814. Successful Treatment of Cutibacterium acnes (CA) Prosthetic Device Infection (PDI) with Oral Linezolid and Rifampin (LR)

Background CA PDI is increasingly recognized. CA is felt to create a slime layer that makes infection more likely and treatment more difficult in this setting. Traditional management has included prosthetic device explantation (PDE), prolonged antibiotic treatment, and delayed reimplantation. Recent interest in the use of oral treatment regimens and single stage procedures with long duration antibiotic therapy led us to treat a series of patients with oral treatment and retained prosthesis after debridement. We report those results. Methods Sequential patients with CA PDI treated with oral therapy were identified. All patients underwent debridement of the tissue, exchange of components and/or reimplantation of the prosthetic device. Only patients with exchanges were included. PDE was excluded. MIC testing for CA isolates was obtained when possible. Initial treatment was recorded at time of surgery. LR was the treatment of choice unless toxicity developed. A minimum of a 3-month follow-up post treatment was required to be included. 6 and 12 month follow up were obtained for all patients but 1 at this time. Results 10 patients were treated (Table 1). Shoulder joint infections were most common. All patients were treated with LR. All completed a minimum of 42 days of treatment (Table 2). The medication was well tolerated. The most common adverse events were nausea. 9/10 patients with 12 month follow up had no evidence of relapse. 1/10 had no relapse at 3 months. Typical for CA infection laboratory markers for infection were not markedly elevated. Notably thrombocytopenia did not occur (Table 3). Table 1. Distribution of Prosthetic Device Infections Table 2. Duration of Treatment Table 3. Selected Laboratory Results Conclusion We demonstrated the ability to successfully treat 10/10 patients with CA PDI without explantation using prolonged oral treatment with LR after debridement. This combination should be considered a treatment option and explored further as a low cost, well tolerated, high value treatment approach to this difficult infection. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker’s Bureau)Merck (Grant/Research Support, Speaker’s Bureau) Kathleen H. Seneca, MSN, Abbvie (Research Grant or Support)Alkermes (Research Grant or Support)Gilead (Speaker’s Bureau)

Prosthetic foot design with biomimetic ankle mechanism

This thesis proposes a novel lower-limb prosthetic device. Current prosthetics either have overly simplistic designs with inaccurate biomechanics or use delicate microprocessors that are easily damaged in harsh environments. This thesis aims to address these concerns by creating a novel device that combines a pneumatic damping system with a ball joint, resulting in a robust design with improved biomechanics. This prosthetic offers an affordable alternative that can be completely rebuilt while providing added comfort through improved biomechanics. Overall, this thesis contributes to the literature by proposing and discussing an innovative design for an affordable, comfortable, biomechanically sound alternative for lower limb prostheses.

Case Report: 18F-FDG PET-CT for Diagnosing Prosthetic Device-Related Infection in an Infant With CHD

Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.

Impact of rifampicin dose in bone and joint prosthetic device infections due to Staphylococcus spp: a retrospective single-center study in France

Background Prosthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide. While surgical management is well defined, rifampicin (RIF) dose remains controversial. The aim of our study was to determine whether Rifampicin dose impact infection outcomes in PJI due to Staphylococcus spp. Methods single-center retrospective study including 411 patients with PJI due to Rifampicin-sensitive Staphylococcus spp. Rifampicine dose was categorized as follow: < 10 mg/kg/day, 10–20 mg/kg/day or > 20 mg/kg/day. The primary endpoint was patient recovery, defined as being free of infection during 12 months after the end of the initial antibiotic course. Results 321 (78%) received RIF for the full antibiotic course. RIF dose didn’t affect patients recovery rate with 67, 76 and 69% in the < 10, 10–20 and > 20 mg/kg/day groups, respectively (p = 0.083). In univariate analysis, recovery rate was significantly associated with gender (p = 0.012) but not to RIF dose, or Staphylococcus phenotype (aureus or coagulase-negative). In multivariate analysis, age (p = 0.01) and treatment duration (p < 0.01) were significantly associated with recovery rate. Conclusion These data suggest that lower doses of RIF are as efficient and safe as the recommended high-dose French regimen in the treatment of PJI.

A simplified model of a multi-jointed mechanical finger calibrated with experimental data by vision system

The development of suitable models for mechanical fingers, whether they are part of prosthetic device or of a robotic hand, is a powerful tool to predict the behaviour of their components since the early stages of design, especially for underactuated mechanisms. Experimental data can improve the reliability of such models and promote their application to build proper control strategies especially for prosthetic hands. Here, we have developed a multi-jointed model of a mechanical finger. The finger is part of the Federica hand: an underactuated mechanical hand that was conceived for prosthetic purpose. The model accounts for friction phenomena in the finger and it is tuned with experimental data acquired through a digital image correlation device. The model allowed us to write kinematics relations of the phalanges and evaluate finger configurations in relation to the closure velocity. Moreover, it was possible to estimate the tendon force and the work analysis occurring during the closure tasks, both in free mode and in presence of objects.

Palate Obturators in the Phono-Articular System in Defects Caused by Nasal T / NK Cell Lymphoma

Lymphomas are frequent malignant neoplasms, due to the destructive and rapidity of their clinical course, they present extensive areas of necrosis, which could be induced by the Epstein Bar virus (EBV) that is present in most of these lymphomas causing oro-nasal communications that they have an impact on phonation, chewing, swallowing and loss of self-esteem. Due to the extension of this type of communication, they represent a challenge in surgical rehabilitation opting for a prosthetic device.

IMMEDIATE PROSTHESIS: LITERATURE REVIEW

The immediate total prosthesis is a device made before the exodontia and is installed soon after the accomplishment of the same ones. Faced with a situation in which the patient encounters the remaining condemned teeth, many resist to remain edentulous while awaiting the healing phase for the manufacture of a conventional total prosthesis; thus, the total immediate prosthesis becomes an ally in these cases, promoting the return of aesthetics, phonetics, chewing and social coexistence. Through a literature review, this work aims to clarify the pertinent issues of the immediate total dentures, where they were presented their classifications, advantages and disadvantages, indications and contraindications, technique of making this prosthetic device, besides post-installation care. Searches were made in the databases Scielo, Medline, Bireme, Google academic, Capes and books; using the key words: immediate total prosthesis; immediate oral rehabilitation; oral surgery and selected articles between the years 2009 to 2019. It was possible to conclude that the advantages of the rehabilitation with immediate prosthesis are very evident, being thus an advantageous alternative of treatment.

Development of Smartphone-Controlled Hand and Arm Exoskeleton for Persons with Disability

This study addresses the need for assistive technology of people who lost control of their upper limbs as well as people who are undergoing rehabilitation. Loss of upper limb control causes lack of functionality and social acceptability especially for many people in developing countries with fewer available technology. The study develops a modern but low-cost prosthetic device that can be controlled by users using a smartphone and can be rapidly manufactured using three-dimensional printing (3D printing) of plastic materials. The development of the prosthetic device includes designing the mechanical and electronic parts, programming the Arduino board and Android application for control, simulation and analysis of 3D printed parts most subjected to stress, and 3D printing the parts under different settings. The device was tested in terms of time spent and capacity of lifting varying loads when not worn and when worn by users. The device can effectively lift 500 grams of load in one second for a person weighing between 50 to 60 kilograms.

Development of an Automatic Robotic Procedure for Machining of Skull Prosthesis

The project presented in this paper develops within the field of automation in the medical-surgical sector. It aims at automating the process for the realization of prosthetic devices for the skull in cranioplasty, following a craniotomy intervention for brain tumor removal. The paper puts emphasis on the possibility to create the prosthetic device in run-time during the surgery, in order to ease the work that surgeons have to do during the operation. Generally, a skull prosthesis is realized before the day of the intervention, based on the plan of the medical operation, on the results of computed tomography, and through image processing software. However, after the surgery is performed, a non-negligible geometrical uncertainty can be found between the part of the skull actually removed and the cut planned during the preliminary analysis, so that the realized prosthesis (or even the skull, at worse) may need to be retouched. This paper demonstrates the possibility to introduce a fully automated process in a hospital environment, to manufacture in runtime the prosthetic operculum, relying on the actual geometry of the incision of the skull detected during the intervention. By processing a 3D scan of the skull after the craniectomy, a digital model of the prosthesis can be created and then used as an input to generate the code to be run by a robotic system in charge of the workpiece machining. Focusing on this second step, i.e., the manufacturing process, the work describes the way the dimensions of the raw material block are automatically selected, and the way robot trajectories for milling operation are automatically generated. Experimental validation demonstrates the possibility to complete the prosthesis within the surgery time, thus increasing the accuracy of the produced prosthesis and consequently reducing the time needed to complete the operation.

Mycobacterium Fortuitum Cholangitis and Sepsis in an Immunocompetent Patient

Mycobacterium fortuitum is an ubiquitous, environmental and opportunistic organism belonging to rapid growing mycobacteria (RGM), a distinctive subset of non-tuberculous mycobacteria. It is mainly transmitted by direct inoculation and causes a wide spectrum of clinical syndromes, including skin, bone, soft tissue and disseminated infections, surgical wound infections, catheter-related sepsis and prosthetic device infections. Scientific literature abounds with cases occurred to cancer and immunosuppressed patients, especially in the presence of vascular devices. Hereby we report an event of Mycobacterium fortuitum sepsis and cholangitis, happened to an apparently immunocompetent individual, with no history of neoplasm, nor of immunosuppressive therapy, nor holding a central venous catheter (CVC). The man had previously undergone transitory biliary prosthesis positioning, followed by laparoscopic cholecystectomy; however, investigations on both the endoscopic and surgical equipment, as well as environmental samplings, ruled out a nosocomial infection. After adequate antibiotic treatment, our patient recovered.