Posts filed under ‘Infecciones osteo-articulares-musculares’

Molecular Diagnosis of Orthopedic-Device-Related Infection Directly from Sonication Fluid by Metagenomic Sequencing

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2334-2347

Teresa L. Street, Nicholas D. Sanderson, Bridget L. Atkins, Andrew J. Brent, Kevin Cole, Dona Foster, Martin A. McNally, Sarah Oakley, Leon Peto, Adrian Taylor, Tim E. A. Peto, Derrick W. Crook, and David W. Eyre

aNuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom

bBone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

cMicrobiology Laboratory, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

dDepartment of Infectious Diseases and Microbiology, Royal Sussex County Hospital, Brighton, United Kingdom

ePublic Health England, Microbiology, Royal Sussex County Hospital, Brighton, United Kingdom

fNational Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom

Culture of multiple periprosthetic tissue samples is the current gold standard for microbiological diagnosis of prosthetic joint infections (PJI). Additional diagnostic information may be obtained through culture of sonication fluid from explants. However, current techniques can have relatively low sensitivity, with prior antimicrobial therapy and infection by fastidious organisms influencing results. We assessed if metagenomic sequencing of total DNA extracts obtained direct from sonication fluid can provide an alternative rapid and sensitive tool for diagnosis of PJI. We compared metagenomic sequencing with standard aerobic and anaerobic culture in 97 sonication fluid samples from prosthetic joint and other orthopedic device infections. Reads from Illumina MiSeq sequencing were taxonomically classified using Kraken. Using 50 derivation samples, we determined optimal thresholds for the number and proportion of bacterial reads required to identify an infection and confirmed our findings in 47 independent validation samples. Compared to results from sonication fluid culture, the species-level sensitivity of metagenomic sequencing was 61/69 (88%; 95% confidence interval [CI], 77 to 94%; for derivation samples 35/38 [92%; 95% CI, 79 to 98%]; for validation samples, 26/31 [84%; 95% CI, 66 to 95%]), and genus-level sensitivity was 64/69 (93%; 95% CI, 84 to 98%). Species-level specificity, adjusting for plausible fastidious causes of infection, species found in concurrently obtained tissue samples, and prior antibiotics, was 85/97 (88%; 95% CI, 79 to 93%; for derivation samples, 43/50 [86%; 95% CI, 73 to 94%]; for validation samples, 42/47 [89%; 95% CI, 77 to 96%]). High levels of human DNA contamination were seen despite the use of laboratory methods to remove it. Rigorous laboratory good practice was required to minimize bacterial DNA contamination. We demonstrate that metagenomic sequencing can provide accurate diagnostic information in PJI. Our findings, combined with the increasing availability of portable, random-access sequencing technology, offer the potential to translate metagenomic sequencing into a rapid diagnostic tool in PJI.

PDF

http://jcm.asm.org/content/55/8/2334.full.pdf+html

July 26, 2017 at 9:27 am

Staphylococcus aureus sensible a la meticilina frente a Staphylococcus aureus resistente en la artritis séptica aguda. Estudio experimental, epidemiológico y clínico en niños

Revista de la Asociación Argentina de Ortopedia y Traumatología Junio 2011 V.76 N.2

Paula Díaz Gallardo, Martín Mangupli, Horacio Galera, Pablo Bruno, Damián Bustos, Gerardo Ferrer y Christian Allende

Departamento de Cirugía Experimental, Universidad Católica de Córdoba

Servicio de Ortopedia y Traumatología, Hospital de Niños de la Santísima Trinidad

Servicio de Ortopedia y Traumatología, Sanatorio Allende – Hospital Misericordia Córdoba, Argentina

Introducción

Los objetivos principales de este estudio fueron establecer la epidemiología de la artritis séptica en nuestra comunidad, determinar las diferencias entre la artritis séptica producida por Staphylococcus aureus sensible a la meticilina y las secundarias a Staphylococcus aureus resistente a la meticilina, y determinar las propiedades bactericidas del líquido sinovial.

Materiales y métodos

Se utilizaron 28 conejos neozelandeses, divididos en cuatro grupos de 2 cada uno; en los de los grupos I y II se inocularon 0,3 mL de Staphylococcus aureus sensible a la meticilina y en los de los grupos III y IV, 0,3 mL de Staphylococcus aureus resistente a la meticilina. Se evaluó a 16 niños con artritis séptica, con un promedio de edad de 6 años. Se tomaron muestras de líquido sinovial de 10 rodillas, las cuales se colocaron en medios de cultivo inoculados con Staphylococcus aureus sensible a la meticilina y con Staphylococcus aureus resistente a la meticilina.

Resultados

La resonancia magnética evidenció signos de artritis en todos los casos. Los hemocultivos fueron negativos. La anatomía patológica evidenció edema, infiltrado inflamatorio purulento con material fibrinoleucocitario, tejido de granulación y áreas con destrucción de la membrana sinovial. En la investigación clínica, la articulación más afectada fue la rodilla (10 casos); el agente causal no se pudo identificar en 9 casos. El estudio experimental para determinar la capacidad bactericida del líquido sinovial reveló 75% de inhibición de crecimiento de colonias de Staphylococcus aureus sensible a la meticilina y 0% de inhibición para colonias de Staphylococcus aureus resistente.

Conclusiones

La elección de la antibioticoterapia para utilizar inicialmente en la artritis séptica debe variar de acuerdo con lo que muestren los estudios epidemiológicos de cada región. El líquido sinovial tiene propiedades bactericidas importantes frente a Staphylococcus aureus sensible a la meticilina, pero no en la artritis por Staphylococcus aureus resistente a la meticilina. La resonancia magnética es el estudio de elección en los pacientes con presunta artritis séptica.

PDF

http://www.scielo.org.ar/pdf/raaot/v76n2/v76n2a03.pdf

July 21, 2017 at 9:58 pm

Profilaxis antibiótica en el paciente poli-traumatizado. Guías 2011 elaboradas por los Comités de Infectología Crítica y de Trauma de la Sociedad Argentina de Terapia Intensiva (SATI)

MEDICINA INTENSIVA – 2011 – 28 Nº 4

Rosa Reina,* Guillermo Ramos,** Carina Balasini,* Héctor Canales,** Wanda Cornistein,* Alberto Cremona,* Eleonora Cunto,* Mercedes Esteban,* Alberto Legarto,** Romina Lendaro,** Candela Llerena,* Monserrat Lloria,* Mónica Quinteros,** Juan Videla* * Comité de Infectología Crítica ** Comité de Trauma Sociedad Argentina de Terapia Intensiva Buenos Aires, Argentina

Resumen

Objetivo.

Elaborar guías de profilaxis antibiótica (P-ATB) para pacientes politraumatizados.

Método.

Sistema GRADE para calidad y fuerza de la evidencia.

Resultados.

1) P-ATB prequirúrgica, desbridamiento amplio: 1-A.

2) Trauma de abdomen sin lesión de víscera hueca, con o sin packing: 2-D; con lesión de víscera hueca, con o sin packing, P-ATB hasta 24 h del posoperatorio: 1-A.

3) Trauma de cráneo: a) colocación de sensor de presión intracraneal: 2-D; b) fractura de base de cráneo: no administrar P-ATB: 1-A; c) fractura con hundimiento, por arma de fuego, con atricción de partes blandas o sin ella (la P-ATB no previene meningitis o absceso): 2-D.

4) Trauma maxilofacial: a) cerrado: con hemoseno o sin él, no administrar P-ATB: 1-A; b) penetrante (ruptura de senos, pérdida de piezas dentarias, con laceración de mucosa o sin ella): P-ATB por un día: 1-A; c) fractura mandibular: reducción cerrada/abierta: P-ATB posoperatoria: 2-D; d) cara sin fractura, lesión de partes blandas: 2-D; e) trauma ocular penetrante: PATB durante un día: 2-D.

5) Quemados: a) prevenir sepsis temprana e infección de herida: 1-C; b) quemados graves, de alto riesgo, en asistencia respiratoria mecánica: prevención de neumonía e infecciones intrahospitalarias: 2-B; c) quemadura <40%: curación simple, balneoterapia y resecciones de escaras: 1-C; d) procedimientos en quemaduras >40%, P-ATB perioperatoria para reducir la bacteriemia y la infección de la quemadura: 2-C; e) prevenir la pérdida de injertos de piel autóloga: 2-C.

6) Trauma de tórax: a) colocación de drenaje: 2-D; b) aspiración de contenido gástrico: no administrar P-ATB: 1-A.

7) Trauma pelviano-genitourinario abierto a vagina/recto y lesión de víscera hueca: P-ATB hasta 24 h del posoperatorio: 1-A.

8) Fractura expuesta de huesos largos: a) iniciar P-ATB rápidamente: 1-A; b) Gustillo I-II: suspender antibiótico a las 24 h del cierre de las heridas: 1-B; c) Gustillo III: continuar antibiótico por 72 h luego del trauma y 24 h después del cierre de las heridas: 1-B.

Conclusión.

Pocas indicaciones con fuerte nivel de evidencia para P-ATB

PDF

http://revista.sati.org.ar/index.php/MI/article/viewFile/285/239

July 17, 2017 at 8:03 am

Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease – United States.

Morbidity and Mortality Weekly Report. June 16, 2017 V.66 N.23 P.607-609.

Marzec NS, Nelson C, Waldron PR, Blackburn BG, Hosain S, Greenhow T, Green GM, Lomen-Hoerth C, Golden M, Mead PS.

Abstract

The term “chronic Lyme disease” is used by some health care providers as a diagnosis for various constitutional, musculoskeletal, and neuropsychiatric symptoms (1,2).

Patients with a diagnosis of chronic Lyme disease have been provided a wide range of medications as treatment, including long courses of intravenous (IV) antibiotics (3,4).

Studies have not shown that such treatments lead to substantial long-term improvement for patients, and they can be harmful (1,5).

This report describes cases of septic shock, osteomyelitis, Clostridium difficile colitis, and paraspinal abscess resulting from treatments for chronic Lyme disease.

Patients, clinicians, and public health practitioners should be aware that treatments for chronic Lyme disease can carry serious risks.

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6623a3.pdf

July 12, 2017 at 3:28 pm

Recomendaciones para la prevención de infecciones asociadas a artoplastia electiva en adultos

Medicina (B. Aires) Abril 2017 V.77 N.2

Juan Carlos Chuluyán1*, Andrea Vila2*, Ana Laura Chattás3*, Marcelo Montero3*, Claudia Pensotti4*+, Claudia Tosello5*, Marisa Sánchez6*, Cecilia Vera Ocampo7*, Guillermina Kremer8*, Rodolfo Quirós8*, Guillermo A. Benchetrit9*, Carolina Fernanda Pérez10*, Ana Laura Terusi11*, Francisco Nacinovich12*

1Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez,

2Servicio de Infectología, Hospital Italiano de Mendoza,

3Hospital General de Agudos Dr. Pirovano,

4Clínica Monte Grande,

5Hospital de Clínicas José de San Martín, UBA,

6Hospital Italiano de Buenos Aires,

7Sanatorio Dupuytren,

8Hospital Universitario Austral,

9Instituto de Investigaciones Médicas A. Lanari, UBA,

10Policlínico del Docente-Centro Médico Huésped,

11Instituto César Milstein,

12Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina

*En representación del grupo de trabajo en infecciones osteoarticulares de la Sociedad Argentina de Infectología

+In memoriam

Dirección postal: Juan Carlos Chuluyan, Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez, J. F. Aranguren 2701, 1406 Buenos Aires, Argentina

e-mail: jcchulu@gmail.com

Resumen

Las infecciones del sitio quirúrgico que complican las cirugías ortopédicas con implante prolongan la estadía hospitalaria y aumentan tanto el riesgo de readmisión como el costo de la internación y la mortalidad.

Las presentes recomendaciones están dirigidas a:

(i) optimizar el cumplimiento de normas y la incorporación de hábitos en cada una de las fases de la cirugía, detectando factores de riesgo para infecciones del sitio quirúrgico potencialmente corregibles o modificables; y

(ii) adecuar la profilaxis antibiótica preoperatoria y el cuidado intra y postoperatorio.

FULL TEXT

http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802017000200014

 

– – –

July 9, 2017 at 3:50 pm

Validation of the diagnosis ‘prosthetic joint infection’ in the Danish Hip Arthroplasty Register

Rev. Bone & Joint Journal 2016 Vol. 98 N.3 P.320-325       

H. Gundtoft, A. B. Pedersen, H. C. Schønheyder, S. Overgaard

Abstract

Aims

The purpose of this study was to validate the diagnosis of periprosthetic joint infection (PJI) in the Danish Hip Arthroplasty Register (DHR).

Patients and Methods

We identified a cohort of patients from the DHR who had undergone primary total hip arthroplasty (THA) since 1 January 2005 and followed them until first-time revision, death, emigration or until 31 December 2012. Revision for PJI, as registered in the DHR, was validated against a benchmark which included information from microbiology databases, prescription registers, clinical biochemistry registers and clinical records. We estimated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PJI in the DHR alone and in the DHR when combined with microbiology databases.

Results

In total, 1382 of the 37 826 primary THAs in the DHR were registered as having been revised for any cause once 26 patients with errors in registration had been excluded: 232 of these were for PJI. For this group, the sensitivity was 67%, specificity 95%, PPV 77%, and NPV 92%. Combining the data from the DHR with those from microbiology databases increased the sensitivity to 90% and also improved specificity (100%), PPV (98%) and NPV (98%).

Conclusion

Only two thirds of revisions for PJI were captured in the DHR and only 77% of the PJI reported to the DHR could be confirmed to be infected. Take home message: combining the data from the DHR with those from microbiology databases substantially improved the validity of the diagnosis of PJI and should enable future register-based studies.

abstract

http://bjj.boneandjoint.org.uk/content/98-B/3/320.long

PDF

http://bjj.boneandjoint.org.uk/content/jbjsbr/98-B/3/320.full.pdf

July 6, 2017 at 8:46 am

Intraoperative diagnosis of Staphylococcus aureus and coagulase-negative Staphylococcus using Xpert MRSA/SA SSTI assay in prosthetic joint infection.

Rev. New Microbiologica 2017 V.40 N.2 P.130-134

Sambri, A.; Pignatti, G.; Romagnoli, M.; Donati, D.; Marcacci, M.; Cadossi, M.

Istituto Ortopedico Rizzoli, Bologna, Italy.

Abstract

The aim of this prospective study was to evaluate the performance of the Polymerase Chain Reaction (PCR) tool Xpert MRSA/SA SSTI test (Cepheid, Sunnyvale, CA, USA) on periprosthetic samples from a cohort of patients with suspected prosthetic joint infection (PJI).

Seventy adult patients were included in this prospective study. On the basis of the preoperative evaluation, 39 patients were clinically considered to have a PJI, whereas 31 were presumed to suffer from an aseptic mobilization of the implant. Xpert MRSA/SA SSTI identified 4 out of 4 MRSA, 7 out of 7 MSSA, and 14 out of 16 methicillin resistant CoNS.

Among the 31 patients not having a PJI, the rapid PCR did not find any bacteria among those identifiable, thus demonstrating an excellent performance in terms of specificity.

Statistical analysis of the analytical performance showed a high correlation (p<0.001) between the result of Xpert MRSA/SA SSTI and culture.

Xpert MRSA/SA SSTI assay is a novel, yet well known, rapid and accurate method for the identification of different species of staphylococci.

The test can be used with peri-operative samples thus dramatically improving the diagnostic sensitivity. In addition, thanks to the very short turnaround time the use of Xpert assay can modify the clinical management of patients suffering from PJI during the ongoing operative procedure.

PDF

http://www.newmicrobiologica.org/PUB/allegati_pdf/2017/2/130.pdf

July 6, 2017 at 8:43 am

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