scholarly journals Microbiological pathogen analysis in native versus periprosthetic joint infections: a retrospective study

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Sebastian Linke ◽  
Alexander Thürmer ◽  
Kevin Bienger ◽  
Christian Kleber ◽  
Petri Bellova ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Joint Infection ◽  
Tertiary Care ◽  
University Hospital ◽  
Nominal Data ◽  
Coagulase Negative Staphylococci ◽  
Joint Infections ◽  
Distributed Parameters ◽  
Chi Squared ◽  
Culture Positive

Abstract Background The presence or absence of an implant has a major impact on the type of joint infection therapy. Thus, the aim of this study was the examination of potential differences in the spectrum of pathogens in patients with periprosthetic joint infections (PJI) as compared to patients with native joint infections (NJI). Methods In this retrospective study, we evaluated culture-positive synovial fluid samples of 192 consecutive patients obtained from January 2018 to January 2020 in a tertiary care university hospital. For metrically distributed parameters, Mann–Whitney U was used for comparison between groups. In case of nominal data, crosstabs and Chi-squared tests were implemented. Results Overall, 132 patients suffered from periprosthetic joint infections and 60 patients had infections of native joints. The most commonly isolated bacteria were coagulase-negative Staphylococci (CNS, 28%), followed by Staphylococcus aureus (S. aureus, 26.7%), and other bacteria, such as Streptococci (26.3%). We observed a significant dependence between the types of bacteria and the presence of a joint replacement (p < 0.05). Accordingly, detections of CNS occurred 2.5-fold more frequently in prosthetic as compared to native joint infections (33.9% vs. 13.4% p < 0.05). In contrast, S. aureus was observed 3.2-fold more often in NJIs as compared to PJIs (52.2% vs. 16.4%, p < 0.05). Conclusion The pathogen spectra of periprosthetic and native joint infections differ considerably. However, CNS and S. aureus are the predominant microorganisms in both, PJIs and NJIs, which may guide antimicrobial therapy until microbiologic specification of the causative pathogen.

scholarly journals Preoperative synovial fluid culture poorly predicts the pathogen causing periprosthetic joint infection

Infection ◽  
2020 ◽  
Author(s):  
Philipp Schulz ◽  
Constantin E. Dlaska ◽  
Carsten Perka ◽  
Andrej Trampuz ◽  
Nora Renz
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Detection Rate ◽  
Pathogen Detection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Exact Test ◽  
Culture Positive ◽  
Synovial Fluid Culture ◽  
Polymicrobial Infections

Abstract Purpose We investigated the value of preoperative pathogen detection and evaluated its concordance with intraoperative cultures in patients with culture-positive periprosthetic joint infection (PJI). Methods Culture-positive PJI episodes with available preoperative (synovial fluid) and intraoperative cultures (periprosthetic tissue, synovial or sonication fluid) were analyzed. The pathogen detection rate in preoperative and intraoperative cultures was compared using Fisher’s exact test and their concordance was calculated. Results Among 167 included PJI episodes, 150 were monomicrobial with coagulase-negative staphylococci (n = 55, 37%), S. aureus (n = 34, 23%), and streptococci (n = 21, 14%) being the most common pathogens. Seventeen episodes (10%) were polymicrobial infections. The pathogen(s) grew in preoperative culture in 110 and in intraoperative cultures in 153 episodes (66% vs. 92%, p < 0.001). The pathogen detection rate was lower in preoperative compared to intraoperative cultures for low-virulent pathogens (40% vs. 94%, p < 0.001), polymicrobial infections (59% vs. 100%, p = 0.007), and in delayed and late PJI (63% vs. 94%, and 66% vs. 91%, respectively, p < 0.001). Full concordance of preoperative and intraoperative cultures was found in 87 episodes (52%). The pathogen was detected solely preoperatively in 14 episodes (8%) and solely intraoperatively in 57 cases (34%); an additional pathogen was found in 3 episodes (2%) preoperatively and in 6 episodes (4%) intraoperatively. Conclusion The concordance of preoperative and intraoperative cultures was poor (52%). The sole or an additional pathogen was found exclusively in intraoperative cultures in 38% of PJI episodes, hence preoperative synovial fluid cultures are considered unreliable for pathogen detection in PJI.

Short-course antibiotic treatment of bone and joint infections in children: a retrospective study at Montpellier University Hospital from 2009 to 2013

2019 ◽  
Vol 74 (12) ◽  
pp. 3579-3587 ◽  
Author(s):  
A Filleron ◽  
M E Laurens ◽  
G Marin ◽  
H Marchandin ◽  
O Prodhomme ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Treatment Duration ◽  
University Hospital ◽  
Short Term ◽  
Joint Infections ◽  
Intravenous Treatment ◽  
Short Course ◽  
Prolonged Antibiotic Therapy

Abstract Background Acute haematogenous bone and joint infections (AHBJI) represent a diagnostic and therapeutic emergency in children, with significant potential sequelae in the case of delayed treatment. Although historically the recommendations for treatment have been based on surgery and prolonged antibiotic therapy, recent studies have demonstrated that short-course antibiotic therapy is also effective. Objectives We evaluated a short-term antibiotic protocol for both osteomyelitis and septic arthritis in a 6 year retrospective study at the University Hospital of Montpellier. Methods This protocol was based on an initial intravenous treatment with a re-evaluation after 48 h and an early switch to oral therapy in the case of a favourable clinical course for a minimum total duration of 15 days. Antibiotics were selected based on local microbiological epidemiology and systematically adapted to bacteriological results. Results One hundred and seventy-six cases of AHBJI were included, comprising 56 patients with osteomyelitis, 95 with septic arthritis and 25 who had both of these. The aetiological agent was identified in 42% of the cases, with the main pathogens being Staphylococcus aureus (39%) and Kingella kingae (27%). The mean intravenous treatment duration was 4 days, while the total treatment duration was 15 days. There were no treatment failures, mild sequelae occurred in 1% of the cases and the secondary surgical revision rate was 7%. Conclusions The results of this study are comparable to those reported for evaluations of prolonged antibiotic therapy protocols, thus indicating that a common short-term antimicrobial therapy for the management of both osteomyelitis and septic arthritis (minimum of 15 days) is a viable option for treating AHBJI in children. Further prospective studies to confirm these findings are hence warranted.

scholarly journals Microbiological Epidemiology Depending on Time to Occurrence of Prosthetic Joint Infection (PJI): Impact on the Empirical Antimicrobial Strategies

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S95-S96
Author(s):  
Tristan Ferry ◽  
Claire Triffault-Fillit ◽  
Frederic Laurent ◽  
Céline Dupieux ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Coagulase Negative Staphylococci ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Lactam Antibiotic ◽  
Revision Prosthesis ◽  
Current Guidelines ◽  
Microbiological Data

Abstract Background Empirical antimicrobial therapy of prosthetic-joint infection (PJI) is a major clinical challenge and current guidelines recommend the combination of vancomycin plus a broad-spectrum β-lactamin. As Gram-negative bacilli (GNB) are probably less represented in late infections, we evaluate the microbiological epidemiology in patients with PJI according to the chronology of infection. Methods All patients managed in a reference center for complex bone and joint infections in France (2011 and 2016) were included in a prospective cohort study. Microbiological data at the time of diagnosis were collected and analyzed according to the chronology of infection. Results We included 567 PJI (284 males, 50.1%; median age 70.3 years). The median occurrence time was 23.4 weeks after prosthesis implantation (285 hip and 255 knee PJI, which were revision prosthesis in 216 [40.3%] cases). Microbiological bone samples found 164 [28.9%] S. aureus (including 26 [16.3%] MRSA), 162 [28.6%] coagulase-negative Staphylococci (CoNS, including 80 [58.8%] methicillin-resistant CoNS), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) Streptococci, and 85 (15.0%) anaerobes (including 60 [10.6%] Propionibacterium). Infection was plurimicrobial in 10 [18.2%] cases. Among the 183 patients (32%) with late PJI (occurring &gt;1 year), obtained after exclusion of the 59 patients (10.4%) with hematogenous origins, Enterobacteriacecae &#x2028;(n = 8; 4.4%; P &lt; 10–3) were much less represented than in patients with early PJI occurring &lt;1 year. No difference was observed regarding the the presence of non-fermenting GNB, with a prevalence of 4.6 and 2.7% in early and late PJI, respectively. Taken together, these data suggest that a broad-spectrum β-lactam antibiotic might be useful in only 12 (6.6%) patients with late PJI, compared with 66 (20.3%) patients with early PJI (P &lt; 10–3). Of note, there were statistically more anaerobes (n = 40; 21.9%) in late PJI, including 32 Propionibacterium (17.5%; P &lt; 10–3). Conclusion Considering the minority amount of GNB in late post-operative PJI and the overrepresentation of anaerobes including P. acnes, the empirical treatment should be reconsidered, especially when a two-stage exchange is planned. In those situations, another acceptable option could be the vancomycin+clindamycin combination. Disclosures T. Ferry, HERAEUS: Consultant, Speaker honorarium. S. Lustig, Heraeus: Consultant, Consulting fee.

scholarly journals Retrospective study of cases of rupture uterus at tertiary care center in Egypt

2018 ◽  
Vol 7 (8) ◽  
pp. 2993
Author(s):  
Laila Ezzat ◽  
Mohamed Salah
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Antenatal Care ◽  
Uterine Rupture ◽  
Care Center ◽  
Tertiary Care ◽  
University Hospital ◽  
Bladder Rupture ◽  
Fetal Life ◽  
Primary Care Center

Background: Uterine rupture (UR)is one of the most serious obstetrical emergencies necessitating prompt diagnosis and management, as it en-dangers the maternal and fetal life. Uterine rupture (scarred/ unscarred) may occur at any stage of pregnancy. In developed countries, with good antenatal care and good supervision during labour, (UR) has become rare except by dehiscence of a caesarean scar. The objective of present study was to find out risk factors, management, related complications and associated maternal and fetal outcomes with rupture uterus.Methods: A retrospective study, data files and the case notes was retrieved from the medical records department at Aswan university hospital from January 1 2013 to December 31 2013 in the form of data relating to the age, parity, gestational age, method of termination, perinatal outcomes, and related maternal complications.Results: There were 4284 deliveries during the period under review among them 5 cases of uterine rupture. Thus, the incidence of uterine rupture was 1.1/1000 deliveries.3 cases (60%) of them had no antenatal care at any hospital or primary care center. The risk factors in these cases are in majority 4 (80%) of cases uterine rupture occurred in women with previous scar, 1case (20%) of cases uterine rupture occurred in women with none scarred uterus. As regard surgical management 3 cases (60%) managed by hysterectomy and 2cases (40%) managed by repair. As regard maternal and fetal outcome all women required blood transfusion. Associated bladder rupture was repaired in two cases (40%). After excluding fetal wastage before the age of viability, perinatal mortality was 100% (5/5).Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life-threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis.

scholarly journals Pasteurella multocidaNon-Native Joint Infection after a Dog Lick: A Case Report Describing a Complicated Two-Stage Revision and a Comprehensive Review of the Literature

2015 ◽  
Vol 26 (4) ◽  
pp. 212-217 ◽  
Author(s):  
Lam Philip W ◽  
Andrea V Page
Keyword(s):  
Pasteurella Multocida ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Review Of The Literature ◽  
Coagulase Negative Staphylococci ◽  
Two Stage ◽  
Oral Flora ◽  
Comprehensive Review ◽  
Joint Infections ◽  
Prosthetic Joint Infections

Prosthetic joint infections (PJIs) are commonly caused by pathogens such asStaphylococcus aureusand coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized.Pasteurella multocidais a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused byP multocidahave been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes aP multocidajoint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regardingP multocidaPJIs follows.

scholarly journals Epidemiology, clinical relevance and prognosis of staphylococci in hospital-acquired postoperative intra-abdominal infections: an observational study in intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kévin Boussion ◽  
Nathalie Zappella ◽  
Nathalie Grall ◽  
Lara Ribeiro-Parenti ◽  
Grégory Papin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Tertiary Care ◽  
University Hospital ◽  
Coagulase Negative Staphylococci ◽  
One Year ◽  
Abdominal Infections ◽  
Hospital Acquired

AbstractThe pathogenic role of staphylococci in hospital-acquired postoperative intra-abdominal infections (HAIs) has never been evaluated. In a tertiary care university hospital, we assessed the clinical characteristics and outcomes of patients admitted to the intensive care unit for HAIs according to the presence of staphylococci (S-HAI) or their absence (nS-HAI) in peritoneal cultures. Patients with S-HAIs were compared to nS-HAIs patients. Overall, 380 patients were analyzed, including 87 (23%) S-HAI patients [29 Staphylococcus aureus (Sa-HAIs) and 58 coagulase-negative staphylococci (CoNS-HAIs)]. The clinical characteristics did not differ between the S-HAI and nS-HAI patients. Adequacy of empirical anti-infective therapy was achieved less frequently in the staphylococci group (54 vs 72%, respectively, p < 0.01). The 90-day (primary endpoint) and one-year mortality rates did not differ between these groups. The S-HAI patients had decreased rates of postoperative complication (p < 0.05). The adjusted analysis of the clinical outcomes reported a decreased frequency of surgical complications in the staphylococci group (OR 0.43, 95% CI [0.20–0.93], p = 0.03). While the trends toward decreased morbidity criteria were observed in S-HAI patients, the clinical outcomes were not different between the CoNS-HAI and Sa-HAI patients. In summary, our data are not substantial enough to conclude that staphylococci exhibit no pathogenicity in HAIs.

scholarly journals METHICILLIN-RESISTANT STAPHYLOCOCCI PREVALENCE IN CANCER PATIENTS AT A TERTIARY CARE CANCER CENTRE – A RETROSPECTIVE STUDY

2021 ◽  
pp. 82-85
Author(s):  
SARAVANAN MURUGESAN ◽  
SUJINA TK ◽  
SAJANI SAMUEL ◽  
SARATH KE ◽  
PARTHIBAN RUDRAPATHY
Keyword(s):  
Retrospective Study ◽  
Cancer Patients ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Common Species ◽  
Study Data ◽  
Coagulase Negative Staphylococci ◽  
Methicillin Resistant ◽  
Cancer Centre ◽  
Multiple Drugs

Objective: The objective of this study was to investigate the prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and MR-coagulase-negative staphylococci (CoNS), as well as their antimicrobial resistance, in various samples from cancer patients in North Kerala. Methods: The retrospective study was conducted at a tertiary care cancer centre in North Kerala over a 4-year period from January 2016 to December 2019. During the study, data on all cultures from cancer patients was analyzed. This study was approved by Institutional Review Board (IRB). Non-duplicate isolates of staphylococci were included in the study obtained from various clinical specimens. Species identification and antimicrobial susceptibility testing was done using automated methods. Results: During the period of 4 years (2016–2019), a total of 1176 isolates of staphylococci were analyzed, out of which 784 were S. aureus isolates (68%) and 392 (32%) isolates were CoNS. Among CoNS species, Staphylococcus epidermidis and Staphylococcus haemolyticus were the most common species of CoNS, representing 39% and 28% of the total CoNS identified. Overall prevalence of methicillin resistance in S. aureus and CoNS was found to be 50.7% and 55.6%, respectively. Methicillin-resistant staphylococci isolates showed higher resistance to multiple drugs than methicillin-sensitive staphylococci isolates. Conclusion: This study demonstrates that MRS could also be a haul in cancer patients at North Kerala. A higher percentage of MR-CoNS isolates are multidrug resistant than MRSA isolates. Glycopeptides and linezolid still stay the mainstay for treatment for MRS infections.

Epidemiology of nosocomial candidaemia in a university hospital: a 12-year study

2010 ◽  
Vol 138 (9) ◽  
pp. 1328-1335 ◽  
Author(s):  
E. GÜRCÜOĞLU ◽  
B. ENER ◽  
H. AKALIN ◽  
M. SINIRTAŞ ◽  
C. EVCI ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Retrospective Study ◽  
Infection Control ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Common Species ◽  
University Hospital ◽  
Care Hospital ◽  
Treatment Protocols ◽  
Incidence And Mortality

SUMMARYThe incidence of nosocomial candidaemia was evaluated in a retrospective study in a Turkish tertiary-care hospital. Over a 12-year period (1996–2007), a total of 743 episodes of candidaemia occurred in 743 patients, accounting for an average incidence of 1·9 episodes/1000 admissions and 2·9 episodes/10 000 patient-days per year. The annual incidence was almost constant during the study period except for 1996 when it was significantly higher in comparison with other years (P<0·05). The most common species isolated was Candida albicans (45%), followed by C. parapsilosis (26%), C. tropicalis (7%), C. krusei (7%), and C. glabrata (3·5%). A significant increase in C. albicans isolates causing candidaemia linked to a decrease in C. parapsilosis isolates in adult patients and C. krusei isolates in children was found between the two 6-year study periods. This trend reflects improved infection control at Uludağ University Hospital. Ninety percent of isolates were susceptible to fluconazole (⩽8 μg/ml) and resistance was found only in C. glabrata and C. parapsilosis isolates. Regular local surveillance of Candida spp. is important in order to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.

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