Archive for November 20, 2016

Prevention of Periprosthetic Joint Infection.

Arch Bone Jt Surg. April 2015 V.3 N.2 P.72-81.

Shahi A1, Parvizi J1.

Author information

1Alisina Shahi MD Javad Parvizi MD, FRCS The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, PA.

Abstract

Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468618/pdf/ABJS-3-72.pdf

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November 20, 2016 at 8:44 pm

The management of an infected total knee arthroplasty.

The Bone & Joint Journal. October 2015 V.97-B 10 Suppl A P.20-29.

Gehrke T1, Alijanipour P2, Parvizi J2.

Author information

1Helios Endo-Klinik, Holstenstr.2, 22767 Hamburg, Germany.

2Rothman Institute, 125 S 9th St Ste 1000, Philadelphia, PA 19107, USA.

Abstract

Periprosthetic joint infection (PJI) is one of the most feared and challenging complications following total knee arthroplasty. We provide a detailed description of our current understanding regarding the management of PJI of the knee, including diagnostic aids, pre-operative planning, surgical treatment, and outcome.

PDF

http://www.bjj.boneandjoint.org.uk/content/jbjsbr/97-B/10_Supple_A/20.full.pdf

November 20, 2016 at 8:42 pm

The Alpha-defensin Test for Periprosthetic Joint Infections Is Not Affected by Prior Antibiotic Administration.

Clin Orthop Relat Res. July 2016 V.474 N.7 P.1610-1615.

Shahi A1, Parvizi J1, Kazarian GS1, Higuera C2, Frangiamore S2, Bingham J3, Beauchamp C3, Valle CD4, Deirmengian C1,5.

Author information

1The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.

2Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.

3Department of Orthopaedic Surgery, Mayo Clinic Phoenix, Phoenix, AZ, USA.

4Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

5The Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA, 19096, USA.

Abstract

BACKGROUND:

Previous studies have demonstrated that the administration of antibiotics to patients before performing diagnostic testing for periprosthetic joint infection (PJI) can interfere with the accuracy of test results. Although a single-institution study has suggested that alpha-defensin maintains its concentration and sensitivity even after antibiotic treatment, this has not yet been demonstrated in a larger multiinstitutional study.

QUESTIONS/PURPOSES:

(1) For the evaluation of PJI, is prior antibiotic administration associated with decreased alpha-defensin levels? (2) When prior antibiotics are given, is alpha-defensin a better screening test for PJI than the traditional tests (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], fluid white blood cells, fluid polymorphonuclear cells [PMNs], and fluid culture)?

METHODS:

This retrospective study included data from 106 hip and knee arthroplasties with Musculoskeletal Infection Society-defined PJI from four centers. Of the 106 patients in this study, 30 (28%) were treated with antibiotics for PJI before diagnostic workup (ABX group), and 76 (72%) were not treated before the diagnostic workup (NO-ABX group). There were no differences in age, sex, joint, culture-negative rate, or bacteriology between groups. The patients in the ABX group had antibiotics initiated by physicians who commenced care before assessment for PJI by the treating surgeon’s service. We compared the alpha-defensin levels and sensitivity between the ABX and NO-ABX groups. Additionally, the sensitivity of the alpha-defensin test was compared to that of traditional tests for PJI among patients on antibiotics.

RESULTS:

The administration of antibiotics before performing the alpha-defensin test for PJI was not associated with a decreased median alpha-defensin level (ABX group, median 4.2 [range, 1.79-12.8 S/CO] versus NO-ABX, median 4.9 [range, 0.5-16.8 S/CO], difference of medians: 0.68 S/CO [95% confidence interval {CI}, -0.98 to 1.26], p = 0.451). Furthermore, the alpha-defensin test had a higher sensitivity (100%; 95% CI, 88.4%-100.0%) in diagnosing PJI among patients on antibiotics when compared with the ESR (69.0% [95% CI, 49.17%-84.72%], p = 0.001), the CRP (79.3% [95% CI, 60.3%-92.0%], p = 0.009), the fluid PMN% (79.3% [95% CI, 60.3%-92.0%), p = 0.009), and fluid culture (70.0% [95% CI, 50.6%-85.3%], p = 0.001).

CONCLUSIONS:

The alpha-defensin test maintains its concentration and sensitivity for PJI even in the setting of antibiotic administration. Furthermore, among patients with PJI on antibiotics, the alpha-defensin tests demonstrated a higher sensitivity in detecting PJI when compared with the ESR, CRP, fluid PMN%, and fluid culture. The high sensitivity of the alpha-defensin test, even in the setting of prior antibiotic treatment, provides excellent utility as a screening test for PJI.

LEVEL OF EVIDENCE:

Level III, diagnostic study.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4887359/pdf/11999_2016_Article_4726.pdf

November 20, 2016 at 8:41 pm

Encefalitis por virus San Luis en la Ciudad de Buenos Aires durante el brote de dengue 2009

Medicina (Bs. Aires) Junio 2011 V.71 N.3

Horacio López1,2, Jorge Neira2, María Alejandra Morales3, Cintia Fabbri3, María Laura D´Agostino1,2, Teresa Zitto1,2

1Centro de Infectología – Institución Afiliada a la Facultad de Medicina de la Universidad de Buenos Aires,

2Sanatorio de la Trinidad Palermo,

3Instituto Nacional de Enfermedades Virales Humanas Dr. J. Maiztegui, ANLIS Dr. Carlos G Malbrán, Pergamino, Buenos Aires

Se presenta un paciente de 80 años de edad, residente en la Ciudad de Buenos Aires, con diagnóstico serológico para el virus de la encefalitis de San Luis (SLE) durante el brote de dengue ocurrido entre enero y mayo de 2009.

Presentaba leucemia linfoide crónica en tratamiento con clorambucilo, cáncer de próstata tratado con hormonoterapia y radioterapia, e imágenes óseas compatibles con metástasis.

El estudio del líquido cefalorraquídeo demostró pleocitosis con predominio de mononucleares y proteinorraquia elevada. El resultado de los cultivos para bacterias, hongos y micobacterias, así como el PCR en LCR para herpes virus, HSV, CMV y EBV, fue negativo.

Se detectaron anticuerpos IgM para virus SLE tanto en LCR como en muestra de suero, con seroconversión IgG por neutralización en cultivos celulares y resultados negativos para los demás Flavivirus con circulación en Argentina.

Se revisan evidencias sobre la presencia de virus de San Luis en nuestro país, y se señala la importancia de la confirmación diagnóstica y el estudio de otros Flavivirus en casos sospechosos de dengue con presentación grave o atípica.

Este trabajo remarca la necesidad de fortalecer tanto la vigilancia epidemiológica del virus SLE, como el control vectorial para prevenir las diferentes infecciones transmitidas por mosquitos y conocer su efecto en Salud Pública en la Argentina.

PDF

http://www.scielo.org.ar/pdf/medba/v71n3/v71n3a09.pdf

November 20, 2016 at 4:30 pm

Encefalitis de San Luis, descripción de un caso clínico.

Archivos de Pediatría del Uruguay 2012 V.83 N.3

Primera comunicación nacional en Uruguay

Dres. Jorge Quian 1, Cristina Scavone 2, Alicia Fernández 3, Araní Ferre 3, Sergio Payssé 3, Raquel Baldovino 3, Mónica Guerra 3

  1. Médico Jefe del Centro de Tratamiento Intensivo Pediátrico de la Asociación Española Primera de Socorros Mutuos.
  2. Profesora de Neuropediatría. Asociación Española Primera de Socorros Mutuos
  3. Médico Pediatra Intensivista del Centro de Tratamiento Intensivo Pediátrico de la Asociación Española Primera de Socorros Mutuos.

Se presenta un varón de 10 años procedente de una zona pobre de Montevideo, que ingresa a fines del verano por un cuadro de 6 días de evolución caracterizado al inicio por fiebre agregando, posteriormente, cefaleas muy intensas y elementos de irritación meníngea.

En la evolución: confuso, fotofobia, incapacidad de responder órdenes simples, no reconoce a los familiares ni al personal. Hipertensión arterial. Luego de 6 días de evolución mejora espontáneamente. En la paraclínica el único elemento positivo en sangre fue IgM positiva para encefalitis de San Luis.

Esta enfermedad es transmitida por picadura de mosquitos del género Culex. El virus pertenece a la familia Flaviviridae. No hay descripciones previas de esta enfermedad en el país.

PDF

http://www.scielo.edu.uy/pdf/adp/v83n3/v83n3a04.pdf

November 20, 2016 at 4:28 pm

Virus de la Encefalitis de San Luis y Virus del Nilo Occidental – Ministerio de Salud de la Nación Argentina

Laboratorio Nacional de Referencia, Instituto Nacional de Enfermedades Virales Humanas ” Dr. Julio I. Maiztegui” Laboratorio de Arbovirus

Dirección De Epidemiología Área de Vigilancia Sistema Nacional De Vigilancia Laboratorial (SNVS-SIVILA)

El presente documento ha sido elaborado por el Laboratorio Nacional de Referencia del Instituto Nacional de Enfermedades Humanas “Dr. Julio Maiztegui” y consensuado con la Coordinación del Sistema Nacional de Vigilancia Laboratorial SIVILA-SNVS de la Dirección de Epidemiología del Ministerio de Salud de la Nación.

PDF

http://www.msal.gob.ar/images/stories/epidemiologia/vigilancia/sivila/tutoriales/virus-encefalitis-de-san-luis-del-nilo-occidental-tutorial-para_la_notificacion_a_traves_del_sivila_2010.pdf

November 20, 2016 at 4:27 pm

Diagnosing Infection in the Setting of Periprosthetic Fractures

Journal of Arthroplasty September 2016 V.31 N.9 P.140–143

Roshan P. Shah, Darren R. Plummer, Mario Moric, Scott M. Sporer, Brett R. Levine, Craig J. Della Valle

Background

The diagnosis of periprosthetic joint infection is particularly challenging in patients with periprosthetic fractures. The purpose of this study was to investigate the utility of commonly used diagnostic tests for periprosthetic joint infection in patients with a periprosthetic fracture.

Methods

Of 121 patients treated with a periprosthetic fracture (97 hips, 24 knees, mean age: 72.9), 14 (11.6%) met Musculoskeletal Infection Society criteria for infection. Diagnostic variables were evaluated using logistic regression models for the prediction of infection and receiver operating characteristics curves.

Results

The synovial white blood cell (WBC) count and differential were the best diagnostic tests, with good test performance (area under the curve, 84%) and optimal cutoffs of 2707 WBC/uL and 77% polymorphonuclear cells. The erythrocyte sedimentation rate and C-reactive protein were found to have overall lower test performance but remained relatively sensitive at standard cutoff values of 30 mm/h and 10 mg/L, respectively.

Conclusion

The synovial fluid WBC count and differential are the best tests with optimal cutoff values that are similar to those used for patients without a periprosthetic fracture.

abstract

http://www.arthroplastyjournal.org/article/S0883-5403(16)00287-4/fulltext

 

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00287-4/pdf

November 20, 2016 at 12:48 pm

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