Posts filed under ‘Infecciones osteo-articulares-musculares’

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

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September 3, 2017 at 7:05 pm

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

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

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

August 31, 2017 at 3:49 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

Excellent Diagnostic Characteristics for Ultrafast Gene Profiling of DEFA1-IL1B-LTF in Detection of Prosthetic Joint Infections

Journal of Clinical Microbiology September 2017 V.55 N.9 P.2686-2697

Regina Fillerova, Jiri Gallo, Martin Radvansky, Veronika Kraiczova, Milos Kudelka, and Eva Kriegova

aDepartment of Immunology, Faculty of Medicine and Dentistry, Palacky University & University Hospital, Olomouc, Czech Republic

bDeptartment of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

cDepartment of Computer Science, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic

The timely and exact diagnosis of prosthetic joint infection (PJI) is crucial for surgical decision-making. Intraoperatively, delivery of the result within an hour is required.

Alpha-defensin lateral immunoassay of joint fluid (JF) is precise for the intraoperative exclusion of PJI; however, for patients with a limited amount of JF and/or in cases where the JF is bloody, this test is unhelpful.

Important information is hidden in periprosthetic tissues that may much better reflect the current status of implant pathology.

We therefore investigated the utility of the gene expression patterns of 12 candidate genes (TLR1, -2, -4, -6, and 10, DEFA1, LTF, IL1B, BPI, CRP, IFNG, and DEFB4A) previously associated with infection for detection of PJI in periprosthetic tissues of patients with total joint arthroplasty (TJA) (n = 76) reoperated for PJI (n = 38) or aseptic failure (n = 38), using the ultrafast quantitative reverse transcription-PCR (RT-PCR) Xxpress system (BJS Biotechnologies Ltd.).

Advanced data-mining algorithms were applied for data analysis. For PJI, we detected elevated mRNA expression levels of DEFA1 (P < 0.0001), IL1B (P < 0.0001), LTF (P < 0.0001), TLR1 (P = 0.02), and BPI (P = 0.01) in comparison to those in tissues from aseptic cases.

A feature selection algorithm revealed that the DEFA1-IL1B-LTF pattern was the most appropriate for detection/exclusion of PJI, achieving 94.5% sensitivity and 95.7% specificity, with likelihood ratios (LRs) for positive and negative results of 16.3 and 0.06, respectively.

Taken together, the results show that DEFA1-IL1B-LTF gene expression detection by use of ultrafast qRT-PCR linked to an electronic calculator allows detection of patients with a high probability of PJI within 45 min after sampling.

Further testing on a larger cohort of patients is needed.

PDF

http://jcm.asm.org/content/55/9/2686.full.pdf+html

August 23, 2017 at 2:53 pm

In vitro activity of tedizolid and linezolid against Staphylococcus epidermidis isolated from prosthetic joint infections

European Journal of Clinical Microbiology & Infectious Diseases September 2017 V.36 N.9 P. 1549–1552

Littorin, B. Hellmark, Å. Nilsdotter-Augustinsson & B. Söderquist

1.School of Medical Sciences, Faculty of Medicine and HealthÖrebro UniversityÖrebroSweden

2.Department of Laboratory Medicine, Clinical MicrobiologyÖrebro University HospitalÖrebroSweden

3.Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health SciencesLinköping UniversityLinköpingSweden

4.Department of Infectious DiseasesCounty Council of ÖstergötlandLinköpingSweden

5.Departments of Infectious Diseases and Laboratory Medicine, Clinical MicrobiologyÖrebro University HospitalÖrebroSweden

Prosthetic joint infections (PJIs) are rare but long-lasting and are serious complications without any spontaneous resolution, requiring additional surgery and long-term treatment with antibiotics.

Staphylococci are the most important aetiological agents of PJIs, and among the coagulase-negative staphylococci Staphylococcus epidermidis is the most common.

However, S. epidermidis often displays multidrug resistance (MDR), demanding additional treatment options.

The objective was to examine the effectiveness of tedizolid and linezolid against S. epidermidis isolated from PJIs. The standard antibiotic susceptibility pattern of S. epidermidis (n = 183) obtained from PJIs was determined by disc diffusion test, and MIC was determined by Etest for tedizolid, linezolid, and vancomycin.

Tedizolid displayed MIC values ranging from 0.094 to 0.5 mg/L (MIC50: 0.19 mg/L, MIC90: 0.38 mg/L), linezolid MIC values ranging from 0.25 to 2 mg/L (MIC50: 0.75 mg/L, MIC90: 1 mg/L), and vancomycin MIC values ranging from 0.5 to 3 mg/L (MIC50 and MIC90 both 2 mg/L).

According to the disc diffusion test, 153/183 (84%) isolates were resistant to ≥3 antibiotic groups, indicating MDR.

In conclusion, S. epidermidis isolates from PJIs were fully susceptible, and the MIC50 and MIC90 values for tedizolid were two- to four-fold dilution steps lower compared with linezolid.

Tedizolid is not approved, and there are no reports of long-term treatment, but it may display better tolerability and fewer adverse effects than linezolid; it thus could be a possible treatment option for PJIs, alone or in combination with rifampicin.

abstract

https://link.springer.com/article/10.1007/s10096-017-2966-z?wt_mc=alerts.TOCjournals

PDF (CLIC en “DOWNLOAD PDF”)

August 22, 2017 at 8:25 am

Finegoldia magna: a forgotten pathogen in prosthetic joint infection rediscovered by molecular biology.

Clin Infect Dis. 2009 Oct 15;49(8):1244-7.

Levy PY1, Fenollar F, Stein A, Borrione F, Raoult D.

Author information

1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes-Unité Mixte de Recherche, Centre National de la Recherche Scientifique 6236-Institut de Recherche et Developpement 198, Faculté de Médecine, Université de la Méditerranée, Marseille, France.

Abstract

In this study, we describe 13 patients with prosthetic infections due to Finegoldia magna (2% of our tested series).

Patients presented with either polymicrobial infection after an open fracture or nosocomial infection after recent prosthesis implantation.

Molecular techniques are critical for diagnosis, and recommended antibiotic prophylaxis has poor activity against F. magna.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/49/8/10.1086/605672/2/49-8-1244.pdf?Expires=1502483696&Signature=eWPUxLaImxwiuvSg~Jgn~q~SQKHBKP-V3v1O9oFwC9o6kEgmZTpWQgSOvl1SkNsLfdEiEuVC-kpTHd5iqQJSLC70l4I2M97RLc6Oss9J~gnXL4Pm3bcgHPoPrZzhFOHQc7Y~ZTc-oNIwLWjXtZVryyhslYhCO9fzUPdVekg9UKBn8DnpPD393C4bJEAKugGM5vGvGZE7nuNce6dmnxut81WQfKFLMtno0pWq8pkgkB6rM9HAdHwo~5KKy~mC957~riCVs11dbtBt0kWU~4Tsnk5r74wo7M1fd2c8uRo1Y1ypUvuA3mEv90p8o~pE7B4h20RbVwgCndAiZL5~FbfBHA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

August 10, 2017 at 3:42 pm

A Case of Septic Arthritis of the Wrist due to Finegoldia magna.

Case Rep Infect Dis. 2014;2014:793053.

Arsene C1, Saste A2, Somiah M1, Mestrovich J1, Berger G1.

Author information

1 Department of Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State School of Medicine, 4th Floor, 6071 West Outer Drive, Detroit, MI 48235, USA.

2 Department of Emergency Medicine, Detroit Receiving Hospital/Detroit Medical Center, 4201 Street Antoine, Suite 3R, Detroit, MI 48201, USA.

Abstract

Finegoldia magna (F. magna) has been described as one of the most frequent pathogens in the etiology of postoperative and prosthetic implant associated septic arthritis.

In this report, we document our first experience with septic arthritis of the wrist caused by F. magna occurring in a joint with primary disease from prior trauma

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005078/pdf/CRIID2014-793053.pdf

August 10, 2017 at 3:41 pm

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