scholarly journals Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

2020 ◽  
Author(s):  
Bruno Alves Rudelli ◽  
Pedro Nogueira Giglio ◽  
Vladimir Cordeiro Carvalho ◽  
Jose Ricardo Pecora ◽  
Henrique Melo Campos Gurgel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Failure Rate ◽  
Multidrug Resistant ◽  
The Other ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Treatment Failure Rate ◽  
Drug Resistance Profile ◽  
Implant Retention

Abstract BACKGROUND: debridement, antibiotics and implant retention (DAIR) with the exchange of modular components is the most widely used option for the treatment of acute periprosthetic joint infections. The objective of this study is to evaluate the effect of bacteria drug resistance profile on the success rates of DAIR. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics.RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05).CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

scholarly journals Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

2020 ◽  
Author(s):  
Bruno Alves Rudelli ◽  
Pedro Nogueira Giglio ◽  
Vladimir Cordeiro Carvalho ◽  
Jose Ricardo Pecora ◽  
Henrique Melo Campos Gurgel ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Failure Rate ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
The Other ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Treatment Failure Rate ◽  
Drug Resistance Profile ◽  
Implant Retention

Abstract BACKGROUND: evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

scholarly journals Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention

2020 ◽  
Author(s):  
Bruno Alves Rudelli ◽  
Pedro Nogueira Giglio ◽  
Vladimir Cordeiro Carvalho ◽  
Jose Ricardo Pecora ◽  
Henrique Melo Campos Gurgel ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Failure Rate ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
The Other ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Treatment Failure Rate ◽  
Drug Resistance Profile ◽  
Implant Retention

Abstract BACKGROUND: evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p<0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p=0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p<0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

scholarly journals Outcomes and Risk Factors in Prosthetic Joint Infections by multidrug-resistant Gram-negative Bacteria: A Retrospective Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 340
Author(s):  
Raquel Bandeira da Silva ◽  
Mauro José Salles
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Revision Arthroplasty ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Postoperative Hematoma ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Gram-negative bacteria (GNB), including multidrug-resistant (MDR) pathogens, are gaining importance in the aetiology of prosthetic joint infection (PJI). This retrospective observational study identified independent risk factors (RFs) associated with MDR-GNB PJI and their influence on treatment outcomes. We assessed MDR bacteria causing hip and knee PJIs diagnosed at a Brazilian tertiary hospital from January 2014 to July 2018. RFs associated with MDR-GNB PJI were estimated by bivariate and multivariate analyses using prevalence ratios (PRs) with significance at p < 0.05. Kaplan–Meier analysis was performed to evaluate treatment outcomes. Overall, 98 PJI patients were analysed, including 56 with MDR-GNB and 42 with other bacteria. Independent RFs associated with MDR-GNB PJI were revision arthroplasty (p = 0.002), postoperative hematoma (p < 0.001), previous orthopaedic infection (p = 0.002) and early infection (p = 0.001). Extensively drug-resistant GNB (p = 0.044) and comorbidities (p = 0.044) were independently associated with MDR-GNB PJI treatment failure. In sum, MDR-GNB PJI was independently associated with previous orthopaedic surgery, postoperative local complications and pre-existing infections and was possibly related to selective pressure on bacterial skin colonisation by antibiotics prescribed for early PJI. Infections due to MDR-GNB and comorbidities were associated with higher treatment failure rates.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p &lt; 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p &lt; 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Multidrug-resistant Gram-negative bacteria-resistant infections: epidemiology, clinical issues and therapeutic options

2016 ◽  
Vol 10 (4) ◽  
pp. 364 ◽  
Author(s):  
Matteo Bassetti ◽  
Davide Pecori ◽  
Maddalena Peghin
Keyword(s):  
Risk Factors ◽  
Multidrug Resistant ◽  
Therapeutic Options ◽  
Gram Negative Bacteria ◽  
Careful Selection ◽  
Clinical Issues ◽  
Gram Negative ◽  
Severe Infections ◽  
Selection Of Patients ◽  
Selection Of

In the last decade, we have witnessed a dramatic increase in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, both in Italy and worldwide, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Inadequate empirical antimicrobial therapy of severe infections caused by MDR Enterobacteriacae has been associated with an increased morbidity and mortality. However, a careful selection of patients who may receive empirical treatment covering MDR Enterobacteriacae is important to avoid the overuse of broad-spectrum antibiotics. The aim of this review is to describe the mechanism of resistance, epidemiology, risk factors, clinical issues, and therapeutic options for MDRGN pathogens.

scholarly journals Current trends in the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 121 ◽  
Author(s):  
Richard R. Watkins ◽  
David Van Duin
Keyword(s):  
Risk Factors ◽  
Healthcare Costs ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Current Management ◽  
Gram Negative ◽  
Current Trends ◽  
The Us ◽  
Advanced Stages ◽  
Common Infections

Pneumonia is one of the most common infections worldwide. Morbidity, mortality, and healthcare costs increase substantially when pneumonia is caused by multidrug-resistant Gram-negative bacteria (MDR-GNB). The ongoing spread of antimicrobial resistance has made treating MDR-GNB pneumonia increasingly difficult. Fortunately, there have been some recent additions to our antibiotic armamentarium in the US and Europe for MDR-GNB, along with several agents that are in advanced stages of development. In this article, we review the risk factors for and current management of MDR-GNB pneumonia as well as novel agents with activity against these important and challenging pathogens.

scholarly journals Management of Pseudomonas Aeruginosa Related Infection in Emergency Department

2020 ◽  
Vol 5 (5) ◽  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Pseudomonas Aeruginosa ◽  
Care Setting ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Drug Selection ◽  
Gram Negative ◽  
Risk Patients ◽  
Tract Infections

Pseudomonas aeruginosa relating infection has high mortality rate in health care setting. In particular, immunocompromised and critically ill patients. Recent studies suggested considering broad-spectrum antipseudomonal antibiotics for Gram-negative bacteria coverage in the emergency Department, especially for high-risk patients. A number of studies have been conducted to assess risk factors of resistance.This review will evaluate the available antipseudomonal antibiotic along with its resistant pattern. Also it will discuss selected antipseudomonal agent in managing Multidrug resistant duo to Pseudomonas aeruginosa. The review will discuss the Drug selection approaches for patients with neutropenia, pneumonia, and urinary tract infections. The last part in the review will highlight the preferred empirical antipseudomonal antibiotic used at Emergency Department.

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