Posts filed under ‘FIEBRE en el POSTOPERATORIO’
2018 GUIA – Prevención y diagnóstico de la Infección del Sitio Quirúrgico. Centro Nacional de Excelencia Tecnológica en Salud México
2018 GUIA – Prevención y diagnóstico de la Infección del Sitio Quirúrgico. Centro Nacional de Excelencia Tecnológica en Salud México. 49 pags
El Centro Nacional de Excelencia Tecnológica en Salud (CENETEC) de México presenta su guía para la prevención y diagnóstico de la infección de sitio quirúrgico. En su desarrollo, el documento responde a las siguientes preguntas de relevancia clínica:
1. ¿Cuáles son los factores de riesgo inherentes al paciente, para desarrollar infección de sitio quirúrgico?
2. ¿Cuáles son los factores de riesgo inherentes al procedimiento, para desarrollar infección de sitio quirúrgico?
3. ¿Cuál es la indicación de la descolonización por S. aureus meticilino resistente en pacientes quirúrgicos?
4. ¿Cuál es el mejor método de antisepsia para la preparación de la piel en el sitio quirúrgico?
5. ¿ Cómo influye el rasurado de la piel en el desarrollo de infección de la herida?
6. ¿Cuáles son las diferencias entre los agentes utilizados en el lavado de manos quirúrgico en la prevención de infección del sitio quirúrgico?
7. ¿En qué tipo de procedimiento está indicada la profilaxis antibiótica y cuál es al antibiótico de elección?
8. ¿Cuántas dosis de antibiótico son las recomendadas para profilaxis y en qué momento deben administrarse?
9. ¿Es efectiva la irrigación de las heridas como medio para reducir el riesgo de infección de la herida quirúrgica?
10. ¿Cuál es la eficacia de antibióticos tópicos en la prevención de infección en las heridas quirúrgicas de primera intención?
http://www.imss.gob.mx/sites/all/statics/guiasclinicas/827%20GER_InfeccionSitioQuirurgico_2018.pdf
The prevention of Prosthetic Joint Infection (PJI)- 12 modifiable risk factors
The Bone & Joint Journal January 2019 V.101-B N.1 Suppl.A P.3-9
K. Alamanda, B. D. Springer
Aims
Prosthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI.
Materials and Methods
A search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Staphylococcus aureus screening, the management of anti-rheumatic medication, perioperative antibiotic prophylaxis, presurgical skin preparation, the operating room environment, irrigant options, and anticoagulation.
Results
Poor glycaemic control, obesity, malnutrition, and smoking are all associated with increased rates of PJI. Vitamin D replacement has been shown in preliminary animal studies to decrease rates of PJI. Preoperative Staphylococcus aureus screening and appropriate treatment results in decreased rates of PJI. Perioperative variables, such as timely and appropriate dosage of prophylactic antibiotics, skin preparation with chlorohexidine-based solution, and irrigation with dilute betadine at the conclusion of the operation, have all been associated with reduced rates of PJI. Similarly, aggressive anticoagulation and increased operating room traffic should be avoided to help minimize risk of PJI.
Conclusion
PJI remains a serious complication of arthroplasty. Surgeons should be vigilant of the modifiable risk factors that can be addressed in an attempt to reduce the risk of PJI.
FULL TEXT
https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.101B1.BJJ-2018-0233.R1
https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.101B1.BJJ-2018-0233.R1
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.
https://www.arthroplastyjournal.org/article/S0883-5403(18)30749-6/pdf
Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention
Journal of Infection January 2019 V.78 N.1 P.40–47
Highlights
- Late acute prosthetic joint infection (LA PJI) treated with surgical debridement and implant retention have a high failure rate.
- The exchange of mobile components during surgical debridement is the most potent predictor for treatment success.
- There are several preoperative patient related variables that increase the risk for failure.
- Treatment strategies for late acute PJIs should be individualized and optimized according to the preoperative risk for failing.
Objectives
Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.
Methods
Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.
Results
340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).
Conclusion
LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients’ age, comorbidity, clinical presentation and microorganism causing the infection.
FULL TEXT
https://www.journalofinfection.com/article/S0163-4453(18)30241-X/fulltext
https://www.journalofinfection.com/article/S0163-4453(18)30241-X/pdf
Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review
Journal of Infection January 2019 V.78 N.1 P.27–34
Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Beraud, Olivier Grossi, Nicolas Varache, Cédric Arvieux, Rozenn Le Berre, Pierre Tattevin, for the Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)
Objectives
We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).
Methods
Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.
Results
During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).
Conclusions
- tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.
FULL TEXT
https://www.journalofinfection.com/article/S0163-4453(18)30253-6/abstract
https://www.journalofinfection.com/article/S0163-4453(18)30253-6/pdf
Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018
Morbidity and Mortality Weekly Report December 21, 2018 V.67 N.50 P.1397–1399
Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018
The only Food and Drug Administration (FDA)–approved stem cell products are derived from umbilical cord blood, and their only approved use is hematopoietic and immunologic reconstitution (1).
On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA–approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12.
Patient isolates of E. cloacae had identical pulsed-field gel electrophoresis patterns, suggesting a common source …
Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection
Journal of Arthroplasty November 2018 V.33 N.11 P. 3551–3554
Alexander J. Rondon, Michael M. Kheir, Timothy L. Tan, Noam Shohat, Max R. Greenky, Javad Parvizi
Background
One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI.
Methods
A retrospective study of 17,393 primary total joint arthroplasties receiving cefazolin as perioperative prophylaxis from 2005 to 2017 was performed. Patients were stratified into 2 groups (underdosed and adequately dosed) based on patient weight and antibiotic dosage. Patients who developed PJI within 1 year following index procedure were identified. A bivariate and multiple logistic regression analyses were performed to control for potential confounders and identify risk factors for PJI.
Results
The majority of patients weighing greater than 120 kg (95.9%, 944/984) were underdosed. Underdosed patients had a higher rate of PJI at 1 year compared with adequately dosed patients (1.51% vs 0.86%, P = .002). Patients weighing greater than 120 kg had higher 1-year PJI rate than patients weighing less than 120 kg (3.25% vs 0.83%, P < .001). Patients who were underdosed (odds ratio, 1.665; P = .006) with greater comorbidities (odds ratio, 1.259; P < .001) were more likely to develop PJI at 1 year.
Conclusion
Cefazolin underdosing is common, especially for patients weighing more than 120 kg. Our study reports that underdosed patients were more likely to develop PJI. Orthopedic surgeons should pay attention to the weight-based dosing of antibiotics in the perioperative period to avoid increasing risk of PJI.
abstract
https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/fulltext
https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/pdf
