Relevance of empirical antibiotic treatment in the evolution of prosthetic joint infection treated with implant retention

Introduction. Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. Material and methods. We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. Results. A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01). Conclusions. Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy

Empiema bacteriano espontáneo como complicación de la cirrosis hepática: ¿cuándo sospecharlo y cómo tratarlo? Presentación de casos

Spontaneous bacterial empyema is defined as infection of the liver hydrothorax in the cirrhotic patients. It is a rare cause of decompensated cirrhosis, with few bibliographic reports in the region, and its presence marks a turning point of inflection in the evolution of the disease with a poor prognosis in the short term. Two clinical cases of patients with this complication are presented, which were referred to the National Liver Transplant Program of Uruguay. The clinical features, a pathophysiology and a therapeutic approach of this pathology are reviewed. Special emphasis is placed on empirical antibiotic treatment based on the site of acquisition of the infection and local epidemiology, and in the opportunity for the resolution of the underlying hepatic hydrothorax, with a high risk of complications that may be associated with invasive treatments.

Effect on 30-day mortality and duration of hospitalization of empirical antibiotic therapy in CRGNB-infected pneumonia

Background The objective of this study was to investigate whether unreasonable empirical antibiotic treatment (UEAT) had an impact on 30-day mortality and duration of hospitalization in bacterial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods This was a retrospective cohort study involving CRGNB-infected pneumonia. All CRGNB-infected pneumonia patients received empirical and targeted antibiotic treatment (TAT), and they were divided into reasonable empirical antibiotic treatment (REAT) and UEAT according to whether the empirical antibiotic treatment (EAT) was reasonable. The data of the two groups were compared to analyze their influence on the 30-day mortality and hospitalization time in CRGNB-infected pneumonia patients. Moreover, we also considered other variables that might be relevant and conducted multivariable regression analysis of 30-day mortality and duration of hospitalization in CRGNB-infected pneumonia patients. Results The study collected 310 CRGNB-infected pneumonia patients, the most common bacterium is Acinetobacter baumannii (211/310 [68%]), the rest were Klebsiella pneumoniae (46/310 [15%]), Pseudomonas aeruginosa and others (53/310 [17%]). Among them, 76/310 (24.5%) patients received REAT. In the analysis of risk factors, dementia, consciousness were risk factors of 30-day mortality, pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. The analysis of 30-day mortality showed that UEAT was not associated with 30-day mortality for the 30-day mortality of REAT and UEAT were 9 of 76 (11.84%) and 36 of 234 (15.38%) (P = 0.447), respectively. Meanwhile, there was difference between REAT and UEAT (P = 0.023) in the analysis of EAT on hospitalization time in CRGNB-infected pneumonia patients. Conclusions UEAT was not associated with 30-day mortality while was related to duration of hospitalization in CRGNB-infected pneumonia patients, in which Acinetobacter baumanniii accouned for the majority.

Sinus Bradycardia Associated with Remdesivir Treatment in COVID-19: A Case Report and Literature Review

Background: Although remdesivir treatment is widely used during the pandemic coronavirus disease 2019 (COVID-19), there is scarce evidence regarding its cardiac side effects. Case presentation: We report the case of a 36-year-old male hospitalized due to severe COVID-19 symptoms. He presented with a 10-day history of fever (up to 39.7 °C), productive cough, hemoptysis, fatigue, myalgias and hypoxemia. The patient received supplemental oxygen, dexamethasone, remdesivir and empirical antibiotic treatment according to protocol. Asymptomatic sinus bradycardia developed on hospital day 3 (namely, heart rate 39/min compared to 92/min on admission). Secondary causes of bradycardia were excluded based on the absence of relevant evidence from laboratory work-up and echocardiographic examination. The patient’s rhythm restored to normal 9 days after the discontinuation of remdesivir. Conclusions: Considering the frequent use of remdesivir in patients with COVID-19, physicians should be aware of this possible adverse event.

Clinical progression and outcomes of 260 patients with severe COVID-19: an observational study

This paper presents the results of an observational, prospective study of the clinical progression and outcomes of patients with severe COVID-19. Overall, 260 patients with severe COVID-19 were included. The median age of the patients was 61 years (IQR 42.0–73.0), and 119 (45.8%) patients had one or more medical comorbidities. The median time from initial onset of symptoms to hospital admission was 8 days (IQR 6.0–11.0). Varying degrees of abnormalities in blood biochemical results were detected in most patients. All patients received supportive therapy and antiviral treatment. All patients were administered empirical antibiotic treatment with a median time of 5 days (IQR 3–7). Mechanical ventilation was required in accordance with respiratory conditions. At the data cutoff, 183 (70.4%) patients had been discharged, and 17 (6.5%) patients had been transferred to the intensive care unit (ICU). Twenty-five (9.6%) patients had died, and 35 (13.5%) patients were still in the hospital. During follow-up, 7 patients with fever were negative for SARS-Cov-2 antigens upon retest. The implications of the results are discussed for clinical features and the management of patients with severe COVID-19.

Microbiological pattern of prosthetic hip and knee infections: a high-volume, single-centre experience in China

Introduction. Prosthetic joint infection (PJI) is a serious complication after arthroplasty, which results in high morbidity, prolonged treatment and considerable healthcare expenses in the absence of accurate diagnosis. In China, microbiological data on PJIs are still scarce. Hypothesis/Gap Statement. The incidence of PJI is increasing year by year, and the proportion of drug-resistant bacteria infection is nicreasing, which brings severe challenges to the treatment of infection. Aim. This study aimed to identify the pathogens in PJIs, multi-drug resistance, and evaluate the effect of the treatment regimen in patients with PJI. Methodology. A total of 366 consecutive cases of PJI in the hip or knee joint were admitted at the Orthopedic Surgery Center in Zhengzhou, China from January 2012 to December 2018. Infections were confirmed in accordance with the Infectious Diseases Society of America and the Musculoskeletal Infection Society (MSIS) criteria. Concurrently, patient demographic data, incidence and antibiotic resistance were investigated. Statistical differences were analysed using Fisher’s exact test or chi-square test. Results. Altogether, 318 PJI cases satisfying the inclusion criteria were enrolled in this study, including 148 with hip PJIs and 170 with knee PJIs. The average age of patients with hip PJIs was lesser than that of patients with knee PJIs (56.4 vs. 68.6 years). Meanwhile, coagulase-negative staphylococcus (CNS, n=81, 25.5 %) was the predominant causative pathogen, followed by Staphylococcus aureus (n=67, 21.1 %). Methicillin-resistant Staphylococcus (MRS) was identified in 28.9 % of PJI patients. In addition, fungus accounted for 4.8 % (n=15), non-tuberculosis mycobacterium accounted for 1.6 % (n=5), polymicrobial pathogens accounted for 21.7 % (n=69), and Gram-negative bacteria accounted for 7.9 % (n=25) of the total infections. The results of antibiotic susceptibility testing showed that gentamicin and clindamycin β-lactam antibiotics were poorly susceptible to Gram-positive isolates, but they were sensitive to rifampicin, linezolid and vancomycin. While antibiotics such as amikacin and imipenem were effective against Gram-negative bacteria, there was a high resistance rate of other pathogens to gentamicin, clindamycin and some quinolone antibacterial drugs. Empirical antibiotic treatment should combine vancomycin and cephalosporin, levofloxacin or clindamycin. When the pathogen is confirmed, the treatment should be individualized. Conclusions. The prevalence of culture-negative PJIs is still very high. Gram-positive bacteria are still the main type of pathogens that cause PJIs. Attention should be paid to the high incidence of MRS, such as MRSA and MR-CNS, among PJI patients. Empirical antibiotic treatment should cover Gram-positive isolates, especially Staphylococcus .

Effect on 30-day Mortality and Duration of Hospitalization of Empirical Antibiotic Therapy in CRGNB-Infected Pneumonia

PurposeThe objective of this study was to investigate whether unreasonable empirical antibiotic treatment(UEAT) had an impact on 30-day mortality and duration of hospitalization in bacterial pneumonia caused by carbapenem-resistant gram-negative bacteria (CRGNB).MethodsThis was a retrospective study involving CRGNB-infected pneumonia. All patients received empirical and targeted antibiotic treatment. The exposure variable was treated with empirical antibiotic treatment(EAT) within 48 hours of incubation and the outcome was 30-day mortality and duration of hospitalization. Moreover, we also considered other variables that might be relevant and conducted multivariable regression analysis of 30-day mortality and duration of hospitalization.ResultsThe experiment collected 310 cases, the most common bacterium is Acinetobacter baumannii (211/310 [68%]) and the others were Klebsiella pneumoniae(46/310 [15%])、Pseudomonas aeruginosa and others (53/310 [17%]). 76/310 (24.5%) patients received appropriate empirical antibiotic treatment(REAT). In the analysis of risk factors, dementia, unconsciousness were risk factors of 30-day mortality and pulmonary disease, hemodynamic support at culture taken day and recent surgery were risk factors for longer hospital stay. 30-day mortality was 9 of 76(11.84%) with REAT vs 36 of 234 (15.38%) with UEAT (P =0.447), UEAT was not associated with 30-day mortality. On the contrary, there was difference between REAT and UEAT(P=0.023) in the analysis of EAT on hospitalization time.ConclusionsUEAT was not associated with 30-day mortality while was related to duration of hospitalization in CRGNB-infected pneumonia, in which Acinetobacter baumanniii accouned for the majority.

Clinical Features of B. Cereus Sepsis in Premature Neonates

Background: To analyze the clinical characteristics and prognosis of bacillus cereus sepsis in premature neonates.Method: Retrospectively analyze the data of 8 premature neonates of bacillus cereus sepsis in Shanghai Children’s Hospital from January 2015 to December 2019, where clinical information is collected from patients’ medical records and charts, information of neurodevelopment is collected for patients from follow-up visits at corrected age of 6 months and 12 months.Results: 8 premature neonates of bacillus cereus sepsis were identified, among which 5 cases developed meningitis, abnormal Cerebral MRI images were seen in 5 cases. After empirical antibiotic treatment with Meropenem and Vancomycin, 1 patient died, 7 patients survived to discharge. Follow-up visits discovered that 1 patient developed hydrocephalus and showed severely delayed neurodevelopment, 2 patients had mild neurodevelopmental delay, and neurodevelopment was basically normal in other 4 patients. Conclusions: Bacillus cereus infection can cause severe nervous system complications, and affect neurodevelopmental outcome. Empirical antibiotic treatment with Meropenem and Vancomycin is proven effective.