Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.619
Filtrar
1.
Infectio ; 25(4): 300-302, oct.-dic. 2021.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286727

RESUMO

Resumen Caso reporte de una enfermedad infrecuente, aproximadamente 1% de las artritis sépticas son esternoclavicular, con poca respuesta a antibioterapia intravenosa, requiriendo manejo quirúrgico agresivo, el siguiente caso narra la excelente respuesta con el uso de perlas de sulfato de calcio impregnadas con antibióticos, existiendo en la literatura sólo casos reportes sobre su uso.


Abstract Case report of an infrequent disease, approximately 1% of septic arthritis are sternoclavicular, with little response to intravenous antibiotic therapy, requiring ag gressive surgical management, the following case narrates the excellent response with the use of calcium sulfate pearls impregnated with antibiotics, existing in the literature only cases reports on its use.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osteomielite , Sulfato de Cálcio , Artrite Infecciosa , Doença
2.
Acta Ortop Mex ; 35(1): 11-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34480433

RESUMO

INTRODUCTION: The most feared complication in hip arthroplasty after septic arthritis is septic failure. It is considered that the two-stage treatment is the accepted treatment for acute septic hip arthritis. The objective in this work is to establish a therapeutic guideline for septic arthritis in native hips, proposing a two-stage treatment for acute, and a one-stage treatment for quiescent. MATERIAL AND METHODS: Observational, descriptive, retrospective study. We analyzed all patients who underwent total primary hip replacement between June 1997 and June 2016. We selected those patients who had a diagnosis of septic arthritis of the hip prior to surgery (group 1: acute septic arthritis; group 2: quiescent septic arthritis). RESULTS: Eight hips in group 1 with a follow-up of one to six years. Each patient fulfilled the antibiotic treatment between the placement of the spacer and the definitive prosthetic replacement, and, in all the cases, the remission of the infection was verified. On the other hand, 12 hips in group 2, the time between the treated infection and the prosthetic replacement varied between five and 46 years. The femoral heads sent to culture were in all cases negative. CONCLUSIONS: In the last 20 years, we have obtained satisfactory results, both in the treatment of acute septic arthritis and in its sequelae, interpreting them as pathologies of the same origin but with a different treatment. Both treatments are adequate, as long as the therapeutic protocol established for each of the groups is respected.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artrite Infecciosa/cirurgia , Seguimentos , Articulação do Quadril/cirurgia , Humanos , Estudos Retrospectivos , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 22(1): 776, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511099

RESUMO

BACKGROUND: Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. METHODS: Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. RESULTS: Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01-2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25-2.21)], AVN [1.65 (1.07-2.56)], femoral neck fracture [1.75 (1.39-2.20)], RA [1.37 (1.23-1.54)], CVD [1.34 (1.03-1.74)], chronic pulmonary disease (CPD) [1.22 (1.08-1.37)], neurological disease [1.19 (1.05-1.35)], opioid use [1.53 (1.35-1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13-1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45-0.93)], and OA [0.70 (0.62-0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. CONCLUSION: Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Artroplastia de Quadril/efeitos adversos , Feminino , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Fatores de Risco
4.
BMC Musculoskelet Disord ; 22(1): 780, 2021 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-34511107

RESUMO

BACKGROUND: Periprosthetic joint infection is a serious complication after total joint arthroplasty and polymicrobial PJI which compose a subtype of PJI often indicate worse outcomes compared to monomicrobial periprosthetic joint infection. However, a literature review suggested that there were limited number studies evaluating the risk factors of polymicrobial PJI. MATERIALS AND METHODS: Between 2015 January and 2019 December, a total of 64 polymicrobial PJI patients and 158 monomicrobial PJI patients in a tertiary center were included in this study and corresponding medical records were scrutinized. The diagnosis of PJI was based on 2014 MSIS criteria. Logistic regression was used to identify the association between various variables and polymicrobial PJI and ROC curve was used to identify their efficiency. RESULTS: The prevalence of polymicrobial PJI is 28.3% in our cohorts. After adjusting for the presence of sinus, previous and knee infection, isolation of enterococci (OR, 3.025; 95%CI (1.277,7.164) p = 0.012), infection with atypical organisms (OR, 5.032;95%CI: (1.470,17.229) p = 0.01), infection with gram-negative organisms (OR, 2.255; 95%CI (1.011,5.031) p = 0.047), isolation of streptococcus spp. (OR, 6; 95%CI (2.094,17.194) p = 0.001), and infection with CNS (OfR, 2.183;95%CI (1.148,4.152) p = 0.017) were risk factors of polymicrobial PJI compared to monomicrobial PJI. However, knee infection is related to a decreased risk of polymicrobial PJI with an adjusted OR = 0.479 (p = 0.023). CONCLUSION: This study demonstrated that the prevalence of polymicrobial PJI is 28.3% in PJI patients. Moreover, the presence of sinus tract and previous joint revisions were risk factors for identifying different bacterial species in the intraoperative specimens. Therefore, in these PJI cases, it is necessary to examine multiple specimens of both intraoperative tissue and synovial fluid for increasing the detection rate and obtaining resistance information.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco
5.
J Am Acad Orthop Surg ; 29(20): e1013-e1024, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34570745

RESUMO

BACKGROUND: The C-reactive protein/albumin ratio (CAR) is a marker of inflammation that has been associated with negative outcomes in the general surgery. This study investigates the potential association of preoperative CAR with postoperative complications and readmission rates in the treatment of patients with single-stage revision total joint arthroplasty for periprosthetic joint infection. METHODS: A total of 213 consecutive patients who had undergone single-stage revision for total joint arthroplasty with the preoperative diagnosis of periprosthetic joint infection and preoperative C-reactive protein and albumin values were included. The area under receiver operating characteristic curves was calculated to evaluate the CAR as a predictive value for the complications. RESULTS: Significant differences between the mean CAR were found for patients with 30- and 60-day readmissions and reinfection (P < 0.01). CAR combined with serum and synovial fluid markers demonstrated significantly higher sensitivities and specificities for the prediction of 30-day (total knee arthroplasty [TKA]: 94%; 95%; total hip arthroplasty [THA]: 91%; 96%) and 60-day readmissions (THA: 94%; 95%; TKA: 92%; 96%) and reinfections (TKA: 94%; 95%; THA: 87%; 96%), when compared with only serum and synovial fluid markers combined (83%; 84%; 85%; 87%; 85%; 88%; P <0.01). DISCUSSION: High preoperative CAR, when combined with serum and synovial fluid markers, was associated with increased risk of reinfection and 30- and 60-day readmissions, suggesting that preoperative CAR is a clinically useful predictor for postoperative complications in patients with periprosthetic hip and knee joint infections.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Proteína C-Reativa/análise , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Albumina Sérica
6.
BMC Infect Dis ; 21(1): 1017, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583654

RESUMO

BACKGROUND: Only three other cases of rat bite fever caused by Streptobacillus notomytis in humans have been reported since this species was identified in 2015. Data specific to the differences in clinical features and geographic distribution between S. notomytis infection and S. moniliformis infection are scarce. All previous cases of human S. notomytis infection were reported from Japan. This is the first case of S. notomytis infection reported from outside of Japan. CASE PRESENTATION: A 72-year-old Thai woman was admitted to Siriraj Hospital (Bangkok, Thailand)-Thailand's largest university-based national tertiary referral center-in August 2020 with fever, myalgia, and polyarthralgia for 3 days, and gradually decreased consciousness for the past 1 day. Physical examination and laboratory investigations revealed septic arthritis of both knee joints, meningitis, and hepatitis. She was initially misdiagnosed as rheumatoid arthritis in the elderly since the initial investigations were unable to detect a causative pathogen. However, S. notomytis infection was later confirmed by polymerase chain reaction amplification of a part of the 16S rRNA gene and sequencing from synovial fluid. Her clinical course was also complicated by spondylodiscitis and epidural abscess caused by S. notomytis, which was detected from tissue biopsy. Therefore, rat bite fever in this patient manifested as meningitis, septic polyarthritis, hepatitis, and spondylodiscitis. The patient was treated with intravenous ceftriaxone then switched to oral amoxicillin with complete recovery. CONCLUSIONS: The clinical manifestations of S. notomytis infection are similar to those demonstrated in S. moniliformis infection. This case also showed that arthritis caused by S. notomytis mimics rheumatoid arthritis, and that meningitis and spondylodiscitis are potential coexisting complications that can be found in S. notomytis infection.


Assuntos
Artrite Infecciosa , Discite , Meningite , Febre por Mordedura de Rato , Streptobacillus , Idoso , Animais , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Discite/diagnóstico , Discite/tratamento farmacológico , Feminino , Humanos , RNA Ribossômico 16S/genética , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos , Streptobacillus/genética , Tailândia
7.
BMC Infect Dis ; 21(1): 1018, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587890

RESUMO

AIMS: Preoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive? MATERIALS AND METHODS: Between 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed. RESULTS: The sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity. CONCLUSIONS: The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture. LEVEL OF EVIDENCE: Level III.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Biomarcadores , Humanos , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/cirurgia , Sensibilidade e Especificidade , Líquido Sinovial
8.
J Pediatr Orthop ; 41(10): e911-e916, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34483307

RESUMO

BACKGROUND: Lyme arthritis often presents as acute monoarticular arthritis challenging to distinguish from septic arthritis. Typical management for Lyme arthritis entails antibiotic therapy, while septic arthritis usually warrants operative debridement. During the period when Western Pennsylvania transitioned to a Lyme-endemic region, many children underwent operative intervention who were ultimately diagnosed with Lyme arthritis due to diagnostic ambiguity. We examined the impact of the operative intervention on pediatric Lyme arthritis outcomes. METHODS: We conducted a retrospective cohort study of patients admitted to a tertiary care children's hospital who were diagnosed with Lyme arthritis from 2008 to 2018 using chart review. Inclusion criteria were positive Lyme serology by Centers for Disease Control and Prevention (CDC) definition, clinical arthritis, and negative bacterial cultures. We recorded clinical presentation, laboratory data, details of hospitalization, costs, and outcomes after therapy to compare the impact of antibiotics alone (nonoperative group) versus antibiotics plus operative debridement (operative group). RESULTS: A total of 149 patients met the inclusion criteria. Overall, 47 (32%) patients underwent orthopaedic intervention. Operative management was associated with increased length (3.17 vs. 1.40 d) and cost ($27,850 vs. $10,716) of admission. The clinical resolution was documented in 57/58 patients (98%) in the nonoperative group and 41/42 patients (98%) in the operative group. The median duration to resolution was 21 days for both groups. CONCLUSIONS: Operative management of pediatric patients with Lyme arthritis is associated with increased resource utilization and costs while being similarly efficacious to nonoperative management. As the US Lyme epidemic expands, improved diagnosis and management of acute undifferentiated arthritis may prevent unneeded operative intervention. LEVEL OF EVIDENCE: Level III-retrospective cohort study.


Assuntos
Artrite Infecciosa , Doença de Lyme , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/terapia , Criança , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/epidemiologia , Doença de Lyme/terapia , Estudos Retrospectivos
9.
J Pediatr Orthop ; 41(10): 610-616, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34483309

RESUMO

BACKGROUND: In pediatric patients, the presentation of the nontraumatic acutely painful joint/limb poses a diagnostic dilemma due to the similarity of presentations of the most likely diagnoses [septic arthritis (SA), transient synovitis (TS), osteomyelitis]. Current tools employed to differentiate these diagnoses rely on nonspecific inflammatory markers, radiologic imaging, and arthrocentesis. Diagnostic algorithms utilizing these clinical, radiographic, and biochemical parameters have produced conflicting results. The purpose of this study was to identify a serum-based inflammatory signature which can differentiate SA from TS in pediatric patients. METHODS: Serum samples were collected from 22 pediatric patients presenting with joint/extremity pain whose working diagnosis included SA or TS. Each sample was analyzed for serum abundance of 72 distinct biomarkers and cytokines using enzyme linked immunosorbent assay based arrays. Linear discriminant analysis was performed to identify a combinatorial biomarker panel to predict a diagnosis of SA or TS. Efficacy of the biomarker panel was compared with definitive diagnoses as based on laboratory tests, arthrocentesis results, and clinical scenario. RESULTS: At the time of presentation: (1) mean erythrocyte sedimentation rate in the SA group was 56.6 mm/h and 12.4 mm/h in the TS group (P<0.001), (2) mean C-reactive protein was 55.9 mg/dL in the SA group and 13.7 mg/dL in the TS group (P=0.12), and (3) mean white blood cell was 10.9 k/mm3 in the SA group and 11.0 k/mm3 in the TS group (P=0.95). A combined panel of 72 biomarkers was examined using discriminant analysis to identify a limited set of predictors which could accurately predict whether a patient was diagnosed with SA or TS. A diagnostic algorithm consisting of transforming growth factor alpha, interleukin (IL)-7, IL-33, and IL-28A serum concentration correctly classified 20 of the 22 cases with a sensitivity and specificity of 90.9% (95% confidence interval: 73.9%-100.0%). CONCLUSION: This study identifies a novel serum-based 4-cytokine panel that accurately differentiates SA from TS in pediatric patients with joint/limb pain. LEVEL OF EVIDENCE: Level II-diagnostic study.


Assuntos
Artrite Infecciosa , Sinovite , Artrite Infecciosa/diagnóstico , Biomarcadores , Criança , Citocinas , Humanos , Projetos Piloto , Estudos Retrospectivos , Sinovite/diagnóstico por imagem
10.
J Assoc Physicians India ; 69(8): 11-12, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34472811

RESUMO

BACKGROUND: Acute onset polyarthritis is a common presentation in rheumatology outpatient consultations, which include both post-infectious arthritis and autoimmune rheumatic diseases (AIRDs). COVID pandemic has added to the list of infectious agents that could result in arthritis. MATERIALS AND METHODS: The retrospective observational study was conducted at a tertiary care centre. The study included patients who presented with clinical suspicion of post-infectious arthritis between July-September 2019 and 2020. The study was extended for another 2 months to include patients who presented between October-November 2020. The patients were categorized into post-viral arthritis, post-COVID arthritis, chikungunya arthritis and AIRDs. The demographics, comorbidities, clinical presentation, examination findings and laboratory parameters and the response to treatment for each participant were collected and assessed. RESULTS: In the year 2019 and 2020 (July-Sep), the corresponding number of patients analyzed were 20 and 33. The mean duration of presentation was 1.53 (±3.10) weeks. Chikungunya arthritis was noted in 10% of patients in 2019, while it was 15.15% in 2020. Other post-viral arthritis was identified in 65% and 66.67% of patients in 2019 and 2020 respectively. In the second part of the study, 65.68% of patients were classified as post-viral arthritis, including chikungunya arthritis, post-COVID arthritis and other post-viral arthritis. Around 27% were categorized as AIRDs. Rheumatoid factor negativity and anti-nuclear antibody negativity were found to be significant (P 0.0) in categorizing the patients into post-viral arthritis group, while presence of urinary symptoms (P 0.0) classified the patients into reactive arthritis. CONCLUSION: The study revealed that the presence of chikungunya arthritis across the two years was comparable. Post-COVID arthritis needs to be considered as a potential differential in post-infectious arthritis. There are no identifiable characteristics (clinical or a simple routine laboratory parameter) that could differentiate the causes of post-infectious arthritis from AIRDs.


Assuntos
Artrite Infecciosa , COVID-19 , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Humanos , Pandemias , SARS-CoV-2 , Centros de Atenção Terciária
11.
BMC Pediatr ; 21(1): 342, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389010

RESUMO

BACKGROUND: In the management of pediatric osteomyelitis or septic arthritis, delay in treatment may affect outcome, while receipt of antibiotics prior to culture may affect culture results. We aimed to determine if pathogen identification decreased in cultures that were pretreated with antibiotics. METHODS: We conducted a retrospective cohort study of 584 hospitalized children between 30 days and 18 years of age admitted to two tertiary children's hospitals. Logistic regression assessed the effect of antibiotic duration on blood, bone, joint aspirate, and "other" culture positivity. RESULTS: Overall, 42% of blood cultures, 70% of bone cultures, 39% of joint cultures, and 70% of "other" cultures were positive. Compared with children who did not receive antibiotics prior to culture, there were no significant differences in odds of a positive culture in children whose cultures were pretreated with antibiotics for any of the culture types [OR (95% CI) 0.90 (0.56-1.44) for blood cultures, 0.77 (0.25-2.34) for bone cultures, 0.71 (0.39-1.28) for joint cultures, 1.18 (0.58-2.41) "for other" cultures; all p > 0.05]. Furthermore, the duration (hours) of antibiotics in the pretreated cultures was also not a significant predictor of culture positivity (OR ranged from 0.99-1.00 for all cultures, p > 0.05). CONCLUSIONS: Culture positivity was not associated with antibiotic pretreatment in any of the samples, even for longer duration of antibiotics prior to culture, though the small sample size of subgroups is an important limitation. In pediatric patients hospitalized with osteomyelitis and/or septic arthritis, early initiation of antibiotics may not affect culture positivity.


Assuntos
Artrite Infecciosa , Osteomielite , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Criança , Humanos , Lactente , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Fatores de Tempo
13.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404656

RESUMO

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive for Mycobacterium fortuitum He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due to M. fortuitum can be managed medically without having to remove the prosthesis or debride the joint.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Prótese de Quadril , Mycobacterium fortuitum , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artroplastia de Quadril/efeitos adversos , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia
14.
J Pediatr Orthop ; 41(9): e849-e854, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34411048

RESUMO

BACKGROUND: Tropical pyomyositis has had a recent increase in the United States, Europe, and other nontropical areas. The purpose of this study was to provide an accurate description of the demographics, presenting features, sites of involvement, microbiology, imaging modalities, medical and surgical management, complications, and predictors of clinical course. METHODS: We searched PubMed, Cochrane, Web of Science Collection, Scopus, and Embase databases yielding 156 studies. Of these, 23 articles were selected for statistical analysis. RESULTS: The average age at presentation was 8.4±1.9 years with males more commonly affected. Fever, painful limp, and localized pain were the most common presenting symptoms. Pelvis, lower extremity, trunk and spine, in descending order, were the most commonly affected locations. Iliopsoas, obturator musculature, and gluteus musculature were the most commonly affected muscle groups. The mean time to diagnosis was 6.6±3.05 days. Staphylococcus aureus was the most common offending organism. The mean length of hospital stay was 12.0±4.6 days. Medical management alone was successful in 40% of cases (143/361) with an average duration of 9.5±4.0 and 22.7±7.2 days of intravenous and oral antibiotics, respectively. Surgical management consisted of open drainage in 91.3% (199/218) or percutaneous drainage in 8.7% (19/218) of cases. Painful limp, fever, and larger values of white cell count and erythrocyte sedimentation rate were associated with an increased need for surgery. Obturator and calf muscle involvement were strongly associated with multifocal involvement. There were 42 complications in 41 patients (11.3%). Methicillin-resistant S. aureus was associated with an increased risk of complications. The most common complications were osteomyelitis, septicemia, and septic arthritis. CONCLUSIONS: Primary pyomyositis should be considered in cases suggesting pediatric infection. Magnetic resonance imaging is the most commonly used imaging modality; however, ultrasound is useful given its accessibility and low cost. Medical management alone can be successful, but surgical treatment is often needed. The prognosis is favorable. Early diagnosis, appropriate medical management, and potential surgical drainage are required for effective treatment. LEVEL OF EVIDENCE: Level IV-systematic review.


Assuntos
Artrite Infecciosa , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Piomiosite , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Criança , Humanos , Masculino , Osteomielite/tratamento farmacológico , Piomiosite/diagnóstico por imagem , Piomiosite/terapia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/terapia
16.
Pan Afr Med J ; 38: 408, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34381552

RESUMO

Hydroxyapatite crystal deposition disease (HADD) of the hand and wrist is rare but can cause acute inflammatory syndromes that mimic infectious arthritis. These symptoms, which rapidly resolve with systemic anti-inflammatory drugs, are a source of diagnostic errors and inappropriate treatment. It is of crucial importance to make the diagnosis in order to avoid iatrogenic surgical management. The aim of this study was to determine the clinical and radiographic signs and the key features on which diagnosis depends. Treatment effectiveness and the course of the disease were also examined. Between 1992 and 2008, 12 patients consulted for an isolated acute local inflammatory syndrome of the hand or wrist, which was accompanied by a unique radiographic picture of calcific density. All patients were reassessed clinically and radiographically with a minimum follow-up of 2 years. All patients had presented with acute local inflammatory syndromes. Nine patients had edema and 8 had swelling and erythema. No patient had fever. The course was favorable in 11 patients and one patient required surgery. No patient had a recurrence at the mean final follow-up of 90 ± 64 months. The symptoms associated with hydroxyapatite crystal deposits suggest septic arthritis with acute joint inflammation. The radiological appearance is characteristic and corrects the diagnosis. Oral anti-inflammatory treatment gives more rapid spontaneous improvement, with complete and long-lasting resolution.


Assuntos
Calcinose/diagnóstico por imagem , Durapatita/metabolismo , Mãos/diagnóstico por imagem , Punho/diagnóstico por imagem , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Artrite Infecciosa/diagnóstico , Calcinose/patologia , Calcinose/terapia , Edema/etiologia , Feminino , Seguimentos , Mãos/patologia , Humanos , Inflamação/diagnóstico por imagem , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Punho/patologia
17.
BMC Musculoskelet Disord ; 22(1): 706, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407779

RESUMO

BACKGROUND: The increasing incidence of primary total knee arthroplasty (TKA) has led to an increase in both the incidence and the cost burden of revision TKA procedures. This study aimed to review the literature on the cost of revision TKA for septic and aseptic causes and to identify the major cost components contributing to the cost burden. METHODS: We searched MEDLINE (OvidSp), Embase, Web of Science, Cochrane Library, EconLit, and Google Scholar to identify relevant studies. Selection, data extraction and assessment of the risk of bias and cost transparency within the studies were conducted by two independent reviewers, after which the cost data were analysed narratively for 1- or 2-stage septic revision without re-revision; 2-stage septic revision with re-revision; and aseptic revision with and without re-revision, respectively. The major cost components identified in the respective studies were also reported. RESULTS: The direct medical cost from the healthcare provider perspective for high-income countries for 2-stage septic revision with re-revision ranged from US$66,629 to US$81,938, which can be about 2.5 times the cost of 1- or 2-stage septic revision without re-revision, (range: US$24,027 - US$38,109), which can be about double the cost of aseptic revision without re-revision (range: US$13,910 - US$29,213). The major cost components were the perioperative cost (33%), prosthesis cost (28%), and hospital ward stay cost (22%). CONCLUSIONS: Septic TKA revision with re-revision for periprosthetic joint infection (PJI) increases the cost burden of revision TKA by 4 times when compared to aseptic single-stage revision and by 2.5 times when compared to septic TKA revision that does not undergo re-revision. Cost reductions can be achieved by reducing the number of primary TKA that develop PJI, avoidance of re-revisions for PJI, and reduction in the length of stay after revision. TRIAL REGISTRATION: PROSPERO; CRD42020171988 .


Assuntos
Artrite Infecciosa , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artrite Infecciosa/cirurgia , Artroplastia do Joelho/efeitos adversos , Humanos , Tempo de Internação , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos
18.
J Infect Chemother ; 27(11): 1591-1595, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34294530

RESUMO

INTRODUCTION: Although early diagnosis of septic arthritis may reduce mortality rates, and limit unnecessary surgical interventions, clinical parameters alone are not adequate for making the diagnosis of septic arthritis. Therefore, relevant laboratory parameters are used to enhance diagnostic sensitivity. The aim of our study was to assist in making the diagnosis of septic arthritis, and prevent delays in the diagnosis. For this purpose; we aimed to determine the diagnostic values of human neutrophil peptides 1-3 (HNP 1-3) and procalcitonin (PCT) in synovial fluids of patients with arthritis. By comparing the HNP 1-3 and procalcitonin levels, as well as CRP, in synovial fluid aspirates, we evaluated the significance of these data in the differential diagnosis of septic arthritis from noninfectious arthritis. METHODS: A total of 67 adults consisting of 37 septic arthritis and 30 noninfectious arthritis patients were included in our study. As bioindicators; levels of HNP 1-3, PCT, synovial and serum CRP levels were found to have significant ROC areas in discriminating septic arthritis patients from noninfectious arthritis patients. RESULTS: As a result, synovial fluid HNP 1-3 levels were significantly higher in septic arthritis patients compared to noninfectious arthritis patients (p < 0.001). The sensitivity, specificity, and accuracy of HNP 1-3 levels in the diagnosis of septic and noninfectious arthritis were found as 86%, 87%, and 87%, respectively (AUC of the ROC curve = 0.828). CONCLUSIONS: It was decided that the level of HNP 1-3 in the synovial fluid can be used as an alternative indicator in the diagnosis of septic arthritis.


Assuntos
Artrite Infecciosa , Líquido Sinovial , Adulto , Artrite Infecciosa/diagnóstico , Biomarcadores , Proteína C-Reativa , Diagnóstico Diferencial , Humanos , Pró-Calcitonina , Curva ROC
20.
Acta Biomed ; 92(S3): e2021009, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34313671

RESUMO

Introduction Periprosthetic joint infection (PJI) is the most problematic complications after shoulder arthroplasty. Many diagnostic tools have been identified to find infection, such as hystopatologic examination of tissue sections or cultures of intraoperative tissue. Implant sonication fluid culture showed good results in order to enhance diagnostic accuracy, but literature results are still controversial. Aim of our study is to compare the results of sonication with intraoperative tissue sample cultures. Patients and Methods From February 2016 to January 2018 we performed 102 revisions of Total Shoulder Arthroplasty (TSA) for suspected PJI.  Sixty - five patients respected the criteria for admission to the study. In each case periprostethic specimens were collected and explanted prosthesis were put inside sterile fluid, sonicated and then placed under culture. Results Among the sixty-five patients, 36 were considered as possible, probable or certain infection. Tissue cultures were positive for infection in thirty - four cases (52,3%) and in nineteen cases was found the positivity for Cutibacterium acnes. Sonication fluid cultures were positive in forty cases (61,5%), with a positivity for Cutibacterium acnes in twenty - seven cases. The sensitivities of sonication and tissue cultures for the diagnosis of shoulder PJI were 83.3% and 88,9% (P = 0,08); the specificities were 65.5%  and 93,1% (P < 0.01) respectively. Conclusion Our results suggest that sonication technique had not shown a clear advantage in postoperative shoulder PJI diagnosis, but it's a real aid to detect Cutibacterium acnes. In any case, sensitivity and mostly specificity were higher with  tissue cultures.


Assuntos
Artrite Infecciosa , Artroplastia do Ombro , Infecções Relacionadas à Prótese , Articulação do Ombro , Artroplastia do Ombro/efeitos adversos , Humanos , Próteses e Implantes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Articulação do Ombro/cirurgia , Sonicação
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...