Archive for May 24, 2013

Increased risk of prosthetic joint infection associated with esophago-gastro-duodenoscopy with biopsy.

Acta Orthop. 2013 Feb;84(1):82-6.

Coelho-Prabhu N, Oxentenko AS, Osmon DR, Baron TH, Hanssen AD, Wilson WR, Steckelberg JM, Baddour LM, Harmsen WS, Mandrekar J, Berbari EF.

Source

Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA.

Abstract

BACKGROUND:

There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty.

METHODS:

We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission.

RESULTS:

339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10).

INTERPRETATION:

EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.

PDF

http://informahealthcare.com/doi/pdfplus/10.3109/17453674.2013.769079

May 24, 2013 at 3:00 pm

Erysipelas – A common potentially dangerous infection.

Acta Dermatovenerol Alp Panonica Adriat. 2007 Sep;16(3):123-7.

Celestin R, Brown J, Kihiczak G, Schwartz RA.

Source

New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103-2714, USA.

Abstract

Erysipelas is an acute superficial cutaneous cellulitis that commonly occurs not only in elderly and immunocompromised persons, but also in neonates and small children subsequent to bacterial inoculation through a break in the skin barrier. Group A Beta-hemolytic streptococcus (GABHS, Streptoccocus pyogenes) is the usual etiologic agent. Factors that predispose pediatric patients to the development of erysipelas include very young age, diabetes mellitus, an immunocompromised state, and nephrotic syndrome. Patients typically have a well-demarcated, erythematous, indurated, rapidly spreading patch with a palpable advancing border on the face or extremities. Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. However, potential complications include abscess formation, necrotizing fasciitis, septicemia, recurrent infection, and lymphedema.

PDF

http://www.zsd.si/ACTA/PUBLIC_HTML/acta-apa-07-3/6.pdf

May 24, 2013 at 2:58 pm

Cellulitis and erysipelas.

Clin Evid (Online). 2008 Jan 2

Morris AD.

Source

University Hospital of Wales, Cardiff, UK.

Abstract

INTRODUCTION:

Cellulitis is a common problem, caused by spreading bacterial inflammation of the skin, with redness, pain, and lymphangitis. Up to 40% of affected people have systemic illness. Erysipelas is a form of cellulitis with marked superficial inflammation, typically affecting the lower limbs and the face. The most common pathogens in adults are streptococci and Staphylococcus aureus. Cellulitis and erysipelas can result in local necrosis and abscess formation. Around a quarter of affected people have more than one episode of cellulitis within 3 years.

METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for cellulitis and erysipelas? What are the effects of treatments to prevent recurrence of cellulitis and erysipelas?

We searched: Medline, Embase, The Cochrane Library and other important databases up to May 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS:

We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS:

In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, comparative effects of different antibiotic regimens, duration of antibiotics, and treatment of predisposing factors.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907977/pdf/2008-1708.pdf

May 24, 2013 at 2:57 pm


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