Posts filed under ‘Infecciones sitio quirurgico’

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

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May 9, 2018 at 3:39 pm

Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit, April 2014

2014-04 Enterobacterias Productoras de Carbaenemasas (EPC) – Herramientas para su Control y prevención 56 pags

Los expertos en control de infecciones y enfermedades infecciosas, así como aquellos preocupados por la seguridad del paciente y la mejora del rendimiento, pueden usar este conjunto de herramientas y desarrollar intervenciones para controlar Enterobacteriaceae resistentes a carbapenémicos (ERC). Las ERC son el resultado de una familia compleja de factores de resistencia transmitidos por plásmidos que circulan entre Enterobacteriaceae.

En los EEUU, la abrumadora mayoría de los casos de ERC son causados por el gen Klebsiella pneumoniae carbapenemase (KPC) transportado por el plásmido que circula entre las Enterobacteriaceae, principalmente entre esta familia de Klebsiella pneumoniae. Los organismos productores de KPC se han propagado de forma epidémica en los EEUU y en todo el mundo entre los pacientes hospitalizados.

FULL TEXT

https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/index.html

PDF

https://www.ahrq.gov/sites/default/files/publications/files/cretoolkit.pdf

 

May 6, 2018 at 6:11 pm

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

 

PDF

https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html

 

May 6, 2018 at 6:08 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

Long-term acute care hospitals.

Clinical Infectious Diseases August 1, 2009  V.49 N.3 P.438-43.     

Munoz-Price LS1.

Author information

1 simunozprice@gmail.com

Abstract

Long-term acute care hospitals (LTACHs) are health care facilities that admit complex patients with acute care needs (eg, mechanical ventilator weaning, administration of intravenous antibiotics, and complex wound care) for a mean duration of stay of 25 days. LTACHs are different than nursing homes and were initially created in the 1990s in an effort to decrease Medicare costs by facilitating prompt discharge from intensive care units of patients with difficulty weaning mechanical ventilation; however, current admission diagnoses are quite broad. Patients admitted to these facilities have multiple comorbidities and are at risk for colonization with multidrug-resistant organisms. LTACH patients have been shown to have high rates of hospital-acquired infections, including central vascular catheter-associated bloodstream infection and ventilator-associated pneumonia. In addition, LTACHs have been implicated in various regional outbreaks of multidrug-resistant organisms. This review summarizes the limited amount of scientific literature on LTACHs while highlighting their infection control problems, as well as the role LTACHs play on regional outbreaks.

abstract

https://academic.oup.com/cid/article/49/3/438/499066

PDF CLIC en PDF

January 30, 2018 at 4:08 pm

Septic arthritis in a native knee due to Corynebacterium striatum.

Reumatol Clin. 2017 Mar 7. 

Septic arthritis in a native knee due to Corynebacterium striatum.

[Article in English, Spanish]

Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.

Author information

1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.

2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.

3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.

4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.

Abstract

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

PDF (CLIC en PDF)

http://www.reumatologiaclinica.org/es/linkresolver/artritis-septica-rodilla-nativa-por/S1699258X17300335/

October 22, 2017 at 12:43 pm

A spontaneous joint infection with Corynebacterium striatum.

J Clin Microbiol. 2007 Feb;45(2):656-8.

Scholle D1.

Author information

1 Department of Medicine, Legacy Emanuel and Good Samaritan Hospitals, 1015 NW 22nd Ave., Portland, OR 97210, USA. dscholle@fastmail.fm

Abstract

Corynebacterium striatum is a ubiquitous saprophyte with the potential to cause bacteremia in immunocompromised patients. Until now, spontaneous infection of a natural joint has not been reported. When phenotyping failed, gene sequencing was used to identify the species. The isolate demonstrated high-level resistance to most antibiotics.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829050/pdf/0827-06.pdf

 

October 22, 2017 at 12:39 pm

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