Posts filed under ‘Infecciones sitio quirurgico’

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study.

Eur J Nucl Med Mol Imaging. May 2018 V.45 N.5 P.798-805.

Kouijzer IJE1,2, Scheper H3, de Rooy JWJ4, Bloem JL5, Janssen MJR4, van den Hoven L6, Hosman AJF7, Visser LG3, Oyen WJG4,8, Bleeker-Rovers CP9, de Geus-Oei LF10,5.

1 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. ilse.kouijzer@radboudumc.nl.

2 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands. ilse.kouijzer@radboudumc.nl.

3 Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

4 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

5 Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

6 Technical Medicine, University of Twente, Enschede, the Netherlands.

7 Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

8 Department of Nuclear Medicine, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.

9 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.

10 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands.

Abstract

PURPOSE:

The aim of this study was to determine the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

METHODS:

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. 18F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

RESULTS:

For 18F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

CONCLUSION:

18F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978906/pdf/259_2017_Article_3912.pdf

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September 21, 2019 at 8:07 pm

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

Clin Infect Dis. September 15, 2015 V.61 N.6 e26-46.

Berbari EF1, Kanj SS2, Kowalski TJ3, Darouiche RO4, Widmer AF5, Schmitt SK6, Hendershot EF7, Holtom PD8, Huddleston PM 3rd9, Petermann GW10, Osmon DR11, Infectious Diseases Society of America.

Abstract

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

FULL TEXT

https://academic.oup.com/cid/article/61/6/e26/452579

PDF (CLIC en PDF)

 

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Clin Infect Dis. April 1, 2016 V.62 N.7 P.953-4.

LETTER – Vertebral Osteomyelitis Guidelines.

TO THE EDITOR—I congratulate Dr Berbari and colleagues for producing the 2015 guidelines for diagnosis and treatment of vertebral osteomyelitis, despite the lack of controlled trials to guide them [1]. However, the guidelines left out any mention of coccidioidomycosis as an etiology of this infection. More than 25% of patients with disseminated coccidioidomycosis have bone and joint infections, and in adults the axial skeleton is involved in more than half of those cases [2]. Infection may be multifocal in the spine. Although …

FULL TEXT

https://academic.oup.com/cid/article/62/7/953/2462943

PDF (CLIC en PDF)

September 21, 2019 at 8:05 pm

Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis.

BMC Infect Dis. September 17, 2018 V.18 N.1 P.468.

Li YD1, Wong CB2, Tsai TT1, Lai PL1, Niu CC1, Chen LH1, Fu TS3.

Abstract

BACKGROUND:

Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.

METHODS:

This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.

RESULTS:

Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).

CONCLUSIONS:

The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142394/pdf/12879_2018_Article_3377.pdf

September 21, 2019 at 8:02 pm

Intraoperative povidone-iodine irrigation for infection prevention

Arthroplasty Today September 2019 V.5 N.3 P.306-308

Although prevention of infection following arthroplasty requires a multifaceted approach, the use of intraoperative irrigation is an important component of any protocol.

Recent clinical practice guidelines from the Centers for Disease Control, World Health Organization, and International Consensus Meeting on Musculoskeletal Infection advocate the use of a dilute povidone-iodine solution prior to wound closure.

Our experience suggests that this practice is safe, inexpensive, and easily implemented.

The present article describes our institutional irrigation protocol and reviews the current literature regarding povidone-iodine solutions.

FULL TEXT

https://www.arthroplastytoday.org/article/S2352-3441(19)30037-8/fulltext?_cldee=ZmVybmFuZG9sb3ByZWl0ZUBob3RtYWlsLmNvbQ%3d%3d&recipientid=contact-735e0277de7de71186420050569142af-587751a5c70a434085280eb593298179&utm_source=ClickDimensions&utm_medium=email&utm_campaign=AAHKS%20News&esid=f4b972ed-02d0-e911-80fc-000d3a03faaf

PDF

https://www.arthroplastytoday.org/article/S2352-3441(19)30037-8/pdf

September 6, 2019 at 8:17 am

Single-Dose Perioperative Antibiotics Do Not Increase the Risk of Surgical Site Infection in Unicompartmental Knee Arthroplasty

Journal of Arthroplasty July 2019 V.34 Supplement S327–S330

Background

Unicompartmental knee arthroplasty (UKA) is commonly performed as an outpatient procedure. To facilitate this process, a single-dose intravenous (IV) perioperative antibiotic administration is required compared to 24-hour IV antibiotic dosing schedules that are typical of most inpatient arthroplasty procedures. There is a paucity of literature to guide surgeons on the safety of single-dose perioperative antibiotic administration for arthroplasty procedures, particularly those that will be performed in the outpatient setting. The purpose of this study is to evaluate a large series of UKA performed with single-dose vs 24-hour IV antibiotic coverage to determine the impact on risk for surgical site infection (SSI).

Methods

All UKA cases were evaluated from 2007 to 2017 performed by a single surgeon at an academic institution. There were 296 UKAs in the cohort: 40 were outpatient procedures receiving single-dose antibiotics and 256 were inpatient procedures receiving 24-hour antibiotics. No patients were prescribed adjuvant oral antibiotics. Mean age was 64 years, 50% were female, mean body mass index was 32 kg/m2, and mean follow-up was 4.1 years (range 1.0-10.4). Perioperative antibiotic regimen was evaluated and SSI, defined as occurring within 1 year of surgery, was abstracted through a prospective total joint registry and manual chart review.

Results

SSI occurred in 2 of 296 cases (0.7%) in the entire cohort, 2 of 256 inpatient UKAs (0.8%), and 0 of 40 outpatient UKAs (0%) (P = 1.00). One SSI was a deep infection occurring 6 weeks postoperatively that required 2-stage exchange and conversion to total knee arthroplasty. The other was a superficial infection treated with 2 weeks of oral antibiotics.

Conclusion

This study demonstrates a low SSI risk (0.8% or less) following UKA with both single-dose and 24-hour IV antibiotics. Administering single-dose perioperative antibiotics is safe for UKA, which should alleviate that potential concern for outpatient surgery.

FULL TEXT

https://www.arthroplastyjournal.org/article/S0883-5403(19)30197-4/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30197-4/pdf

August 30, 2019 at 4:15 pm

Traditional Laboratory Markers Hold Low Diagnostic Utility for Immunosuppressed Patients With Periprosthetic Joint Infections

Journal of Arthroplasty July 2019 V.34 N.7 P.1441–1445

Background

Although predictive laboratory markers and cutoffs for immunocompetent patients are well-studied, similar reference ranges and decision thresholds for immunosuppressed patients are less understood. We investigated the utility of typical laboratory markers in immunosuppressed patients undergoing aspiration of a prosthetic hip or knee joint.

Methods

A retrospective review of adult patients with an immunosuppressed state that underwent primary and revision total joint arthroplasty with a subsequent infection at our tertiary, academic institution was conducted. Infection was defined by Musculoskeletal Infection Society criteria. A multivariable analysis was used to identify independent factors associated with acute (<90 days) and chronic (>90 days) infection. Area under the receiver-operator curve (AUC) was used to determine the best supported laboratory cut points for identifying infection.

Results

We identified 90 patients with immunosuppression states totaling 172 aspirations. Mean follow-up from aspiration was 33 months. In a multivariate analysis, only synovial fluid cell count and synovial percent neutrophils were found to be independently correlated with both acute and chronic infection. A synovial fluid cell count cutoff value of 5679 nucleated cells/mm3 maximized the AUC (0.839) for predicting acute infection, while a synovial fluid cell count cutoff value of 1293 nucleated cells/mm3 maximized the AUC (0.931) for predicting chronic infection.

Conclusion

Physicians should be aware of lower levels of synovial nucleated cell count and percentage of neutrophils in prosthetic joint infections of the hip or knee in patients with immunosuppression. Further investigation is necessary to identify the best means of diagnosing periprosthetic joint infection in this patient population.

FULL TEXT

https://www.arthroplastyjournal.org/article/S0883-5403(19)30236-0/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30236-0/pdf

August 30, 2019 at 4:10 pm

The Presence of Sinus Tract Adversely Affects the Outcome of Treatment of Periprosthetic Joint Infections

Journal of Arthroplasty June 2019 V.34 N.6 P.1227-1232

Background

A sinus tract may be encountered in patients with periprosthetic joint infection (PJI) and constitutes a major criterion for diagnosis. The aim of this study is to identify associated factors for the presence of sinus tract and outcome of 2-stage exchange arthroplasty in these patients.

Methods

We retrospectively reviewed all patients with PJI following hip and knee arthroplasty from 2000 to 2017. Of them, 161 patients with a sinus tract had a minimum follow-up of 1 year following 2-stage exchange arthroplasty. These patients were matched 1:2 with those without sinus tract by using propensity score matching. Treatment success was assessed using the modified Delphi criteria. A multiple logistic regression analysis was performed to determine the effect of sinus tract on the outcome and associated factors for the presence of sinus tract.

Results

Factors significantly associated with sinus tract included smoking (odds ratio [OR] = 1.83), hypothyroidism (OR = 1.62), hypoalbuminemia (OR = 1.52), hip joint involvement (OR = 1.43), and prior revision surgery (OR = 1.37). Patients with sinus tract had a significantly higher rate of failure compared to those without sinus tract (OR = 2.94).

Conclusion

This study demonstrates that the presence of sinus tract in patients with PJI adversely affects the outcome of treatment of these patients. The presence of sinus tract may be a proxy for other issues such as poor periarticular soft tissue, the poor nutritional status of the host, and multiple prior operations. These findings need to be borne in mind when treating patients with PJI and a concomitant sinus tract.

FULL TEXT

https://www.arthroplastyjournal.org/article/S0883-5403(19)30196-2/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30196-2/pdf

August 30, 2019 at 4:08 pm

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