Posts filed under ‘Infecciones osteo-articulares-musculares’

Sarcopenia as a Risk Factor for Prosthetic Infection After Total Hip or Knee Arthroplasty

Journal of Arthropasty January 2019 V.34 N.1 P.116–122

Jacob M. Babu, MD, MHA a, *, Saisanjana Kalagara b, Wesley Durand b,Valentin Antoci, MD, PhD a, Matthew E. Deren, MD c, Eric Cohen, MD a

a Division of Arthroplasty, Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI

b Warren Alpert Medical School of Brown University, Providence, RI

c Division of Arthroplasty, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH

Background

Sarcopenia, an age-related loss of muscle mass and function, has been previously linked to an increased risk of morbidity, mortality, and infection after a variety of surgical procedures. This study is the first to evaluate the impact of the psoas-lumbar vertebral index (PLVI), a validated marker for central sarcopenia, on determining post-arthroplasty infection status.

Methods

This is a case-control, retrospective review of 30 patients with prosthetic joint infection (PJI) diagnosed by the Musculoskeletal Infection Society criteria compared to 69 control patients who underwent a total hip or knee arthroplasty. All patients had a recent computed tomography scan of the abdomen/pelvis to calculate the PLVI. PLVI was evaluated alongside age, gender, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, and smoking status to determine the predictive value for infection.

Results

Notably, the infected group had a large, significant difference in their average PLVI (0.736 vs 0.963, P < .001). The patient’s PLVI was a predictor of infection status, with a higher PLVI being protective against infection (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.109-0.715, P = .008). Additional predictors of infection status were higher American Society of Anesthesiologists score (OR 10.634, 95% CI 3.112-36.345, P < .001) and Charlson Comorbidity Index (OR 1.438, 95% CI 1.155-1.791, P = .001). Multivariate, binary logistic regression analysis confirmed that PLVI was a significant independent predictor of infection status (B = −0.685, P = .039).

Conclusion

PLVI, a marker for central sarcopenia, was demonstrated to be a risk factor for PJI. Further research and consideration of sarcopenia as a screening and optimizable risk factor for total joint arthroplasty must be explored.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30818-0/pdf

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January 12, 2019 at 10:51 am

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Journal of Infection January 2019 V.78 N.1 P.40–47 

Highlights

  • Late acute prosthetic joint infection (LA PJI) treated with surgical debridement and implant retention have a high failure rate.
  • The exchange of mobile components during surgical debridement is the most potent predictor for treatment success.
  • There are several preoperative patient related variables that increase the risk for failure.
  • Treatment strategies for late acute PJIs should be individualized and optimized according to the preoperative risk for failing.

Objectives

Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.

Methods

Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.

Results

340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).

Conclusion

LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients’ age, comorbidity, clinical presentation and microorganism causing the infection.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30241-X/fulltext

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30241-X/pdf

January 12, 2019 at 10:02 am

Mycobacterium tuberculosis prosthetic joint infections: A case series and literature review

Journal of Infection January 2019 V.78 N.1 P.27–34

Fabrice Uhel, Gregory Corvaisier, Yves Poinsignon, Catherine Chirouze, Guillaume Beraud, Olivier Grossi, Nicolas Varache, Cédric Arvieux, Rozenn Le Berre, Pierre Tattevin, for the Groupe d’Epidémiologie et Recherche en Infectiologie Clinique Centre-Ouest (GERICCO)

Objectives

We aimed to characterize diagnosis, management, and outcome of Mycobacterium tuberculosis prosthetic joint infections (PJI).

Methods

Cases of M. tuberculosis PJI documented in 7 referral French centers were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire. We performed a literature review using the keywords ‘prosthetic joint’, and ‘tuberculosis’.

Results

During years 1997–2016, 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) had documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. Seventeen additional cases of documented M. tuberculosis PJI have been reported, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement, 86% (19/22) with revision arthroplasty, and 81% (17/21) with resection (NS).

Conclusions

  1. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.

FULL TEXT

https://www.journalofinfection.com/article/S0163-4453(18)30253-6/abstract

PDF

https://www.journalofinfection.com/article/S0163-4453(18)30253-6/pdf

January 12, 2019 at 10:01 am

Candida auris Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Emerging Infectious Diseases January 2019 V.25  N.1

H. Heath et al.

In Australia in 2015, Candida auris sternal osteomyelitis was diagnosed in a 65-year-old man with a history of intensive care treatment in Kenya in 2012 and without a history of cardiac surgery.

The isolate was South Africa clade III.

Clinicians should note that C. auris can cause low-grade disease years after colonization.

PDF

https://wwwnc.cdc.gov/eid/article/25/1/pdfs/18-1321.pdf

December 26, 2018 at 3:48 pm

Culture-Negative Periprosthetic Joint Infection: An Update on What to Expect.

JB JS Open Access. 2018 July 12, 2018 V.3 N.3 e0060.

doi: 10.2106/JBJS.OA.17.00060. eCollection 2018 Sep 25.

Tan TL1, Kheir MM1, Shohat N1, Tan DD1, Kheir M1, Chen C1, Parvizi J1.

1 Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.

Abstract

BACKGROUND:

Culture-negative periprosthetic joint infection (PJI) is a challenging condition to treat. The most appropriate management of culture-negative PJI is not known, and there is immense variability in the treatment outcome of this condition. The purpose of this study was to elucidate the characteristics, outcomes, and risk factors for failure of treatment of culture-negative PJI.

METHODS:

A retrospective review of 219 patients (138 hips and 81 knees) who had undergone surgery for the treatment of culture-negative PJI was performed utilizing a prospectively collected institutional PJI database. PJIs for which the results of culture were unavailable were excluded. An electronic query and manual review of the medical records were completed to obtain patient demographics, treatment, microbiology data, comorbidities, and other surgical characteristics. Treatment failure was assessed using the Delphi consensus criteria.

RESULTS:

The prevalence of suspected culture-negative PJI was 22.0% (219 of 996), and the prevalence of culture-negative PJI as defined by the Musculoskeletal Infection Society (MSIS) was 6.4% (44 of 688). Overall, the rate of treatment success was 69.2% (110 of 159) in patients with >1 year of follow-up. Of the 49 culture-negative PJIs for which treatment failed, 26 (53.1%) subsequently had positive cultures; of those 26, 10 (38.5%) were positive for methicillin-sensitive Staphylococcus aureus. The rate of treatment success was greater (p = 0.019) for patients who had 2-stage exchange than for those who underwent irrigation and debridement.

CONCLUSIONS:

The present study demonstrates that culture-negative PJI is a relatively frequent finding with unacceptable rates of treatment failure. Every effort should be made to isolate the infecting organism prior to surgical intervention, including extending the incubation period for cultures, withholding antibiotics prior to obtaining culture specimens, and possibly using newly introduced molecular techniques.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6242327/pdf/jbjsoa-3-e0060.pdf

 

December 20, 2018 at 7:27 pm

Culturing Periprosthetic Joint Infection: Number of Samples, Growth Duration, and Organisms.

J Arthroplasty. November 2018 V.33 N.11 P.3531-3536.e1.

doi: 10.1016/j.arth.2018.06.018. Epub 2018 Jul 11.

Kheir MM1, Tan TL1, Ackerman CT1, Modi R1, Foltz C1, Parvizi J1.

Abstract

BACKGROUND:

Owing to the difficulty isolating microorganisms in periprosthetic joint infection (PJI), current guidelines recommend that 3-5 intraoperative samples be cultured and maintained for 3-14 days. We investigated (1) the optimal number of culture samples and growth duration to diagnose PJI and (2) the microbiology profile at our institution.

METHODS:

A retrospective review of 711 patients (329 hips, 382 knees) with PJI that met Musculoskeletal Infection Society criteria from 2000 to 2014 was performed. Two thousand two hundred ninety aerobic and anaerobic cultures were analyzed. A manual chart review collected demographic, surgical, and microbiological data. Microbiology profiles were trended. Logistic regression analysis was performed to determine statistical significance.

RESULTS:

Obtaining 5 samples provided the greatest yield positive cultures for diagnosing PJI. The percentage of positive cultures overall was 62.6% and stratified by organism type: antibiotic resistant (80.0%), Staphylococcus aureus (76.0%), gram negative (58.9%), Pseudomonas (52.0%), variant PJI organisms (28.2%), Propionibacterium acnes (20.0%), and Escherichia coli (8.0%). Although most organisms were cultured in 5 days or less, 10.8 days were needed for Propionibacterium acnes, 6.6 for variant PJI organisms, and 5.2 for coagulase-negative Staphylococcus. At 3 days, only 42.2% of cultures turned positive compared with 95.0% at 8 days. There was a significant decrease in time in gram-positive PJIs and an increase in culture-negative PJIs.

CONCLUSION:

The optimal number of cultures and growth duration depended on the type of organism. This study provides evidence that 5 samples should be obtained and held for at least 8 days given that the type of organisms is likely to be unknown at the time of surgery.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30588-6/pdf

 

December 20, 2018 at 7:25 pm

Highlights From Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.207-20

Clinical Guidelines

File, Thomas M. Jr

Recently, the Infectious Diseases Society published evidence-based guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections.

The guideline discusses the management of a variety of infections including skin infections, bacteremia and endocarditis, pneumonia, and osteomyelitis and joint infections.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/Highlights_From_Clinical_Practice_Guidelines_by.13.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:28 am

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