
171. Is there a relationship between levels of airborne microorganisms in the operating room and the risk of prosthesis-related infection (PRI)?