Posts filed under ‘FIEBRE en el POSTOPERATORIO’

Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review

International Journal of Infectious Diseases February 2018 V.67 P.3–6

Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli

Highlights

  • Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
  • A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
  • At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
  • PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
  • This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.

Objective

To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.

Methods

Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.

Results

One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.

Conclusions

Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30228-X/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30228-X/pdf

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February 18, 2018 at 4:03 pm

Septic arthritis in a native knee due to Corynebacterium striatum.

Reumatol Clin. 2017 Mar 7. 

Septic arthritis in a native knee due to Corynebacterium striatum.

[Article in English, Spanish]

Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.

Author information

1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.

2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.

3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.

4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.

Abstract

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

PDF (CLIC en PDF)

http://www.reumatologiaclinica.org/es/linkresolver/artritis-septica-rodilla-nativa-por/S1699258X17300335/

October 22, 2017 at 12:43 pm

Septic arthritis of a native knee joint due to Corynebacterium striatum.

J Clin Microbiol. 2014 May;52(5):1786-8.

Westblade LF1, Shams F, Duong S, Tariq O, Bulbin A, Klirsfeld D, Zhen W, Sakaria S, Ford BA, Burnham CA, Ginocchio CC.

Author information

1 Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.

Abstract

We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic, mass spectrometric, and nucleic acid-based assays and exhibited high-level resistance to most antimicrobials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993712/pdf/zjm1786.pdf

October 22, 2017 at 12:41 pm

A spontaneous joint infection with Corynebacterium striatum.

J Clin Microbiol. 2007 Feb;45(2):656-8.

Scholle D1.

Author information

1 Department of Medicine, Legacy Emanuel and Good Samaritan Hospitals, 1015 NW 22nd Ave., Portland, OR 97210, USA. dscholle@fastmail.fm

Abstract

Corynebacterium striatum is a ubiquitous saprophyte with the potential to cause bacteremia in immunocompromised patients. Until now, spontaneous infection of a natural joint has not been reported. When phenotyping failed, gene sequencing was used to identify the species. The isolate demonstrated high-level resistance to most antibiotics.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829050/pdf/0827-06.pdf

 

October 22, 2017 at 12:39 pm

Readmission due to infection following total hip and total knee procedures: A retrospective study

Medicine: September 2017 – Volume 96 – Issue 38 – p e7961

Zawadzki, Nadine BSPHa; Wang, Yao MPHa; Shao, Hui PhDa; Liu, Emelline MSHSb; Song, Chao MPHc; Schoonmaker, Michele PhDc; Shi, Lizheng PhDa,*

Abstract

Policymakers have expanded readmissions penalty programs to include elective arthroplasties, but little is known about the risk factors for readmissions following these procedures. We hypothesized that infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) lead to excess readmissions and increased costs. This study aims to evaluate the proportion of readmissions due to infections following THA and TKA.

Healthcare Cost and Utilization Project–State Inpatient Databases were used for the study. Procedure codes “8151” and “8154” were used to identify inpatient discharges with THA and TKA in Florida (FL) 2009 to 2013, Massachusetts (MA) 2010 to 2012, and California (CA) 2009 to 2011. Readmission was measured by a Centers for Medicare and Medicaid Services (CMS) validated algorithm. Infections were identified by ICD-9-CM codes: 99859, 99666, 6826, 0389, 486, 4821, 00845, 5990, 48242, 04111, 04112, 04119, 0417, 99591, and 99592. Descriptive analysis was performed.

In CA, 4.29% of patients were readmitted with 33.02% of the total readmissions for infection. In FL, 4.7% of patients were readmitted with 33.39% of the readmissions for infection. In MA, 3.92% of patients were readmitted with 35.2% of readmissions for infection. Of the total number of readmissions due to infection, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) together accounted for 14.88% in CA, 13.38% in FL, and 13.11% in MA.

The rate of infection is similar across all 3 states and is a leading cause for readmission following THA and TKA. Programs to reduce the likelihood of MRSA or MSSA infection would reduce readmissions due to infection.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Readmission_due_to_infection_following_total_hip.18.aspx

PDF (CLIC en “ARTICLE as PDF”)

 

September 22, 2017 at 4:20 pm

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.

PDF

http://seq.es/seq/0214-3429/24/1/garciaoltra.pdf

September 3, 2017 at 7:05 pm

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

PDF

https://www.nature.com/articles/s41598-017-07321-6.pdf

August 24, 2017 at 6:37 pm

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