Archive for April 21, 2015

Are antibiotics necessary in hip arthroplasty with asymptomatic bacteriuria? Seeding risk with/without treatment.

Clin Orthop Relat Res. 2013 Dec;471(12):3822-9.

Cordero-Ampuero J1, González-Fernández E, Martínez-Vélez D, Esteban J.

1Orthopaedic Surgery Department, University Hospital La Princesa, Océano Antártico 41, Tres Cantos, 28760, Madrid, Spain, jcordera@telefonica.net.

Abstract

BACKGROUND:

In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear.

QUESTIONS/PURPOSES:

We determined

(1) the prevalence of asymptomatic bacteriuria; and

(2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics.

METHODS:

We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1-12 months).

RESULTS:

Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery.

CONCLUSIONS:

We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825921/pdf/11999_2013_Article_2868.pdf

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April 21, 2015 at 3:41 pm

Urinary tract infections in pregnancy.

Malays Fam Physician. 2007 Aug 31;2(2):54-7. eCollection 2007.

Loh K1, Sivalingam N2.

1MMed(FamMed UKM).

2FRCOG.

Abstract

Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure.

Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria,

acute cystitis and

acute pyelonephritis.

Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs.

Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia.

Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170332/pdf/MFP-02-54.pdf

April 21, 2015 at 3:36 pm

Salmonella enterica Serotype Choleraesuis Infection of the Knee and Femur in a Nonbacteremic Diabetic Patient.

Case Rep Infect Dis. 2013;2013:506157.

Sy AM1, Sandhu J, Lenox T.

Author information

1Department of Medicine, Metropolitan Hospital Center, New York Medical College, 1901 1st Avenue New York, NY 10029, USA.

Abstract

Osteoarticular infections caused by Salmonella are rare. The rates of osteomyelitis and septic arthritis due to Salmonella are estimated to be less than 1% and 0.1%-0.2%, respectively (Kato et al., 2012).

Salmonella enterica serotype Choleraesuis is a nontyphoidal Salmonella, highly pathogenic in humans, usually causing septicemic disease with little or no intestinal involvement.

Serotype Choleraesuis accounts for a small percentage of published studies of Salmonella infections in the United States. It is not commonly reported in joint fluid and bones in contrast to serotype Enteritidis and Typhi, where a considerable number of cases have been published. Chen et al.

in Taiwan found that 21% of bacteremic patients with this infection subsequently develop focal infections such as septic arthritis, pneumonia, peritonitis, and cutaneous abscess (Chen et al., 1999, Chiu et al., 2004).

In contrast, our patient presented with localized osteoarticular infection with Salmonella enterica serotype Cholerasuis, but without evidence of bacteremia.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679818/pdf/CRIM.ID2013-506157.pdf

April 21, 2015 at 3:30 pm

Salmonella enteridis Septic Arthritis: A Report of Two Cases.

Case Rep Infect Dis. 2013;2013:642805.

Uygur E1, Reddy K, Ozkan FÜ, Söylemez S, Aydin O, Senol S.

Author information

1Department of Orthopedics and Traumatology, Istanbul Medeniyet University, Göztepe Training and Research Hospital, Istanbul, Turkey.

Abstract

Introduction.

Nontyphoidal salmonellosis causes significant morbidity, is transmitted via fecal-oral route, and is a worldwide cause of gastroenteritis, bacteremia, and local infections. Salmonella is a less common etiologic factor for septic arthritis compared with other gram-negative bacteria.

Cases.

We present two septic arthritis cases with Salmonella enteridis as a confirmed pathogen and also discuss the predisposing factors and treatment.

Discussion.

Septic arthritis is an orthopedic emergency. The gold standard treatment of septic arthritis is joint debridement, antibiotic therapy according to the culture results, and physiotherapy, which should start in the early postoperative period to prevent limitation of motion. Salmonella is an atypical agent for septic arthritis. It must be particularly kept in mind as an etiologic factor for the acute arthritis of a patient with sickle cell anemia and systemic lupus erythematosus. Clinicians should be cautious that the white blood cell count in synovial fluid can be under 50.000/mm(3) in immune compromised individuals with septic arthritis. The inflammatory response can be deficient, or the microorganism may be atypical.

Conclusion.

Atypical bacteria such as Salmonella species in immune compromised patients can cause joint infections. Therefore, Salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819818/pdf/CRIM.ID2013-642805.pdf

April 21, 2015 at 3:24 pm


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