Don Bambino Geno Tai’s research while affiliated with University of Minnesota Rochester and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (32)


Addressing Spinal Implant Infections: Emerging Options and Unresolved Challenges
  • Article

February 2025

·

1 Read

Clinical Infectious Diseases

Don Bambino Geno Tai

·

Robin Patel

·

Francis Lovecchio

·

[...]

·


P-896. Artificial Intelligence Performs Well in Assessing the Clarity of Definitions of Variables in Periprosthetic Joint Infection Studies

January 2025

·

1 Read

Open Forum Infectious Diseases

Background Artificial intelligence (AI) has the potential to improve healthcare research methodologies, particularly in addressing the need for consistency and clarity in defining variables in observational studies. However, concerns exist regarding the accuracy and reliability of AI in this context. Performance of Artificial Intelligence in Assessing Clarity of Definition of Variables Methods We reviewed observational studies on prosthetic joint infection studies from 2017-2023, focusing on 13 categories of variables. We used ClaudeAI 2 (Anthropic, San Francisco, CA), a large language model, in analyzing definitions from full texts, instructing it to classify them as objective, subjective, or undefined. Some examples of a highly objective definition are the presence of time element, severity, staging, frequencies, laboratory cut-off, and medication dependence. A simple chart review was deemed subjective. Results We included 75 studies with a total of 369 variables in the analysis. AI detected 88% of variables (n=324). Of those detected, 74% (241/324) were correctly classified. It accurately identified antibiotic use and infection type as the variables that are most frequently defined objectively (94%). For the 9/13 categories, it appropriately assessed that most studies lacked definitions. Smoking (20%) and alcohol use (33%) were least frequently defined. Notably, 5 detected variables did not exist in the manuscripts. Conclusion The model demonstrated high performance in detecting variables from study text and evaluating the clarity of variable definitions. The false positive detections serve as an important reminder that human oversight remains crucial to ensuring accuracy when integrating AI into the research process. Looking ahead, AI may assist researchers in objectively defining study variables from the outset and verifying the correct application of definitions. More studies are needed on how to optimally integrate its capabilities into the research process. Disclosures All Authors: No reported disclosures


State-of-the-Art Review: Diagnosis and Management of Spinal Implant Infections

December 2024

·

10 Reads

Clinical Infectious Diseases

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement with implant retention combined with at least 12 weeks of antibiotics is currently considered appropriate treatment. Staphylococcal infections are ideally treated with biofilm-active antibiotics. Suppressive antibiotic therapy can be considered when surgical debridement has been delayed or is incomplete, and for those who are poor surgical candidates for another surgery. Chronic infections may present insidiously with implant failure or pseudarthrosis; implant removal or revision is generally pursued. As current guidance is heavily based on the periprosthetic joint infection literature and low-level studies on spinal implant infections, further research on optimizing diagnostic and treatment approaches is needed.



Orthopedic infectious diseases: a survey on the composition and perceived value of an emerging subspecialty clinical service
  • Article
  • Full-text available

June 2024

·

25 Reads

Journal of Bone and Joint Infection

We surveyed US orthopedic infectious disease (Ortho ID) specialists and surgeons (n=54 clinicians from at least 17 institutions). Three-quarters had a dedicated clinic or inpatient service; orthopedic device-related infections were most commonly seen. All respondents highly valued Ortho ID teams for improving multidisciplinary communication, trust, access to care, and outcomes.

Download

Role of routine suppressive antibiotic therapy after DAIR for acute periprosthetic joint infections

April 2024

·

79 Reads

·

1 Citation

Open Forum Infectious Diseases

Background Debridement, antibiotics, irrigation, and implant retention (DAIR) is the first-line management strategy for acute periprosthetic joint infections (PJI). Suppressive antibiotic therapy (SAT) after DAIR is proposed to improve outcomes, yet its efficacy remains under scrutiny. Methods We conducted a multicenter retrospective study in patients with acute PJI of the hip or knee and treated with DAIR in centers from Europe and the USA. We analyzed the effect of SAT using a Cox model landmarked at 12 weeks. The primary covariate of interest was SAT, which was analyzed as a time-varying covariate. Patients who experienced treatment failure or lost to follow-up within 12 weeks were excluded from the analysis. Results The study included 510 patients with 66 treatment failures with a median follow-up of 801 days. We did not find a statistically significant association between SAT and treatment failure (HR 1.37, 95% CI 0.79-2.39, p=0.27). Subgroup analyses for joint, country cohort, and type of infection (early or late acute) did not show benefit for SAT. Secondary analysis of country cohorts showed a trend toward benefit for the USA cohort (HR 0.36, 95% CI 0.11-1.15, p=0.09) which also had the highest risk of treatment failure. Conclusion The utility of routine SAT as a strategy for enhancing DAIR's success in acute PJI remains uncertain. Our results suggest that SAT's benefits might be restricted to specific groups of patients, underscoring the need for randomized controlled trials. Identifying patients most likely to benefit from SAT should be a priority in future studies.


Figure 1. Timeline of eight patients in the retrospective study.
Demographics of patients in retrospective study.
Selected antimicrobial susceptibilities of rapidly growing mycobacteria causing prosthetic joint infections.
Articles included in the review of the literature.
Characteristics and management of periprosthetic joint infections caused by rapidly growing mycobacteria: a retrospective study and a review of the literature

February 2024

·

67 Reads

Journal of Bone and Joint Infection

Background: Periprosthetic joint infection (PJI) following total joint arthroplasty is a serious complication associated with significant morbidity. While Gram-positive cocci are the predominant causative organisms, PJIs caused by rapidly growing mycobacteria (RGM) have been reported, albeit at a lower frequency. This study aimed to investigate the characteristics and management of PJI caused by RGM. Methods: A retrospective review was conducted using an institutional PJI database to identify patients diagnosed with PJI due to RGM from January 2010 to December 2021. Clinical data, including demographics, symptoms, comorbidity information, laboratory parameters, surgical procedures, medical treatment and outcomes, were collected and analyzed. Results: A total of eight patients were identified with PJI caused by RGM during the study period. The median age was 66 years old, and most cases occurred in patients with total knee arthroplasty (n=6). The isolated RGM species included Mycobacterium abscessus (three cases), M. fortuitum (three cases), and one case each of M. immunogenum and M. mageritense. Surgical debridement was performed in all cases, with six patients undergoing two-stage revision and two patients requiring amputation. Combination antimicrobial therapy was administered based on antimicrobial susceptibility testing, and the median duration of treatment was 7.5 months. Adverse events related to therapy occurred in 75 % of cases. No relapses were observed during the median follow-up period of 39.6 months. Conclusions: PJI caused by RGM is a rare complication of total joint arthroplasty. Surgical debridement and combination antimicrobial therapy are the mainstays of treatment. Although clinical cure rates are high, amputation may be required in severe cases.


Comparison of operational elements of OPAT and COpAT.
Recommendations for oral antimicrobial dosing and monitoring.*
Establishing a COpAT program.
Advancing an existing COpAT program.
Taking the route less traveled: on the way to COpAT

August 2023

·

120 Reads

·

5 Citations

Therapeutic Advances in Infectious Disease

Antimicrobial therapy is an essential practice within medicine. Over the last 4 years, complex outpatient antimicrobial therapy (COpAT) with oral antimicrobials has become a rapidly developing area of practice and is non-inferior to outpatient parenteral antimicrobial therapy (OPAT) in certain infectious syndromes. Currently, the available literature does not describe the implementation of oral antimicrobials within the current outpatient antimicrobial therapy process. Throughout this article, the authors present a review of current literature, a proposed definition of COpAT and offer methods readers can utilize to implement an integrated COpAT/OPAT program with oral antimicrobial-specific monitoring within their current practice.


Defeating the Hidden Foe: Antibiotic Therapy and Clinical Outcomes of Cutibacterium acnes Spinal Implant Infections

July 2023

·

30 Reads

·

5 Citations

Open Forum Infectious Diseases

Background Cutibacterium acnes can cause spinal implant infections. However, little is known about the optimal medical management and outcomes of C. acnes spinal implant infections (CSII). Our study aims to describe the management of patients with CSII and evaluate the clinical outcomes. Methods We performed a retrospective cohort study of patients aged 18 years or older who underwent spinal fusion surgery with instrumentation between January 1, 2011, and December 31, 2020, and whose intraoperative cultures were positive for C. acnes: the primary outcome was treatment failure based on subsequent recurrence, infection with another organism or unplanned surgery secondary to infection. Results There were 55 patients with a median follow-up of 2 years (IQR 1.2-2.0). Overall, there were six treatment failures over 85.8 total person-years, for an annual rate of 7.0% (95% CI 2.6%-15.2%). Systemic antibiotic treatment was given to 74.5% (n = 41) of patients for a median duration of 352 days. In the subgroup treated with systemic antibiotics, there were 4 treatment failures (annual rate 6.3%, 95% CI 1.7%-16.2%), all of which occurred while on antibiotic therapy. Two failures occurred in the subgroup without antibiotic treatment (annual rate 8.8%, 95% CI 1.1% - 31.8%). Conclusion Our study found that the estimated annual treatment failure rate was slightly higher among patients who did not receive antibiotics. Of the six failures observed, four had to recurrence of C. acnes either on initial or subsequent treatment failures. More studies are warranted to determine the optimal duration of therapy for CSII.


Figure 1. Cases of Cutibacterium acnes in spine tissue at Mayo Clinic between 2011-2021.
Cutibacterium acnes in spine tissue: characteristics and outcomes of non-hardware-associated vertebral osteomyelitis

April 2023

·

110 Reads

·

5 Citations

Journal of Bone and Joint Infection

Cutibacterium acnes isolation from spine tissue can be challenging because the organism can represent a contaminant. There is a paucity of data regarding the role of C. acnes in non-hardware-associated vertebral osteomyelitis (VO). Herein we evaluate the clinical and microbiological characteristics, treatment, and outcome of patients with C. acnes VO. Data were retrospectively collected from adults with a positive spine culture for C. acnes at Mayo Clinic, Rochester (MN), from 2011 to 2021. Patients with spinal hardware and polymicrobial infections were excluded. Of the subjects, 16 showed radiological and clinical findings of VO: 87.5 % were male, the average age was 58 years (±15 SD), and back pain was the predominant symptom. Of the lesions, 89.5 % involved the thoracic spine. Of the subjects, 69 % had experienced an antecedent event at the site of VO. In five subjects, C. acnes was isolated after 7 d of anaerobic culture incubation. Thirteen subjects were treated with parenteral β-lactams, and three with oral antimicrobials, without any evidence of recurrence. Twenty-one subjects were not treated for VO, as C. acnes was considered a contaminant; at follow-up, none had evidence of progressive disease. C. acnes should be part of microbiological differential diagnosis in patients with suspected VO, especially in the context of a prior spinal procedure. Anaerobic spine cultures should undergo prolonged incubation to enable recovery of C. acnes. C. acnes VO may be managed with oral or parenteral antimicrobial therapy. Without clinical and radiological evidence of VO, a single positive culture of C. acnes from spine tissue frequently represents contaminants.


Citations (16)


... [4][5][6] In addition, complications such as venous thrombosis associated with line insertion and excessive costs associated with parenteral therapy can be avoided altogether. 7 The implementation of complex outpatient oral antimicrobial therapy clinic (COpAT) has been described in the United Kingdom (UK) and the United States, 8,9 but it is a novel concept in Canada. The definition of COpAT varies in the literature; it is generally considered complex when a patient requires prolonged treatment of antimicrobial(s) that can potentially cause significant side effects. ...

Reference:

Implementation and evaluation of a complex outpatient oral antimicrobial therapy program (COpAT) in Canada
Taking the route less traveled: on the way to COpAT

Therapeutic Advances in Infectious Disease

... The absence of these microorganisms in the syndromic panels aims to minimize the false positive results since some of them, such as Cutibacterium acnes or Staphylococcus epidermidis, can also be contaminants [19]. However, there is growing interest in the pathogenic roles of these bacteria, especially in some clinical scenarios such as shoulder infections [20], hardware-associated infections [21,22], and cases of chronic and indolent infections [16]. Therefore, further studies are needed to help to distinguish between true pathogens and contaminants. ...

Defeating the Hidden Foe: Antibiotic Therapy and Clinical Outcomes of Cutibacterium acnes Spinal Implant Infections

Open Forum Infectious Diseases

... Cutibacterium acnes is an organism that might need extended incubation or inoculation of the specimen in blood culture bottles to enhance diagnostic accuracy [48]. However, without clinical, radiological, or histopathological signs of infection, a single culture yielding C. acnes from non-instrumented spine sites usually represents contamination [49]. Confirmation from a second spinal aspiration or surgical biopsy is recommended before extended antimicrobial therapy, though heavy C. acnes growth might justify immediate treatment, ideally with an antimicrobial covering staphylococcus [50]. ...

Cutibacterium acnes in spine tissue: characteristics and outcomes of non-hardware-associated vertebral osteomyelitis

Journal of Bone and Joint Infection

... This presentation can occasionally be seen with disseminated meningococci. Tenosynovitis has also been described with secondary syphilis [31], chronic Q fever [32], and brucellosis [33]. Disseminated pulmonary tuberculosis can cause infectious tenosynovitis [34,35]. ...

Chronic Q fever presenting as bilateral extensor tenosynovitis: a case report and review of the literature

Journal of Bone and Joint Infection

... The program offers a broad range of commands on many distributions, such as making a plot for a certain distribution, generating a sample from a specific distribution, and more. Of note, the world-renowned Mayo Clinic recently announced the use of BlueSky Statistics in their research, which was noted in research published by researchers affiliated with the institute (e.g., references Tabaja et al. 2022;Schmidt et al. 2023;Chesdachai et al. 2023). This highlights the power of the software for medical researchers. ...

Deep Brain Stimulator Device Infection: The Mayo Clinic Rochester Experience

Open Forum Infectious Diseases

... Choosing an appropriate antimicrobial agent for patients diagnosed with CN-NVO is challenging as it is based on empirical therapy and clinical suspicion, together with epidemiological awareness rather than organism-specific criteria [13], and because of the Administering antimicrobial therapy before a definitive etiological diagnosis is established in these patients can clear the bloodstream infection, if present, or reduce the bacterial burden of disc space/bone tissue and jeopardize the sensitivity of standard culture techniques. Therefore, in all but critically ill patients with signs of sepsis or with neurological compromise that requires surgery, it is suggested to withhold empiric antimicrobials [19] and perform a watchful waiting approach, for which it has already been shown that an antimicrobial-free period of at least four days can maximize the yield of the invasive diagnostic procedure [20]. In a systematic review and meta-analysis by McNamara et al., the biopsy in patients who had previously taken antibiotics resulted in a yield of 32%, which was not significantly different from the group who did not take antibiotics (43%) [21]. ...

Factors Impacting the Yield of Image-Guided Biopsy in Native Vertebral Osteomyelitis: A 10-Year Retrospective Study

Open Forum Infectious Diseases

... Further analysis of patients who initiated rifampin ≤ 5 days from surgery identified a greater incidence of S. aureus infections, less frequent exchange of mobile components and a higher incidence of surgery performed > 4 weeks from arthroplasty in early acute infections, which may have influenced this finding [43]. Tai et al. contributed additional evidence on use of rifampin in PJIs following DAIR via a retrospective cohort study [44]. There were 247 PJI cases included and reduction in the risk of failure in Staphylococcal knee PJIs was found with both use of rifampin (hazard ratio 0.4, 95% CI 0.2-0.79) ...

Truth in DAIR: Duration of Therapy and the Use of Quinolone/Rifampin-Based Regimens following Debridement and Implant Retention for Periprosthetic Joint Infections

Open Forum Infectious Diseases

... Corynebacterium species are relative rare in orthopaedic surgery, with the vast majority of them concerning Corynebacterium striatum spp. [5,[7][8][9]. However, few authors have reported that Corynebacterium spp. ...

Clinical Profile of Monomicrobial Corynebacterium Hip and Knee Periprosthetic Joint Infections

Open Forum Infectious Diseases

... The twenty first century doctor continues to be bound by definitions that were penned more than 20 years ago by mostly Western authors 7 and it is onerous for younger doctors to abide by the rules set by earlier generations. 40 Despite there being more women, people of color and people who are more open about their gender and sexuality, 41 this study shows they continue to be held to former ideas and norms around professionalism. What makes this particularly challenging is that although in North America scholars suggest that students and staff be trained on how to deal with racism, 34 in a country like SA, with a history of apartheid that continues to influence all aspects of society today, how does one challenge racism, which can be subtle and invisible, and therefore difficult to confront? ...

LGBTQ+ Physicians: History, Progress, and Recommendations for a Better Future
  • Citing Article
  • January 2022

Academic Medicine

... Cultures for AFB are often sent from surgical specimens in situations where the prior probability of infection is low. [1][2][3][4][5][6][7][8][9][10][11][12] Submitting these cultures routinely is not cost effective and takes resources in terms of time for microbiology laboratory personnel as well as adding unnecessary costs for patients. Most clinical microbiology laboratories are not able to perform identification and sensitivity testing and must send these cultures out to reference laboratories. ...

Fungal and mycobacterial cultures should not be routinely obtained for diagnostic work-up of patients with suspected periprosthetic joint infections
  • Citing Article
  • January 2022

Bone and Joint Journal