Bacteria drug resistance profile affects knee and hip periprosthetic joint infection outcome with debridement, antibiotics and implant retention.

BACKGROUND: Evaluate the effect of bacteria drug resistance profile on the success rates of debridement, antibiotics and implant retention. METHODS: All early acute periprosthetic infections in hip and knee arthroplasties treated with DAIR at our institution over the period from 2011 to 2015 were retrospectively analyzed. The success rate was evaluated according to the type of organism identified in culture: multidrug-sensitive (MSB), methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRB) and according to other risk factors for treatment failure. The data were analyzed using univariate and multivariate statistics. RESULTS: Fifty-seven patients were analyzed; there were 37 in the multidrug-sensitive bacteria (MSB) group, 11 in the methicillin-resistant Staphylococcus aureus (MRSA) group and 9 in the other multidrug-resistant Gram-negative bacteria (MRB) group. There was a statistically significant difference (p < 0.05) in the treatment failure rate among the three groups: 8.3% for the MSB group, 18.2% for the MRSA group and 55.6% for the MRB group (p = 0.005). Among the other risk factors for treatment failure, the presence of inflammatory arthritis presented a failure rate of 45.1 (p < 0.05). CONCLUSION: DAIR showed a good success rate in cases of early acute infection by multidrug-sensitive bacteria. In the presence of infection by multidrug-resistant bacteria or association with rheumatic diseases the treatment failure rate was higher and other surgical options should be considered in this specific population. The MRSA group showed intermediate results between MSB and MRB and should be carefully evaluated.

Preoperative Anemia Is Associated With Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection.

BACKGROUND: Acute and acute hematogenous prosthetic joint infections (PJIs) are often treated with open debridement and polyethylene exchange (ODPE) in an effort to save the prosthesis, decrease morbidity, and reduce costs. However, failure of ODPE may compromise a subsequent 2-stage treatment. The purpose of this study is to identify patient factors that impact the success of ODPE for acute and acute hematogenous PJIs. METHODS: A retrospective review examined comorbidities, preoperative laboratory values, and patient history for patients with successful and failed ODPE treatment for acute perioperative or acute hematogenous periprosthetic hip or knee joint infections. Successful treatment was defined as retaining a well-fixed implant without the need for additional surgery for a minimum of 6-month follow-up with or without lifelong oral maintenance antibiotics. RESULTS: Fifty-three of 72 patients (73.6%) underwent successful ODPE. Of the 19 failures, 14 completed 2-stage revision with one subsequent known failure for recurrent infection. Patients with a Staphylococcus aureus infection were more likely to fail ODPE (48.3% vs 11.6%, P = .0012, odds ratio 7.1, 95% confidence interval 2.3-25.3). Patients with a preoperative hematocrit ≤32.1 were also more likely to fail ODPE (55% vs 16%, P = .0013, odds ratio 6.7, 95% confidence interval 2.2-22.4). When neither risk factor was present, 97.1% of PJIs were successfully treated with ODPE. CONCLUSION: S aureus infection and preoperative hematocrit ≤32.1 are independent risk factors for ODPE failure. ODPE is a safe alternative to 2-stage revision in patients without preoperative anemia and without S aureus infection. Two-thirds of patients with a failed ODPE were successfully treated with a 2-stage reimplantation.

Taxa de prenhez em cabras da raça Saanen no nordeste do Pará submetidas à inseminação artificial em tempo fixo / Pregnancy rate in Saanen goats in northeast Pará submitted to artificial insemination in fixed time

Control of the estrous cycle through estrus synchronization protocols allows the producer to share lotsof females according to the management capacity and ownership of facilities easier handling and better use ofplayers. Therefore, the objective was to verify the influence of artificial insemination in fixed time (FTAI) withthe use of frozen semen in pregnancy rates of dairy goats. The study was conducted in the state of Pará, in themunicipality of Iguarapé-Acu, in a private property that is located in the northeastern region of Pará. 12 Saanengoats intended for milk production were used. Animals submitted to TAI with the use of six frozen semen becamepregnant, representing a pregnancy rate of 50%, which proved satisfactory results.

Taxa de prenhez em cabras da raça Saanen no nordeste do Pará submetidas à inseminação artificial em tempo fixo / Pregnancy rate in Saanen goats in northeast Pará submitted to artificial insemination in fixed time

Control of the estrous cycle through estrus synchronization protocols allows the producer to share lotsof females according to the management capacity and ownership of facilities easier handling and better use ofplayers. Therefore, the objective was to verify the influence of artificial insemination in fixed time (FTAI) withthe use of frozen semen in pregnancy rates of dairy goats. The study was conducted in the state of Pará, in themunicipality of Iguarapé-Acu, in a private property that is located in the northeastern region of Pará. 12 Saanengoats intended for milk production were used. Animals submitted to TAI with the use of six frozen semen becamepregnant, representing a pregnancy rate of 50%, which proved satisfactory results.(AU)