Posts filed under ‘Infecciones relacionadas a prótesis’

Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin.

Clin Orthop Relat Res. 2017 Jul;475(7):1775-1778.

Soriano A1.

Author information

1 Service of Infectious Diseases, IDIBAPS, Hospital Clinic Universitari, University of Barcelona, C/ Villarroel 170, Barcelona, Catalonia, 08036, Spain. asoriano@clinic.cat.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449340/pdf/11999_2017_Article_5355.pdf

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August 1, 2018 at 8:17 am

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

Int J Antimicrob Agents. 2018 Jan;51(1):38-42.                     

Wouthuyzen-Bakker M1, Tornero E2, Morata L3, Nannan Panday PV4, Jutte PC5, Bori G6, Kampinga GA7, Soriano A3.

Author information

1 Department of Internal Medicine / Infectious Diseases, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands. Electronic address:m.wouthuyzen-bakker@umcg.nl.

2 Department of Orthopaedic Surgery, Sant Joan de Déu, Barcelona, Spain.

3 Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

4 Department of Clinical Pharmacy, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

5 Department of Orthopaedic Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

6 Department of Orthopaedic Surgery and Traumatology, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

7 Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.

Abstract

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.

PDF

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

July 31, 2018 at 6:52 pm

The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review.

J Clin Microbiol. 2017 Sep;55(9):2765-2774.                    

Wouthuyzen-Bakker M1, Benito N2, Soriano A3.

Author information

1 Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands m.wouthuyzen-bakker@umcg.nl.

2 Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

3 Service of Infectious Diseases, Hospital Clínic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.

Abstract

Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group (P = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively (P = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648712/pdf/zjm2765.pdf

 

July 31, 2018 at 6:50 pm

Analysis of 10 years of surveillance of infections associated with hip and knee prostheses

International Journal of Infectious Diseases August 2018 V.73 Supplement P.21

Corral, L. Guerriero, L. Fernandez, D. Arcidiacono, R. Giordano Lerena, N. Peralta

Background

Surgical site infections are the third reported cause of healthcare-associated infections (HAIs), representing 14% to 16% of them.

Prosthetic joint infection (PJI) are one of the most frequent complications that lead to an increase in morbidity and mortality.

In the first world countries, surveillance systems report an approximate infection rate for total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), from 0.5 to 1% and 0,5 to 2% respectively.

Due to the lack of knowledge of local epidemiology, we propose to describe the rates associated with these procedures, the most frequent microbiological isolations and their resistance patterns.

Methods & Materials

A retrospective study, from 2006 to 2016, of the PJI episodes of THAs and TKAs was carried out through the review of the events reported by all the institutions in Argentina that voluntarily joined the National Surveillance System (VIHDA) for HAI and selected such procedures.

Results

They were surveyed 11114 THAs and 4262 TKAs, presenting 410 and 157 PJIs respectively, which constituted a global rate for the period described of 3.68% for THAs and 3.69% for TKAs.

The mean age for THAs and AR were 65.5 and 71 years, respectively.

Female sex predominated for both procedures with 62.7% (hips) and 61.8% (knees).

The main etiologies for THAs infections were Staphylococcus aureus (n = 153, 43% MRSA), Pseudomonas aeruginosa (n = 69, 22% resistant to ciprofloxacin), Escherichia coli (n = 62, 42% resistant to ciprofloxacin), and coagulase-negative Staphylococcus (n = 52, 54% methicillin-resistant). In TKAs infections, the most commonly found microorganisms were: Staphylococcus aureus (n = 41, 20% MRSA), coagulase-negative Staphylococcus (n = 38, 32% methicillin-resistant), Enterococcus sp. (n = 9; 0% resistant to vancomycin) and Pseudomonas aeruginosa (n = 8; 50% resistant to ciprofloxacin). 32% of THAs infections and 18% of TKAs infections were polymicrobial.

Conclusion

The infection rates in both procedures were similar, being relatively low.

The mean age was lower for THAs and the female sex predominated in both surgeries.

In TKAs, gram-positive cocci (77%) predominated over gram-negative bacilli (23%).

The THAs perceives the similar percentages of Gram-positive cocci isolates (48%) and Gram-negative bacilli (52%), with 2/3 of the Enterobacteriae.

A high rate of isolations of resistant microorganisms was observed.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33556-2/pdf

July 29, 2018 at 11:57 am

Shotgun Metagenomic Detection of Pathogens: a Micro-Comic Strip

Journal of Clinical Microbiology  August 2018 V.56 N.8

Editorial

Alexander J. McAdam

Next-generation sequencing has made shotgun metagenomic testing of primary clinical specimens for detection of pathogens feasible (1).

These technologies can routinely detect a range of pathogens (bacterial, viral, fungal, and eukaryotic parasites), allowing for hypothesis-free testing, in which test selection does not depend on knowing what pathogens are likely to be present.

Such testing has been applied for detecting infections or colonization of the nervous system (2–4), gastrointestinal tract (5, 6), prosthetic joints (7, 8), and blood or serum (9, 10).

Shotgun metagenomic testing for pathogens is now available for patient testing at a small number of academic and commercial laboratories, and it is expensive compared to other microbiology tests.

Where do the cost of and diversity of pathogens detected by shotgun metagenomic testing fit into the range of available microbiology tests?

FULL TEXT

http://jcm.asm.org/content/56/8/e00799-18?etoc

PDF

http://jcm.asm.org/content/56/8/e00799-18.full.pdf+html

July 28, 2018 at 6:32 pm

Risk factors in septic revisions following total hip arthroplasty

LANCET INFECTIOUS DISEASES August 2018 V.18 N.8

Comment

In their Article in The Lancet Infectious Diseases, Erik Lenguerrand and colleagues1 identify several risk factors associated with increased or decreased risk of revision due to prosthetic joint infection (PJI) after primary total hip arthroplasty (THA). In this cohort study, the largest to date, the authors followed a novel analytical approach in which they stratified multiple patient, surgery, and health-care system-related risk factors for developing PJI over several chronological postoperative periods. In addition to adding stronger evidence on previously known risk factors,2, 3 the study also identified novel factors, including previous native hip infections and the use of lateral surgical approach. Furthermore, the authors provided stronger evidence to the role of the bearing surface, showing a potentially lower risk with ceramic bearings than metal bearings….

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30433-X/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30433-X.pdf

 

July 26, 2018 at 12:37 pm

Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study

LANCET INFECTIOUS DISEASES August 2018 V.18 N.8

Background

The risk of prosthetic joint infection (PJI) is influenced by patient, surgical, and health-care factors. Existing evidence is based on short-term follow-up. It does not differentiate between factors associated with early onset caused by the primary intervention from those associated with later onset more likely to result from haematogenous spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to PJI after primary total hip replacement.

Methods

We did a prospective observational cohort study analysing 623 253 primary hip procedures performed between April 1, 2003, and Dec 31, 2013, in England and Wales and recorded the number of procedures revised because of PJI. We investigated the associations between risk factors and risk of revision for PJI across the overall follow-up period using Poisson multilevel models. We reinvestigated the associations by post-operative time periods (0–3 months, 3–6 months, 6–12 months, 12–24 months, >24 months) using piece-wise exponential multilevel models with period-specific effects. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data.

Findings

2705 primary procedures were subsequently revised for an indication of PJI between 2003 and 2014, after a median (IQR) follow up of 4·6 years (2·6–7·0). Among the factors associated with an increased revision due to PJI there were male sex (1462 [1·2‰] of 1 237 170 male-years vs 1243 [0·7‰] of 1 849 691 female-years; rate ratio [RR] 1·7 [95% CI 1·6–1·8]), younger age (739 [1·1‰] of 688 000 person-years <60 years vs 242 [0·6‰] of 387 049 person-years ≥80 years; 0·7 [0·6–0·8]), elevated body-mass index (BMI; 941 [1·8‰] 517 278 person-years with a BMI ≥30 kg/m2 vs 272 [0·9‰] of 297 686 person-years with a BMI <25 kg/m2; 1·9 [1·7–2·2]), diabetes (245 [1·4‰] 178 381 person-years with diabetes vs 2120 [1·0‰] of 2 209 507 person-years without diabetes; 1·4 [1·2–1·5]), dementia (5 [10·1‰] of 497 person-years with dementia at 3 months vs 311 [2·6‰] of 120 850 person-years without dementia; 3·8 [1·2–7·8]), previous septic arthritis (22 [7·2‰] of 3055 person-years with previous infection vs 2683 [0·9‰] of 3 083 806 person-years without previous infection; 6·7 [4·2–9·8]), fractured neck of femur (66 [1·5‰] of 43 378 person-years operated for a fractured neck of femur vs 2639 [0·9‰] of 3 043 483 person-years without a fractured neck of femur; 1·8 [1·4–2·3]); and use of the lateral surgical approach (1334 [1·0‰] of 1 399 287 person-years for lateral vs 1242 [0·8 ‰] of 1 565 913 person-years for posterior; 1·3 [1·2–1·4]). Use of ceramic rather than metal bearings was associated with a decreased risk of revision for PJI (94 [0·4‰] of 239 512 person-years with ceramic-on-ceramic bearings vs 602 [0·5‰] of 1 114 239 peron-years with metal-on-polyethylene bearings at ≥24 months; RR 0·6 [0·4–0·7]; and 82 [0·4‰] of 190 884 person-years with ceramic-on-polyethyene bearings vs metal-on-polyethylene bearings at ≥24 months; 0·7 [0·5–0·9]). Most of these factors had time-specific effects. The risk of revision for PJI was marginally or not influenced by the grade of the operating surgeon, the absence of a consultant surgeon during surgey, and the volume of procedures performed by hospital or surgeon.

Interpretation

Several modifiable and non-modifiable factors are associated with the risk of revision for PJI after primary hip replacement. Identification of modifiable factors, use of targeted interventions, and beneficial modulation of some of these factors could be effective in reducing the incidence of PJI. It is important for clinicians to consider non-modifiable factors and factors that exhibit time-specific effects on the risk of PJI to counsel patients appropriately preoperatively.

Funding

National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30345-1/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30345-1.pdf

July 26, 2018 at 12:36 pm

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