Posts filed under ‘Infecciones osteo-articulares-musculares’

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis

Pol J Radiol. February 2017 V.82 P.71-87.

Antecedentes

La espondilodiscitis infecciosa se caracteriza por la participación de dos vértebras adyacentes y el disco intermedio.

La tasa de incidencia de la enfermedad se estima en 0.4-2 casos por 100000 por año.

Staphylococcus aureus es el agente infeccioso más común que causa espondilodiscitis piógena.

Las infecciones no piógenas de la columna vertebral son causadas con mayor frecuencia por Mycobacterium tuberculosis y hongos.

Los síntomas clínicos son inespecíficos.

El diagnóstico temprano y el tratamiento adecuado pueden evitar secuelas irreversibles desfavorables para el paciente.

Los desarrollos significativos en las técnicas de imagen de tejidos patológicos aumentaron las expectativas entre los médicos con respecto a la posibilidad de distinguir entre la espondilodiscitis tuberculosa y la espondilodiscitis piógena en las imágenes de RM.

El objetivo de este estudio fue identificar y diferenciar las características de la espondilodiscitis tuberculosa y piógena en las imágenes de RM.

Material/métodos

Realizamos un análisis retrospectivo de imágenes de RM obtenidas de 34 pacientes con espondilodiscitis confirmada (18 con espondilodiscitis piógena y 16 con espondilodiscitis tuberculosa). La adquisición de datos se realizó utilizando escáneres de resonancia magnética de 1,5 T, donde se obtuvieron imágenes utilizando protocolos similares. T2 TIRM y las imágenes ponderadas en T1 con y sin realce de contraste fueron sujetas a evaluación en planos coronal, axial y sagital.

Resultados

Las características de la espondilodiscitis piógena incluyen: afectación de la columna lumbar, aumento del contraste anormal paraespinal mal definido, aumento del contraste difuso / homogéneo de los cuerpos vertebrales, destrucción de grado bajo de los cuerpos vertebrales, señal hiperintensa / homogénea de los cuerpos vertebrales en las imágenes T2 TIRM . Las características predominantes de la espondilodiscitis tuberculosa incluyeron: afectación de la columna torácica, afectación de 2 o más cuerpos vertebrales adyacentes, destrucción severa del cuerpo vertebral, realce de contraste focal / heterogéneo de los cuerpos vertebrales, señal heterogénea de los cuerpos vertebrales en imágenes T2 TIRM, bien Mejora de contraste anormal paraespinal -definido, abscesos paraespinales y epidurales, realce meníngeo a nivel de la columna afectada.

Conclusiones

La comparación de imágenes de RM de pacientes diagnosticados con espondilodiscitis piógena y espondilodiscitis tuberculosa permitió la identificación de características individuales para la diferenciación preliminar entre TB y espondilodiscitis infecciosa y, por lo tanto, permitió un tratamiento adecuado.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317295/pdf/poljradiol-82-71.pdf

July 12, 2020 at 1:39 pm

Magnetic Resonance Imaging of Bacterial and Tuberculous Spondylodiscitis With Associated Complications and Non-Infectious Spinal Pathology Mimicking Infections: A Pictorial Review

BMC Musculoskelet Disord. June 5, 2017 V.18 N.1 P.244.

La resonancia magnética (RM) desempeña un papel importante en la evaluación de la espondilodiscitis bacteriana y tuberculosa y las complicaciones asociadas.

Debido a su alta sensibilidad y especificidad, es una poderosa herramienta de diagnóstico en el diagnóstico precoz de infecciones en curso y, por lo tanto, proporciona ayuda para el inicio inmediato de una terapia adecuada, que puede ser médica o quirúrgica, al definir el alcance de la participación y la detección de complicaciones. tales como abscesos epidurales y paraespinales.

Más específicamente, la resonancia magnética ayuda a diferenciar las infecciones bacterianas de las tuberculosas y permite el seguimiento de la progresión o resolución después del tratamiento adecuado.

Sin embargo, otra patología no infecciosa puede demostrar apariencias similares de imágenes de RM y uno debe ser consciente de estos posibles imitadores al interpretar imágenes de RM.

Los radiólogos y otros médicos deben ser conscientes de estas posibles imitaciones, que incluyen patologías tales como cambios degenerativos tipo I, trauma, enfermedad metastásica y amiloidosis.

En esta revisión pictórica, describiremos e ilustraremos los hallazgos de imágenes de la espondilodiscitis bacteriana y tuberculosa, sus complicaciones y patologías no infecciosas que imitan estas infecciones espinales.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460517/pdf/12891_2017_Article_1608.pdf

 

July 12, 2020 at 1:38 pm

Dosificación de cefazolina prequirúrgica en pacientes obesos y no obesos. Importa el peso

Revista Española de Quimioterapia Junio 2020

PDF

https://seq.es/wp-content/uploads/2020/04/rodriguez15apr2020.pdf

June 29, 2020 at 5:48 pm

REVIEW – Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic

J Am Acad Orthop Surg. June 2020 V.28 N.11 P.451-463

Mohamed E. Awad, MD

Jacob C.L. Rumley, DO

Jose A. Vazquez, MD, FACP, FIDSA

John G. Devine, MD, FAOA

From the Hull College of Business, Augusta University (Dr. Awad), the Department of Orthopedic Surgery,

Medical College of Georgia, Augusta University (Dr. Awad, Dr. Rumley, and Dr. Devine), the Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University (Dr. Vazquez), and Antimicrobial Stewardship Service, Augusta University (Dr. Vazquez), Augusta, GA.

By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, emergency department consultation room, induction room, operating room, and recovery room) are reviewed….

FULL TEXT

https://pubmed.ncbi.nlm.nih.gov/32282441/

June 24, 2020 at 3:18 pm

Dalbavancin for treating prosthetic joint infections caused by Gram-positive bacteria: A proposal for a low dose strategy. A retrospective cohort study

Revista Española de Quimioterapia Diciembre 2019 V.32 N.6 P.532-538

Introducción.

Las bacterias grampositivas son la principal causa de infección periprotésica (IPP). Dalbavancina es un lipoglicopéptido con interesantes propiedades farmacocinéticas y una importante actividad bactericida frente a la mayoría de gram positivos. Aunque aún necesitamos mayor evidencia en relación con su uso en infección osteoarticular, estudios recientes sugieren un papel importante de dalbavancina en la IPP.

Métodos.

Desde el 1 de Junio de 2016 al 1 de Mayo de 2018, todos los pacientes diagnosticados con IPP y tratados con dalbavancina sola o en combinación con otros fármacos fueron evaluados de forma retrospectiva. La sensibilidad a dalbavancina de los aislamientos fue evaluada según las recomendaciones de CLSI. El objetivo primario fue determinar la eficacia y tolerabilidad del fármaco en pacientes con IPP. Se realizó un análisis de coste siguiendo la metodología descrita en el estudio DALBUSE.

Resultados.

Dieciséis pacientes fueron tratados con dalbavancina, ocho con infección de prótesis total de cadera y ocho con infección de prótesis total de rodilla. Staphylococcus spp. y Enterococcus spp. fueron los microorganismos implicados. No hubo efectos adversos relevantes. La infección se resolvió en 12 pacientes. En dos pacientes el tratamiento falló, y otro paciente falleció por causas no relacionadas. Un paciente es actualmente en tratamiento supresor por infección por diseminación hematógena de prótesis total de rodilla a partir de endocarditis protésica aórtica. Tras la discontinuación de dalbavancina, y exceptuando los pacientes fallecidos y/o con fallo terapéutico, el seguimiento medio fue de 503 dias (rango intercuartílico 434.5-567 dias). Se estimó un ahorro de 264.769 dólares USA.

Conclusiones.

Este estudio sugiere que dalbavancina para el tratamiento de IPP causada por microorganismos gram positivos es segura y una opción eficaz que reduce la estancia hospitalaria y los costes. Se precisan más comunicaciones para confirmar estos datos.

PDF

https://seq.es/wp-content/uploads/2019/10/buzon22oct2019.pdf

December 29, 2019 at 2:32 pm

Dilute Povidone-Iodine Solution Prevents Intraoperative Contamination of Sterile Water Basins During Total Joint Arthroplasty

Journal of Arthroplasty January 2020 V.35  N.1  P.241–246

Background

Periprosthetic joint infection is a major complication of total joint arthroplasty (TJA). The intraoperative splash basin has been found to be a potential source of contamination. Although consensus recommendations against the use of splash basin have been made, splash basin use continues to be taught and utilized in practice. This study aims to investigate the effect of dilute betadine addition to the sterile water (SW) contents (0.02% solution) of the splash basin on contamination rates. This intervention could preserve the functionality and preferential use of the splash basin. The primary outcome of this study is the rate of splash basin contamination, with secondary outcomes of prevalence of culture speciation and mean operative times association with the rate of positive cultures.

Methods

Patients undergoing primary TJA were enrolled in a randomized controlled trial with assignment to either the intervention/betadine group, in which dilute betadine was added to the standard SW splash basin, or the control/standard SW group. For a total cohort of 104 patients, a 120 mL aliquot sample of basin fluid was collected at incision (“preprocedure”) and closure (“postprocedure”). Samples were cultured and monitored for 48 hours for growth, with further testing as necessary to identify microbial speciation.

Results

Of the final 100 postprocedure samples, 0 (0.0%) were positive in the betadine group, while there were 23 (47.9%) positive samples in the SW group (P < .001). Of the positive cultures, the most common species grown were coagulase-negative Staphylococcus, Corynebacterium, and Micrococcus. The mean operative time was an average of 11 minutes longer for cases with positive cultures.

Conclusion

In conclusion, treating SW splash basins with dilute povidone-iodine (0.02% solution) eliminates intraoperative contamination of splash basins in TJA procedures. This intervention is simple, low cost, and readily implementable, making it a reasonable addition to TJA protocols.

Level of Evidence

Level 1, Controlled Laboratory Study.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30747-8/pdf

December 29, 2019 at 2:11 pm

Differences in Diagnostic Properties Between Standard and Enrichment Culture Techniques Used in Periprosthetic Joint Infections

Journal of Arthroplasty January 2020 V.35  N.1  P.235–240

Background

Culture-negative infections can complicate the diagnosis and management of orthopedic infections, particularly periprosthetic joint infections (PJIs). This study aimed to identify differences in rate of detection of infection and organisms between cultured using standard and enriched methods.

Methods

This retrospective, cross-sectional study evaluated PJI samples obtained between January 2013 and December 2017 at Yokohama City University Hospital. Samples were assessed using standard and enrichment culture techniques. White blood cell counts, C-reactive protein levels, type of microorganism (coagulase-positive or coagulase-negative), and methicillin-resistant Staphylococcus were investigated.

Results

A total of 151 PJI samples were included in the analysis; of these, 68 (45.0%) were positive after standard culture while 83 (55.0%) were positive only after enrichment culture. The mean white blood cell counts and C-reactive protein levels were significantly lower in the enrichment culture group than in the standard culture group (P < .01). The rate of methicillin-resistant Staphylococcus and coagulase-negative Staphylococci was significantly higher in the enrichment culture group than in the standard culture group (P < .01).

Conclusion

The enrichment culture method has a higher rate of detection of infection than standard culture techniques and should, therefore, be considered when diagnosing orthopedic infections, particularly PJI.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30766-1/pdf

December 29, 2019 at 2:06 pm

Combined Measurement of D-Dimer and C-Reactive Protein Levels: Highly Accurate for Diagnosing Chronic Periprosthetic Joint Infection

Journal of Arthroplasty January 2020 V.35  N.1  P.229–234

Background

Diagnosis of chronic periprosthetic joint infection (PJI) can be challenging and elusive in the absence of a gold standard. D-dimer plays an important role in inflammation that occurs during infections and therefore could be a valuable biomarker for PJI. This study aims to investigate the sensitivity and specificity of D-dimer in detecting chronic PJI and to improve the accuracy of chronic PJI diagnosis through combined measurement of serum D-dimer with C-reactive protein (CRP)/erythrocyte sedimentation rate.

Methods

One hundred twenty-two patients presenting with a painful knee or hip after total hip or total knee arthroplasty for surgical revision were included in this prospective trial. Our cohort consisted of 55 patients undergoing revision for chronic PJI and 67 patients undergoing revision for aseptic failure. PJI was defined using the Musculoskeletal Infection Society criteria. Receiver operating characteristic curves and area under the curve were analyzed for each biomarker.

Results

The area under the curve for D-dimer was 0.915 and was more accurate than serum erythrocyte sedimentation rate 0.719 and CRP 0.761. 1170 ng/mL was determined to be the optimal threshold value of D-dimer for the diagnosis of chronic PJI, with a sensitivity of 92.73% and a specificity of 74.63% in the diagnosis of chronic PJI. The combination of D-dimer and CRP tests demonstrated a sensitivity of 98.11% and negative predictive value of 96.55% for the diagnosis of chronic PJI.

Conclusion

The present study identified the D-dimer is a valuable biomarker in detecting chronic PJI. The combinations of serum D-dimer and CRP led to the improvement of sensitivity compared with those of the single-index test.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30743-0/pdf

December 29, 2019 at 1:58 pm

Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients.

Journal of Bone and Joint Infection September 18, 2019 V.4 N.5 P.209-215.   

Abad CL1, Phuoc V2, Kapoor P3, Tosh PK4, Sia IG4, Osmon DR4, Tande AJ4.

Author information

1 Department of Internal Medicine, Section of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

2 Division of Hematology, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

3 Division of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila Philippines.

4 Mayo Clinic, Rochester MN, USA.

Abstract

Background:

Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.

Methods:

We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.

Results:

Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).

Conclusion:

BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831805/pdf/jbjiv04p0209.pdf

December 27, 2019 at 3:55 pm

Prosthetic Joint Infection due to Actinomyces species: A case series and review of literature.

Journal of Bone and Joint Infection August 2, 2019 V.4 N.4 P.174-180.

Dagher R1, Riaz T1, Tande AJ1, Osmon DR1, Jagtiani A1, Steckelberg JM1, Mabry T2, Berbari EF1.

Author information

1 Department of Internal Medicine and Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905.

2 Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905.

Abstract

Background:

Actinomyces prosthetic joint infections (APJIs) are rare and optimal medical and surgical treatment strategies are unknown. The purpose of our study was to characterize the demographics, risk factors, management and outcomes of patients with PJIs due to Actinomyces spp.

Methods:

Using a retrospective cohort study design, the medical records of all patients with Actinomyces spp. total hip or knee arthroplasty infection (APJI) seen at a single institution between January 1, 1969 and December 31, 2016 were reviewed. We abstracted information including patient demographics, co-morbidities, joint age, surgical history, microbiology, management and outcomes. A simultaneous literature search via PubMed was performed to identify cases of APJI published in literature and a descriptive analysis was performed.

Results:

Eleven cases were identified over a 47 year study period at our institution. Seven patients (64%) were female. The median age at the time of diagnosis of infection was 71 years (range, 57-89). The knee was involved in six cases (55%) followed by the hip in 5 (45 %) cases. Three cases had dentures, broken teeth, or poor dentition. Actinomyces odonotlyticus was the most commonly found subspecies at our institution. Median ESR and CRP values were 61mm/hr and 64 mg/L respectively. Eight (72%) patients were managed with 2 stage exchange. Most patients received a course of beta-lactam therapy for 6 weeks. Ten cases (91%) were free of failure after a median duration of follow-up of 2 years (range, 0.67 – 5 years). The median duration from joint arthroplasty to the onset of symptoms was 162 days, range (20-3318). Six (54%) had a history of prior PJI with a different microorganism at the same joint site and 4 patients had history of prior 2 stage exchange (36%). In the literature group, we identified 12 cases and the most common subspecies was Actinomyces israelii; most patients underwent two stage exchange and were treated with 6 weeks of beta lactam antibiotics.

Conclusions:

Based on our observational study, Actinomyces PJI presents as a late complication of TJR, may be associated with prior PJI at the index joint and antecedent dental manipulation may portend as an additional risk factor. Treatment includes two stage exchange and beta- lactam therapy for 6weeks. These results will help clinicians in improved understanding and management of APJIs which although are rare but warrant special attention as population with implanted joint arthroplasties continues to rise.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757008/pdf/jbjiv04p0174.pdf

 

December 27, 2019 at 3:52 pm

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