Posts filed under ‘Infecciones nosocomiales’

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

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August 30, 2019 at 4:10 pm

Clinical Klebsiella pneumoniae Isolate with Three Carbapenem Resistance Genes Associated with Urology Procedures – King County, Washington, 2018.

MMWR Morb Mortal Wkly Rep. 2019 Aug 2;68(30):667-668.

Vannice K, Benoliel E, Kauber K, Brostrom-Smith C, Montgomery P, Kay M, Walters M, Tran M, D’Angeli M, Duchin J.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677168/pdf/mm6830a4.pdf

August 29, 2019 at 6:12 pm

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa.

Clin Infect Dis. March 21, 2019 pii: ciy1121. doi: 10.1093/cid/ciy1121. [Epub ahead of print]

Nicolle LE1, Gupta K2, Bradley SF3, Colgan R4, DeMuri GP5, Drekonja D6, Eckert LO7, Geerlings SE8, Köves B9, Hooton TM10, Juthani-Mehta M11, Knight SL12, Saint S13, Schaeffer AJ14, Trautner B15, Wullt B16, Siemieniuk R17.

Author information

1 Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

2 Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts.

3 Division of Infectious Diseases, University of Michigan, Ann Arbor.

4 Department of Family and Community Medicine, University of Maryland, Baltimore.

5 Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison.

6 Division of Infectious Diseases, University of Minnesota, Minneapolis.

7 Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle.

8 Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands.

9 Department of Urology, South Pest Teaching Hospital, Budapest, Hungary.

10 Division of Infectious Diseases, University of Miami, Florida.

11 Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut.

12 Library and Knowledge Services, National Jewish Health, Denver, Colorado.

13 Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor.

14 Department of Urology, Northwestern University, Chicago, Illinois.

15 Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.

16 Division of Microbiology, Immunology and Glycobiology, Lund, Sweden.

17 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Abstract

Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

FULL TEXT

https://academic.oup.com/cid/article/68/10/e83/5407612

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August 29, 2019 at 6:10 pm

Risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection among rectal carriers: a prospective observational multicentre study.

Clin Microbiol Infect. December 2014 V.20 N.12 P.1357-62.

Giannella M1, Trecarichi EM, De Rosa FG, Del Bono V, Bassetti M, Lewis RE, Losito AR, Corcione S, Saffioti C, Bartoletti M, Maiuro G, Cardellino CS, Tedeschi S, Cauda R, Viscoli C, Viale P, Tumbarello M.

Author information

1 Infectious Diseases Unit, Department of Medical and Clinical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.

Abstract

Knowledge of carbapenem-resistant Klebsiella pneumoniae (CR-KP) colonization is important to prevent nosocomial spread but also to start prompt adequate antibiotic therapy in patients with suspicion of infection. However, few studies have examined the incidence and risk factors for CR-KP bloodstream infection (BSI) among rectal carriers. To identify risk factors for CR-KP BSI among carriers, we performed a multicentre prospective matched case-control study of all adult CR-KP rectal carriers hospitalized in five tertiary teaching hospitals in Italy over a 2-year period. Carriers who developed CR-KP BSI were compared with those who did not develop subsequent BSI. Overall, 143 CR-KP BSIs were compared with 572 controls without a documented infection during their hospitalization. Multivariate analysis revealed that admission to the Intensive Care Unit (ICU) (OR, 1.65; 95% CI, 1.05-2.59; p 0.03), abdominal invasive procedure (OR, 1.87; 95% CI, 1.16-3.04; p 0.01), chemotherapy/radiation therapy (OR, 3.07; 95% CI, 1.78-5.29; p <0.0001), and number of additional colonization sites (OR, 3.37 per site; 95% CI, 2.56-4.43; p <0.0001) were independent risk factors for CR-KP BSI development among CR-KP rectal carriers. A CR-KP BSI risk score ranging from 0 to 28 was developed based on these four independent variables. At a cut-off of ≥2 the model exhibited a sensitivity, specificity, positive predictive value and negative predictive value of 93%, 42%, 29% and 93%, respectively. Colonization at multiple sites with CR-KP was the strongest predictor of BSI development in our large cohort of CR-KP rectal carriers.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)60042-8/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(15)60042-8/pdf

 

2014-12 Risk factors for carbapenem-resistant Kleb pneumoniae BSI among rectal carriers 6p CMI

August 24, 2019 at 8:57 pm

The use of labelled leucocyte scintigraphy to evaluate chronic PJI – A retrospective multicentre study on 168 patients

European Journal of Clinical Microbiology & Infectious Diseases, V.38 N.9

Labelled leucocyte scintigraphy (LS) is regarded as helpful when exploring bone and joint infections. The aim of this study was to evaluate the utility of LS for the diagnosis of chronic periprosthetic joint infections (PJIs) in patients exhibiting arthroplastic loosening. One hundred sixty-eight patients were referred to centres for treatment of complex PJI. One hundred fifty underwent LS using 99mTc-HMPAO (LLS); 18 also underwent anti-granulocyte scintigraphy (AGS) and 13 additional SPECT with tomodensitometry imaging (SPECT-CT). The LS results were compared with bone scan data. For all, the final diagnoses were determined microbiologically; perioperative samples were cultured. LS values were examined, as well as sensitivity by microorganism, anatomical sites, and injected activity. LS results were also evaluated according to the current use of antibiotics or not. The sensitivity, specificity, and positive predictive value of LLS were 72%, 60%, and 80%, respectively. LLS performed better than did AGS. SPECT-CT revealed the accurate locations of infections. The sensitivity of LS was not significantly affected by the causative pathogen or the injected activity. No correlation was evident between the current antibiotic treatment and the LS value. The test was more sensitive for knee (84%) than hip arthroplasty (57%) but was less specific for knee (52% vs. 75%). Sensitivity and specificity of LLS varied by the location of infection bone scan provide no additional value in PJI diagnosis. Current antibiotic treatment seems to have no influence on LS sensitivity as well as labelling leukocyte activity or pathogens responsible for chronic PJI.

 

La gammagrafía con leucocitos marcados (LS) se considera útil cuando se exploran infecciones óseas y articulares. El objetivo de este estudio fue evaluar la utilidad de LS para el diagnóstico de infecciones periprotésicas crónicas (PJI) en pacientes que presentan aflojamiento artroplásico. Ciento sesenta y ocho pacientes fueron remitidos a centros para el tratamiento de PJI complejo. Ciento cincuenta se sometieron a LS utilizando 99mTc-HMPAO (LLS); 18 también se sometieron a gammagrafía anti-granulocitos (AGS) y 13 SPECT adicionales con tomodensitometría (SPECT-CT). Los resultados del LS se compararon con los datos de la exploración ósea. Para todos, los diagnósticos finales se determinaron microbiológicamente; Se cultivaron muestras perioperatorias. Se examinaron los valores de LS, así como la sensibilidad por microorganismos, sitios anatómicos y actividad inyectada. Los resultados de LS también se evaluaron según el uso actual de antibióticos o no. La sensibilidad, especificidad y valor predictivo positivo de LLS fueron 72%, 60% y 80%, respectivamente. LLS funcionó mejor que AGS. SPECT-CT reveló las ubicaciones precisas de las infecciones. La sensibilidad de LS no se vio afectada significativamente por el patógeno causante o la actividad inyectada. No hubo correlación evidente entre el tratamiento antibiótico actual y el valor de LS. La prueba fue más sensible para la rodilla (84%) que la artroplastia de cadera (57%) pero fue menos específica para la rodilla (52% frente al 75%). La sensibilidad y la especificidad de LLS variadas por la ubicación de la exploración ósea de infección no proporcionan valor adicional en el diagnóstico de PJI. El tratamiento antibiótico actual parece no tener influencia en la sensibilidad al LS ni en el marcado de la actividad leucocitaria o de los patógenos responsables de la PJI crónica.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03587-y?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_9

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August 20, 2019 at 3:42 pm

Streptococcus salivarius Prosthetic Joint Infection following Dental Cleaning despite Antibiotic Prophylaxis.

Case Rep Infect Dis. April 21, 2019   

Olson LB1, Turner DJ2, Cox GM3, Hostler CJ3,4.

Author information

1 Duke University School of Medicine, Durham, USA.

2 Department of Medicine, Duke University School of Medicine, Durham, USA.

3 Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.

4 Infectious Disease Section, Durham VA Health Care System, Durham, USA.

Abstract

We present the case of a 92-year-old man with septic arthritis of a prosthetic hip joint due to Streptococcus salivarius one week following a high-risk dental procedure despite preprocedure amoxicillin. S. salivarius is a commensal bacterium of the human oral mucosa that is an uncommon cause of bacteremia. S. salivarius has previously been described as a causative agent of infective endocarditis and spontaneous bacterial peritonitis but was only recently recognized as a cause of prosthetic joint infection. This case highlights the potential pathogenicity of a common commensal bacteria and the questionable utility of prophylactic antibiotics before dental procedures to prevent periprosthetic joint infections

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501194/pdf/CRIID2019-8109280.pdf

August 9, 2019 at 8:26 am

“’The not-so good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study.”

Clinical Infectious Diseases June 15, 2017 V.64 N.12 P.1742–1752

Lora-Tomayo, ´E. Senneville, A. Ribera et al.,

BACKGROUND.

Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success.

METHODS.

A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy.

RESULTS.

Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34).

CONCLUSIONS.

This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.

FULL TEXT

https://academic.oup.com/cid/article/64/12/1742/3078956

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August 9, 2019 at 8:25 am

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