Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection

The objective of this study was to evaluate our preliminary results after changing our surgical strategy from 2-stage revision arthroplasty to 1-stage revision arthroplasty for patients with chronic knee periprosthetic joint infection. We conducted a prospective study of knee arthroplasty patients that had been diagnosed with chronic infection and treated using a 1-stage revision regardless of the traditional criteria applied for indication thereof. We evaluated two main variables: infection control and economic costs. The definitive diagnosis of infection of the revision was determined by using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated as average costs in USD, as described by Srivastava (2019), for 1-stage or 2-stage revisions. Eighteen patients were included in the study, and infection was controlled in 17 patients. The total economic savings for our hospital from these 18 patients amounted to USD 291,152. This clinical success has led to major changes in how our hospital approaches the treatment of chronically infected knee replacements, in addition to substantial economic advantages for the hospital.

Nucleic Acids Analytical Methods for Viral Infection Diagnosis: State-of-the-Art and Future Perspectives

The analysis of viral nucleic acids (NA), DNA or RNA, is a crucial issue in the diagnosis of infections and the treatment and prevention of related human diseases. Conventional nucleic acid tests (NATs) require multistep approaches starting from the purification of the pathogen genetic material in biological samples to the end of its detection, basically performed by the consolidated polymerase chain reaction (PCR), by the use of specialized instruments and dedicated laboratories. However, since the current NATs are too constraining and time and cost consuming, the research is evolving towards more integrated, decentralized, user-friendly, and low-cost methods. These will allow the implementation of massive diagnoses addressing the growing demand of fast and accurate viral analysis facing such global alerts as the pandemic of coronavirus disease of the recent period. Silicon-based technology and microfluidics, in this sense, brought an important step up, leading to the introduction of the genetic point-of-care (PoC) systems. This review goes through the evolution of the analytical methods for the viral NA diagnosis of infection diseases, highlighting both advantages and drawbacks of the innovative emerging technologies versus the conventional approaches.

Diagnostic Challenges in Sepsis

Purpose of Review Sepsis is a leading cause of death worldwide. Groundbreaking international collaborative efforts have culminated in the widely accepted surviving sepsis guidelines, with iterative improvements in management strategies and definitions providing important advances in care for patients. Key to the diagnosis of sepsis is identification of infection, and whilst the diagnostic criteria for sepsis is now clear, the diagnosis of infection remains a challenge and there is often discordance between clinician assessments for infection. Recent Findings We review the utility of common biochemical, microbiological and radiological tools employed by clinicians to diagnose infection and explore the difficulty of making a diagnosis of infection in severe inflammatory states through illustrative case reports. Finally, we discuss some of the novel and emerging approaches in diagnosis of infection and sepsis. Summary While prompt diagnosis and treatment of sepsis is essential to improve outcomes in sepsis, there remains no single tool to reliably identify or exclude infection. This contributes to unnecessary antimicrobial use that is harmful to individuals and populations. There is therefore a pressing need for novel solutions. Machine learning approaches using multiple diagnostic and clinical inputs may offer a potential solution but as yet these approaches remain experimental.

Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis?

The diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with “old” biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.

Prevalence urinary tract infections in newborns of Baghdad hospital

In the neonatal period, urinary tract infection sepsis and urinary system It is an important clinical problem because it can be associated with congenital anomalies. The aim was determine the prevalence of UTI and the causative agent in neonates with their antibiotics sensitivity patterns. This study was planned as cross-sectional study. urinary tract at a 4-year time interval in a primary neonatal unit. It was performed on newborns who were hospitalized with the diagnosis of infection. patient data It was obtained retrospectively from patient files. Prior hospitalization, urinary catheterization, premature birth and urinary Newborns with multipathogen growth in their culture were not included in the study. for study Consent was obtained from the local ethics committee. Urinary tract infection, urine sample taken by bladder catheterization 10000-50000 CFU/ml colony count or pyuria in the presence of pyuria in the culture Colony count of ≥50000 CFU/ml in the absence of microorganism was defined as growth. Gender of the patients, weeks of gestation, mode of delivery, birth weight, urinary tract postnatal days of diagnosis of infection. The difference and relationships between the obtained data were statistically evaluated. In the present study, 186 urine specimens from neonates with UTI, 110(59.13%) were positive for bacterial culture. In addition 100 specimens from healthy neonates (control) included in the present study, only 8 (8%) were positive for bacterial culture The study showed that, E. coli were the most isolated bacteria According to the distribution of the isolated bacteria among the study groups, K. pneumoniae is the second, S. aureus and P. mirabilis the least isolated bacteria from neonates, The study showed that majority of neonates with UTI were females (65.45%) and 34.55% were males, The study demonstrated that, most cases suffered from dysuria due to UTI and 27.27% suffered from fever, The research indicated that, S. aureus showed high rate of sensitivity to ciprofloxacin and oxacillin (88.23%) and resistant to ampicillin and lincomycin. S. saprophyticus showed were sensitive to cephalothin, ciprofloxacin, oxacillin and lincomycin and complete resistant to ampicillin, erythromycin and amikacin. Streptococcus faecalis showed 100% sensitivity to oxacillin while it was resistant to ciprofloxacin, ampicillin, erythromycin and amikacin. E. coli isoaltes were 53 sensitive to to ceftazidim and resistant to oxacillin and lincomycin . K. pneumoniae were sensitive to amoxiclave and resistant to ampicillin, tetracycline, erythromycin, oxacillin and lincomycin. Proteus mirabilis was sensitive to cefotaxim and it was resistant to erythromycin, ampicillin, oxacillin and lincomycin. Proteus vulgaris showed high sensitivity rate to nirtrofurontoin, cefotaxim (92.85%) and low rate of sensitivity to erythromycin (Figure 4.8). Pseudomonas aeroginosae showed high sensitivity rate to cefotaxim (86.66% ) and low rate of sensitivity (20%) to ampicillin.

Role of Nucleocapsid Protein Antigen Detection for Safe End of Isolation of SARS-CoV-2 Infected Patients with Long Persistence of Viral RNA in Respiratory Samples

Background. In SARS-CoV-2 infection, viral RNA may persist in respiratory samples for several weeks after the resolution of symptoms. Criteria to assess the end of infectivity are not unequivocally defined. In some countries, time from diagnosis is the unique criterion used, in addition to symptom cessation. This study evaluates the role of the Lumipulse® Antigen Assay (LAA) for the safe end of isolation of patients ≥21 days after the diagnosis of infection. Methods. A total of 671 nasopharyngeal swabs from patients diagnosed with infection at least 21 days before were assessed by RT-PCR and LAA, and the role of LAA in predicting the absence of infectivity was evaluated by virus cell culture. Results. Viable virus was present in 10/138 cultured samples. Eight out of ten infective patients suffered from a concomitant disease, predisposing them to long-term shedding of infective virus. In particular, infectious virus was isolated from 10/20 RT-PCR+/LAA+ cultured samples, whereas no viable virus was found in all 118 RT-PCR+/LAA– cultured swabs. LLA and RT-PCR agreed in 484/671 (72.1%) samples, with 100% and 26.7% concordance in RT-PCR negative and positive samples, respectively. Conclusions. Viable virus can be found ≥21 days after diagnosis in immunocompromised or severely ill patients. LAA better than RT-PCR predicts non-infectivity of patients and can be safely used to end isolation in cases with long persistence of viral RNA in the respiratory tract.

Diagnosis of infection after cardiovascular surgery (DICS): a study protocol for developing and validating a prediction model in prospective observational study

IntroductionPostoperative infection (PI) is one of the main severe complications after cardiovascular surgery. Therefore, antibiotics are routinely used during the first 48 hours after cardiovascular surgery. However, there is no effective method for early diagnosis of infection after cardiovascular surgery, particularly, to determine whether postoperative patients need to prolong the use of antibiotics after the first 48 hours. In this study, we aim to develop and validate a diagnostic model to help identify whether a patient has been infected after surgery and guide the appropriate use of antibiotics.Methods and analysisIn this prospective study, we will develop and validate a diagnostic model to determine whether the patient has a bacterial infection within 48 hours after cardiovascular surgery. Baseline data will be collected through the electronic medical record system. A total of 2700 participants will be recruited (n=2000 for development, n=700 for validation). The primary outcome of the study is the newly PI during the first 48 hours after cardiovascular surgery. Logistic regression penalised with elastic net regularisation will be used for model development and bootstrap and k-fold cross-validation aggregation will be performed for internal validation. The derived model will be also externally validated in patients who are continuously included in another time period (N=700). We will evaluate the calibration and differentiation performance of the model by Hosmer-Lemeshow good of fit test and the area under the curve, respectively. We will report sensitivity, specificity, positive predictive value and negative predictive value in the validation data-set, with a target of 80% sensitivity.Ethics and disseminationEthical approval was obtained from Medical Ethics Committee of Affiliated Nanjing Drum Tower Hospital, Nanjing University Medical College (2020-249-01).Trial registration numberChinese Clinical Trial Register (www.chictr.org.cn, ChiCTR2000038762); Pre-results.

CHARACTERISTICS OF USING 3RD AND 4TH GENERATION CEPHALOSPORIN AT THONG NHAT HOSPITAL

Objective: Describing characteristics of using 3rd and 4th generation Cephalosporin antibiotics at Thong Nhat Hospital in the period of 2019 - 2020.Subjects and methods: cross-sectional descriptive study on 158 medical records of patients discharged from hospital from February 20th, 2020 to February 24th, 2020 (5 days) was kept at themedical records store, Department of general planning, Thong Nhat hospital.Results: The majority of patients had no diagnosis of infection but had signs of infection, accounting for 69.92%. Duration of C3G/C4G antibiotic treatment of group with signs of infection was 9.22± 2.79 days. Cefotaxim was used the most, accounting for 26.58%. The majority of indications for the use of antibiotics C3G/C4G for patients were appropriate or partly appropriate, accounting for 74.05%. Efficiency of using appropriate or partially appropriate antibiotics had achieved high results, accounting for 39.24%. Most of the cases diagnosed or showed signs of infection after using antibiotics C3G/C4G obtained treatment efficacy, accounting for 75%. The majority of patients using C3G/C4G antibiotics achieved effectiveness in preventing wound infection in the patient with no signs of infection, accounting for 77.78%. The rate of elevated liver enzyme was 7.59%, the rate of thrombocytopenia was 3.16%.Conclusion: Duration of C3G/C4G antibiotic treatment of group with signs of infection was 9.22 ± 2.79 days. Cefotaxim were used the most. Most of indications to use antibiotics C3G/C4G were appropriate or partially appropriate. Efficiency of using appropriate or partially appropriate antibiotics had achieved high results. The rate of elevated liver enzyme was 7.59%, the rate of thrombocytopenia was 3.16%.