Pyogenic arthritis of native joints due to Bacteroides fragilis: Case report and review of the literature.

Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity.In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981-2015) identified 19 additional cases.Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ±â€Š17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%.Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.

Clinical findings of bacteremic septic arthritis according to the site of acquisition: The overlap between health care-related and community- and nosocomial-acquired cases.

BACKGROUND: The site of acquisition of infection may have a major impact on outcome. The health care-related (HCR) environment has recently come under scrutiny. In a group of patients with bacteremic septic arthritis (SA), we compared their characteristics, type of SA, microbiology and prognosis according to the site of acquisition: community-acquired (CA), nosocomial-acquired (NA), and HCR. METHODS: We studied all patients with bacteremic SA seen at our institution between 1985 and 2013. Data were obtained from a protocol of prospectively recorded bacteremia cases. RESULTS: There were 273 cases of bacteremic SA (CA: 51%; NA: 31%; and HCR: 18%). NA and HCR sites were more frequent in older and fragile patients. SA of peripheral joints was the most common presentation; infections of the axial skeleton predominated in CA and HCR (24%), and prosthetic joint infection in NA (44%). MRSA and Pseudomonas aeruginosa were mainly found in NA (21% and 6% respectively) and HCR (14% and 8% respectively), whereas Streptococcus spp. was more frequent in CA (30%) and HCR (28%). The 30-day mortality rates were: CA 7%, HCR 18%, and NA 26%. CONCLUSION: The characteristics of HCR-SA overlapped with those of the CA or NA-SA cases. The HCR and NA cases presented more advanced age, greater fragility, and the predominance of difficult-to-treat microorganisms, while the HCR and CA cases presented an involvement of the axial skeleton, streptococcal etiology, and a lower number of prosthetic joint infections. Our data show that the site of acquisition should be considered when planning diagnostic and therapeutic management for SA.

Osteoarticular infection caused by MDR Pseudomonas aeruginosa: the benefits of combination therapy with colistin plus ß-lactams.

OBJECTIVES: In the era of emergence of MDR Pseudomonas aeruginosa, osteoarticular infections (OIs) add more difficulties to its treatment. The role of ß-lactams (BLs) is questioned and older drugs need to be reconsidered. The objective of this study was to describe our experience in the management of OIs caused by MDR P. aeruginosa and evaluate different therapeutic options. METHODS: This was a retrospective analysis of a prospectively collected cohort (2004-13) of patients with OI caused by MDR P. aeruginosa. We created two groups: (i) Group A (more difficult to treat), prosthetic joint infections (PJIs) and osteoarthritis (OA) managed with device retention; and (ii) Group B (less difficult to treat), OA managed without device retention. Antibiotic treatment was administered according to clinician criteria: monotherapy/combined therapy; and BL used by intermittent bolus (IB)/continuous infusion. RESULTS: Of 34 patients, 15 (44.1%) had PJI and 19 (55.9%) had OA (8 related to an orthopaedic device). Twenty-three cases (68%) were caused by XDR P. aeruginosa. The initial management included removal of an orthopaedic device in 14 cases, together with antibiotic [alone, 19 (55.9%; 4 colistin, 14 BL-IB and 1 BL continuous infusion); and in combination, 15 (44.1%; 5 BL-IB and 10 BL continuous infusion)]. The overall cure rate was 50% (39% and 63% in Groups A and B, respectively), ranging from 31.6% with monotherapy to 73.3% with combined therapy (P = 0.016), with special interest within Group A (cure rate with combined therapy 71.4%, P = 0.049). After rescue therapy, which included removal of remaining devices, the cure rate reached 85.3%. CONCLUSIONS: We suggest that the BL/colistin combination is an optimized therapy for OI caused by MDR P. aeruginosa, together with an appropriate surgical treatment.

Pyogenic arthritis of native joints in non-intravenous drug users: A detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period.

OBJECTIVE: To analyze the clinical features, microbiological spectrum, diagnostic procedures and outcomes in native joint pyogenic arthritis among non-intravenous drug users. METHODS: We collected all microbiologically proved cases of infectious arthritis at our hospital between 1992 and 2013. Patients with prosthetic joint infection were excluded, as were patients with non-pyogenic arthritis and intravenous drug users. RESULTS: We identified 268 patients; the mean age was 61 ± 14.7 years and 62% were men. The incidence increased over the period of study. In 188 patients (70%), one or more underlying medical illnesses were found. The mean symptom duration was 8.9 ± 9.5 days. Globally, 311 affected joints were found, 232 (75%) involving peripheral joints and 79 (25%) axial joints. Staphylococci (55%) and Streptococci (29%) were the predominant microorganisms. Blood cultures were positive in 78% (173/223) of the cases. In 81 patients (30%), one or more concomitant infectious processes were found. Antimicrobial therapy was prescribed 4-8 weeks in most cases, and surgical drainage was performed in 65% of patients. Four patients relapsed and 23 (8%) died. CONCLUSIONS: The prevalence of pyogenic native joint arthritis in non-intravenous drug users is increasing, frequently affecting old patients with underlying medical conditions. Although large joints are the most frequently compromised, the involvement of axial joints is a relevant feature that has not been recognized in other series. Staphylococci and Streptococci are the main causative agents. Bacteremia and concomitant infectious processes are frequent complications. Diagnostic delay and mortality continue to be important concerns.

Infected hip hemiarthroplasties and total hip arthroplasties: Differential findings and prognosis.

OBJECTIVES: Infected hip hemiarthroplasties (HHA) are classically analyzed along with infected total hip arthroplasties (THA), but patients with either one or other device are different. We describe the clinical presentation, etiology and prognosis of infected HHA compared with infected THA. METHODS: Comparative study of patients with infected HHA and THA from a prospective database of prosthetic joint infection (PJI) cases in our hospital (2003-2011), focusing on patients managed with debridement, antibiotics and implant retention (DAIR). RESULTS: 210 episodes of hip-PJI (age 74 years, 63% women): 62 (39%) HHA and 148 (61%) THA. HHA-patients were older and had more comorbidities. Late-chronic and hematogenous infections were more frequent in THA. 123 (59%) patients were managed with DAIR: 72 THA and 51 HHA. Staphylococcus aureus was more frequent in THA (44% vs 26%, p = 0.032), while Gram-negative bacilli were more prevalent in HHA (73% vs 51%, p = 0.018), with a higher prevalence of fluoroquinolone-resistance in cemented-HHA. Overall failure was 37%, with no significant differences among groups. A higher mortality was observed in HHA cases (21% vs 4%, p = 0.005), particularly in cemented-HHA. CONCLUSION: Infected THA and HHA have different characteristics, etiology and prognosis. Overall failure was similar, probably balanced by different predictors among groups, but mortality was higher among cemented-HHA.