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1.
Eur J Clin Microbiol Infect Dis ; 37(4): 715-722, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29270861

RESUMEN

In order to evaluate the usefulness of sonication of retrieved implants for the diagnosis of prosthetic joint infection (PJI) in a large group of patients in a routine setting, we designed a 3-year retrospective study. Patients were classified into two groups: those meeting the clinical criteria of PJI and those that did not (control group). Two hundred patients and 276 samples were included. The types of infection were early (n = 44), delayed (n = 53), positive intraoperative cultures (n = 13) and late-acute (n = 8). The culture sensitivities of sonicate fluid, periprosthetic tissue, synovial fluid and combination of periprosthetic tissue and/or synovial fluid were 69.5, 52.8, 54.8 and 60.2%, respectively. The specificities were 97.6, 90.3, 93.0 and 89.9%, respectively. Sonicate fluid culture of implants was more sensitive than peri-implant tissue, synovial fluid and combination of periprosthetic tissue and/or synovial fluid for all infection types, though it was especially useful in delayed infection: 91.3% vs. 60.0% (p = 0.0015), 63.2% (p = 0.0005) and 66.7% (p = 0.0001), respectively. When sonicate fluid culture of implants was performed in addition to conventional cultures, the sensitivity increased significantly in total (from 60.2 to 77.1%) and delayed PJI (from 45.1 to 71.7%). On the other hand, for early PJI, sonicate fluid culture of prosthesis was not superior to conventional diagnostic methods.


Asunto(s)
Técnicas Bacteriológicas/métodos , Técnicas Bacteriológicas/estadística & datos numéricos , Prótesis Articulares/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Sonicación/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Líquido Sinovial/microbiología , Adulto Joven
2.
Enferm Infecc Microbiol Clin ; 35(4): 236-242, 2017 Apr.
Artículo en Inglés, Español | MEDLINE | ID: mdl-27769681

RESUMEN

BACKGROUND: The development of sonication protocols over the last few years has improved the sensitivity of conventional cultures for the diagnosis of prosthetic-joint infection (PJI). However, the development of a new, specifically designed kit for the molecular diagnosis of PJI could provide a major improvement in this field. METHODS: Prostheses retrieved from patients who underwent implant removal from May 2014 to May 2015 were sent for culture, and processed according to a previously defined protocol that included sonication. Furthermore, 180 microlitres of sonication fluid were used to carry out the multiplex PCR test (Unyvero i60 system®). A comparison of the sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, was performed. The study was approved by the Clinical Research Ethics Committee. RESULTS: The analysis included 88 prostheses from 68 patients (1.29 prostheses/patient). The type of prostheses studied were knee (n=55), total hip (n=26), partial hip (n=5), and shoulder (n=2). Twenty-nine patients were diagnosed with a PJI (15 delayed, 12 acute, and 2 haematogenous infections). In 24 cases, the result of the PCR was positive, all but 1 corresponding to patients with clinical criteria of PJI. Nine resistance mechanisms were detected from 5 samples. The Unyvero i60 system® showed slightly better results than traditional culture in terms of specificity and PPV. CONCLUSIONS: The Unyvero i60 system® may play a role in rapid diagnosis of PJI, due to its high specificity and PPV. However, despite these results, cultures have to be performed to detect organisms not detected by the system.


Asunto(s)
Enfermedades Óseas/diagnóstico , Enfermedades Óseas/microbiología , Artropatías/diagnóstico , Artropatías/microbiología , Reacción en Cadena de la Polimerasa Multiplex , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Femenino , Humanos , Masculino , Estudios Prospectivos , Sonicación
4.
Diagn Microbiol Infect Dis ; 89(4): 258-261, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29037465

RESUMEN

Implant sonication is considered a useful method for the diagnosis of implant-related infections. We designed an in vitro study using Ti6Al4V discs and 5 different bacteria to determine the optimal sonication time for recovery of most bacteria tested to enable use of sonication in clinical practice for microbiological diagnosis of implant-related infections. We carried out a specific protocol for the adherence and subsequent biofilm formation on the materials used. The discs were then sonicated and the retrieved bacteria were quantified. From minute 1 to 5, the amount of recovered organisms grew progressively for all bacteria. Between minute 6 and minute 10, the number was irregular for all strains except E. coli, though no pattern was evidenced. E. coli was the only microorganism with a progressive increase in liberation throughout the process. Significant differences were observed in each of the 10minutes analyzed as concerns the release of the 5 strains (P<0.021) as well as in the mean dislodgement (of the 10minutes) of all tested strains (P<0.00001). Considering that infections in which biofilms are involved could be polymicrobial, we concluded that 5minutes is the optimal time of sonication in order to recover the maximum amount of most bacteria attached to Ti6Al4V discs.


Asunto(s)
Biopelículas/crecimiento & desarrollo , Sonicación , Titanio/química , Aleaciones , Recuento de Colonia Microbiana , Enterococcus faecalis/crecimiento & desarrollo , Enterococcus faecalis/aislamiento & purificación , Escherichia coli/crecimiento & desarrollo , Escherichia coli/aislamiento & purificación , Prótesis e Implantes , Infecciones Relacionadas con Prótesis , Pseudomonas aeruginosa/crecimiento & desarrollo , Pseudomonas aeruginosa/aislamiento & purificación , Staphylococcus aureus/crecimiento & desarrollo , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/crecimiento & desarrollo , Staphylococcus epidermidis/aislamiento & purificación , Factores de Tiempo
5.
Surg Infect (Larchmt) ; 17(4): 459-64, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27046739

RESUMEN

BACKGROUND: The use of drains in patients undergoing abdominal surgery has been a subject of debate for several decades. In this paper, the usefulness of quantitative cultures of sonicated abdominal drains for diagnosing surgical site of infection (SSI) and the association between culture results with patient outcome is evaluated. METHODS: Forty-five abdominal drainage tubes from 35 patients who underwent abdominal surgery were studied. Samples were sonicated for 5 min, the sonicate was centrifuged, and the sediment was cultured on different media. Total bacterial counts were adjusted to the actual surface of the drainage tubing. Clinical information of the patients was reviewed retrospectively. RESULTS: A relation was observed between SSI and the use of drains for more than 3 d (p = 0.0216). The presence of a suspected pathogen was related to the prevalence of SSI (p = 0.035), complications (p = 0.013), and greater leukocyte count (p = 0.048 Mann Whitney test), as well as to the use of drains for more than 3 d (p = 0.0386) and to the serous appearance of the exudates at the point of insertion of the drain (p = 0.0399). The sonication procedure showed a sensitivity of 50%, specificity of 84.2%, positive predictive value of 72.72%, and negative predictive value of 66.67% in the diagnosis of SSI. The most commonly isolated group of organisms was coagulase-negative staphylococci, being present in 18 patients (51.43%) who, however, were not associated with SSI. One or two organisms considered as pathogens were detected in 11 patients (31.43%). The more common pathogens detected were Enterobacteriae spp. (nine patients): Enterobacter aerogenes (2), Enterobacter cloacae (1), Escherichia coli (4), Klebsiella pneumoniae (1), Morganella morganii (1); and Pseudomonas aeruginosa (five patients). Candida spp. and Enterococcus spp. were detected in one patient each one. CONCLUSIONS: The detection and quantification of organisms not present in skin microbiota after drain sonication is helpful in the diagnosis of SSI and it is associated with a worse outcome in patients. Duration of use of drainage tubes is an independent risk factor for the development of SSI.


Asunto(s)
Sonicación/métodos , Infección de la Herida Quirúrgica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Candidiasis/diagnóstico , Candidiasis/microbiología , Drenaje/métodos , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infección de la Herida Quirúrgica/microbiología , Adulto Joven
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