Comparativa de corrección de la deformidad triplanar del Hallux Valgus mediante dos técnicas quirúrgicas. Análisis radiológico y funcional / A comparison of two surgical procedures for the triplanar correction of hallux valgus deformity. Functional and radiological evaluation

Objetivo Comparar los resultados radiológicos en el plano coronal y axial y los resultados funcionales en los pacientes intervenidos de Hallux Valgus mediante la artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron. Material y método Estudio de cohortes retrospectivo entre enero de 2018 y enero de 2020 en el que se incluyeron pacientes intervenidos de Hallux Valgus mediante artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron con al menos 1 año de seguimiento. Se analizaron variables radiológicas: Ángulo Intermetatarsiano, Ángulo de Hallux Valgus, Posición de sesamoideo medial pre y postquirúrgico. Los resultados funcionales fueron evaluados según la escala AOFAS. Resultados 78 pacientes fueron incluidos. No se encontraron diferencias estadísticamente significativas en el valor del ángulo intermetatarsiano y la técnica quirúrgica utilizada (p=0,367). Se encontraron diferencias estadísticamente significativas en el valor de ángulo de Hallux Valgus y la posición del sesamoideo medial según la técnica quirúrgica utilizada ( p=0,010 y p=0,000). Se encontraron diferencias estadísticamente significativas en cuanto al valor de la escala AOFAS y la técnica quirúrgica utilizada (p=0,032) y el valor de la escala AOFAS y la posición del sesamoideo medial (p=0,035; R=-0,245). Conclusión La técnica de Lapidus modificada corrige la deformidad presente en el plano axial y coronal en la patología del Hallux Valgus, encontrando mejores resultados funcionales y radiológicos que en la técnica de Austin-Chevron convencional. (AU)

Objetive To compare radiographic outcomes in the cor-onal and axial planes and functional results in pa-tients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy. Methods Retrospective cohort study conducted from 2018 to January 2020 with patients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy with a minimum 1-year follow-up. The analysed radiographic variables were pre- and postoper-ative intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. Functional outcomes were assessed using the AOFAS score. Results 78 patients were included. No statistically sig-nificant differences were found in the measurement of the intermetatarsal angle by surgical procedure (p=0.367). Statistically significant differences were found in the measurement of the hallux val-gus angle and tibial sesamoid position according to the surgical procedure (p=0.010 and p=0.000). Statistically significant differences were found for the AOFAS score by surgical procedure (p=0.032) and for the AOFAS score by tibial sesamoid position (p=0.035); R=-0.245). Conclusion The modified Lapidus procedure corrects the coronal and axial plane deformity in hallux valgus, resulting in better functional and radiographic outcomes than the conventional Austin-Chevron procedure. (AU)

Comparativa de corrección de la deformidad triplanar del Hallux Valgus mediante dos técnicas quirúrgicas. Análisis radiológico y funcional / A comparison of two surgical procedures for the triplanar correction of hallux valgus deformity. Functional and radiological evaluation

Objetivo Comparar los resultados radiológicos en el plano coronal y axial y los resultados funcionales en los pacientes intervenidos de Hallux Valgus mediante la artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron. Material y método Estudio de cohortes retrospectivo entre enero de 2018 y enero de 2020 en el que se incluyeron pacientes intervenidos de Hallux Valgus mediante artrodesis de Lapidus modificada y la osteotomía de Austin-Chevron con al menos 1 año de seguimiento. Se analizaron variables radiológicas: Ángulo Intermetatarsiano, Ángulo de Hallux Valgus, Posición de sesamoideo medial pre y postquirúrgico. Los resultados funcionales fueron evaluados según la escala AOFAS. Resultados 78 pacientes fueron incluidos. No se encontraron diferencias estadísticamente significativas en el valor del ángulo intermetatarsiano y la técnica quirúrgica utilizada (p=0,367). Se encontraron diferencias estadísticamente significativas en el valor de ángulo de Hallux Valgus y la posición del sesamoideo medial según la técnica quirúrgica utilizada ( p=0,010 y p=0,000). Se encontraron diferencias estadísticamente significativas en cuanto al valor de la escala AOFAS y la técnica quirúrgica utilizada (p=0,032) y el valor de la escala AOFAS y la posición del sesamoideo medial (p=0,035; R=-0,245). Conclusión La técnica de Lapidus modificada corrige la deformidad presente en el plano axial y coronal en la patología del Hallux Valgus, encontrando mejores resultados funcionales y radiológicos que en la técnica de Austin-Chevron convencional. (AU)

Objetive To compare radiographic outcomes in the cor-onal and axial planes and functional results in pa-tients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy. Methods Retrospective cohort study conducted from 2018 to January 2020 with patients who underwent hallux valgus surgery using modified Lapidus arthrodesis and Austin-Chevron osteotomy with a minimum 1-year follow-up. The analysed radiographic variables were pre- and postoper-ative intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. Functional outcomes were assessed using the AOFAS score. Results 78 patients were included. No statistically sig-nificant differences were found in the measurement of the intermetatarsal angle by surgical procedure (p=0.367). Statistically significant differences were found in the measurement of the hallux val-gus angle and tibial sesamoid position according to the surgical procedure (p=0.010 and p=0.000). Statistically significant differences were found for the AOFAS score by surgical procedure (p=0.032) and for the AOFAS score by tibial sesamoid position (p=0.035); R=-0.245). Conclusion The modified Lapidus procedure corrects the coronal and axial plane deformity in hallux valgus, resulting in better functional and radiographic outcomes than the conventional Austin-Chevron procedure. (AU)

Skin and soft tissue infection caused by Cutibacterium (formerly Propionibacterium) avidum: Report of eleven cases.

We describe the characteristics of 11 cases of skin and soft tissue infections due to Cutibacterium (formerly Propionibacterium) avidum. This microorganism should be considered a potential skin pathogen especially in patients with breast infections. The clinical outcome is usually good but serious infections such as necrotizing infections may occur.

Infectious Keratitis: Microbiological Review of 297 Cases.

Infectious keratitis is a serious ocular infection that can lead to loss of vision. The aim of this study was to investigate the microbiological characteristics of this infection at the University Hospital of Guadalajara (Spain). We retrospectively reviewed all cases diagnosed between January 2010 and December 2016. During the 7-year study period, 297 corneal scrapes corresponding to 298 patients were performed. Antibiotic treatment prior to the culture was administered in 59 cases (19.9%). Contact lens wear was the most common risk factor (33.2%). Bacterial keratitis accounted for 64.6% of cases, viral keratitis for 3.4%, and fungal keratitis for 1%. A total of 241 bacterial strains were identified. Gram-positive isolates represented 87.1%, and gram-negative 12.7%. Coagulase-negative Staphylococcus strains were the most common microorganisms isolated (30.3%). When gram-positive microorganisms were analyzed, the sensitivity prevalence rates for vancomycin (VCM), levofloxacin, gentamicin (GM), and tobramycin (TO) were 99.4%, 84.6%, 87.9%, and 88.3%, respectively. For the gram-negative organisms, the sensitivity prevalence rates for ceftazidime, ciprofloxacin, GM, and TO were 83.3%, 93.5%, 96.3%, and 100%, respectively. Our study revealed strong predominance of gram-positive microorganisms. We suggest empirically treating bacterial keratitis originating in our area with VCM and TO, especially severe bacterial keratitis and pretreated cases in the community without a clinical response.

Lactational mastitis caused by Streptococcus lactarius.

Human infections caused by Streptococcus lactarius have not been previously reported. In the present report, we describe a lactational mastitis caused by this organism. The infection occurred in a 28-year-old breast-feeding female, with a 10-days history of moderate pain on the right breast. The patient was cured after antibiotic treatment with levofloxacin for 21 days. Our case shows that S. lactarius should be considered as a cause of lactational mastitis. The introduction of molecular microbiology techniques can be extremely useful for knowing the implication of streptococci in lactational mastitis.

Pseudomonas oryzihabitans: an unusual cause of skin and soft tissue infection.

Skin and soft tissue infections (SSTIs) due to Pseudomonas oryzihabitans are very rare. The aim of the present study was to investigate the clinical and microbiological characteristics of this infection. We performed a retrospective review of six cases that occurred in our area over a period of 6 years, and six cases previously reported in the literature. Predisposing factors were recognized in 76.9% of patients, including previous surgery, immunosuppression, diabetes mellitus, trauma, bites and lactation. The source of infection was probably environmental in most cases. Our study shows that P. oryzihabitans should be considered a potential pathogen, especially in patients with surgical site infections, mastitis and wound infections after bites or trauma. Clinical outcome is usually favourable and treatment is not difficult due to the low level of resistance to commonly used antibiotics.

Alcaligenes faecalis: an unusual cause of skin and soft tissue infection.

Skin and soft tissue infection (SSTI) due to Alcaligenes faecalis is very rare and has never been studied. The aim of the present study was to investigate the clinical and microbiological characteristics of this infection. We conducted a retrospective review of 5 cases that occurred at our institution over a period of 6 years. All patients had underlying diseases, and infection was secondary to vascular disease or recent surgery in 4 of them. The most common clinical presentations were vascular ulcer infection and surgical site infection. The clinical outcome was uniformly good after treatment, except in 1 patient. In conclusion, A. faecalis should be considered a potential pathogen of SSTI, particularly in patients with vascular diseases or after surgery. The history of contact with water or aqueous solutions should be investigated in all cases. The clinical outcome is usually good, but treatment can be difficult in some cases due to the high level of resistance to commonly used antibiotics.

Skin and soft-tissue infections caused by Actinobaculum schaalii: report of two cases and literature review.

Skin and soft-tissue infections (SSTIs) caused by Actinobaculum spp. are very rare. In the present study, we report two cases and review the literature. The first case was an immunocompromised patient with an extensive cellulitis secondary to an inguinal abscess, and the second case was a patient with a pilonidal abscess. Clinical outcomes of both patients were good after surgical drainage and treatment with cloxacillin. The review of the literature showed that SSTIs caused by Actinobaculum spp. are usually located on the perineal and inguinal regions and can be severe, particularly in immunocompromised patients. SSTIs caused by Actinobaculum spp. can be overlooked because identification is often difficult and they can be considered as contaminants.

Muscular abscess caused by Cupriavidus gilardii in a renal transplant recipient.

Cupriavidus gilardii is a rare cause of human infection. We report a muscular abscess on the right thigh caused by this organism in a renal transplant recipient, who had suffered a septic shock associated with an extensive cellulitis caused by Streptococcus pyogenes. The patient was successfully treated with surgical drainage and intravenous ciprofloxacin for 13 days. This is the first time that C. gilardii is isolated from a human abscess. C. gilardii should be considered as a cause of human infection, especially in immunocompromised patients. Infection caused by this organism may be underdiagnosed because the identification is very difficult.

Fournier's gangrene caused by Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi.

We report the first case of Fournier's gangrene caused by three unusual anaerobic organisms: Actinomyces funkei, Fusobacterium gonidiaformans and Clostridium hathewayi. The infection occurred in a 73-year-old man without typical risk factors for the development of Fournier's gangrene. Clinical outcome was good after prolonged antibiotic treatment and extensive debridement of the perineum. The case suggests that A. funkei, F. gonidiaformans and C. hathewayi should be considered as potential pathogens of Fournier's gangrene. Human infections caused by these organisms are very rare but can be underestimated because correct identification is very difficult, especially in polymicrobial infections such as Fournier's gangrene.

Peritonitis caused by Bifidobacterium longum: case report and literature review.

Bifidobacterium spp. rarely causes human infections. We report a case of a 42-year-old man with a history of pancolonic diverticulosis, who suffered a purulent peritonitis caused by Bifidobacterium longum secondary to intestinal perforation. Clinical outcome was good after urgent surgery and antibiotic treatment with imipenem and amoxicillin/clavulanic acid. Our case shows that Bifidobacterium spp. should be considered as a cause of peritonitis, especially in patients with risk of intestinal perforation. The review of the literature shows that these organisms can cause a wide spectrum of severe infections, especially in patients with underlying diseases. Infections caused by Bifidobacterium spp. may be overlooked or underreported since it may be considered normal microbiota.

Skin and soft tissue infection caused by Achromobacter xylosoxidans: report of 14 cases.

BACKGROUND: Skin and soft tissue infections (SSTIs) caused by Achromobacter xylosoxidans are very infrequent. The aim of the present study was to investigate the clinical and microbiological characteristics of this infection. METHODS: We carried out a retrospective review of 14 cases of SSTI due to A. xylosoxidans that occurred at the University Hospital of Guadalajara (Spain) from January 2007 to December 2012. RESULTS: The infection was secondary to vascular diseases, trauma, and recent surgery in 12 patients (85.7%). The most frequent clinical presentation was infection of a vascular ulcer (5 cases). The infection was monomicrobial in 7 patients (50%) and 9 cases were community-acquired (64.2%). The clinical outcome of the patients was uniformly good after antibiotic treatment, except in 4 patients who suffered recurrence of the infection. CONCLUSION: A. xylosoxidans should be considered a potential pathogen in patients with SSTIs, especially in patients with vascular diseases or after surgery or trauma. A history of contact with water should be investigated in all cases. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment in outpatients with community-acquired infections.

Outbreak of multiresistant OXA-24- and OXA-51-producing Acinetobacter baumannii in an internal medicine ward.

Here we describe the clinical, microbiological, epidemiological, and molecular characterization of an outbreak of multidrug-resistant Acinetobacter baumannii (MRAB) involving 5 patients admitted to the internal medicine ward of our hospital. Over a 6-week period, 5 MRAB isolates were recovered from 5 patients, including 1 with fatal meningitis, 3 with skin and soft tissue infections, and 1 with respiratory colonization. One sample obtained during environmental monitoring in the ward was A. baumannii-positive. According to the pulsed-field gel electrophoresis typing results, the strains isolated from all patients and the environmental sample belonged to a single clone, identified as ST79 by multilocus sequence typing. The blaOXA-24 and blaOXA-51 carbapenemases were detected in all isolates. Four patients died, but only the death of the meningitis patient was probably related to the A. baumannii infection. The infection source was probably the hands of the healthcare workers because the outbreak strain was isolated from the surface of a serum container. The results of the present study revealed the importance of strict adherence to control measures by all healthcare workers because the consequences of noncompliance can be very serious.

Acute acalculous cholecystitis complicated with peritonitis caused by Lactobacillus plantarum.

Lactobacillus spp. rarely causes human disease. We report a case of a 57-year-old man with non-insulin-dependent diabetes and vascular disease admitted to our hospital with severe abdominal pain and fever. Signs of peritonitis were found upon examination. The patient underwent surgery, and a diagnosis of perforated cholecystitis with purulent peritonitis was made intra-operatively. A cholecystectomy was performed, and therapy with imipenem was initiated. Lactobacillus plantarum was isolated from bile and peritoneal fluid cultures 2 days later. The patient recovered well and was discharged on post-operative day 16 after 14 days of treatment with imipenem. To our knowledge, this is the second case reported of acute cholecystitis caused by Lactobacillus spp. This organism should be considered as a cause of biliary infections, especially in patients with underlying diseases. Correct identification is often difficult, but it is very important because these organisms are usually resistant to vancomycin and other antibiotics.

Recurrent prosthetic joint infection due to Salmonella enteritidis: case report and literature review.

Prosthetic joint infection (PJI) due to Salmonella spp. is rare. We report a case of a recurrent prosthetic infection with involvement of two joints in a 72-year-old man and review the literature. The review of all cases previously reported and our case shows that conservative approach using antibiotics alone is insufficient to cure the infection. Prolonged antibiotic treatment and two-stage reconstruction with the use of joint spacer is the best choice for the treatment. Salmonella spp. should be considered as a cause of PJI, especially in patients with previous infections caused by this microorganism.

Skin and soft tissue infections caused by Staphylococcus lugdunensis: report of 20 cases.

Staphylococcus lugdunensis is an unusually virulent coagulase-negative Staphylococcus (CoNS). The aim of the present study was to investigate the clinical and microbiological characteristics of 20 cases of skin and soft tissue infections (SSTIs) due to S. lugdunensis that occurred in our area. The frequency of SSTIs due to this organism was 0.42%. The infection was secondary to trauma, surgery or skin disease in 15 patients (75%). Abscesses (7 cases), surgical wound infections (6 cases) and cellulitis (3 cases) were the most common clinical presentations. Breast, abdomen and lower limbs were the most frequent locations. Twelve infections were community-acquired (60%) and S. lugdunensis was the only pathogen isolated from 15 of the 20 specimens (75%). All patients were cured after therapy with antibiotics, associated or not with surgical drainage. The duration of antibiotic treatment ranged from 5 to 21 days. All isolates were susceptible to most of the antibiotics tested including oxacillin. In conclusion, S. lugdunensis is a CoNS that should be considered a potential pathogen when isolated from SSTIs, especially in patients with skin diseases or after trauma or surgery. S. lugdunensis can be underrated if microbiology laboratories do not routinely identify CoNS to the species level in these infections.

[Changes in the antimicrobial susceptibility of Escherichia coli isolates from community diagnosed urinary tract infections during the period 2003-2007. Multicentre study in Castilla la Mancha (Spain)]. / Evolución del patrón de sensibilidad de Escherichia coli en infecciones del tracto urinario diagnosticadas en la comunidad durante el periodo 2003-2007. Estudio multicéntrico en Castilla la Mancha.

OBJECTIVE: To know the evolution of susceptibility patterns of Escherichia coli in patients with community diagnosed urinary tract infections (UTIs) during last years in Castilla la Mancha (Spain). METHODS: Descriptive and retrospective study performed between january 2003 and december 2007. We studied data about frequency and susceptibility of 33.651 E. coli isolates from urine cultures that were remited from primary care centres depending of 6 hospitals in Castilla la Mancha (Spain). RESULTS: Susceptibility rates of E. coli for most antibiotics decreased significantly during the 5-year period, especially for amoxicillin-clavulanic acid, cefuroxime and quinolones. Average rates of susceptibility for amoxicillin-clavulanic acid, ciprofloxacin, cefuroxime, fosfomycin and nitrofurantoin were: 86.7, 75.4, 87.3, 97.6 and 96.2%, respectively. We observed a significantly increase of E. coli isolates producing extended-spectrum betalactamases ESBLs), from 1.9% in 2003 to 4,9% in 2007 (χ² TL = 143.6, p<0.001). CONCLUSIONS: We observed a significantly reduction of E. coli susceptibility for most antibiotics and an increase of E. coli isolates producing ESBLs. Fosfomycin and nitrofurantoin are the best choices for empiric treatment. Prospective studies should be performed in the future to confirm the results of our study.