Posts filed under ‘Resistencia bacteriana’
Medicina (B Aires). 2016;76(1):10-8.
[Article in Spanish]
Méndez N1, Gancedo E, Sawicki M, Costa N, Di Rocco R.
1Sector Ecografía de la División Radiodiagnóstico, Hospital de Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina. E-mail: firstname.lastname@example.org
Primary pyomyositis is a bacterial infection of striated muscle which is acquired by hematogenous route. It is related to risk factors such as HIV/aids and other immuno suppressing diseases, and can be associated with local muscle stress factors.
The most frequent etiology is Staphylococcus aureus. Its diagnostic delay may cause a fatal evolution. In this series 32 patients with primary pyomyositis diagnosed by ultrasound were evaluated. The most frequent risk factor was HIV/aids (61%).
Local factors were detected in 21 (66%) cases: first, the practice of football. The monofocal form was observed in 19 (59%), the most commonly affected muscles were quadriceps, calves and psoas. Samples for bacteriological study were obtained in 30 cases, 22 blood culture and 27 abscess materials.
In 30 cases the etiologic agent was isolated. Staphylococcus aureus accounted for 83.3% (25 cases) and Escherichia coli, Nocardia spp., Streptococcus agalactiae, nontuberculous mycobacteria, Pseudomonas aeruginosa were isolated in one case each.
Seventeen patients received surgical treatment, aspirative punctures, 9; antibiotics alone, 4. Twenty eight (93.3%) patients had a good evolution; deaths, 2 (6.6%); unknown, 2.
Main conclusions of this study were: due to the diverse and changing etiology of the primary pyomyositis it is important to recognize the etiological agent involved and their antibiotic susceptibility.
The ultrasound performed the study in real time so it can be used to guide the puncture and to facilitate the immediate diagnosis. This makes the difference with other techniques and transforms it into a first-line method for the study of this disease.
Journal of Antimicrobial Chemotherapy JUNE 2012 V.97 N.6 P.1427-1431
David Landman, Elizabeth Babu, Neha Shah, Paul Kelly, Olafisoye Olawole, Martin Bäcker, Simona Bratu, and John Quale
Division of Infectious Diseases, Department of Medicine, State University of New York–Downstate Medical Center, Brooklyn, New York, USA
Carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are endemic in many medical centres. Because therapeutic options are limited, understanding the epidemiology and controlling the spread of these pathogens are of paramount importance.
Isolates of K. pneumoniae, A. baumannii and P. aeruginosa were collected from 14 hospitals in New York City over a 3 month period in 2009, and analysed for the presence of genes encoding important carbapenemases. Comparisons were made with a similar study conducted in 2006. Demographic and infection control-related information from hospitals was collected.
Overall, 29% of K. pneumoniae possessed the carbapenemase KPC, significantly improved from the 38% observed in 2006 (P<0.001). However, carbapenem resistance worsened in A. baumannii (mostly due to the emergence of strains with OXA-type carbapenemases) and P. aeruginosa. The decline in KPC-possessing K. pneumoniae was not uniformly observed in all of the hospitals. In a subset analysis of nine hospitals, those with a decreasing prevalence of blaKPC had shorter average lengths of stay.
Measurable improvement has occurred in reducing the spread of KPC-possessing K. pneumoniae, and reducing the average length of stay may augment infection control efforts. However, the problem of carbapenem-resistant A. baumannii and P. aeruginosa lingers. New approaches, including respiratory isolation and environmental cleaning, need to be examined to control the spread of A. baumannii and P. aeruginosa.
Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty
Journal of Arthroplasty September 2016 V.31 N.9 P.162–165
Richard L. Purcell, Nancy L. Parks, Jeanine M. Gargiulo, William G. Hamilton
The orthopedic literature documents that obesity can place patients at increased risk for complications. This is the first study to document the increased risk of infection in obese patients after direct anterior approach (DAA) primary total hip arthroplasty (THA).
We retrospectively evaluated 1621 consecutive primary THAs performed with a DAA. Patients were stratified by body mass index <35 kg/m2 (group 1) or ≥35 kg/m2 (group 2). Rates of postoperative infection requiring revision, superficial wound dehiscence, return to the operating room, and total wound complications were compared. There were 1417 cases in group 1 and 204 in group 2.
Five cases in each group had a deep infection, resulting in a significantly higher rate in group 2 (0.35% vs 2.5%, P = .0044, relative risk = 7.1). Superficial wound dehiscence was diagnosed in 13 (0.92%) THA in group 1 and 4 (1.96%) in group 2 (P = .256). The all-cause reoperation rate was 0.92% and 3.43% in each group, respectively (P = .008). The total rate of all studied complications was 1.27% compared to 4.41% (P = .0040, relative risk = 3.5).
This is the first study to report on significantly increased rates of postoperative infection requiring revision in patients with body mass index ≥35 kg/m2 after anterior approach hip arthroplasty. We believe it is the combination of immune dysfunction and proximity of the anterior incision to the inguinal crease and genitalia with overlying abdominal pannus that contributes to this risk. Further studies comparing other surgical approaches in obese patients are needed to determine if this complication is truly attributable to the DAA alone.
Journal of Arthroplasty September 2016 V.31 N.9 P.156–161
Adam R. Cochran, Kevin L. Ong, Edmund Lau, Michael A. Mont, Arthur L. Malkani
The purpose of this study was to determine the incidence of subsequent reinfections after initial treatment of an infected total knee arthroplasty, identify risk factors leading to reinfection, and compare results among the varying treatment modalities.
A total of 1,493,924 primary TKA patients were identified from the Medicare data between October 1, 2005, and December 31, 2011. Patients who encountered periprosthetic joint infection (PJI) after TKA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 996.66. The risk of subsequent PJI was stratified based on the first-line treatment and compared between the various first-line treatment groups.
A total of 16,622 patients (1.1%) were diagnosed with PJI. The Kaplan-Meier risk of PJI was 0.77% at 1 year and 1.58% at 6 years. Age (P < .001), Charlson score (P < .001), hospital control (P < .001), race (P = .036), census region (P = .031), gender (P < .001) were identified as risk factors for PJI. Of the PJI patients, 20.8% (n = 2806) were treated with incision and drainage (I&D), 15.9% (n = 2150) treated with I&D and liner exchange, 22.7% (n = 3069) treated with 1-stage revision, 39.7% (n = 5364) treated with 2-stage revision, and 0.98% (n = 132) treated with amputation. After first-line treatment, 26% of patients with PJI had a subsequent PJI. Patients undergoing I&D as a first-line treatment had the highest risk of reinfection, with risks of 28.2% at 1 year and 43.2% at 6 years. One-stage revision patients had 33.9% greater adjusted risk of reinfection than 2-stage revision patients (P < .001).
Two-stage reimplantation, despite 19% recurrence, had the highest success rate. Given the higher failure rates of I&D and single-stage revisions, guidelines need to be established for their specific indications.
Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty
Journal of Arthroplasty September 2016 V.31 N.9 P.144–147
Scott M. Sporer, Thea Rogers, Linda Abella
Deep infection after elective total joint arthroplasty remains a devastating complication. Preoperative nasal swab screening for Staphylococcus aureus colonization and subsequent treatment of colonized patients is one proposed method to identify at-risk patients and decrease surgical site infections (SSIs). The purpose of this study was to determine whether a preoperative staphylococcus screening and treatment program would decrease the incidence of SSI in elective joint arthroplasty patients.
Since January 2009, a total of 9690 patients having an elective joint arthroplasty were screened before surgery for Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) with nares swabs. All patients with positive nare colonization for MSSA and MRSA were treated with mupirocin and chlorhexidine gluconate showers for 5 days before surgery. MRSA patients received vancomycin preoperatively and were placed in contact isolation. All elective arthroplasty patients used chlorhexidine gluconate antiseptic cloths the evening prior and the day of surgery. Perioperative infection rates were compared from 1 year before implementation to 5 years after implementation of this screening protocol.
SSI rates have decreased from 1.11% (prescreening) to 0.34% (nasal screening; P < .05) after initiation of the process. Staphylococcus was identified in 66.7% of the SSI infections before nasal screening and in 33.3% of the SSI after routine screening (P > .05).
The addition of MRSA and/or MSSA nares screening along with a perioperative decolonization protocol has resulted in a decreased SSI rate by 69%.
Arch Bone Jt Surg. April 2015 V.3 N.2 P.72-81.
Shahi A1, Parvizi J1.
1Alisina Shahi MD Javad Parvizi MD, FRCS The Rothman Institute of Orthopaedics at Thomas Jefferson University, Philadelphia, PA.
Prosthetic joint infection (PJI) is a calamitous complication with high morbidity and substantial cost. The reported incidence is low but it is probably underestimated due to the difficulty in diagnosis. PJI has challenged the orthopaedic community for several years and despite all the advances in this field, it is still a real concern with immense impact on patients, and the healthcare system. Eradication of infection can be very difficult. Therefore, prevention remains the ultimate goal. The medical community has executed many practices with the intention to prevent infection and treat it effectively when it encounters. Numerous factors can predispose patients to PJI. Identifying the host risk factors, patients’ health modification, proper wound care, and optimizing operative room environment remain some of the core fundamental steps that can help minimizing the overall incidence of infection. In this review we have summarized the effective prevention strategies along with the recommendations of a recent International Consensus Meeting on Surgical Site and Periprosthetic Joint Infection.
The Bone & Joint Journal. October 2015 V.97-B 10 Suppl A P.20-29.
Gehrke T1, Alijanipour P2, Parvizi J2.
1Helios Endo-Klinik, Holstenstr.2, 22767 Hamburg, Germany.
2Rothman Institute, 125 S 9th St Ste 1000, Philadelphia, PA 19107, USA.
Periprosthetic joint infection (PJI) is one of the most feared and challenging complications following total knee arthroplasty. We provide a detailed description of our current understanding regarding the management of PJI of the knee, including diagnostic aids, pre-operative planning, surgical treatment, and outcome.