Posts filed under ‘BIOMARCADORES’

2017 WSES and SICG guidelines on acute calcolous cholecystitis in elderly population

World J Emerg Surg. 2019 Mar 4;14:10.

Pisano M, Ceresoli M, Cimbanassi S, Gurusamy K, Coccolini F, Borzellino G, et al

Background

Gallstone disease is very common afflicting 20 million people in the USA. In Europe, the overall incidence of gallstone disease is 18.8% in women and 9.5% in men. The frequency of gallstones related disease increases by age. The elderly population is increasing worldwide.

Aim

The present guidelines aims to report the results of the World Society of Emergency Surgery (WSES) and Italian Surgical Society for Elderly (SICG) consensus conference on acute calcolous cholecystitis (ACC) focused on elderly population.

Material and methods

The 2016 WSES guidelines on ACC were used as baseline; six questions have been used to investigate the particularities in elderly population; the answers have been developed in terms of differences compared to the general population and to statements of the 2016 WSES Guidelines. The Consensus Conference discusses, voted, and modified the statements. International experts contributed in the elaboration of final statements and evaluation of the level of scientific evidences.

Results

The quality of the studies available decreases when we approach ACC in elderly. Same admission laparoscopic cholecystectomy should be suggested for elderly people with ACC; frailty scores as well as clinical and surgical risk scores could be adopted but no general consensus exist. The role of cholecystostomy is uncertain.

Discussion and conclusions

The evaluation of pro and cons for surgery or for alternative treatments in elderly suffering of ACC is more complex than in young people; also, the oldest old age is not a contraindication for surgery; however, a larger use of frailty and surgical risk scores could contribute to reach the best clinical judgment by the surgeon. The present guidelines offer the opportunity to share with the scientific community a baseline for future researches and discussion.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399945/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399945/pdf/13017_2019_Article_224.pdf

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April 3, 2019 at 8:37 am

Microscopic Examination and Broth Culture of Cerebrospinal Fluid in Diagnosis of Meningitis

Journal of Clinical Microbiology June 1998 V.36 N.6 P.1617-1620

Dunbar SA et al

We reviewed the results of microscopic Gram stain examination and routine culture for 2,635 cerebrospinal fluid (CSF) samples processed in an adult hospital microbiology laboratory during 55 months. There were 56 instances of bacterial or fungal meningitis (16 associated with central nervous system [CNS] shunt infection), four infections adjacent to the subarachnoid space, four cases of sepsis without meningitis, and an additional 220 CSF specimens with positive cultures in which the organism isolated was judged to be a contaminant. Because 121 of these contaminants were isolated in broth only, elimination of the broth culture would decrease unnecessary work. However, 25% of the meningitis associated with CNS shunts would have been missed by this practice. The most common cause of meningitis was Cryptococcus neoformans, followed by Streptococcus pneumoniaeand Neisseria meningitidis. In 48 of 56 (88%) of cases, examination of the Gram-stained specimen revealed the causative organism. If patients who had received effective antimicrobial therapy prior to lumbar puncture are excluded, the CSF Gram stain is 92% sensitive. Microscopic examination incorrectly suggested the presence of organisms in only 3 of 2,635 (0.1%) CSF examinations. Thus, microscopic examination of Gram-stained, concentrated CSF is highly sensitive and specific in early diagnosis of bacterial or fungal meningitis.

Bacterial meningitis is a life-threatening infection. Although patients typically present with fever, headache, stiff neck, and altered mental status, these symptoms may be subtle in elderly or immunocompromised persons (1, 6, 7,18). Early implementation of appropriate antimicrobial therapy requires prompt identification of the infecting pathogen. Although culture is considered to be the definitive diagnostic test, microscopic examination of a Gram-stained specimen of cerebrospinal fluid (CSF) may provide immediate information about the causative microorganism. Previous studies have suggested that the sensitivity of this technique ranges from 60 to 90% and the specificity approaches 100% (1, 5,6, 8, 12, 18). Scheld concludes that the overall sensitivity is only 75% (14). It is often unclear whether earlier studies have stratified patients based upon their having received prior antimicrobial therapy. Further, the role of semiquantitative assessment of leukocytes (WBC) by microscopic examination as an indicator of infection (8, 12) is uncertain. The value of using broth culture in various populations is also questionable (9, 10,17). In the present study, we reviewed the results of microscopic examination and routine culture of 2,635 CSF specimens to establish the predictive value of the cytocentrifuged Gram stain and the usefulness of broth culture in a veteran population.

FULL TEXT

https://jcm.asm.org/content/36/6/1617

PDF

https://jcm.asm.org/content/jcm/36/6/1617.full.pdf

April 2, 2019 at 6:15 pm

Predictive Value of Cerebrospinal Fluid (CSF) Lactate Level vs CSF-Blood Glucose Ratio for the Diagnosis of Bacterial Meningitis Following Neurosurgery

Clinical Infectious Diseases July 1999 V.29 N.1 P.69-74

Stephen L. Leib; Remy Boscacci; Othmar Gratzl; Werner Zimmerli

The value of cerebrospinal fluid (CSF) lactate level and CSF/blood glucose ratio for the identification of bacterial meningitis following neurosurgery was assessed in a retrospective study. During a 3-year period, 73 patients fulfilled the inclusion criteria and could be grouped by preset criteria in one of three categories: proven bacterial meningitis (n = 12), presumed bacterial meningitis (n = 14), and nonbacterial meningeal syndrome (n = 47). Of 73 patients analyzed, 45% were treated with antibiotics and 33% with steroids at the time of first lumbar puncture. CSF lactate values (cutoff, 4 mmol/L), in comparison with CSF/blood glucose ratios (cutoff, 0.4), were associated with higher sensitivity (0.88 vs. 0.77), specificity (0.98 vs. 0.87), and positive (0.96 vs. 0.77) and negative (0.94 vs. 0.87) predictive values. In conclusion, determination of the CSF lactate value is a quick, sensitive, and specific test to identify patients with bacterial meningitis after neurosurgery.

FULL TEXT

https://academic.oup.com/cid/article/29/1/69/323396

PDF (CLIC en PDF)

April 2, 2019 at 6:13 pm

Characterization of Chemical Meningitis after Neurological Surgery

Clinical Infectious Diseases January 2001 V.32 N.2 P.179-185

Pierre Forgacs; Carl A. Geyer; Stephen R. Freidberg

We reviewed the records of 70 consecutive adult patients with meningitis after a neurosurgical procedure, to determine the characteristics that might help to distinguish a sterile postoperative chemical meningitis from bacterial infection. The spinal fluid profiles in bacterial and chemical meningitis are similar. The exceptions are that a spinal fluid white blood cell count >7500/µL (7500 × 106/L) and a glucose level of <10 mg/dL were not found in any case of chemical meningitis. The clinical setting and clinical manifestations were distinct enough that no antibiotic was administered after lumbar puncture to 30 (43%) of the 70 patients with postoperative meningitis. Chemical meningitis was infrequent after surgery involving the spine and sinuses. Patients with chemical meningitis did not have purulent wound drainage or significant wound erythema or tenderness, coma, new focal neurological findings, or onset of a new seizure disorder. They rarely had temperatures >39.4°C or cerebrospinal fluid rhinorrhea or otorrhea.

FULL TEXT

https://academic.oup.com/cid/article/32/2/179/319157

PDF (CLIC en PDF)

April 2, 2019 at 6:10 pm

Meningitis postquirúrgica. Características diferenciales de la meningitis aséptica post-quirúrgica

Neurocirugía ABRIL 2009 V.20 N.2

Ramos-Martínez; T. de las Heras-Carballo; C. Fernández-Mateos*; L. de Reina*; T. Álvarez de Espejo-Montiel; N. Escamilla-Fernández; I. Sánchez-Romero** e I. Millán***

Servicios de Medicina Interna (Unidad de Infecciosas) Neurocirugía* y Microbiología**. Sección de Bioestadística***. Hospital Universitario Puerta de Hierro. Madrid.

Introducción

La meningitis postquirúrgica es una complicación infrecuente que se acompaña de un incremento de la estancia hospitalaria y de una elevada mortalidad. Algunos de estos casos no son debidos a una verdadera infección sino a una inflamación aséptica de las meninges denominada meningitis aséptica post-quirúrgica (MAPQ). La adecuada identificación de estos casos permitiría una mejor utilización de los fármacos antimicrobianos.

Material y métodos

Estudio retrospectivo de los pacientes con meningitis postquirúrgica en un hospital terciario durante 14 años comparando las características clínicas de los pacientes con meningitis bacteriana postquirúrgica (MBP) frente a las de pacientes con MAPQ

Resultados

Durante el período analizado se identificaron 35 pacientes (71%) con MBP y 14 pacientes (29%) con MAPQ. La edad media de los pacientes con MBP fue similar a la de los pacientes con MAPQ. Hubo predominio de varones en el grupo de MBP (71%) en relación con los pacientes con MAPQ (36%, p=0,020). La proporción de pacientes con hemorragia intracraneal tendió a ser más frecuente en pacientes que posteriormente desarrollaron MAPQ (9 pacientes, 64 %) que en los pacientes con MBP (12 casos, 34%, p=0,055). Los pacientes sometidos a craneotomía posterior (p=0,092) y los que recibían tratamiento esteroideo (p=0,051) mostraron una mayor tendencia a padecer MAPQ. Siete pacientes MBP (20%) presentaron un recuento celular superior a 5000 células/mm3 en el LCR, cifra no encontrada en ningún caso de MAPQ. No se detectaron diferencias en la glucorraquia y proteinorraquia entre ambos grupos. La bacterias más frecuentemente aisladas fueron Staphylococcus coagulasa negativa y S. aureus. En 5 pacientes (14%) se aislaron bacilos gramnegativos no fermentadores (Pseudomonas aeruginosa y Acinetobacter spp). No hubo ningún fallecimiento atribuido a meningitis postquirúrgica.

Conclusión

Los pacientes sometidos a neurocirugía que fueron ingresados por hemorragia cerebral, intervenidos de la fosa posterior o tratados con esteroides presentan una mayor tendencia a presentar MAPQ. Los recuentos celulares en LCR elevados (superiores a 5000 células /mm3) sugieren la existencia de MBP.

PDF

http://scielo.isciii.es/pdf/neuro/v20n2/2.pdf

April 2, 2019 at 6:08 pm

Executive summary: Diagnosis and Management of Prosthetic Joint Infection: clinical practice Guidelines by the Infectious Diseases Society of America (IDSA).

Clinical Infectious Diseases January 2013 V.56 N.1 P.1-10   doi: 10.1093/cid/cis966.

Osmon DR, Berbari EF, Berendt AR, et al.

These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.

FULL TEXT

https://academic.oup.com/cid/article/56/1/1/419472

PDF (HACER CLIC en PDF)

 

Clinical Infectious Diseases January 2013 V.6 N.1 P.e1-e25   doi: 10.1093/cid/cis803.

Diagnosis and Management of Prosthetic Joint Infection: clinical practice Guidelines by the Infectious Diseases Society of America (IDSA).

Osmon DR, Berbari EF, Berendt AR, et al.

These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.

FULL TEXT

https://academic.oup.com/cid/article/56/1/e1/415705

PDF (HACER CLIC en PDF)

March 30, 2019 at 5:17 pm

What Is the Role of Repeat Aspiration in the Diagnosis of Periprosthetic Hip Infection?

Journal of Arthropasty January 2019 V.34 N.1 P.126–131

Jeffrey D. Hassebrock, Michael G. Fox, Mark J. Spangehl, Matthew R. Neville, Adam J. Schwartz

Background

The American Academy of Orthopedic Surgeons clinical practice guideline currently recommends repeat joint aspiration when workup of periprosthetic joint infection (PJI) reveals conflicting data. This guideline is based on a single study of 31 patients published 25 years ago. We sought to determine the correlation between first and second aspirations and factors that may play a role in variability between them.

Methods

Sixty patients with less than 90 days between aspirations and no intervening surgery were identified at our institution and classified by Musculoskeletal Infection Society (MSIS) criteria as infected, not infected, or not able to determine after both aspirations. Culture results from both aspirations were recorded. The rates of change and correlation in clinical diagnosis and culture results between aspirations were determined.

Results

Repeat aspiration changed the diagnosis in 26 cases (43.3%, 95% confidence interval 31.6-55.9, kappa coefficient 0.32, P < .001), and the culture results in 25 cases (41.7%, 95% confidence interval 30.1-54.3, kappa coefficient 0.27, P < .01). Among patients initially MSIS negative, the proportion who changed to MSIS positive was greater for those with a history of prior PJI compared to those without (66.7% vs 0%, P < .05), and the first aspiration mean volume was higher for those changed to MSIS positive compared to those that remained MSIS negative (12.0 vs 3.0 mL, P < .01). Among patients initially MSIS positive, the proportion of patients who changed to MSIS negative was greater for those with a history of adverse local tissue reaction (ALTR) to metal debris compared to patients without suspicion of ALTR (100% vs 7.7%, P < .05).

Conclusion

Repeat aspiration is particularly useful in patients with conflicting clinical data and prior history of PJI, suspicion of ALTR, or with high clinical suspicion of infection.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30749-6/pdf

January 12, 2019 at 10:54 am

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