Posts filed under ‘BIOFILM – BIOPELICULAS’

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

Pol J Radiol. February 2017 V.82 P.71-87.

Antecedentes

La espondilodiscitis infecciosa se caracteriza por la participación de dos vértebras adyacentes y el disco intermedio.

La tasa de incidencia de la enfermedad se estima en 0.4-2 casos por 100000 por año.

Staphylococcus aureus es el agente infeccioso más común que causa espondilodiscitis piógena.

Las infecciones no piógenas de la columna vertebral son causadas con mayor frecuencia por Mycobacterium tuberculosis y hongos.

Los síntomas clínicos son inespecíficos.

El diagnóstico temprano y el tratamiento adecuado pueden evitar secuelas irreversibles desfavorables para el paciente.

Los desarrollos significativos en las técnicas de imagen de tejidos patológicos aumentaron las expectativas entre los médicos con respecto a la posibilidad de distinguir entre la espondilodiscitis tuberculosa y la espondilodiscitis piógena en las imágenes de RM.

El objetivo de este estudio fue identificar y diferenciar las características de la espondilodiscitis tuberculosa y piógena en las imágenes de RM.

Material/métodos

Realizamos un análisis retrospectivo de imágenes de RM obtenidas de 34 pacientes con espondilodiscitis confirmada (18 con espondilodiscitis piógena y 16 con espondilodiscitis tuberculosa). La adquisición de datos se realizó utilizando escáneres de resonancia magnética de 1,5 T, donde se obtuvieron imágenes utilizando protocolos similares. T2 TIRM y las imágenes ponderadas en T1 con y sin realce de contraste fueron sujetas a evaluación en planos coronal, axial y sagital.

Resultados

Las características de la espondilodiscitis piógena incluyen: afectación de la columna lumbar, aumento del contraste anormal paraespinal mal definido, aumento del contraste difuso / homogéneo de los cuerpos vertebrales, destrucción de grado bajo de los cuerpos vertebrales, señal hiperintensa / homogénea de los cuerpos vertebrales en las imágenes T2 TIRM . Las características predominantes de la espondilodiscitis tuberculosa incluyeron: afectación de la columna torácica, afectación de 2 o más cuerpos vertebrales adyacentes, destrucción severa del cuerpo vertebral, realce de contraste focal / heterogéneo de los cuerpos vertebrales, señal heterogénea de los cuerpos vertebrales en imágenes T2 TIRM, bien Mejora de contraste anormal paraespinal -definido, abscesos paraespinales y epidurales, realce meníngeo a nivel de la columna afectada.

Conclusiones

La comparación de imágenes de RM de pacientes diagnosticados con espondilodiscitis piógena y espondilodiscitis tuberculosa permitió la identificación de características individuales para la diferenciación preliminar entre TB y espondilodiscitis infecciosa y, por lo tanto, permitió un tratamiento adecuado.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317295/pdf/poljradiol-82-71.pdf

July 12, 2020 at 1:39 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications – New York, 2019.

MMWR Morb Mortal Wkly Rep. January 10, 2020 V.69 N.1 P.6-9.  

Ostrowsky B, Greenko J, Adams E, Quinn M, O’Brien B, Chaturvedi V, Berkow E, Vallabhaneni S, Forsberg K, Chaturvedi S, Lutterloh E, Blog D; C. auris Investigation Work Group.

Abstract

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1).

Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1).

C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2).

As of June 28, 2019, a total of 801 patients with C. auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization (3).

Among these patients, three were found to have pan-resistant C. auris that developed after receipt of antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall.

All three patients had multiple comorbidities and no known recent domestic or foreign travel.

Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning.

The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications.

This report summarizes investigations related to the three New York patients with pan-resistant infections and the subsequent actions conducted by the New York State Department of Health and hospital and long-term care facility partners.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973342/pdf/mm6901a2.pdf

January 30, 2020 at 3:42 pm

From contamination to infective endocarditis—a population-based retrospective study of Corynebacterium isolated from blood cultures.

European Journal of Clinical Microbiology & Infectious Diseases January 2020 V.39 N.1 P.113-119   

Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE).

Our purpose was to investigate microbiological and clinical features associated with contamination and true infection.

A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed.

Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS).

Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared.

Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection.

Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities.

The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination.

Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis.

Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination.

The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.

abstract

https://link.springer.com/article/10.1007/s10096-019-03698-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_39_1

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03698-6.pdf

January 19, 2020 at 8:08 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

MMWR. January 10, 2020 V.69 N.1 P.6-9.

Summary

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 18, 2020 at 6:13 pm

Dalbavancin for treating prosthetic joint infections caused by Gram-positive bacteria: A proposal for a low dose strategy. A retrospective cohort study

Revista Española de Quimioterapia Diciembre 2019 V.32 N.6 P.532-538

Introducción.

Las bacterias grampositivas son la principal causa de infección periprotésica (IPP). Dalbavancina es un lipoglicopéptido con interesantes propiedades farmacocinéticas y una importante actividad bactericida frente a la mayoría de gram positivos. Aunque aún necesitamos mayor evidencia en relación con su uso en infección osteoarticular, estudios recientes sugieren un papel importante de dalbavancina en la IPP.

Métodos.

Desde el 1 de Junio de 2016 al 1 de Mayo de 2018, todos los pacientes diagnosticados con IPP y tratados con dalbavancina sola o en combinación con otros fármacos fueron evaluados de forma retrospectiva. La sensibilidad a dalbavancina de los aislamientos fue evaluada según las recomendaciones de CLSI. El objetivo primario fue determinar la eficacia y tolerabilidad del fármaco en pacientes con IPP. Se realizó un análisis de coste siguiendo la metodología descrita en el estudio DALBUSE.

Resultados.

Dieciséis pacientes fueron tratados con dalbavancina, ocho con infección de prótesis total de cadera y ocho con infección de prótesis total de rodilla. Staphylococcus spp. y Enterococcus spp. fueron los microorganismos implicados. No hubo efectos adversos relevantes. La infección se resolvió en 12 pacientes. En dos pacientes el tratamiento falló, y otro paciente falleció por causas no relacionadas. Un paciente es actualmente en tratamiento supresor por infección por diseminación hematógena de prótesis total de rodilla a partir de endocarditis protésica aórtica. Tras la discontinuación de dalbavancina, y exceptuando los pacientes fallecidos y/o con fallo terapéutico, el seguimiento medio fue de 503 dias (rango intercuartílico 434.5-567 dias). Se estimó un ahorro de 264.769 dólares USA.

Conclusiones.

Este estudio sugiere que dalbavancina para el tratamiento de IPP causada por microorganismos gram positivos es segura y una opción eficaz que reduce la estancia hospitalaria y los costes. Se precisan más comunicaciones para confirmar estos datos.

PDF

https://seq.es/wp-content/uploads/2019/10/buzon22oct2019.pdf

December 29, 2019 at 2:32 pm

Highlights of Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America

Infectious Diseases in Clinical Practice November 2019 V.27  N.6  P.308-309

CLINICAL GUIDELINES

Politis, Paula A.; File, Thomas M. Jr

Asymptomatic bacteriuria is a common cause of unnecessary antimicrobial use. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the management of asymptomatic bacteriuria. The guideline provides recommendations for avoidance of antimicrobial use for the great majority of patients with asymptomatic bacteriuria. Included in the recommendations is to refrain from screening with urinalysis and/or urine culture for older patients with cognitive impairment or fall and rather to look for alternative causes of altered mental status (eg, dehydration, metabolic causes, medication effects).

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2019/11000/Highlights_of_Clinical_Practice_Guideline_for_the.2.aspx

PDF (CLIC en PDF)

December 29, 2019 at 2:17 pm

Dilute Povidone-Iodine Solution Prevents Intraoperative Contamination of Sterile Water Basins During Total Joint Arthroplasty

Journal of Arthroplasty January 2020 V.35  N.1  P.241–246

Background

Periprosthetic joint infection is a major complication of total joint arthroplasty (TJA). The intraoperative splash basin has been found to be a potential source of contamination. Although consensus recommendations against the use of splash basin have been made, splash basin use continues to be taught and utilized in practice. This study aims to investigate the effect of dilute betadine addition to the sterile water (SW) contents (0.02% solution) of the splash basin on contamination rates. This intervention could preserve the functionality and preferential use of the splash basin. The primary outcome of this study is the rate of splash basin contamination, with secondary outcomes of prevalence of culture speciation and mean operative times association with the rate of positive cultures.

Methods

Patients undergoing primary TJA were enrolled in a randomized controlled trial with assignment to either the intervention/betadine group, in which dilute betadine was added to the standard SW splash basin, or the control/standard SW group. For a total cohort of 104 patients, a 120 mL aliquot sample of basin fluid was collected at incision (“preprocedure”) and closure (“postprocedure”). Samples were cultured and monitored for 48 hours for growth, with further testing as necessary to identify microbial speciation.

Results

Of the final 100 postprocedure samples, 0 (0.0%) were positive in the betadine group, while there were 23 (47.9%) positive samples in the SW group (P < .001). Of the positive cultures, the most common species grown were coagulase-negative Staphylococcus, Corynebacterium, and Micrococcus. The mean operative time was an average of 11 minutes longer for cases with positive cultures.

Conclusion

In conclusion, treating SW splash basins with dilute povidone-iodine (0.02% solution) eliminates intraoperative contamination of splash basins in TJA procedures. This intervention is simple, low cost, and readily implementable, making it a reasonable addition to TJA protocols.

Level of Evidence

Level 1, Controlled Laboratory Study.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30747-8/pdf

December 29, 2019 at 2:11 pm

Differences in Diagnostic Properties Between Standard and Enrichment Culture Techniques Used in Periprosthetic Joint Infections

Journal of Arthroplasty January 2020 V.35  N.1  P.235–240

Background

Culture-negative infections can complicate the diagnosis and management of orthopedic infections, particularly periprosthetic joint infections (PJIs). This study aimed to identify differences in rate of detection of infection and organisms between cultured using standard and enriched methods.

Methods

This retrospective, cross-sectional study evaluated PJI samples obtained between January 2013 and December 2017 at Yokohama City University Hospital. Samples were assessed using standard and enrichment culture techniques. White blood cell counts, C-reactive protein levels, type of microorganism (coagulase-positive or coagulase-negative), and methicillin-resistant Staphylococcus were investigated.

Results

A total of 151 PJI samples were included in the analysis; of these, 68 (45.0%) were positive after standard culture while 83 (55.0%) were positive only after enrichment culture. The mean white blood cell counts and C-reactive protein levels were significantly lower in the enrichment culture group than in the standard culture group (P < .01). The rate of methicillin-resistant Staphylococcus and coagulase-negative Staphylococci was significantly higher in the enrichment culture group than in the standard culture group (P < .01).

Conclusion

The enrichment culture method has a higher rate of detection of infection than standard culture techniques and should, therefore, be considered when diagnosing orthopedic infections, particularly PJI.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30766-1/pdf

December 29, 2019 at 2:06 pm

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

Journal of Arthroplasty January 2020 V.35  N.1  P.229–234

Background

Diagnosis of chronic periprosthetic joint infection (PJI) can be challenging and elusive in the absence of a gold standard. D-dimer plays an important role in inflammation that occurs during infections and therefore could be a valuable biomarker for PJI. This study aims to investigate the sensitivity and specificity of D-dimer in detecting chronic PJI and to improve the accuracy of chronic PJI diagnosis through combined measurement of serum D-dimer with C-reactive protein (CRP)/erythrocyte sedimentation rate.

Methods

One hundred twenty-two patients presenting with a painful knee or hip after total hip or total knee arthroplasty for surgical revision were included in this prospective trial. Our cohort consisted of 55 patients undergoing revision for chronic PJI and 67 patients undergoing revision for aseptic failure. PJI was defined using the Musculoskeletal Infection Society criteria. Receiver operating characteristic curves and area under the curve were analyzed for each biomarker.

Results

The area under the curve for D-dimer was 0.915 and was more accurate than serum erythrocyte sedimentation rate 0.719 and CRP 0.761. 1170 ng/mL was determined to be the optimal threshold value of D-dimer for the diagnosis of chronic PJI, with a sensitivity of 92.73% and a specificity of 74.63% in the diagnosis of chronic PJI. The combination of D-dimer and CRP tests demonstrated a sensitivity of 98.11% and negative predictive value of 96.55% for the diagnosis of chronic PJI.

Conclusion

The present study identified the D-dimer is a valuable biomarker in detecting chronic PJI. The combinations of serum D-dimer and CRP led to the improvement of sensitivity compared with those of the single-index test.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30743-0/pdf

December 29, 2019 at 1:58 pm

Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients.

Journal of Bone and Joint Infection September 18, 2019 V.4 N.5 P.209-215.   

Abad CL1, Phuoc V2, Kapoor P3, Tosh PK4, Sia IG4, Osmon DR4, Tande AJ4.

Author information

1 Department of Internal Medicine, Section of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

2 Division of Hematology, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

3 Division of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

4 Mayo Clinic, Rochester MN, USA.

Abstract

Background:

Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.

Methods:

We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.

Results:

Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).

Conclusion:

BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831805/pdf/jbjiv04p0209.pdf

December 27, 2019 at 3:55 pm

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