El uso local de vancomicina en injerto autólogo para reconstrucción de ligamento cruzado anterior. ¿Reduce la tasa de artritis séptica? Comparación en dos grupos: uso local de profilaxis con vancomicina versus sin uso / The local use of vancomycin in autologous hamstring graft for ACL reconstruction. Does it reduce the rate of septic arthritis? Comparison in two groups: local use of prophylaxis with vancomycin vs. without use

Introducción: El objetivo del trabajo es evaluar y comparar de manera retrospectiva la tasa de artritis séptica (AS) postquirúrgicas en reconstrucción de LCA entre dos grupos de estudio: A, sin el uso local de vancomicina en el injerto autólogo de isquiotibiales, versus grupo B, con profilaxis antibiótica local.Materiales y métodos: se trabajaron dos grupos compuestos por 683 pacientes en total, con diagnóstico primario de ruptura de LCA. Grupo A, operados entre 2016 y 2017, en los que no se utilizó profilaxis antibiótica del autoinjerto; y el grupo B, intervenidos entre 2018 y 2019, donde se sumergió el autoinjerto de isquiotibiales en 500 mg de vancomicina en 100 ml de solución fisiológica como profilaxis local. En ambos grupos se llevó a cabo el protocolo usual pre, intra y postquirúrgico. Resultados: se analizó la relación entre presencia de infección y las diferentes variables estudiadas, se observó que el uso local de vancomicina en el injerto autólogo de isquiotibiales está asociado a menor infección (p <0.05). La edad, el sexo y el sanatorio donde se realiza la cirugía no condicionan necesariamente la presencia de infección (p >0.05).Conclusión: presentamos este trabajo como prueba en nuestro medio del claro beneficio que se obtuvo, ya que los pacientes que fueron sometidos a la profilaxis local de vancomicina del autoinjerto mostraron una disminución notable de artritis séptica.Tipo de estudio: Artículo Original ­ Descriptivo-transversal. Nivel de evidencia: III

Introduction: The aim of the study is to evaluate and retrospectively compare the rate of postoperative septic arthritis (SA) in ACL reconstruction, between two study groups: A without local use of vancomycin in autologous hamstring graft versus group B with local antibiotic prophylaxisMaterials and methods: two groups composed of 683 patients in total, with a primary diagnosis of ACL rupture, were studied. Group A, operated on in 2016 and 2017, in which antibiotic prophylaxis of the autograft was not used; and the second group B, between 2018 and 2019, where the hamstring autograft was submerged in 500 mg of vancomycin in 100 ml of physiological solution as local prophylaxis. Preoperative intravenous antibiotic prophylaxis was carried out in both groups as the usual protocol.Results: it was obtained as a result that in group A, the two years that they worked without "pre-soaking" of antibiotics in the autograft and the relationship between the presence of infection and the different variables studied was analyzed, where they found that the use Local vancomycin in the autologous hamstring graft is associated with a minor infection (p <0.05). However, age, sex and the sanatorium where the surgery is performed do not necessarily determine the presence of infection (p >0.05)Conclusion: we present this work as proof in our environment of the clear benefit that we obtained, since the patients who underwent local prophylaxis of vancomycin of the autograft, showed a notable decrease in septic arthritis.Type of study: Original Article - Descriptive-cross-sectional. Level of Evidence: III

The Economics of Antibiotic Cement in Total Knee Arthroplasty: Added Cost with No Reduction in Infection Rates.

BACKGROUND: To reduce the substantial clinical and financial burden of periprosthetic joint infection (PJI), some surgeons advocate for the use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA), although its effectiveness continues to be debated in the literature. The purpose of this study was to determine whether the routine use of ALBC is cost-effective in reducing PJI after primary TKA. METHODS: We retrospectively reviewed a consecutive series of patients undergoing cemented primary TKA at two hospitals within our institution from 2015 to 2017. We compared demographics, comorbidities, costs, and PJI rates between patients receiving ALBC and plain cement. We performed a multivariate regression analysis to determine the independent effect of ALBC on PJI rate. We calculated readmission costs for PJI and reduction in PJI needed to justify the added cost of ALBC. RESULTS: Of 2511 patients, 1077 underwent TKA with ALBC (43%), with no difference in PJI rates (0.56% vs 0.14%, P = .0662) or complications (1.2% vs 1.6%, P = .3968) but higher cement costs ($416 vs $117, P < .0001) and overall procedure costs ($6445 vs $5.968, P < .0001). ALBC had no effect on infection rate (P = .0894). Patients readmitted with PJI had higher overall 90-day episode-of-care claims costs ($49,341 vs $19,032, P < .001). To justify additional costs, ALBC would need to prevent infection in one of every 101 patients. CONCLUSION: Routine use of ALBC in primary TKA is not cost-effective, adding $299 to the cost of episode of care without a reduction in PJI rate. Further study is needed to determine whether select use of ALBC would be justified in high-risk patients.

Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection.

BACKGROUND: One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI. METHODS: A retrospective study of 17,393 primary total joint arthroplasties receiving cefazolin as perioperative prophylaxis from 2005 to 2017 was performed. Patients were stratified into 2 groups (underdosed and adequately dosed) based on patient weight and antibiotic dosage. Patients who developed PJI within 1 year following index procedure were identified. A bivariate and multiple logistic regression analyses were performed to control for potential confounders and identify risk factors for PJI. RESULTS: The majority of patients weighing greater than 120 kg (95.9%, 944/984) were underdosed. Underdosed patients had a higher rate of PJI at 1 year compared with adequately dosed patients (1.51% vs 0.86%, P = .002). Patients weighing greater than 120 kg had higher 1-year PJI rate than patients weighing less than 120 kg (3.25% vs 0.83%, P < .001). Patients who were underdosed (odds ratio, 1.665; P = .006) with greater comorbidities (odds ratio, 1.259; P < .001) were more likely to develop PJI at 1 year. CONCLUSION: Cefazolin underdosing is common, especially for patients weighing more than 120 kg. Our study reports that underdosed patients were more likely to develop PJI. Orthopedic surgeons should pay attention to the weight-based dosing of antibiotics in the perioperative period to avoid increasing risk of PJI.

Padronização e utilização de testes sorológicos como ferramentas para controle da artrite encefalite caprina em rebanho leiteiro semi-intensivo / Standardization and use serological tests as tools for control of arthritis encephalitis goat dairy herd in semi-intensive

Este estudo teve como objetivo avaliar um programa de controle da CAE, em rebanho leiteiro, utilizando testes sorológicos. Para tanto, foram padronizadas as técnicas de Ensaio Imunoenzimático Indireto (Elisa-i) e Western Blot (WB) a fim de diagnosticar precocemente anticorpos contra o Vírus da Artrite Encefalite Caprina (CAEV). A partir das padronizações realizadas testou-se 222 amostras de soro caprino, as quais também foram avaliadas comparativamente com a prova de rotina, Imunodifusão em Gel de Agarose (IDGA). Os testes de WB/IDGA, Elisa-i/IDGA e WB/Elisa-i foram comparados estatisticamente, tendo apresentado sensibilidade de 100%, 70% e 84,6% e concordância de 73,9%, 90,1%, e 72,5%, concomitantemente. Desta forma, essas três técnicas foram utilizadas para o acompanhamento de animais leiteiros com práticas de manejo a fim de controlar a enfermidade. Foram realizadas sete coletas de sangue a cada quatro meses em matrizes e reprodutores, utilizando os testes de IDGA, Elisa-i e WB. As crias que tiveram parto assistido foram submetidas a coletas de sangue logo após o nascimento. Um total de 283 amostras de soro de neonatos foi analisado pelas técnicas de IDGA e WB. A prevalência dos animais adultos foi de 6,8%, 14,9% e 39,2% respectivamente por IDGA, Elisa-i e WB. Na ultima análise detectou-se 1,9% no teste de IDGA e 7,5% nos testes de Elisa-i e de WB. Dos 283 neonatos avaliados ao nascimento, quatro apresentaram resultado positivo no teste de WB. Esses dados revelam que os testes de Elisa-i e WB apresentaram melhores resultados quando comparados a IDGA, sendo mais sensíveis. O WB por sua vez se destacou como o método mais sensível para o diagnóstico precoce de anticorpos anti-CAEV, porém as medidas de manejo aliadas as provas sorológicas adotadas não foram suficientes para erradicar a CAE, mas favoreceu uma redução significativa de animais soropositivos no rebanho estudado. Além disso, apesar da baixa frequência a transmissão vertical dos Lentivírus de Pequenos Ruminantes (LVPR), ocorre.

This study aimed to evaluate a control program of CAE, in dairy herd, using serological tests. For this, techniques of Enzyme linked immunosorbent assay (ELISA) and Western Blot (WB) were standardized to diagnose early antibodies the caprine arthritis encephalitis virus (CAEV). From the patterning were tested 222 goat serum samples, which were also evaluated by the test routine agarose gel immunodiffusion (AGID) for comparison. Tests for WB/IDGA, ELISA/IDGA and WB/ELISA were compared statistically, and presented a sensitivity of 100%, 70% and 84.6% and concordance of 73.9%, 90.1%, and 72.5% concomitantly. Thus, these three techniques were used for tracking dairy animals with management practices control of disease. Seven surveys serological were realized, every four months, with collected samples blood the bucks and matrices, using the AGID tests, Elisa-i and WB. The kids who had delivery assisted were subjected to blood draws, shortly after birth, 283 serum samples were analyzed by the AGID and WB. The prevalence of adult animals was 6.8%, 14.9% and 39.2%, respectively, for AGID, ELISA and WB. In the final analysis detected 1.9% in test AGID and 7.5% in tests ELISA and WB. Of the 283 newborns evaluated the birth, four were positive in the WB. These data show that the tests of ELISA and WB shows better results when compared to AGID, being more sensitive. The WB in turn stood out as the most sensitive method for early diagnosis of the disease, but the management practices adopted allied with serologic tests were not sufficient to eradicate CAE, but favored to a significant reduction of the disease in the herd studied. Furthermore, despite the low frequency the vertical transmission of Small Ruminant Lentivirus (SRLV) occurs.

Profilaxis de la artritis séptica en la reconstrucción de ligamento cruzado anterior / Profilaxis management for septic arthritis in anterior cruciate ligament reconstruction

Introducción: El propósito de este trabajo es analizar y evaluar los resultados obtenidos luego de la implementación de medidas profilácticas para la prevención de la artritis séptica post reconstrucción del ligamento cruzado anterior (LCA). Material y métodos: Entre diciembre del 2003 y diciembre del 2006 fueron realizadas 843 reconstrucciones de LCA. Los injertos utilizados fueron semitendinoso-recto interno (STRI) 583, (69,16%) Y tendón patelar (HTH) 266, (30,84%). La totalidad de pacientes fueron sometidos a un protocolo de medidas profilácticas pre, intra y post operatorias instauradas por el comité de infectología junto con nuestro equipo de trabajo. Fueron analizaados tiempos quirúrgicos, técnicas quirúrgicas y gérmenes aislados como variables asociadas. Comparando reesultados con nuestro reporte del 2002. Resultados: Tres pacientes (0,35%) se consideraron infectados. Dos con injerto STRI y uno HTH. Los tiempos quirúrgicos fueron de 55, 42 Y 52 minutos respectivamente y los gérmeenes aislados fueron: estafilococo au. (1), estafilococo coag. negativo (1) y un cultivo no desarrolló germen. Connclusiones: Consideramos en base a estos resultados que la reducción de los tiempos quirúrgicos no fue un facctor de gran importancia, al igual que la técnica quirúrgica utilizada. Los microorganismos aislados fueron en la mayoría de los casos estafilococo s de diferentes subtipos, gérmenes éstos saprofitos de la piel. Consideramos que las medidas profilácticas implementadas fueron de gran utilidad para reducir los índices de AS, ya que pasamos de 1,89 en 2002 a 0,35% en 2006. Proponemos un protocolo para la prevención de infeccciones post quirúrgicas luego de la reconstrucción de LCA.

Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia.

Because studies of the treatment of children with occult bacteremia have yielded conflicting results, we compared ceftriaxone with amoxicillin for therapy. Inclusion criteria were age 3 to 36 months, temperature > or = 39 degrees C, an acute febrile illness with no focal findings or with otitis media (6/10 centers), and culture of blood. Subjects were randomly assigned to receive either ceftriaxone, 50 mg/kg intramuscularly, or amoxicillin, 20 mg/kg/dose orally for six doses. Of 6733 patients enrolled, 195 had bacteremia and 192 were evaluable: 164 Streptococcus pneumoniae, 9 Haemophilus influenzae type b, 7 Salmonella, 2 Neisseria meningitidis, and 10 other. After treatment, three patients receiving amoxicillin had the same organism isolated from their blood (two H. influenzae type b, one Salmonella) and two from the spinal fluid (two H. influenzae type b), compared with none given ceftriaxone. Probable or definite infections occurred in three children treated with ceftriaxone and six given amoxicillin (adjusted odds ratio 0.43, 95% confidence interval 0.08 to 1.82, p = 0.31). The five children with definite bacterial infections (three meningitis, one pneumonia, one sepsis) received amoxicillin (adjusted odds ratio 0.00, 95% confidence interval 0.00 to 0.52, p = 0.02). Fever persisted less often with ceftriaxone (adjusted odds ratio 0.52, 95% confidence interval 0.28 to 0.94, p = 0.04). Although the difference in total infections was not significant, ceftriaxone eradicated bacteremia, prevented significantly more definite focal bacterial complications, and was associated with less persistent fever.