Posts filed under ‘Infecciones osteo-articulares-musculares’

Osteoarticular infections in a tertiary care children’s hospital: Epidemiology and clinical characteristics in association with bacteremia.

Arch Argent Pediatr. 2018 Apr 1;116(2):e204-e209.

[Article in English, Spanish; Abstract available in Spanish from the publisher]

Highton E1, Pérez MG2, Cedillo Villamagua C1, Sormani MI1, Mussini MS1, Isasmendi A3, Pinheiró J3, Reijtman V3, Taicz M1, Mastroianni A3, García ME3, Rosanova MT1.

Author information

1 Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina.

2 Servicio de Control Epidemiológico e Infectología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina. guaperez@hotmail.com.

3 Servicio de Microbiología, Hospital de Pediatría “Prof. Dr. Juan P. Garrahan”, Ciudad Autónoma de Buenos Aires, Argentina.

INTRODUCTION:

Osteoarticular infections are an important cause of morbidity and may present with bacteremia. The epidemiology has changed in recent years.

OBJECTIVES:

To describe the epidemiological, clinical, and evolutionary characteristics of children with osteoarticular infections and compare patients with and without bacteremia.

POPULATION AND METHODS:

Retrospective cohort. Patients younger than 18 years admitted between January 1st, 2016 and December 31st, 2016 suspected of osteoarticular infections who had undergone an arthrocentesis and/or joint biopsy were included. Clinical and laboratory characteristics were compared between patients with and without bacteremia. The Stata 10 software was used.

RESULTS:

N: 62. Patients’ median age was 59.5 months (interquartile range [IQR]: 24-84). Fever developed in 44 patients (70%). Arthritis predominated (54 patients, 87%). An etiologic agent was identified in 29 patients (47%). Staphylococcus aureus was prevalent (n: 20, 32%). Among these, 15 developed bacteremia (24%). Clindamycin was administered to 56 patients (90%) as empirical therapy. The median intravenous treatment duration was 7 days (IQR: 5-11) and the median length of stay, 7 days (IQR: 4-12). Patients with bacteremia were younger (26 months versus 60 months, p < 0.05), had a higher baseline C-reactive protein level (101 U/L versus 33 U/L, p < 0.05), a lower hemoglobin level at the time of admission (10.8 g/dL versus 12.5 g/dL, p = 0.04), and a higher frequency of fever (100% versus 57%, p < 0.05).

CONCLUSIONS:

Staphylococcus aureus was prevalent. Children with bacteremia were younger, had a higher C-reactive protein level, a lower hemoglobin level at the time of admission, and 100% presented fever.

PDF

http://www.sap.org.ar/docs/publicaciones/archivosarg/2018/v116n2a11e.pdf

 

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May 18, 2018 at 8:17 am

Hydrogel delivery of lysostaphin eliminates orthopedic implant infection by Staphylococcus aureus and supports fracture healing.

Proc Natl Acad Sci U S A. 2018 May 14. pii: 201801013.

Johnson CT1,2, Wroe JA1,2, Agarwal R2,3, Martin KE2,3, Guldberg RE2,3, Donlan RM4, Westblade LF5, García AJ6,3.

Abstract

Orthopedic implant infections are a significant clinical problem, with current therapies limited to surgical debridement and systemic antibiotic regimens. Lysostaphin is a bacteriolytic enzyme with high antistaphylococcal activity. We engineered a lysostaphin-delivering injectable PEG hydrogel to treat Staphylococcus aureus infections in bone fractures. The injectable hydrogel formulation adheres to exposed tissue and fracture surfaces, ensuring efficient, local delivery of lysostaphin. Lysostaphin encapsulation within this synthetic hydrogel maintained enzyme stability and activity. Lysostaphin-delivering hydrogels exhibited enhanced antibiofilm activity compared with soluble lysostaphin. Lysostaphin-delivering hydrogels eradicated S. aureus infection and outperformed prophylactic antibiotic and soluble lysostaphin therapy in a murine model of femur fracture. Analysis of the local inflammatory response to infections treated with lysostaphin-delivering hydrogels revealed indistinguishable differences in cytokine secretion profiles compared with uninfected fractures, demonstrating clearance of bacteria and associated inflammation. Importantly, infected fractures treated with lysostaphin-delivering hydrogels fully healed by 5 wk with bone formation and mechanical properties equivalent to those of uninfected fractures, whereas fractures treated without the hydrogel carrier were equivalent to untreated infections. Finally, lysostaphin-delivering hydrogels eliminate methicillin-resistant S. aureus infections, supporting this therapy as an alternative to antibiotics. These results indicate that lysostaphin-delivering hydrogels effectively eliminate orthopedic S. aureus infections while simultaneously supporting fracture repair.

PDF

http://www.pnas.org/content/pnas/early/2018/05/08/1801013115.full.pdf

May 18, 2018 at 7:50 am

Differential Contributions of Specimen Types, Culturing, and 16S rRNA Sequencing in Diagnosis of PJI.

Journal of Clincal Microbiology May 2018 V.56 N.5

Lone Heimann Larsena,b, Vesal Khalidc, Yijuan Xub,d, Trine Rolighed Thomsenb,d and Henrik C. Schønheydera,e the PRIS Study Group

aDepartment of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark

bCenter for Microbial Communities, Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark

cDepartment of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark

dBiotech, Danish Technological Institute, Aarhus, Denmark

eDepartment of Clinical Medicine, Aalborg University, Aalborg, Denmark

Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark

Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark

Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark

Danish Technological Institute, Biotech, Aarhus, Denmark

Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark

Department of Health Science and Technology, Faculty of Medicine, Aalborg University

Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ, and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI (n = 43) or AF (n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation.

PDF

http://jcm.asm.org/content/56/5/e01351-17.full.pdf+html

May 9, 2018 at 3:39 pm

Microbiology and Antimicrobial Therapy for Diabetic Foot Infections.

Infect Chemother. 2018 Mar;50(1):11-20.

Kwon KT1, Armstrong DG2.

1 Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

2 Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery of Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. armstrong.dg@gmail.com

Abstract

Además de ser el factor principal asociado con la amputación, las infecciones del pie diabético (DFIs) se asocian con una gran morbilidad, un aumento de la mortalidad y una reducción de la calidad de vida.

La elección de los ATB apropiados es muy importante para reducir el fracaso del tratamiento, la resistencia a los ATB, los eventos adversos y los costos.

Revisamos artículos sobre microbiología y terapia antimicrobiana y discutimos la selección de ATB en pacientes coreanos con DFIs.

Al igual que en los países occidentales, Staph aureus es el patógeno más común, con Streptococcus, Enterococcus, Enterobacteriaceae y Pseudomonas también son frecuentes en Corea.

Se recomienda que no se prescriban ATB para heridas clínicamente no infectadas y que se seleccionen ATB empíricos en función de las características clínicas, la gravedad de la enfermedad y los patrones locales de resistencia a los antimicrobianos. Los ATB orales de espectro reducido pueden administrarse para infecciones leves y se deben administrar ATB parenterales de amplio espectro para algunas infecciones moderadas y graves.

En los casos con factores de riesgo para SAMR o Pseudomonas, se deben considerar ATB empíricos para cubrir cada patógeno.

Los estándares del Servicio de evaluación y evaluación del seguro médico también deben considerarse al elegir  ATB empíricos. En Corea, se deben realizar estudios a nivel nacional y se deben desarrollar pautas DFIs.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895826/pdf/ic-50-11.pdf

May 3, 2018 at 8:22 am

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Open Forum Infectious Diseases Winter 2017 V.4 N.1

EDITOR’S CHOICE

Benjamin A. Lipsky; Michael H. Silverman; Warren S. Joseph

Los esquemas para clasificar las infecciones de la piel y los tejidos blandos (SSTI) presentan limitaciones para los médicos y las agencias reguladoras. Las infecciones del pie diabético (DFI) son un subconjunto de SSTI.

Desarrollamos y proponemos una clasificación para armonizar los esquemas actuales para SSTI e IFD. Los esquemas existentes para clasificar los SSTI son limitados tanto en su utilidad para los médicos como para las agencias reguladoras.

Las directrices sobre SSTI de la Sociedad de Enfermedades Infecciosas de América (IDSA) y la orientación de la Administración de Alimentos y Medicamentos de los EEUU (FDA). No abordan adecuadamente muchos tipos de infecciones de heridas.

Sin embargo, las pautas desarrolladas por la IDSA para las DFI proporcionan un esquema de clasificación que ha sido validado y ampliamente utilizado. Las infecciones del pie diabético son similares a los SSTI en fisiopatología, microbiología y tratamiento, y se pueden ver como un subconjunto de SSTI.

Por lo tanto, en base a los documentos mencionados anteriormente, y nuestra revisión de la literatura, hemos desarrollado un esquema de clasificación propuesto para SSTI que armoniza bien con la clasificación DFI. Creemos que este nuevo esquema ayudará a los médicos a clasificar la mayoría de las infecciones de heridas y, potencialmente, ayudará a las agencias reguladoras a evaluar y aprobar nuevos antimicrobianos para estas infecciones.

FULL TEXT

https://academic.oup.com/ofid/article/4/1/ofw255/2632203

PDF (CLIC en PDF)

 

April 9, 2018 at 1:15 pm

Influence of multidrug resistant organisms on the outcome of diabetic foot infection

International Journal of Infectious Diseases March 2018 V.70 N.3 P.10–14

  • Entre pacientes rehospitalizados, las infecciones por SAMR se detectaron como el MO más común.
  • Las infecciones causadas por la neumonía Klebsiella tienen tasas de mortalidad significativamente más altas.
  • Las enfermedades cardíacas crónicas y la necesidad de diálisis aumentan el riesgo de muerte.

Objetivos

Describimos los resultados clínicos de pacientes con pie diabético por MO resistentes a múltiples ATB.

Métodos

Se incluyeron los pacientes con infecciones del pie diabético (DFI) de 19 centros, entre mayo 2011 y diciembre 2015. La infección se definió de acuerdo con las directrices IDSA. Los pacientes con infección grave, infección moderada y complicada fueron hospitalizados. Los pacientes fueron seguidos durante 6 meses después del alta.

Resultados

En total, se incluyeron 791 pacientes con DFI, 531 (67%) eran hombres, la mediana de edad fue de 62 (19-90). La infección severa se diagnosticó en 85 (11%) pacientes. La OM fue diagnosticada en 291 (36.8%) pacientes. Se aislaron 536 MO, los más comunes fueron S. aureus (20%), P. aeruginosa (19%) y E. coli (12%). La tasa de resistencia a la meticilina (MR) entre los aislados de S aureus fue del 31%. Se detectaron bacterias resistentes a múltiples ATB en el 21% de los aislamientos de P. aeruginosa. Se detectaron BGN productoras de BLEE en el 38% de los aislados de E. coli y Klebsiella. Sesenta y tres pacientes (8%) fueron rehospitalizados. De los 791 pacientes, 127 (16%) tuvieron una amputación mayor y 24 (3%) pacientes fallecieron. En el análisis multivariado, se encontraron predictores significativos de mortalidad; diálisis (OR: 8,3, IC: 1,82 – 38,15, p = 0,006), aislamiento de Klebsiella spp. (OR: 7.7, CI: 1.24-47.96, p = 0.028) e insuficiencia cardíaca crónica (OR: 3, IC: 1.01-9.04, p = 0.05). El Staphylococcus MR se detectó en el 21% de los pacientes re-hospitalizados, como el MO más común (p <0,001).

Conclusión

Entre los pacientes re-hospitalizados, se detectaron infecciones por SAMR como el MO más común, y Klebsiella spp. las infecciones se asociaron significativamente con la mortalidad.

FULL TEXT

http://www.ijidonline.com/article/S1201-9712(18)30049-3/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(18)30049-3/pdf

 

April 1, 2018 at 3:18 pm

Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with Staphylococcus aureus

International Journal of Antimicrobial Agents January 2018 V.51 N.1 P.38–42

Marjan Wouthuyzen-Bakker, Eduard Tornero, Laura Morata, Prashant V. Nannan Panday, Paul C. Jutte, Guillem Bori, Greetje A. Kampinga, Alex Soriano

Highlights

  • Excellent outcome with moxifloxacin/rifampin combination therapy in the treatment of early PJI caused by MSSA.
  • Moxifloxacin is an attractive agent in treatment of PJI.
  • Dose adjustments are not required in patients with renal insufficiency.
  • Moxifloxacin exhibits a high genetic barrier for resistance.
  • Moxifloxacin/rifampin may be used as an alternative for levofloxacin/rifampin in the treatment of early PJI caused by MSSA.

Objectives

The combination of a fluoroquinolone with rifampin is one of the cornerstones in the treatment of prosthetic joint infections (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin–susceptible Staphylococcus aureus (MSSA) and, therefore, is an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with early acute PJI caused by MSSA treated with either moxifloxacin/rifampin or levofloxacin/rifampin.

Methods

Medical files of patients treated with moxifloxacin/rifampin (University Medical Centre Groningen) or levofloxacin/rifampin (Hospital Clinic Barcelona) were retrospectively reviewed (2005–2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up.

Results

Differences in baseline characteristics between the two cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C–reactive protein and Cemented prosthesis), were similar in the two groups (2.9 [1.5 SD] for the moxifloxacin group vs. 2.2 [1.2 SD] for the levofloxacin group [P?=?0.16]). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (P?=?0.36), treatment was successful in 89% vs. 87.5%, respectively (P?=?0.89). None of the failures in the moxifloxacin group were due to rifampin– or moxifloxacin–resistant S. aureus strains.

Conclusion

Our data indicate that moxifloxacin combined with rifampin is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA.

abstract

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/fulltext

PDF

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/pdf

February 5, 2018 at 6:05 pm

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