Posts filed under ‘FIEBRE en el POSTOPERATORIO’
Infección por Candida spp. sobre prótesis articulares
Rev Esp Quimioter 2011:24(1):37-41
GARCÍA-OLTRA, S. GARCÍA-RAMIRO, J. C MARTÍNEZ, R. TIBAU, G. BORI, J. BOSCH, J. MENSA, A. SORIANO
Introducción
Las infecciones periprotésicas por Candida spp.constituyen una entidad poco frecuente. El objetivo de este trabajo fue revisar la experiencia en dos centros hospitalarios.
Material y métodos
Se realizó una revisión retrospectiva de los casos de infección protésica de etiología fúngica atendidos en dos hospitales de Barcelona entre febrero de 2002 y octubre de 2010. Se incluyeron todos aquellos pacientes con criterios clínicos de infección y aislamiento de Candida spp. Se recogieron las principales variables demográficas, microbiológicas, terapéuticas y evolutivas.
Resultados
Se identificaron 10 casos, 8 mujeres y 2 varones, cuya edad media fue de 77,7 (rango 66-92) años. Nueve pacientes habían tenido una infección bacteriana previa, por la que recibieron tratamiento antibiótico durante más de 15 días y precisaron desbridamiento en más de una ocasión. La especie más frecuente fue Candida albicans con 6 casos. Todos los pacientes recibieron fluconazol y tratamiento quirúrgico consistente en desbridamiento sin retirada de la prótesis en 3 casos y recambio en 2 tiempos con un espaciador en los 7 restantes. El tratamiento fracasó en los 10 casos y fue necesario practicar un desbridamiento adicional en 1 caso, artroplastia de resección en 8 y tratamiento “supresivo”con fluconazol en uno. Tras un seguimiento medio de 31 meses (rango 2-67) dos pacientes estaban libres de enfermedad.
Conclusión
La infección protésica por Candida spp. se observa en pacientes que han recibido tratamiento antibiótico previo prolongado y han sido intervenidos en más de una ocasión. El tratamiento con fluconazol y desbridamiento o recambio en 2 tiempos con un espaciador se asoció a una elevada tasa de fracaso.
http://seq.es/seq/0214-3429/24/1/garciaoltra.pdf
Employing high-frequency alternating magnetic fields for the non-invasive treatment of prosthetic joint infections.
Scientific Report 8 Ago 2017;7(1):7520. PMID: 28790407
Chopra R, Shaikh S, Chatzinoff Y , Munaweera I, y cols.
Treatment of prosthetic joint infection (PJI) usually requires surgical replacement of the infected joint and weeks of antibiotic therapy, due to the formation of biofilm.
We introduce a non-invasive method for thermal destruction of biofilm on metallic implants using high-frequency (>100 kHz) alternating magnetic fields (AMF).
In vitro investigations demonstrate a >5-log reduction in bacterial counts after 5 minutes of AMF exposure.
Confocal and scanning electron microscopy confirm removal of biofilm matrix components within 1 minute of AMF exposure, and combination studies of antibiotics and AMF demonstrate a 5-log increase in the sensitivity of Pseudomonas aeruginosa to ciprofloxacin.
Finite element analysis (FEA) simulations demonstrate that intermittent AMF exposures can achieve uniform surface heating of a prosthetic knee joint.
In vivo studies confirm thermal damage is confined to a localized region (<2 mm) around the implant, and safety can be achieved using acoustic monitoring for the presence of surface boiling.
These initial studies support the hypothesis that AMF exposures can eradicate biofilm on metal implants, and may enhance the effectiveness of conventional antibiotics.
FULL TEXT
https://www.nature.com/articles/s41598-017-07321-6
In vitro activity of tedizolid and linezolid against Staphylococcus epidermidis isolated from prosthetic joint infections
European Journal of Clinical Microbiology & Infectious Diseases September 2017 V.36 N.9 P. 1549–1552
Littorin, B. Hellmark, Å. Nilsdotter-Augustinsson & B. Söderquist
1.School of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden
2.Department of Laboratory Medicine, Clinical MicrobiologyÖrebro University HospitalÖrebroSweden
3.Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health SciencesLinköping UniversityLinköpingSweden
4.Department of Infectious DiseasesCounty Council of ÖstergötlandLinköpingSweden
5.Departments of Infectious Diseases and Laboratory Medicine, Clinical MicrobiologyÖrebro University HospitalÖrebroSweden
Prosthetic joint infections (PJIs) are rare but long-lasting and are serious complications without any spontaneous resolution, requiring additional surgery and long-term treatment with antibiotics.
Staphylococci are the most important aetiological agents of PJIs, and among the coagulase-negative staphylococci Staphylococcus epidermidis is the most common.
However, S. epidermidis often displays multidrug resistance (MDR), demanding additional treatment options.
The objective was to examine the effectiveness of tedizolid and linezolid against S. epidermidis isolated from PJIs. The standard antibiotic susceptibility pattern of S. epidermidis (n = 183) obtained from PJIs was determined by disc diffusion test, and MIC was determined by Etest for tedizolid, linezolid, and vancomycin.
Tedizolid displayed MIC values ranging from 0.094 to 0.5 mg/L (MIC50: 0.19 mg/L, MIC90: 0.38 mg/L), linezolid MIC values ranging from 0.25 to 2 mg/L (MIC50: 0.75 mg/L, MIC90: 1 mg/L), and vancomycin MIC values ranging from 0.5 to 3 mg/L (MIC50 and MIC90 both 2 mg/L).
According to the disc diffusion test, 153/183 (84%) isolates were resistant to ≥3 antibiotic groups, indicating MDR.
In conclusion, S. epidermidis isolates from PJIs were fully susceptible, and the MIC50 and MIC90 values for tedizolid were two- to four-fold dilution steps lower compared with linezolid.
Tedizolid is not approved, and there are no reports of long-term treatment, but it may display better tolerability and fewer adverse effects than linezolid; it thus could be a possible treatment option for PJIs, alone or in combination with rifampicin.
abstract
https://link.springer.com/article/10.1007/s10096-017-2966-z?wt_mc=alerts.TOCjournals
PDF (CLIC en “DOWNLOAD PDF”)
Finegoldia magna: a forgotten pathogen in prosthetic joint infection rediscovered by molecular biology.
Clin Infect Dis. 2009 Oct 15;49(8):1244-7.
Levy PY1, Fenollar F, Stein A, Borrione F, Raoult D.
Author information
1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes-Unité Mixte de Recherche, Centre National de la Recherche Scientifique 6236-Institut de Recherche et Developpement 198, Faculté de Médecine, Université de la Méditerranée, Marseille, France.
Abstract
In this study, we describe 13 patients with prosthetic infections due to Finegoldia magna (2% of our tested series).
Patients presented with either polymicrobial infection after an open fracture or nosocomial infection after recent prosthesis implantation.
Molecular techniques are critical for diagnosis, and recommended antibiotic prophylaxis has poor activity against F. magna.
A Case of Septic Arthritis of the Wrist due to Finegoldia magna.
Case Rep Infect Dis. 2014;2014:793053.
Arsene C1, Saste A2, Somiah M1, Mestrovich J1, Berger G1.
Author information
1 Department of Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State School of Medicine, 4th Floor, 6071 West Outer Drive, Detroit, MI 48235, USA.
2 Department of Emergency Medicine, Detroit Receiving Hospital/Detroit Medical Center, 4201 Street Antoine, Suite 3R, Detroit, MI 48201, USA.
Abstract
Finegoldia magna (F. magna) has been described as one of the most frequent pathogens in the etiology of postoperative and prosthetic implant associated septic arthritis.
In this report, we document our first experience with septic arthritis of the wrist caused by F. magna occurring in a joint with primary disease from prior trauma
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005078/pdf/CRIID2014-793053.pdf
A case report of intraventricular tigecycline therapy for intracranial infection with extremely drug resistant A baumannii.
MEDICINE August 2017 V.96 N.31
Fang, Yu-Qing MDa; Zhan, Ru-Cai MDb; Jia, Wei MDc; Zhang, Bao-Qing MMd; Wang, Jian-Jun MDb,*
Section Editor(s): Rosca., Elena Cecilia
Rationale
Intracranial infection with Acinetobacter baumannii is a tough problem due to the presence of multiresistance and drugs poor penetration through the blood brain barrier (BBB). Tigecycline is effective to cure A baumannii, but it can only be used intravenously which is also difficult to pass BBB. So, it will be a breakthrough if intraventricular (IVT) tigecycline is used in the clinical therapy. However, this treatment has been reported quite rarely until now.
Patient concerns
We described a case of a 50-year-old male worker whose clinical futures were high fever and cerebral rigidity after neurosurgery.
Diagnoses
Intracranial infection with extensive drug resistant (XDR) A baumannii.
Interventions
The patient was treated with IVT tigecycline.
Outcomes
The symptoms of intracranial infection disappeared. The temperature of this patient decreased to normal and cerebral rigidity disappeared. The cerebrospinal fluid culture became negative, with normal levels of white blood cell, glucose and chlorine.
Lessons
IVT tigecycline therapy maybe effective to intracranial infection with XDR A baumannii. However, more studies will further demonstrate the therapeutic values of IVT tigecycline to intracranial infection, and not only restricted to A baumannii infections.
FULL TEXT
Editorial – Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin
Clinical Orthopaedics and Related Research July 2017 V.475 N.7 P.1762-1766
Daniel Wongworawat MD
https://link.springer.com/content/pdf/10.1007%2Fs11999-017-5354-1.pdf
