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Dolors Rodríguez-Pardo,
Benito Almirante,
Rosa M Bartolomé,
Virginia Pomar,
Beatriz Mirelis,
Ferran Navarro, Alex Soriano,
Luisa Sorlí,
Joaquín Martínez-Montauti,
Maria Teresa Molins,
Maily Lung,
Jordi Vila,
Albert Pahissa
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ABSTRACT: Objectives: Prospective, hospital-based surveillance for Clostridium difficile-associated disease (CDAD) was conducted in Barcelona (Spain) to describe the epidemiology of this condition and investigate the risk factors for an unfavorable outcome.Methods: All patients diagnosed with CDAD during 2009 were included. Using logistic regression modeling, we analyzed potential risk factors associated with recurrent and complicated CDAD, defined as a colectomy requirement or death within 30 days.Results: There were 365 episodes of CDAD, yielding an incidence of 22.5 cases/105 person-years, 1.22 cases/103 hospital-discharges, and 1.93 cases/104 patient-days. The main ribotypes identified were 241 (26%), 126 (18%), 078 (7%), and 020 (5%). PCR ribotype 027 was not detected. Among 348 cases analyzed, 232 (67%) patients cured, 63 (18%) recurred, and 53 (15%) had complicated CDAD. Predictors of complicated CDAD were continued use antibiotics following CDAD diagnosis (odds ratio [OR], 2.009; 95% confidence interval [CI], 1.012-3.988; P=0.046), Charlson comorbidity index score (OR, 1.265; 95% CI, 1.105-1.449; P=0.001), and age (OR, 1.028; 95% CI, 1.005-1.053; p=0.019). Leukocyte count >15×103 cells/mL (OR 2.277; 95% CI 1.189-4.362; P=0.013), continuation of proton pump inhibitors (PPIs) after CDAD diagnosis (OR 2.168; 95% CI 1.081-4.347; P=0.029), and age (OR 1.021; 95% CI 1.001-1.041; P=0.036) were independently associated with higher odds of recurrence.Conclusions: The incidence of CDAD in Barcelona during 2009 was located at the lower end of the previously described range in Europe. Our analysis suggests that continuation of non-C. difficile antibiotics and PPIs in patients diagnosed with CDAD is associated with unfavorable clinical outcomes.
Journal of clinical microbiology 02/2013; · 4.16 Impact Factor
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Laura Morata,
Marta Cuesta,
Jhon F Rojas,
Sebastian Rodriguez,
Merce Brunet,
Gregori Casals,
Nazareth Cobos,
Cristina Hernandez,
José A Martínez,
Josep Mensa, Alex Soriano
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ABSTRACT: Introduction: Linezolid activity is time-dependent antibiotic and both the percentage of time that plasma concentrations exceed the MIC and AUC(24)/MIC are associated with clinical response. The aim of this study was to analyze linezolid trough plasma concentration (C(min)) and to determine factors associated with a C(min) <2 mg/L and other clinically relevant thresholds.Material and methods: Characteristics of 78 patients receiving 600 mg/12h of linezolid with a C(min) determination at steady state and within the first 10 days of treatment were retrospectively reviewed. Concentration was measured using high-pressure liquid chromatography. Univariate and multivariate analysis were performed to identify risk factors of low C(min).Results: 29.5% of patients had a C(min) <2 mg/L. The percentage was significantly higher in patients with an estimated glomerular filtration (eGF) >80 mL/min., in ICU patients, and with an infection due to S. aureus. The independent predictors of C(min) <2 mg/L were an eGF >80 mL/min. (OR: 10; 95%CI: 2.732-37.037, p=0.001), and infection due to S. aureus (OR: 5.906; 95%CI: 1.651-21.126, p=0.006).Conclusions: A linezolid C(min) <2 mg/L was found in 29.5% of cases, and the risk was significantly higher among those with an eGF >80 ml/min. and in infections due to S. aureus. In patients with severe sepsis, loading dose or continuous infusion and drug monitoring could improve the pharmacodynamic parameters associated with linezolid efficacy.
Antimicrobial Agents and Chemotherapy 02/2013; · 4.84 Impact Factor
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ABSTRACT: Different types of hip spacers have been described (hand-made, custom-molded or prefabricated) for treatment of a chronic hip infection. A potential disadvantage of monoblock prefabricated spacer is that it may cause acetabular bone loss. This study assesses the radiological acetabular erosion using an antibiotic-impregnated pre-fabricated polymethylmethacrylate Spacer-G. We retrospectively reviewed the radiographs of thirty five patients who were managed with Spacer-G to treat chronic hip infection. No acetabular erosion were observed in thirty two patients with a mean time from the first to second stage and from the first to the last radiograph of 5.09 and 3.77months respectively. In three patients the time between the radiographs was more than one year and the second stage was not performed; two developed a protrusion acetabuli whereas the other one a destruction of the acetabular roof. Using a Spacer-G in chronic hip infection treatment for less than one year is not associated with radiological acetabular erosion if the patient is maintained at partial weight bearing.
The Journal of arthroplasty 11/2012; · 1.79 Impact Factor
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ABSTRACT: Purposes: To evaluate the specific characteristics, outcome, and predictors of failure of prosthetic joint infections (PJI) due to S. aureus and coagulase-negative staphylococci (CNS) treated with open debridement and retention of the implant. Methods: PJI due to S. aureus or CNS prospectively registered in a database from 1999 to 2009 were retrospectively reviewed. During the study period, 106 patients met the inclusion criteria. The mean follow-up period was 3.8 years and for at least 2 years in all patients. The failure rate was 23.6% (25 out of 106). The only variable significantly associated with failure in the global cohort was polymicrobial infection (38.7% vs. 17.3%, p = 0.024). Fifty-seven (53.8%) patients had an infection due to S. aureus and 49 (46.2%) due to CNS. Among S. aureus infections, 95% corresponded to primary arthroplasties while 98% of PJIs due to CNS were after revision arthroplasties (p<0.001). C-reactive protein was significantly higher in PJI due to S. aureus (9.5 mg/dl vs. 4.9 mg/dl, p = 0.007). The rate of methicillin-resistance (8.8% vs. 59.2%, p<0.001) and fluoroquinolone-resistance (15.8% vs. 34.7%, p = 0.005) was significantly higher in CNS infections. The global failure rate was higher in S. aureus infections (28% vs. 18.3. p = 0.26). In S. aureus infections, patients diagnosed within the first 15 days after joint arthroplasty (p = 0.031) and with bacteremia (p = 0.046) had poor pro-gnosis. In CNS infections only the location of the prosthesis (knee 27.6% vs. hip 5%, p = 0.045) was associated with failure. Conclusions: PJIs due to S. aureus were mainly in primary arthroplasties; they had a higher inflammatory response; and the strains were more susceptible to fluoroquinolones and methicillin than CNS infections. S. aureus infections had a higher failure rate than CNS infections, however, the difference was not statistically significant. There were few factors associated with failure and they were different in S. aureus and CNS infections.
The International journal of artificial organs 10/2012; · 1.86 Impact Factor
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ABSTRACT: Purposes: To evaluate the long-term outcome (at least 4 years) of patients who underwent a surgical debridement due to an acute prosthetic joint infection (PJI) and to compare them with a control group that did not have an acute septic complication.Methods: From January 1999 to December 2007, 61 patients with an acute PJI in remission after 2 years of follow-up (cases) were retrospectively reviewed and compared with a control group (2:1) without an acute PJI matched by age, year of arthroplasty, and type of prosthesis. Septic and aseptic complications of each group were gathered and compared using a chi-square test. A two-tailed p value <0.05 was considered statistically significant.Results: Out of 183 patients, 4 cases and 2 controls were excluded due to death or lost to follow up; 113 (63.8%) were females and 109 (61.5%) had a knee replacement. The mean age and time of followup were 68.3 and 6.4 years, respectively. There were no statistically significant differences between cases and controls in the percentage of late septic or aseptic loosening. However, the late relapse rate in patients with acute PJI caused by S. aureus, was 12.5% (2 out of 16) and there was a trend towards significance when compared with the rest of the cohort (3.3%, p = 0.09). Aseptic late complications were more frequent in GN-cases (10.7%) than in the other groups (3.4% in GP-cases and 5% in controls) but this difference was not statistically significant (p = 0.19).Conclusions: In conclusion, although analyzing all late complications together, patients with an acute PJI have a similar long-term outcome in comparison with controls; patients with an acute PJI due to S. aureus had a higher late relapse rate; and GN-cases developed an aseptic loosening more frequently. In the future, it is necessary to evaluate larger series to confirm our results.
The International journal of artificial organs 10/2012; · 1.86 Impact Factor
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ABSTRACT: This study aimed to prospectively evaluate the usefulness of PET/CT using F-FDG in comparison to bone scan and Ga in the diagnosis of spondylodiskitis.
This prospective study included 34 patients (15 women and 19 men) aged 59 (18) years with clinical symptoms of spondylodiskitis. Whole-body PET/CT and bone scan combined with planar and SPECT/CT Ga was performed in all patients. Diagnosis of spondylodiskitis was made by microbiology and/or on the basis of clinical and laboratory findings and imaging follow-up.
Spondylodiskitis was confirmed in 18 of 34 patients. In the other 16 patients, spondylodiskitis was finally excluded, and the most frequent findings observed were degenerative spondyloarthropathy (n = 7), vertebral fracture (n = 3), endocarditis (n = 2), and other processes (n = 4). The sensitivity and specificity of combined bone scan and Ga were 78% and 81%, with a positive predictive value of 82%, a negative predictive value of 76%, and an overall accuracy of 79%. SPECT/CT with Ga helped identify soft tissue involvement in 10 of 18 patients. The sensitivity and specificity of PET/CT were 89% and 88%, with a positive predictive value of 89%, a negative predictive value of 87%, and an overall accuracy of 88%. Concordance between Ga and PET/CT was good (κ = 0.71; 95% confidence interval, 0.48-0.94). PET/CT was able to detect soft tissue involvement in 12 of 18 patients. In 2 patients, a multifocality was found, which was only diagnosed by PET/CT.
PET/CT is useful in the diagnosis of spondylodiskitis, with more accurate results than combined bone scan and Ga. SPECT/CT with Ga is recommended, especially when planar bone scan and Ga pattern is suggestive of spondylodiskitis.
Clinical nuclear medicine 09/2012; 37(9):827-32. · 3.92 Impact Factor
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ABSTRACT: Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are increasing. The aim of our study was to evaluate the influences of appropriate empirical antibiotic therapy and multidrug resistance on mortality in patients with bacteremia due to P. aeruginosa (PAB). Episodes of PAB were prospectively registered from 2000 to 2008. MDR was considered when the strain was resistant to ≥3 antipseudomonal antibiotics. Univariate and multivariate analyses were performed. A total of 709 episodes of PAB were studied. MDR PAB (n = 127 [17.9%]) was more frequently nosocomial and associated with longer hospitalization, bladder catheter use, steroid and antibiotic therapy, receipt of inappropriate empirical antibiotic therapy, and a higher mortality. Factors independently associated with mortality were age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002 to 1.033), shock (OR, 6.6; 95% CI, 4 to 10.8), cirrhosis (OR, 3.3; 95% CI, 1.4 to 7.6), intermediate-risk sources (OR, 2.5; 95% CI, 1.4 to 4.3) or high-risk sources (OR, 7.3; 95% CI, 4.1 to 12.9), and inappropriate empirical therapy (OR, 2.1; 95% CI, 1.3 to 3.5). To analyze the interaction between empirical therapy and MDR, a variable combining both was introduced in the multivariate analysis. Inappropriate therapy was significantly associated with higher mortality regardless of the susceptibility pattern, and there was a trend toward higher mortality in patients receiving appropriate therapy for MDR than in those appropriately treated for non-MDR strains (OR, 2.2; 95% CI, 0.9 to 5.4). In 47.9% of MDR PAB episodes, appropriate therapy consisted of monotherapy with amikacin. In conclusion, MDR PAB is associated with a higher mortality than non-MDR PAB. This may be related to a higher rate of inappropriate empirical therapy and probably also to amikacin as frequently the only appropriate empirical therapy given to patients with MDR PAB.
Antimicrobial Agents and Chemotherapy 07/2012; 56(9):4833-7. · 4.84 Impact Factor
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Journal of Antimicrobial Chemotherapy 03/2012; · 5.07 Impact Factor
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ABSTRACT: To review patients with a hematogenous and early post-surgical prosthetic joint infection (PJI) due to S. aureus treated with debridement and retention of the implant and to compare their clinical characteristics and outcome.
From January 2000 all patients with a prosthetic joint infection treated in a single-center were prospectively registered and followed-up. All potentially variables associated with outcome were recorded. For the present study, cases with a hematogenous or early post-surgical PJI due to S. aureus treated with debridement and at least 2 years of follow-up were reviewed. Cox regression model to identify factors associated with outcome were applied.
12 hematogenous and 53 early post-surgical PJI due to S. aureus were included. Number of patients presenting with fever, leucocyte count, C-reactive protein concentration, and the number of bacteremic patients were significantly higher in hematogenous infections while the number of polymicrobial infections was lower in hematogenous than in early post-surgical infections. The global failure rate in hematogenous and early post-surgical PJI was 58.7% and 24.5%, respectively (p=0.02). The Cox regression model identified hematogenous infections (OR: 2.57, CI95%: 1.02-6.51, p=0.04) and the need of a second debridement (OR: 4.61, CI95%: 1.86-11.4, p=0.001) as independent predictors of failure.
Hematogenous infections were monomicrobial and had more severe symptoms and signs of infection than early post-surgical PJI. Hematogenous PJI due to S. aureus, using debridement with implant retention, had a worse outcome than early post-surgical infections.
The International journal of artificial organs 11/2011; 34(9):863-9. · 1.86 Impact Factor
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ABSTRACT: To evaluate the relationship between intraoperative cultures during hip arthroplasty, the different patient characteristics, and the risk of developing a prosthetic joint infection (PJI).
A prospective observational study was performed. Patients who underwent elective THA from March 2007 to March of 2011 were included. Three samples were taken just after arthrotomy: synovial fluid inoculated into blood culture flasks (SF), a tissue sample (TS), and a swab of peri- prosthetic tissue (S). Patients received standard antibiotic prophylaxis. The PJI rate within the first 3 months after arthroplasty was recorded.
402 prostheses were included in the study. Contamination rate of synovial fluid was 10.2%. The most frequent isolated microorganism was coagulase-negative staphylococci (CoNS) (32 out of 41). Body mass index (BMI) was the only host characteristic associated with positive intraoperative culture (p=0.009). The PJI rate was 3.7%. Variables associated with PJI in the univariate and multivariate analysis were: age =67 years (p=0.012 OR: 5.35 (1.45-19.81); CI95%) and a BMI =35 (p=0.002, OR: 7.7 (2.12-27.85) CI95%). PJI rate among patients with BMI<35 with negative and positive intraoperative cultures was 3% and 2.7%, respectively, however, the rate among patients with BMI = 35 was 15% and 25%, respectively.
A BMI =35 was associated with a higher risk of positive intraoperative culture during hip arthroplasty. In addition, a BMI ≥35 was independently associated with a high risk of PJI and the highest rate was documented among obese patients with positive intraoperative cultures.
The International journal of artificial organs 11/2011; 34(9):870-5. · 1.86 Impact Factor
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ABSTRACT: To assess the potential relationship between preoperative nutritional status, including anthropometric parameters, and infection following total knee replacement surgery.
A total of 213 patients undergoing total knee replacement between December 2007 and May 2008 were prospectively studied. Patients with rheumatoid arthritis were excluded. For each patient we pre-operatively checked biochemical and anthropometric parameters of nutrition information about co-morbidities such as diabetes and high blood pressure, ASA score, age, and gender. Information about early infections, both superficial and deep, was collected. A descriptive statistical analysis and univariate/multivariate logistic regression model for risk factors were performed.
Eleven patients (5.16%) had an infection, 5 deep and 6 superficial. Neither co-morbidities nor preoperatively biochemical parameters were associated with infection. However, in the univariate logistic regression model there was an inversely proportional relationship between triceps skinfold (TSF) and infection. After adjusting for age, ASA score and gender (multivariate logistic regression), TSF remained significantly associated with infection.
There was a statistically significant association between TSF and post-operative infection risk after TKR.
Level I (Prospective prognostic study).
The International journal of artificial organs 11/2011; 34(9):876-81. · 1.86 Impact Factor
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Clinical Infectious Diseases 07/2011; 53(1):10-2. · 9.15 Impact Factor
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ABSTRACT: Gram-positive microorganisms have been the predominant pathogens in central venous catheter-related bloodstream infections (CRBSIs). Recent guidelines recommend empirical therapy according to this and restrict coverage for Gram-negatives to specific circumstances. This study aimed to analyse the epidemiological changes in CRBSIs over the 1991-2008 period and to analyse predictors of Gram-negative CRBSIs.
A prospectively collected cohort of patients with confirmed CRBSIs was analysed. Strains isolated and antimicrobial susceptibility, as well as clinical and demographic variables were recorded. Differences observed during the study period were analysed by means of a χ² trend test and factors associated with Gram-negative CRBSIs by means of multivariable analysis.
Between 1991 and 2008, 1129 episodes of monomicrobial CRBSIs were recorded. There was an increase in the incidence of CRBSIs, from 0.10 (1991-92) to 0.31 (2007-08) episodes/1000 patient-days. A significant increase in the number of Gram-negative strains among the total isolates was also found, from 3 (4.7%) in 1991-92 to 70 (40.23%) in 2007-08, with a parallel decrease in the percentage of Gram-positives. Solid organ transplantation, prior use of penicillins and hospital stay longer than 11 days were independently associated with a significantly higher risk of Gram-negative CRBSIs, while cirrhosis, diabetes and use of quinolones were associated with a higher risk of Gram-positives.
Gram-negative strains are an increasing cause of CRBSIs, reaching a prevalence of 40% in the 2007-08 period in our hospital. If this trend is confirmed in other centres, a broad-spectrum empirical therapy should be considered in managing these infections.
Journal of Antimicrobial Chemotherapy 06/2011; 66(9):2119-25. · 5.07 Impact Factor
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Josep M Sierra,
Sebastián García,
Juan C Martínez-Pastor,
Xavier Tomás,
Xavier Gallart,
Jordi Vila,
Guillem Bori,
Francisco Maculé,
Josep Mensa,
Josep Riba, Alex Soriano
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ABSTRACT: The pathogenesis of prosthesis loosening is not well understood. The aim of our study was to sonicate components of joint prostheses removed due to aseptic loosening, culture the sonicate fluid, and to correlate these results with the degree of radiological osteolysis.
From January 2008 to June 2009 all consecutive patients who underwent a revision of hip or knee prosthesis due to aseptic loosening were included in the study. Aseptic loosening was established when the patient had radiological signs of loosening without symptoms or signs of infection. The diagnosis was confirmed when histology was negative, and ≥ 5 out of 6 standard cultures of periprosthetic tissue were negative. Bone lysis was measured according to the Paprosky or Engh classifications without knowing the result of sonication cultures. Removed components were placed in sterile bags and immediately transported to the microbiology laboratory and sonicated. Sonicate fluid was cultured and the results were correlated with the degree of bone lysis. The proportion of components with positive sonication culture according to the bone lysis classification was compared using χ(2) test.
A total of 52 patients were included and 123 components were sonicated. In 30 patients at least 1 sonicated component was positive (57.7%) and 44 out of 123 (35.8%) components were positive. The proportion of positive sonication cultures was significantly higher in the group of components with a higher degree of bone lysis of 3 (76.5%) than in those with lower degrees (33.9% for 1 and 24% for 2) (χ(2) test, p = 0.0004).
Sonication cultures were positive in 57% of patients who underwent revision arthroplasty for aseptic loosening. The percentage of positive sonication cultures was significantly higher in patients with severe osteolysis.
level I of Prognostic Studies-Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
Archives of Orthopaedic and Trauma Surgery 05/2011; 131(10):1357-61. · 1.37 Impact Factor
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ABSTRACT: The objective of our study was to study which is the most accurate specimen for histological diagnosis of prosthetic joint infections (pseudocapsule or interface membrane). This is a prospective study including hip revision arthroplasties performed from January 2007 to June 2009. Specimens from pseudocapsule and from interface membrane were obtained from each patient. The histology was considered positive for infection when ≥5 neutrophils per high-power field ( × 40) were found. Definitive diagnosis of infection was considered when ≥2 cultures were positive for the same microorganism. According to the definition of infection, patients were classified in two groups: (A) patients with aseptic loosening in whom cultures obtained during surgery were negative and (B) patients with prosthetic joint infection. A total of 69 revisions were included in the study; 57 were classified in group A and 12 in group B. In group B, the percentage of positive interface membrane histology was significantly higher than the percentage of positive pseudocapsule histology (83 vs 42%, P=0.04, Fisher's exact test). The results suggest that periprosthetic interface membrane is the best specimen for the histological diagnosis of prosthetic joint infection.
Modern Pathology 12/2010; 24(4):579-84. · 4.79 Impact Factor
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ABSTRACT: Prosthetic joint infection (PJI) after femoral neck fracture is associated with a higher mortality, morbidity and economic costs. Although is well known that the presence of a post surgical haematoma is associated with infection, in our knowledge there are no articles evaluating the contamination of the femoral neck fracture haematoma and the possible relationship with early postoperative PJI. The aim of our study was to evaluate the prevalence of positive cultures from haematoma in patients with femoral neck fracture and the relationship with early PJI.
A prospective observational study was performed. All patients who underwent hiphemiarthroplasty for a femoral neck fracture from April'08 to February'09 were included. Three samples were taken just after the arthrotomy, a tissue sample, a swab of haematoma and blood of haematoma inoculated into blood culture flasks. Patients received the standard prophylaxis.
A total of 109 patients were treated during this period in our center, 16 were excluded for mistakes during taking samples or for receiving extra antibiotic treatment after or before the surgery of the fracture. In 29 patients (31.2%) one or more intraoperative cultures were positive. Four patients developed an early PJI caused by Gram-negative bacilli (GNB) in all cases. The early PJI rate in the group of patients with negative intraopertive cultures was 3.1% while in the group with one or more positive cultures was 6.9% (p = 0.3). In 3 cases the haematoma was contaminated with a GNB. The PJI rate inpatients with intraoperative cultures positive for a GNB was 66.6% (2/3) while in the group of patients without a GNB the infection rate was 2.2% (2/89, p = 0.004, Fisher exact-test). Furthermore in these two patients the microorganism that caused the PJI was the same that had been isolated from the haematoma.
The haematoma in femoral neck fractures was contaminated in 31.2% of cases before surgery. The contamination of the haematoma with a GNB was associated with a higher risk of early postoperative PJI.
Injury 10/2010; 42(2):200-3. · 1.98 Impact Factor
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ABSTRACT: To evaluate the usefulness of 99Tc-ciprofloxacin scintigraphy (CFS) in patients with hip or knee arthroplasty and suspected infection.
Forty patients (26 women, 14 men) with a mean age of 66±10 years and local pain in the hip (21), knee (16), or shoulder (three) prosthesis were recruited. CFS was performed at 1, 4, and 24 h after intravenous injection of 370 MBq. Anterior and posterior views centered on the affected joint were performed in all patients. A routine bone scan, 99Tc-hexamethylpropyleneamine oxime leukocyte scan, and 99Tc-colloid scan [leukocyte scintigraphy-bone marrow scintigraphy (LS-MS)] were performed. Final diagnosis of infection was confirmed by positive microbiological analysis or macroscopic evidence of purulent material.
Diagnosis of arthroplasty infection was established in 16 out 40 cases: coagulase-negative staphylococci (nine), Staphylococcus aureus (three), Enterococcus (one), and macroscopic infection in the remaining three cases. CFS imaging showed the 24-h image to be the best acquisition time-point. The sensitivity, specificity, negative predictive value, and positive predictive value for LS-MS were 75, 92, 86, and 85%, whereas for CFS at 24 h these figures were 88, 71, 67, and 89%. The sensitivity and specificity for LS-MS and for CFS at 24 h for hip were (74, 90, and 88, 85%) and for knee (83, 90 and 100, 50%).
CFS can be useful in the diagnosis of arthroplasty infection of the hip as a substitute for LS-MS. It is recommended that CFS images be obtained 24 h after injection. The lack of specificity of CFS makes this technique inadequate for knee prostheses in this series.
Nuclear Medicine Communications 10/2010; 32(1):44-51. · 1.40 Impact Factor
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Xavier Tomas,
Guillem Bori,
Sebastián Garcia,
Ana Isabel Garcia-Diez,
Jaime Pomes, Alex Soriano,
Jose Ríos,
Manel Almela,
Josep Mensa,
Xavier Gallart,
Juan Carlos Martinez,
Josep Riba
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ABSTRACT: To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery.
Sixty-three patients (35 women and 28 men; age range, 29-86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients.
Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P=0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher's exact test, the presence of periprosthetic fluid collections (P=0.001), prosthetic acetabular malposition (P=0.025) and aspirated fluid volume (P=0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P=0.429).
Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis.
Skeletal Radiology 05/2010; 40(1):57-64. · 1.54 Impact Factor
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ABSTRACT: Identifying the etiologic microorganism is essential to guide antimicrobial therapy in prosthetic joint infection.
We (1) compared the frequency of positive cultures with synovial fluid inoculated in blood culture flasks (SF) with those of periprosthetic tissues or swabs in traditional cultures from patients with acute and chronic prosthetic joint infections (PJI) and (2) determined the sensitivity, specificity, and predictive values of the three methods.
We retrospectively reviewed 87 patients with PJIs (54 knees, 33 hips) and 63 patients with aseptic loosening (34 knees, 29 hips). Two SF, periprosthetic tissue, and swab samples were taken for culture in all 150 patients except for 14 in whom only one SF fluid sample was obtained. Synovial fluid was inoculated in blood culture flasks and periprosthetic tissue and swab samples in standard media. Positive cultures were identified with standard biochemical procedures.
SF samples were positive in 78 of 87 infected cases (90%), periprosthetic tissue samples were positive in 71 (82%), and swab samples were positive in 59 (68%). SF, periprosthetic tissue, and swab samples were positive more frequently in acute than in chronic infections (96% versus 82% for SF, 87% versus 74% for periprosthetic tissue, and 87% versus 44% for swabs). The sensitivity, specificity, and positive and negative predictive values of SF were 91, 100, 100, and 93 for acute infections and 79, 100, 100, and 88 for chronic infections, respectively.
SF samples cultured in flasks had higher sensitivity, specificity, and positive and negative predictive values for diagnosis of PJI when compared with standard tissue and swab samples. The usefulness of all samples was less in chronic than in acute infections.
Level II, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 02/2010; 468(8):2238-43. · 2.53 Impact Factor
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ABSTRACT: The aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJIs) due to gram-negative bacilli (GNB) treated without implant removal. Patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, comorbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy, and outcome were recorded. Classification and regression tree analysis, the Kaplan-Meier survival method, and the Cox regression model were applied. Forty-seven patients were included. The mean age was 70.7 years, and there were 15 hip prostheses and 32 knee prostheses. The median number of days from the time of arthroplasty was 20. The most frequent pathogens were members of the Enterobacteriaceae family in 41 cases and Pseudomonas spp. in 20 cases. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin. The median durations of intravenous and oral antibiotic treatment were 14 and 64 days, respectively. A total of 35 (74.5%) patients were in remission after a median follow-up of 463 days (interquartile range, 344 to 704) days. By use of the Kaplan-Meier survival curve, a C-reactive protein (CRP) concentration of < or = 15 mg/dl (P = 0.03) and receipt of a fluoroquinolone, when all GNB isolated were susceptible (P = 0.0009), were associated with a better outcome. By use of a Cox regression model, a CRP concentration of < or = 15 mg/dl (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.05 to 12.5; P = 0.043) and receipt of a fluoroquinolone (OR, 9.09; 95% CI, 1.96 to 50; P = 0.005) were independently associated with better outcomes. Open debridement without removal of the implant had a success rate of 74.5%, and the factors associated with good prognosis were a CRP concentration at the time of diagnosis < or = 15 mg/dl and treatment with a fluoroquinolone.
Antimicrobial Agents and Chemotherapy 08/2009; 53(11):4772-7. · 4.84 Impact Factor
