Ilker Uçkay

University of Melbourne, Melbourne, Victoria, Australia

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Publications (173)

  • Dan Lebowitz · Benjamin Kressmann · Shpresa Gjoni · [...] · Ilker Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe. By multivariate analysis, the presence of fracture fixation plates was the variable most strongly associated with anaerobic infection (odds ratio: 2.1, 95% CI: 1.3–3.5). Anaerobes were also associated with spondylodesis and polymicrobial infections. In contrast, it revealed less likely in native bone or prosthetic joint infections and was not related to prior antibiotic use. In conclusion, obligate anaerobes in our case series of orthopaedic infections were rare, and mostly encountered in infections related to trauma with open-fracture fixation devices rather than clean surgical site infection. Anaerobes were often co-pathogens, and cultures most frequently recovered P. acnes. These observations thus do not support changes in current practices such as broader anaerobe coverage for perioperative prophylaxis.
    Article · Aug 2016
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    Parham Sendi · Ilker Uckay · Domizio Suva · [...] · Martin Clauss
    [Show abstract] [Hide abstract] ABSTRACT: In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group ‘Infection’ of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints.
    Full-text Article · Jul 2016
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Empiric therapy of methicillin-susceptible Staphylococcus aureus (MSSA) with vancomycin is associated with poorer outcome than targeted therapy with beta-lactams. Our objective was to evaluate if rapid determination of methicillin resistance shortens the time from Gram stain to targeted antimicrobial therapy in staphylococcal bacteraemia, thereby reducing vancomycin overuse. Methods: Single-center open parallel RCT. Gram positive cocci in clusters positive blood culture underwent real-time PCR for rapid species and methicillin resistance determination parallel to conventional microbiology. Patients were randomized 1:1 so that clinicians would be informed of PCR results (intervention group) or not (control group). Results: 89 patients (intervention 48, control 41) were analysed. MRSA was identified in 7 patients, MSSA in 46 and CoNS in 36. PCR results were highly concordant (87/89) with standard microbiology. Median time (hours) from Gram stain to transmission of methicillin-susceptibility was 3.9 (2.8-4.3) vs. 25.4 (24.4-26-7) in intervention vs. control groups (p< 0.001). Median time (hours) from Gram stain to targeted treatment was similar for "all staphylococci" [6 (3.8-10) vs. 8 (1-36) p = 0.13] but shorter in intervention group when considering S. aureus only [5 (3-7) vs. 25.5 (3.8-54) p<0.001]. When standard susceptibility testing complete, 41/48 (85.4%) patients in intervention group were already receiving targeted therapy compared to 23/41 (56.1%) in control group (p=0.004). There was no significant effect on clinical outcomes. Conclusions: Rapid determination of methicillin resistance in staphylococcal bacteraemia is accurate and reduces significantly the time to targeted antibiotic therapy in the subgroup of S. aureus, thereby avoiding unnecessary exposure to vancomycin.
    Article · Jul 2016 · Clinical Microbiology and Infection
  • Julien Billières · Ilker Uçkay · Antonio Faundez · [...] · Guillaume Racloz
    Article · Jun 2016 · International Journal of Spine Surgery
  • M.-C. Zanella · B. Kressmann · L. Wuarin · [...] · I. Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: In diabetic patients, foot ulcer is a common problem which prevalence during life is about 25 %. Infection occurs as a complication in almost 50 % of cases, is associated with significant morbidity and a reduced quality of life and is sometimes the trigger leading to amputation. Ulcers and infections occur among patients with predisposing factors such as peripheral neuropathy and arterial insufficiency, and require a multi-disciplinary care system. The knowledge of the microbiology of diabetic foot infection is necessary for a wise use of empirical and targeted antibiotic therapy. This article will focus on the definition and diagnosis of diabetic foot infection, on the main aspects of its microbiology and antibiotic treatment.
    Article · Apr 2016
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    [Show abstract] [Hide abstract] ABSTRACT: Background: Data on long-term effects of interventions in infection control are scarce. We aimed to evaluate the 8-year sustainability of a successful intervention to reduce urinary tract infections (UTIs) through restriction of urinary catheter (UC) use in an orthopedic surgical population. Methods: Prospective UTI surveillance from November 2009-January 2010 was conducted to compare the results against the 2-year sustainability assessment performed in 2004. Semistructured staff interviews focused on UC indication, training, insertion techniques, and recall of the former intervention. Results: A total of 336 consecutive patients were included (median age, 63 years; range, 16-95 years; 55% women). A UC was placed in 17.6% of patients (operating room [OR], 10.1%; postanesthesia care unit [PACU], 3.6%; surgical wards [SW], 3.9%) compared with 20.0% in 2004 (OR, 15.7%; PACU, 1.0%; SW, 3.7%). The incidence rate of UTI was 2.4 per 1,000 patient-days in 2010 versus 2.6 per 1,000 patient-days in 2004; adjusted incidence rate ratio 0.76; 95% confidence interval, 0.21-2.76; P = .67. The qualitative inquiry demonstrated poor recall of the intervention and knowledge of guidelines except in the OR, where we identified a champion leader. Discussion: The intervention effect was sustained with regard to overall UTI rate and UC placement in the OR, but less in the PACU and SW. Conclusions: Continuous leadership of a single opinion leader in a pivotal position can contribute critically to sustainability.
    Full-text Article · Mar 2016 · American Journal of Infection Control
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    [Show abstract] [Hide abstract] ABSTRACT: Background and purpose — Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. Patients and methods — We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25–29.9, 30–34.9, 35–39.9, and ≥ 40) and weight (5 categories: < 60, 60–79, 80–99, 100–119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5–18 years). Results — 111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35–39.9 (adjusted HR = 2.1, 95% CI: 1.1–4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8–9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3–3.6). Interpretation — BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.
    Full-text Article · Jan 2016 · Acta Orthopaedica
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    [Show abstract] [Hide abstract] ABSTRACT: Purpose of review Diabetes mellitus has reached pandemic levels and will continue to increase worldwide. Physicians and surgeons should know to manage one of its most prevalent complications, the diabetic foot infection (DFI), in a scientifically based and resource-sparing way. We performed a nonsystematic review of recent scientific literature to provide guidance on management of DFIs. Recent findings Studies in the past couple of years provide data on which recommendations for diagnosing and treating DFI are based, especially with validated guidelines and reviews of the microbiology and selected aspects of the complex DFI problem. Recent literature provides approaches to prevention and studies support more conservative surgical treatment. Unfortunately, there have been virtually no new therapeutic molecules, antibiotic regimens, randomized trials, or surgical techniques introduced in the recent past; we briefly discuss how this may change in the future. Summary Recent scientific evidence on DFI strongly supports the value of multidisciplinary and some new care models, guideline-based management, more preventive approaches, and confirms several established therapeutic concepts. In contrast, there has been almost no new substantial information regarding the optimal antibiotic or surgical management in recent literature.
    Full-text Article · Jan 2016 · Current Opinion in Infectious Diseases
  • M. Al-Mayahi · P. Vaudaux · L. Deabate · [...] · I. Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: Millions of orthopedic implant procedures are performed worldwide each year. The safety and biocompatibility of these devices are good and only 10% of patients experience complications, of which infections are one of the most serious. Their management usually requires a combined approach of surgical intervention and prolonged courses of intravenous or oral antimicrobial therapy. Despite a significant amount of basic and clinical research, many questions pertaining to the definition, diagnosis, prevention and management of these infections remain unanswered. The aim of this chapter is to provide some basic insight into the clinical diagnosis and management of implant-associated infections.
    Chapter · Dec 2015
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    Morad Mohamad · Luca Deabate · Wilson Belaieff · [...] · Ilker Uckay
    [Show abstract] [Hide abstract] ABSTRACT: Context: Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are the most frequently isolated pathogens and are responsible for approximately two-thirds of joint replacement infections. Evidence Acquisition: Although both belong to the staphylococci genus, there are several epidemiological and therapeutic differences between S. aureus and the heterogenous group of CoNS. In general, however, preventive and therapeutic recommendations for Prosthetic Joint Infection PJI due to CoNS do not differ from PJI caused by other pathogens. Results: The main differences between the pathogens lie in the clinical presentation of PJI, the presumed origin of infection, and the presence of a higher proportion of methicillin-resistant strains leading to a limited choice of antibiotic agents. Conclusions: Fortunately, due to its lower virulence as compared to its cousin S. aureus, PJI due to CoNS may display higher remission rates than S. aureus-caused PJI after combined surgical and medical management.
    Full-text Article · Dec 2015
  • Article · Nov 2015 · Revue de Chirurgie Orthopédique et Traumatologique
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    [Show abstract] [Hide abstract] ABSTRACT: Objective: In this study, we assess interdisciplinary surgical and medical parameters associated to recurrences of infected pressure ulcers. Background: There is a little in the published literature regarding factors associated with the outcome of treatment of infected pressure ulcers. Methods: We undertook a single-center review of spinal injured adults hospitalized for an infected pressure ulcer or implant-free osteomyelitis and reviewed the literature on this topic from 1990-2015. Results: We found 70 lesions in 31 patients (52 with osteomyelitis) who had a median follow-up of 2.7 years (range, 4 months to 19 years). The median duration of antibiotic therapy was 6 weeks, of which 1 week was parenteral. Clinical recurrence after treatment was noted in 44 infected ulcers (63%), after a median interval of 1 year. In 86% of these recurrences, cultures yielded a different organism than the preceding episode. By multivariate analyses, the following factors were not significantly related to recurrence: number of surgical interventions (hazard ratio 0.9, 95% confidence interval 0.5-1.5); osteomyelitis (hazard ratio 1.5; 0.7-3.1); immune suppression; prior sacral infections, and duration of total (or just parenteral) antibiotic sue. Patients with antibiotic treatment for <6 weeks had the same failure rate as those with as >12 weeks (χ test; P = 0.90). Conclusions: In patients with infected pressure ulcers, clinical recurrence occurs in almost two-thirds of lesions, but in only 14% with the same pathogen(s). The number of surgical debridements, flap use, or duration of antibiotic therapy was not associated with recurrence, suggesting recurrences are caused by reinfections caused by other extrahospital factors.
    Full-text Article · Oct 2015 · Annals of surgery
  • Diem-Lan Vu · Ilker Uçkay · Amanda Gonzalez · [...] · Anne Lübbeke
    Article · Oct 2015 · The Journal of infection
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    [Show abstract] [Hide abstract] ABSTRACT: Background: Infection is a common epiphenomenon of advanced diabetic foot disease and the most common reason for diabetes-related hospitalizations and lower extremity amputations. Major advances have been made in the past three decades in our understanding and management of diabetic foot infections (DFIs). The optimal treatment of DFIs clearly involves multidisciplinary input. Methods: A comprehensive search of the literature on DFIs from January 1960 through June 2015 was performed, with an emphasis on information published in the past 30 years. Results: There have been many new insights into the microbiology, diagnosis, and treatment of DFIs, although the implementation of this knowledge in clinical practice has been suboptimal. Today, the use of evidence-based guidelines, multidisciplinary teams, and institution-specific clinical pathways helps guide optimal care of this multifaceted problem. Patients are more often treated in the ambulatory setting, with antibiotic regimens that are more targeted, oral and shorter course, and with more conservative (but earlier) surgical interventions. New diagnostic and therapeutic methods are being developed at an accelerating pace. Conclusions: The worldwide increase in the incidence of diabetes and longer lifespan of diabetic patients will undoubtedly increase the incidence of DFIs. Clinicians caring for diabetic patients should have an understanding of current methods for preventing, diagnosing, and treating DFIs.
    Full-text Article · Oct 2015 · International Journal of Infectious Diseases
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    Mohamed Al-Mayahi · Anais Cian · Benjamin Kressmann · [...] · Ilker Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: Background: Clinical experience suggests that a high proportion of orthopaedic infections occur in persons with diabetes. Methods: We reviewed several databases of adult patients hospitalized for orthopaedic infections at Geneva University Hospitals from 2004 to 2014 and retrieved 2740 episodes of infection. Results: Overall, diabetes was noted in the medical record for 659 (24%) of these cases. The patients with, compared with those without, diabetes had more than five times more foot infections (274/659 [42%] vs 155/2081 [7%]; p < 0.01) and a significantly higher serum C-reactive protein level at admission (median 96 vs 70 mg/L; p < 0.01). Diabetic patients were older (median 67 vs 52 years; p < 0.01), more often male (471 [71%] vs 1398 [67%]; p = 0.04), and had more frequent polymicrobial infections (219 [37%] vs 353 [19%]; p < 0.01), including more gram-negative non-fermenting rods (90 [15%] vs 168 [9%]; p < 0.01). Excluding foot infections from these analyses did not change the statistically significant differences. Diabetes was present in 17% of all infected orthopaedic patients without foot involvement. In Geneva canton, the overall prevalence of diabetes is estimated at 5.1%, while we have found that the prevalence is 13% in our hospitalized adults. Conclusions: Diabetes is present in 24% of all adult patients hospitalized for surgery for an orthopaedic infection, a prevalence that is several times higher than for the general population and twice as high as that for the population of hospitalized patients. Compared with non-diabetics, patients with diabetes have significantly more infections that are polymicrobial, including gram-negative non-fermenting rods.
    Full-text Article · Sep 2015
  • E. Gjika · D. Suva · I. Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: The total number of total knee and hip joint arthroplasties is constinuously rising, due to an increasing population of physically active elderly patients. For primary elective arthroplasties, the infection risk ranges between 1 and 2%, but equals to a high morbidity, costs and complications for the individual infected patient. Diagnosis and management of prosthetic joint infections are improving. We review the latest consensus on the diagnosis and management of these infections and reveal some insight in still debated issues.
    Article · Sep 2015
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    Camillo T Müller · Ilker Uçkay · Paolo Erba · [...] · Jean-Yves Beaulieu
    [Show abstract] [Hide abstract] ABSTRACT: Treatment of septic hand tenosynovitis is complex, and often requires multiple débridements and prolonged antibiotic therapy. The authors undertook this study to identify factors that might be associated with the need for subsequent débridement (after the initial one) because of persistence or secondary worsening of infection. In this retrospective single-center study, the authors included all adult patients who presented to their emergency department from 2007 to 2010 with septic tenosynovitis of the hand. The authors identified 126 adult patients (55 men; median age, 45 years), nine of whom were immunosuppressed. All had community-acquired infection; 34 (27 percent) had a subcutaneous abscess and eight (6 percent) were febrile. All underwent at least one surgical débridement and had concomitant antibiotic therapy (median, 15 days; range, 7 to 82 days). At least one additional surgical intervention was required in 18 cases (median, 1.13 interventions; range, one to five interventions). All but four episodes (97 percent) were cured of infection on the first attempt after a median follow-up of 27 months. By multivariate analysis, only two factors were significantly associated with the outcome "subsequent surgical débridement": abscess (OR, 4.6; 95 percent CI, 1.5 to 14.0) and longer duration of antibiotic therapy (OR, 1.2; 95 percent CI, 1.1 to 1.2). In septic tenosynovitis of the hand, the only presenting factor that was statistically predictive of an increased risk of needing a second débridement was the presence of a subcutaneous abscess. Risk, III.
    Full-text Article · Sep 2015 · Plastic and Reconstructive Surgery
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    Mohamed Al-Mayahi · Anais Cian · Benjamin A Lipsky · [...] · Ilker Uçkay
    [Show abstract] [Hide abstract] ABSTRACT: Many physicians and surgeons think that prescribing antibiotics before intraoperative sampling does not alter the microbiological results. Case-control study of adult patients hospitalised with orthopaedic infections. Among 2740 episodes of orthopaedic infections, 1167 (43%) had received antibiotic therapy before surgical sampling. Among these, 220 (19%) grew no pathogens while the proportion of culture-negative results in the 2573 who had no preoperative antibiotic therapy was only 6%. By multivariate analyses, pre-operative antibiotic exposure was associated with significantly more culture-negative results (odds ratio 2.8, 95% confidence interval 2.1-3.7), more non-fermenting rods and skin commensals (odds ratio 2.8 and 3.0, respectively). Even asingle pre-operative dose of antibiotic was significantly associated with subsequent culture-negative results (19/93 vs. 297/2350; χ(2)-test, p=0.01) and skin commensals (17/74 vs. 274/2350; p=0.01) compared to episodes without preceding prophylaxis. Prior antibiotic use, including single-dose prophylactic administrations, is three-fold associated with culture-negative results, non-fermenting rods and resistant skin commensals. Copyright © 2015 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
    Full-text Article · Aug 2015 · The Journal of infection
  • [Show abstract] [Hide abstract] ABSTRACT: Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management.
    Article · Jun 2015 · Revue médicale suisse
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    I Uckay · B Kressmann · A Agostinho · [...] · D Pittet
    Full-text Article · Jun 2015 · Antimicrobial Resistance & Infection Control

Publication Stats

2k Citations


  • 2015
    • University of Melbourne
      Melbourne, Victoria, Australia
  • 2005-2009
    • Hôpitaux Universitaires de Genève
      Genève, Geneva, Switzerland
    • University of Geneva
      • Division of Infectious Diseases
      Genève, Geneva, Switzerland
  • 2007
    • Federal University of Minas Gerais
      Cidade de Minas, Minas Gerais, Brazil