scholarly journals Periprosthetic hip infections in a Swedish regional hospital between 2012 and 2018: is there a relationship between <i>Cutibacterium acnes</i> infections and uncemented prostheses?

2021 ◽  
Vol 6 (6) ◽  
pp. 219-228
Author(s):  
Urban Hedlundh ◽  
Michail Zacharatos ◽  
Jonas Magnusson ◽  
Magnus Gottlander ◽  
Johanna Karlsson
Keyword(s):  
Medical Records ◽  
Hip Replacement ◽  
Joint Infection ◽  
Regional Hospital ◽  
Postoperative Infections ◽  
Cutibacterium Acnes ◽  
Standardized Treatment ◽  
Hip Arthroplasties ◽  
Infection Eradication ◽  
Microbiological Data

Abstract. The purpose of this study was to evaluate patients requiring in-patient care due to a periprosthetic joint infection (PJI), with respect to bacterial agents, surgical treatment, antibiotics, and outcome. We retrospectively identified all infected total hip arthroplasties (THAs) in a Swedish regional hospital during a 7-year period (2012–2018) and reviewed medical records and microbiological data. A total of 89 infected THAs in 87 patients were identified. Standardized treatment with debridement with retention of the implant and antibiotics (DAIR) was initially performed in 53 cases (60 %), one or two stage revisions in 33 cases (37 %), and an immediate Girdlestone in 3 cases (3 %). Infection eradication was seen in 77 PJIs (87 %) in addition to six patients (7 %) ending up with a permanent but uninfected Girdlestone. All six patients with manifest failures were infected with Staphylococcus aureus, two of which were also polymicrobial. Cutibacterium acnes was found in 18 of 89 patients (16 %) distributed in 15 uncemented implants but only in 3 hybrids and cemented arthroplasties, while remaining pathogens were equally distributed in uncemented THAs (n=31) and THAs with at least one cemented component (n=40; p=0.003). Eradication was achieved in all 18 patients when Cutibacterium acnes was the only culture (n=14) or clearly dominant among positive cultures (n=4). DAIR was successful in selected postoperative infections up to 6 months after hip replacement. Cutibacterium acnes infections in hip arthroplasty may be underdiagnosed. Cemented components in THAs seem to protect from colonization with Cutibacterium acnes.

Red Blood Cell Transfusions for Total Hip Replacement in a Regional Hospital

Vox Sanguinis ◽  
1994 ◽  
Vol 66 (4) ◽  
pp. 270-275
Author(s):  
Douwe H. Biesma ◽  
Charlotte E. van Iperen ◽  
Rob J. Kraaijenhagen ◽  
Joannes J.M. Marx ◽  
Harry B.M. van de Wiel ◽  
...  
Keyword(s):  
Blood Cell ◽  
Total Hip Replacement ◽  
Red Blood Cell ◽  
Hip Replacement ◽  
Regional Hospital ◽  
Total Hip ◽  
Red Blood Cell Transfusions

scholarly journals The role of serum C-reactive protein in the diagnosis of periprosthetic shoulder infection

2021 ◽  
Author(s):  
Doruk Akgün ◽  
Mats Wiethölter ◽  
Paul Siegert ◽  
Victor Danzinger ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Joint Infection ◽  
Receiver Operating Curve ◽  
C Reactive Protein ◽  
Level Of Evidence ◽  
Reactive Protein ◽  
Median Serum ◽  
Cutibacterium Acnes ◽  
Serum Crp ◽  
Receiver Operating

Abstract Introduction There is a paucity of literature regarding serum C-reactive protein (CRP) in the evaluation of a shoulder periprosthetic joint infection (PJI). The purpose of the current study was to establish cutoff values for diagnosing shoulder PJI and evaluate the influence of the type of infecting microorganism and the classification subgroups according to last proposed International Consensus Meeting (ICM) criteria on the CRP level. Materials and methods A retrospective analysis of all 136 patients, who underwent septic or aseptic revision shoulder arthroplasty in our institution between January 2010 and December 2019, was performed. Shoulder PJI was defined according to the last proposed definition criteria of the ICM. Serum CRP levels were compared between infected and non-infected cases, between infection subgroups, as well as between different species of infecting microorganisms. A receiver-operating characteristic (ROC) analysis was performed to display sensitivity and specificity of serum CRP level for shoulder PJI. Results A total of 52 patients (38%) were classified as infected, 18 meeting the criteria for definitive infection, 26 for probable infection and 8 for possible infection. According to the ROC curve, an optimized serum CRP threshold of 7.2 mg/l had a sensitivity of 69% and specificity of 74% (area under curve = 0.72). Patients with definitive infection group demonstrated significantly higher median serum CRP levels (24.3 mg/l), when compared to probable, possible infection groups and PJI unlikely group (8 mg/l, 8.3 mg/l, 3.6 mg/l, respectively, p < 0.05). The most common isolated microorganism was Cutibacterium acnes in 25 patients (48%) followed by coagulase-negative staphylococci (CNS) in 20 patients (39%). Patients with a PJI caused by high-virulent microorganisms had a significantly higher median serum CRP level compared to patients with PJI caused by low-virulent microorganisms (48 mg/l vs. 11.3 mg/l, p = 0.04). Conclusions Serum CRP showed a low sensitivity and specificity for the diagnosis of shoulder PJI, even applying cutoffs optimized by receiver-operating curve analysis. Low-virulent microorganisms and patients with probable and possible infections are associated with lower CRP levels compared to patients with definitive infection and infections caused by high-virulent microorganisms. Level of evidence Diagnostic Level III.

scholarly journals GAMBARAN PENGGUNAAN TERAPI GEA (GASTROENTERITIS ) PADA PASIEN ANAK DI RSUD BATARA SIANG PANGKEP SULSEL

2021 ◽  
Vol 3 (3) ◽  
pp. 189-198
Author(s):  
Dwi Fitrah Wahyuni ◽  
Riska Riska
Keyword(s):  
Experimental Study ◽  
Medical Records ◽  
Pediatric Patients ◽  
Diarrheal Disease ◽  
Evaluation Study ◽  
Initial Therapy ◽  
Regional Hospital ◽  
Inclusion Criteria ◽  
South Sulawesi ◽  
Appropriate Therapy

GEA (Gastroenteritis) or diarrhea is a disease caused by digestive tract disorders that are infected by bacteria. Treatment of early diarrhea, especially the choice of initial therapy, greatly affects the success of providing appropriate and appropriate therapy. This study aims to determine the rationality of therapy in pediatric patients at Batara Siang Pangkep Regional Hospital, South Sulawesi City. This study is a non-experimental study with a retrospective descriptive evaluation study using patient medical records. The samples that met the inclusion criteria were 65 patients. Acute diarrhea was mostly found in men as many as 38 patients (58%) while for women as many as 27 patients (42%). Characteristics of age 1-3 years (82%). The result showed that there are 3 therapeutic regimen in pediatric patient namely cotrimoxazole,electrolit, and zinc. So from these data meet the standards of management of diarrheal disease in children.

scholarly journals A Four-Year Hospital-Based Retrospective Study of the Predictors of Tuberculosis in People Living with HIV and Receiving Care at Bamenda Regional Hospital, Cameroon

2020 ◽  
Vol 9 (2) ◽  
pp. 167-172
Author(s):  
Cho Sabastine Anye ◽  
Claude Ngwayu Nkfusai ◽  
Brenda Mbouamba Yankam ◽  
Frankline Sevidzem Wirsiy ◽  
Joyce Mahlako Tsoka-Gwegweni ◽  
...  
Keyword(s):  
Medical Records ◽  
Chart Review ◽  
Descriptive Analysis ◽  
Healthcare Systems ◽  
Regional Hospital ◽  
People Living With Hiv ◽  
Mycobacterium Tuberculosis Infection ◽  
Immunodeficiency Virus ◽  
Latent Tb ◽  
Living With Hiv

Background: Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infections place immense burdens on healthcare systems with particularly diagnostic and therapeutic challenges. TB is high among opportunistic diseases and the most leading cause of death among patients with HIV/AIDS. HIV infection is the most-known risk factor for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation by 20-fold. We present a four-year descriptive analysis of TB in people living with HIV in the Bamenda Regional Hospital (BRH) from 2012-2016. Methods: This was a hospital-based descriptive chart review. We conducted manual reviews of medical records of HIV/TB co-infected patients from June 2017-July 2017 at BRH

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Clinical Analysis of Suction Drainage in Cementless Hip Replacement: A Prospective Randomised Study

2020 ◽  
Author(s):  
Pawel Bartosz ◽  
Wojciech Marczynski ◽  
Marcin Para ◽  
Maciej Kogut ◽  
Jerzy Białecki
Keyword(s):  
Hip Replacement ◽  
Joint Infection ◽  
Hip Osteoarthritis ◽  
Inclusion Criteria ◽  
Suction Drainage ◽  
Exclusion Criteria ◽  
Randomised Study ◽  
Group 5 ◽  
Drainage Group ◽  
Prospective Randomised Study

Abstract Background: Several studies have suggested that the use of drains did not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drainage use.Methods: Prospective, randomised study was performed. The analysis included 100 patients. Inclusion criteria: idiopathic hip osteoarthritis. Exclusion criteria: secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. Results: We found smaller haematomas in the no-drainage group (9.76 mm vs. 10.33 mm, p = 0.653). The visual analogue scale score was lower in the no-drainage group (5 vs. 6). Less bloodloss in the no-drainage group (1,124 ml vs 1,224 ml, p = 0.59). Two patients had a deep joint infection in the no-drainage group, none in the drainage group.Conclusion: It is noteworthy that two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Further research is warranted to validate our findings.Trial registration: The study was successfully retrospectively registered in Clinicaltrial.gov with identification number: NCT04333264 (03/04/2020). https://clinicaltrials.gov/ct2/show/NCT04333264?term=NCT04333264&draw=2&rank=1

A case of Mycobacterium fortuitum prosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement

2021 ◽  
Vol 14 (8) ◽  
pp. e243675
Author(s):  
Maya Ramanathan ◽  
Folusakin Ayoade
Keyword(s):  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Mycobacterium Fortuitum ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Prosthetic Joint ◽  
The Right

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum. He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.

scholarly journals Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 872
Author(s):  
Isabel Mur ◽  
Marcos Jordán ◽  
Alba Rivera ◽  
Virginia Pomar ◽  
José Carlos González ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Infection ◽  
Assistive Device ◽  
Matched Cohort ◽  
Knee Prostheses ◽  
Matched Cohort Study ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

scholarly journals Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

2020 ◽  
Vol 5 (2) ◽  
pp. 89-95 ◽  
Author(s):  
Pascale Bémer ◽  
Céline Bourigault ◽  
Anne Jolivet-Gougeon ◽  
Chloé Plouzeau-Jayle ◽  
Carole Lemarie ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Predictive Value ◽  
Serological Test ◽  
Bacterial Species ◽  
Joint Infection ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Cutibacterium Acnes

Abstract. Introduction: The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening.Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines.Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes.Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

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