The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess ...the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date.
A retrospective, observational, multicenter study was performed during 2007–2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism.
203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3–13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03–12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91–7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90–6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB.
Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
•The overall prognosis of unsuspected positive intraoperative cultures (PIOC) is good.•Partial revision of the orthopedic device is the main risk factor for failure in PIOC.•Gram-negative bacilli infection worsens the prognosis in PIOC.•Biofilm-active antibiotics (rifampin and fluoroquinolones) may improve the prognosis.•This is the largest cohort of patients with PIOC reported to date.
The availability of highly sensitive molecular tests for the detection of
in feces leads to overtreatment of patients who are probably only colonized. In this prospective study, the usefulness of ...fecal calprotectin (fCP) is evaluated in a cohort of patients with detection of toxigenic
in feces. Patients were classified by an infectious diseases consultant blinded to fCP results into three groups-group I, presumed
infection (CDI); group II, doubtful but treated CDI; and group III, presumed
colonization or self-limited CDI not needing treatment. One hundred and thirty-four patients were included. The median fCP concentrations were 410 (138-815) μg/g in group I, 188 (57-524) μg/g in group II, and 51 (26-97) μg/g in group III (26 cases);
< 0.05 for all comparisons. In forty-five out of 134 cases (33.5%), the fCP concentrations were below 100 µg/g. In conclusion, fCP is low in most patients who do not need treatment against
, and should be investigated as a potentially useful test in the management of patients with detected toxigenic
.
Two-stage exchange is the gold standard in the surgical management of prosthetic joint infection (PJI). However, perioperative reinfections (RePJI) can occur to newly inserted prosthesis, which ...highlights the importance of an adequate antibiotic prophylaxis, although there is scarce evidence in this field. Our objective was to evaluate the characteristics of RePJI, its prognosis and the antibiotic prophylaxis that is commonly used in second-stage surgery.
Multicentric retrospective observational study in Spanish hospitals including patients with RePJI between 2009 and 2018.
We included 92 patients with RePJI from 12 hospitals. The most frequent isolated microorganism was Staphylococcus epidermidis in 35 cases (38.5%); 61.1% of staphylococci were methiciliin-resistant. In 12 cases (13%), the same microoganism causing the primary PJI was isolated in RePJI. When comparing with the microbiology of primary PJI, there were more cases caused by Gram-negative bacteria (the most frequent was Pseudomonas spp.) and less by Gram-positive bacteria. Failure occured in 69 cases (75%). There were 43 different courses of antibiotic prophylaxis after the second-stage surgery; the most frequent was a unique preoperative cefazolin dose, but most patients received prophylaxis before and after the second-stage surgery (61 cases).
The most frequent microorganisms in RePJI are coagulase-negative staphylococci, although Gram-negative bacteria, especially Pseudomonas spp. are also common. There is a significant heterogeneity in antibiotic prophylaxis for a second-stage surgery. ReIPJI treatment has a high failure rate.
El recambio en 2 tiempos es un procedimiento habitual en el tratamiento de las infecciones de prótesis articular (IPA). Sin embargo, la prótesis que se coloca en el segundo tiempo (2T) puede reinfectarse de nuevo (ReIPA). Además, existe escasa evidencia sobre qué profilaxis antibiótica debe utilizarse en el 2T. Nuestro objetivo es describir las características de las ReIPA, su pronóstico y las profilaxis antibióticas que se emplean habitualmente en la cirugía del 2T.
Estudio observacional retrospectivo descriptivo multicéntrico en hospitales españoles de pacientes con ReIPA en el periodo 2009–2018.
Se registraron 92 casos de 12 hospitales. El microorganismo más frecuentemente implicado fue Staphylococcus epidermidis con 35 casos (38,5%). El 61,1% de Staphylococcus spp. eran meticilin-resistentes. En 12 casos (13%), la ReIPA fue provocada por el mismo microrganismo responsable de la IPA primaria. En comparación con la IPA primaria hubo más casos producidos por gramnegativos (el más frecuente Pseudomonas spp.) y menos por grampositivos. En 69 casos (75%), la estrategia de tratamiento elegida fracasó. Se identificaron 43 pautas diferentes de profilaxis en la cirugía del 2T, la más frecuente cefazolina en dosis única preoperatoria, aunque lo más frecuente es que se administraran antibióticos antes y después del implante.
Los principales agentes causales de ReIPA son Staphylococcus spp. meticilin-resistentes, aunque los gramnegativos, particularmente Pseudomonas spp., también participan en una importante cuantía. Existe una notable heterogeneidad en la profilaxis antibiótica que se emplea en la cirugía del 2T. El tratamiento de la ReIPA tiene una alta tasa de fracasos.
Carbapenemase-producing Enterobacterales (CPE) infections have been occasionally described in patients with coronavirus disease-19 (COVID-19). We assess the clinical features and outcome of these ...infections.
In this retrospective single-centre, case-control study, we included 54 patients with CPE infection: 30 case-patients (COVID-19) and 24 controls (non-COVID-19), collected between March and May 2020. We compared the epidemiological, clinical features, and outcome between cases and controls.
CPE infection was more frequent in COVID-19 patients than in controls (1.1 vs. 0.5%, p = .005). COVID-19 patients were younger, had a lower frequency of underlying diseases (p = .01), and a lower median Charlson score (p = .002). Predisposing factors such as antimicrobial use, mechanical ventilation, or ICU admission, were more frequent in COVID-19 patients (p < .05). There were 73 episodes of infection (42 cases and 31 controls) that were more frequently hospital-acquired and diagnosed at the ICU in COVID-19 patients (p < .001). Urinary tract was the most common source of infection (47.9%), followed by pneumonia (23.3%). The frequency of severe sepsis or shock (p = .01) as well as the median SOFA score (p = .04) was higher in cases than in controls. Klebsiella pneumoniae (80.8%), Serratia marcescens (11%) and Enterobacter cloacae (4.1%) were the most common bacteria in both groups (KPC 56.2%, OXA-48 26% and VIM 17.8%). Overall 30-d mortality rate of COVID-19 patients and controls was 30 and 16.7%, respectively (p = .25).
COVID-19 patients have an increased risk of CPE infections, which usually present as severe, nosocomial infections, appearing in critically-ill patients and associated with a high mortality.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Infection after spinal instrumentation (IASI) by Cutibacterium spp. is being more frequently reported. The aim of this study was to analyse the incidence, risk factors, clinical characteristics, and ...outcome of a Cutibacterium spp. IASI (CG) compared with non-Cutibacterium IASI (NCG) infections, with an additional focus on the role of rifampin in the treatment. All patients from a multicentre, retrospective, observational study with a confirmed IASI between January 2010 and December 2016 were divided into two groups: (CG and NCG) IASI. Baseline, medical, surgical, infection treatment, and follow-up data were compared for both groups. In total, 411 patients were included: 27 CG and 384 NCG. The CG patients were significantly younger. They had a longer median time to diagnosis (23 vs. 13 days) (p = 0.025), although 55.6% debuted within the first month after surgery. Cutibacterium patients were more likely to have the implant removed (29.6% vs. 12.8%; p = 0.014) and received shorter antibiotic regimens (p = 0.014). In 33% of Cutibacterium cases, rifampin was added to the baseline therapy. None of the 27 infections resulted in treatment failure during follow-up regardless of rifampin use. Cutibacterium spp. is associated with a younger age and may cause both early and late IASIs. In our experience, the use of rifampin to improve the outcome in the treatment of a Cutibacterium spp. IASI is not relevant since, in our series, none of the cases had therapeutic failure regardless of the use of rifampin.
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of
-related prosthetic joint infection (PJI) and the potential benefit of ...rifampin-based therapies. Patients with
-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with
-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.
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