Posts filed under ‘Health Care-Associated Infections’

Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit

Emerging Infectious Diseases October 2019 V.25 N.10

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/10/18-1626_article?deliveryName=DM9244

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September 23, 2019 at 10:00 am

Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China

Emerging Infectious Diseases October 2019 V.25 N.10

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a public health concern worldwide, but comprehensive analysis of risk factors for CRPA remains limited in China.

We conducted a retrospective observational study of carbapenem resistance in 71,880 P. aeruginosa isolates collected in Zhejiang Province during 2015–2017.

We analyzed risk factors for CRPA, including the type of clinical specimen; the year, season, and region in which it was collected; patient information, including age, whether they were an outpatient or inpatient, and whether inpatients were in the intensive care unit or general ward; and the level of hospital submitting isolates.

We found CRPA was more prevalent among isolates from patients >60 years of age and in inpatients, especially in intensive care units. In addition, specimen types and seasons in which they were collected were associated with higher rates of CRPA.

Our findings can help hospitals reduce the spread of P. aeruginosa and optimize antimicrobial drug use.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/10/18-1699_article?deliveryName=DM9244

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September 23, 2019 at 9:59 am

Vertebral osteomyelitis: clinical features and diagnosis.

Clin Microbiol Infect. October 2014 V.20 N.10 P.1055-60. Jun 14.

Eren Gök S1, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, Dokuzoğuz B.

1 Infectious Diseases and Clinical Microbiology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Abstract

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/pdf

September 21, 2019 at 8:09 pm

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study.

Eur J Nucl Med Mol Imaging. May 2018 V.45 N.5 P.798-805.

Kouijzer IJE1,2, Scheper H3, de Rooy JWJ4, Bloem JL5, Janssen MJR4, van den Hoven L6, Hosman AJF7, Visser LG3, Oyen WJG4,8, Bleeker-Rovers CP9, de Geus-Oei LF10,5.

1 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. ilse.kouijzer@radboudumc.nl.

2 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands. ilse.kouijzer@radboudumc.nl.

3 Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

4 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

5 Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

6 Technical Medicine, University of Twente, Enschede, the Netherlands.

7 Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

8 Department of Nuclear Medicine, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.

9 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.

10 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands.

Abstract

PURPOSE:

The aim of this study was to determine the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

METHODS:

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. 18F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

RESULTS:

For 18F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

CONCLUSION:

18F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978906/pdf/259_2017_Article_3912.pdf

September 21, 2019 at 8:07 pm

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

Clin Infect Dis. September 15, 2015 V.61 N.6 e26-46.

Berbari EF1, Kanj SS2, Kowalski TJ3, Darouiche RO4, Widmer AF5, Schmitt SK6, Hendershot EF7, Holtom PD8, Huddleston PM 3rd9, Petermann GW10, Osmon DR11, Infectious Diseases Society of America.

Abstract

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

FULL TEXT

https://academic.oup.com/cid/article/61/6/e26/452579

PDF (CLIC en PDF)

 

– – –

 

Clin Infect Dis. April 1, 2016 V.62 N.7 P.953-4.

LETTER – Vertebral Osteomyelitis Guidelines.

TO THE EDITOR—I congratulate Dr Berbari and colleagues for producing the 2015 guidelines for diagnosis and treatment of vertebral osteomyelitis, despite the lack of controlled trials to guide them [1]. However, the guidelines left out any mention of coccidioidomycosis as an etiology of this infection. More than 25% of patients with disseminated coccidioidomycosis have bone and joint infections, and in adults the axial skeleton is involved in more than half of those cases [2]. Infection may be multifocal in the spine. Although …

FULL TEXT

https://academic.oup.com/cid/article/62/7/953/2462943

PDF (CLIC en PDF)

September 21, 2019 at 8:05 pm

Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis.

BMC Infect Dis. September 17, 2018 V.18 N.1 P.468.

Li YD1, Wong CB2, Tsai TT1, Lai PL1, Niu CC1, Chen LH1, Fu TS3.

Abstract

BACKGROUND:

Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.

METHODS:

This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.

RESULTS:

Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).

CONCLUSIONS:

The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142394/pdf/12879_2018_Article_3377.pdf

September 21, 2019 at 8:02 pm

Traditional Laboratory Markers Hold Low Diagnostic Utility for Immunosuppressed Patients With Periprosthetic Joint Infections

Journal of Arthroplasty July 2019 V.34 N.7 P.1441–1445

Background

Although predictive laboratory markers and cutoffs for immunocompetent patients are well-studied, similar reference ranges and decision thresholds for immunosuppressed patients are less understood. We investigated the utility of typical laboratory markers in immunosuppressed patients undergoing aspiration of a prosthetic hip or knee joint.

Methods

A retrospective review of adult patients with an immunosuppressed state that underwent primary and revision total joint arthroplasty with a subsequent infection at our tertiary, academic institution was conducted. Infection was defined by Musculoskeletal Infection Society criteria. A multivariable analysis was used to identify independent factors associated with acute (<90 days) and chronic (>90 days) infection. Area under the receiver-operator curve (AUC) was used to determine the best supported laboratory cut points for identifying infection.

Results

We identified 90 patients with immunosuppression states totaling 172 aspirations. Mean follow-up from aspiration was 33 months. In a multivariate analysis, only synovial fluid cell count and synovial percent neutrophils were found to be independently correlated with both acute and chronic infection. A synovial fluid cell count cutoff value of 5679 nucleated cells/mm3 maximized the AUC (0.839) for predicting acute infection, while a synovial fluid cell count cutoff value of 1293 nucleated cells/mm3 maximized the AUC (0.931) for predicting chronic infection.

Conclusion

Physicians should be aware of lower levels of synovial nucleated cell count and percentage of neutrophils in prosthetic joint infections of the hip or knee in patients with immunosuppression. Further investigation is necessary to identify the best means of diagnosing periprosthetic joint infection in this patient population.

FULL TEXT

https://www.arthroplastyjournal.org/article/S0883-5403(19)30236-0/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30236-0/pdf

August 30, 2019 at 4:10 pm

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