Archive for April 10, 2015

Prosthetic joint infection due to Salmonella species: a case series.

BMC Infect Dis. 2014 Nov 26;14(1):633.

Gupta A, Berbari EF, Osmon DR, Virk A.



Prosthetic joint infection (PJI) due to Salmonella is rare. Numerous outbreaks of Salmonella have been reported throughout the United States in the last decade.

We reviewed and analyzed cases of Salmonella PJI seen at our institution.


The medical records of all patients diagnosed with a Salmonella PJI between 1969¿2013 were reviewed. Patients were followed till death, treatment failure or loss to follow-up.


Six patients of Salmonella PJI were identified during the 44 year study period. Five were male; median age was 63.5 years (range 52¿76). Five patients were immunodeficient. Five had a total hip arthroplasty infection, while one had a total knee arthroplasty infection. Median prosthesis age at the time of diagnosis of first episode of Salmonella PJI was 5 years (range 4 months-9 years). Four presented with fever and constitutional signs within two weeks of symptom onset. Two patients each had gastrointestinal symptoms and Salmonella bacteremia. Salmonella enterica serovar Enteritidis was the most common organism isolated (4 patients). None were Salmonella enterica serovar Typhi. Initial management included aspiration and antimicrobial therapy only (3), debridement and component retention (1) and two-staged exchange (2). All four patients treated without resection failed treatment a median of 2.5 months (range 2¿11) after diagnosis and required resection arthroplasty. All six patients who underwent prosthesis removal (and exchange or arthrodesis) had successful outcome with a median duration of follow-up of 11 years (range 4¿21). Three of these received oral antimicrobial therapy for a median duration eight weeks (range 4¿8) and three received parenteral antimicrobial therapy for a median duration of six weeks (range 4¿6).


The increase in Salmonella outbreaks does not seem to lead to increased Salmonella PJI. PJIs due to Salmonella remain rare, and the presentation is often acute with fever. It frequently occurs in immunocompromised patients. In our patient population, removal of prosthesis with or without reimplantation, along with 4¿6 weeks of effective parenteral antimicrobial therapy was most often associated with successful eradication of infection.



April 10, 2015 at 3:07 pm

Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE)

Journal of Antimicrobial Chemotherapy Febreuary 2015 V.70 N.2 P.325-359

Jonathan A. T. Sandoe, Gavin Barlow, John B. Chambers, Michael Gammage, Achyut Guleri, Philip Howard, Ewan Olson, John D. Perry, Bernard D. Prendergast, Michael J. Spry, Richard P. Steeds, Muzahir H. Tayebjee, and Richard Watkin

1University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK

2Hull and East Yorkshire Hospitals NHS Trust, Hull, UK

3Guy’s and St Thomas’ NHS Foundation Trust, London, UK

4University of Birmingham, Birmingham, UK

5Lancashire Cardiac Centre, Lancaster, UK

6Royal Infirmary of Edinburgh, Edinburgh, UK

7Freeman Hospital, Newcastle, UK

8Oxford University Hospitals NHS Trust, Oxford, UK

9Countess of Chester Hospital NHS Foundation Trust, Chester, UK

10University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK

11Heart of England NHS Foundation Trust, Birmingham, UK

*Corresponding author. E-mail:

Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted.

These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations.

ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage.

This guideline aims to

(i) improve the quality of care provided to patients with ICEDs,

(ii) provide an educational resource for all relevant healthcare professionals,

(iii) encourage a multidisciplinary approach to ICED infection management,

(iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and

(v) advise on future research projects/audit.

The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies.

The questions covered by the guideline are presented at the beginning of each section.


April 10, 2015 at 3:03 pm

Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists

Journal of Antimicrobial Chemotherapy April 2015 V.70 N.4 P.965-970

Gilchrist and R. A. Seaton

1Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK

2NHS Greater Glasgow and Clyde, Brownlee Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK

*Corresponding author. Tel: +44-203-311-1704; Fax: +44-203-311-1342; E-mail:

Outpatient parenteral antimicrobial therapy (OPAT) has become, for many countries, an established form of healthcare delivery. At the same time, there have been calls to ensure the prudent use of the existing antimicrobial armamentarium.

For OPAT, this presents a dilemma. On one hand, stewardship principles look for the most effective agent with minimal collateral effects.

In OPAT, whilst the aims of the service are similar, convenience of dosing to optimize early hospital discharge or admission avoidance may take precedence over an agent’s spectrum of activity.

This brief article aims to highlight the importance and explore the challenges of antimicrobial stewardship in the context of OPAT.

Within the UK, the safe and effective use of antimicrobials is modelled around the IDSA/Society for Healthcare Epidemiology of America stewardship practice guidelines with local customization where appropriate.

Current UK stewardship practice principles were compared with published good practice recommendations for OPAT to identify how OPAT could support the broader antimicrobial stewardship agenda.

It is essential that antimicrobial stewardship teams should understand the challenges faced in the non-inpatient setting and the potential benefits/lower risks associated with avoided admission or shortened hospital stay in this population.

Within its limitations, OPAT should practise stewardship principles, including optimization of intravenous to oral switch and the reporting of outcomes, healthcare-associated infections and re-admission rates. OPAT should report to the antimicrobial stewardship team.

Ideally the OPAT team should be formally represented within the stewardship framework. A checklist has been proposed to aid OPAT services in ensuring they meet their stewardship agenda.



April 10, 2015 at 2:58 pm


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