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1.
Acta Chir Orthop Traumatol Cech ; 88(2): 131-136, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33960926

RESUMO

PURPOSE OF THE STUDY The aim of this study was to investigate the culture results of children undergoing debridement for suspected septic arthritis or acute osteomyelitis and to compare the laboratory parameters and clinical characteristics of culture-positive and culture-negative patients. MATERIAL AND METHODS Patients who underwent surgery in our hospital for septic arthritis and acute osteomyelitis between 2011 and 2019 were retrospectively analyzed. Seventy-two of 96 patients were included in the study. The patients had documented joint swelling, redness, pain with joint movement and weight-bearing failure. Fever was assessed preoperatively. Sedimentation rate, C-reactive protein level, white blood cell count and the leukocyte count in aspiration material as well as complications were evaluated preoperatively and 3 months postoperatively. RESULTS Twenty patients underwent surgery of the hip; 39 of the knee; 7 of the foot, ankle and distal tibia; 1 of the elbow; and 1 of the distal radius. Additionally, 4 patients had septic arthritis and acute osteomyelitis of the femur. The mean age of the patients was 7.8 years (1-16). The mean follow-up period was 16.2 months (3-42). Preoperative aspiration was performed in 44 of 72 patients. Thirty of 72 patients had positive cultures. No statistically significant difference in age, preoperative duration, C-reactive protein, sedimentation, white blood cell count, preoperative fever or complications was found when compared between patients with culture growth and those without reproduction (p > 0.05). There was a significant difference between the leukocyte count in the aspiration material (p < 0.05). CONCLUSIONS Prediagnosis of septic arthritis or acute osteomyelitis in pediatric patients is important in terms of future joint health and sepsis. According to our findings an inability to obtain bacteria does not exclude septic arthritis as a diagnosis. Empirical antibiotic therapy with a wide postoperative spectrum is important for joint health in these patients. Preoperative serum parameters cannot predict the agent needed for treatment. Key words: septic arthritis, osteomyelitis, pediatric septic arthritis, pediatric joint infection, pediatric infection.


Assuntos
Artrite Infecciosa , Osteomielite , Adolescente , Artrite Infecciosa/diagnóstico , Sedimentação Sanguínea , Criança , Pré-Escolar , Humanos , Lactente , Contagem de Leucócitos , Osteomielite/diagnóstico , Estudos Retrospectivos
2.
Pan Afr Med J ; 38: 77, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33889243

RESUMO

Introduction: infections are the leading cause of morbidity and mortality in patients with sickle cell disease, especially before age 5 years. The purpose of this study was to highlight the epidemiological features, etiologies and management of osteoarticular infections in patients with sickle cell disease in Lubumbashi. Methods: we conducted a descriptive, cross-sectional and retrospective study at the Research Center for Sickle Cell Disease in Lubumbashi (RCSCDL) over a three-year period from June 2014 to June 2017. It included all patients with sickle cell disease on follow up at the RCSCDL who developed osteoarticular infection. Data were obtained from a survey form. Parameters were patient's age, age at first visit, sex, reason for consultation, history, physical signs, diagnosis, paraclinical assessment and treatment. Results: we identified 35 cases of osteoarticular infections out of a total of 380 cases of sickle-cell disease, reflecting a rate of 9.2%. The most affected age group was people under 5 years of age (37.1%); the average age was 10.9±9.5 years ranging from 8 months and 37 years. There was a slight female predominance (51.4% of cases; sex ratio 1.06 in favor of women). Most patients with osteoarticular infection had a history of transfusion (16.6%) and splenectomy (8.6%). The most common reason for consulting was limb pain (84%); 20 patients (57.1%) had bulbar conjunctival icterus and 26 (74.3%) were pale. Clinical examination showed limb swelling and wound in 27 patients (77.1%) and 19 patients (54.3%), respectively. Clinical palpation of the splenomegaly was performed in 6 patients (17.1%). Three types of osteoarticular infections were detected. They were dominated by osteomyelitis (24 cases; 68.57%) followed by osteitis (7 cases; 20%) and suppurative arthritis (4 cases; 11.43%). Out of 24 cases of osteomyelitis, 18 were acute (75%) and 6 were chronic (25%), of which 4 had a hyperostosing behaviour and 2 a fistulising behaviour. Tibia was the most affected bone (18 cases), X-ray mainly showed osteolysis (27 cases; 77.1%) and then periosteolysis (15 cases; 42.9%). Homozygous sickle cell disease was found in 88.6% of cases. Hemoculture was performed in 17 out the 35 patients and salmonella was isolated in 15 out of 17 cultures (88.23%). Pyoculture was performed in 10 patients; it isolated other germs. Assessment of inflammation was performed in 21 patients: 15 had hyperleukocytosis, 13 pathological white blood cell formula , all had increased sedimentation rate (greater than 20mm in the 1st hour). With respect to immunization schedule, 62.86% of patients received EPI vaccines while patients with sickle cell disease who needed specific vaccine had an adherence rate of 17.14%. With respect to therapy, all of our patients received medical treatment; 6 patients underwent sequestrectomy (17.14%) while the majority of patients (25 cases) underwent orthopedic treatment. Conclusion: bone infection in patients with sickle cell disease is a worryng issue in our poor environment where there isn't a specific vaccine for patients with sickle cell disease.


Assuntos
Anemia Falciforme/complicações , Artrite Infecciosa/etiologia , Osteíte/etiologia , Osteomielite/etiologia , Adolescente , Adulto , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , República Democrática do Congo , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Osteíte/diagnóstico , Osteíte/epidemiologia , Osteomielite/diagnóstico , Osteomielite/epidemiologia , Estudos Retrospectivos , Esplenomegalia/etiologia , Adulto Jovem
3.
Orthopade ; 50(5): 410-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33661317

RESUMO

Septic arthritis is a common joint infection in neonates and young children. Since osteoarticular infections cause permanent disability in bones and joints, they should be treated appropriately as soon as possible. If there is a delay in starting treatment it can cause severe morbidity. It is most common in the hip and shoulder joints. In this article the surgical treatment process and postoperative clinical status of a 35-year-old patient with severe coxarthrosis and 12 cm femoral shortening due to septic arthritis are reported. To avoid damage to neurovascular structures an extremity lengthening procedure was performed first, followed by a total hip replacement. In order to complete the distraction and consolidation phase in one session and to reduce complications, a growing intramedullary nail was selected. As a result of the surgical interventions, the complaints of the patient in the hip joint and the limping due to shortness of the leg decreased and the performance of activities of daily living was improved.


Assuntos
Artrite Infecciosa , Osteogênese por Distração , Atividades Cotidianas , Adulto , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Criança , Pré-Escolar , Extremidades , Fêmur , Humanos , Recém-Nascido , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Resultado do Tratamento
6.
BMC Infect Dis ; 21(1): 151, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546627

RESUMO

BACKGROUND: Joint replacement is an effective intervention and prosthetic joint infection (PJI) is one of the most serious complications of such surgery. Diagnosis of PJI is often complex and requires multiple modalities of investigation. We describe a rare cause of PJI which highlights these challenges and the role of whole-genome sequencing to achieve a rapid microbiological diagnosis to facilitate prompt and appropriate management. CASE PRESENTATION: A 79-year-old man developed chronic hip pain associated with a soft-tissue mass, fluid collection and sinus adjacent to his eight-year-old hip prosthesis. His symptoms started after intravesical Bacillus Calmette-Guerin (BCG) therapy for bladder cancer. Synovasure™ and 16S polymerase chain reaction (PCR) tests were negative, but culture of the periarticular mass and genome sequencing diagnosed BCG infection. He underwent a two-stage joint revision and a prolonged duration of antibiotic therapy which was curative. CONCLUSIONS: BCG PJI after therapeutic exposure can have serious consequences, and awareness of this potential complication, identified from patient history, is essential. In addition, requesting appropriate testing is required, together with recognition that traditional diagnostics may be negative in non-pyogenic PJI. Advanced molecular techniques have a role to enhance the timely management of these infections.


Assuntos
Artrite Infecciosa/etiologia , Vacina BCG/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Vacina BCG/administração & dosagem , Vacina BCG/genética , Vacina BCG/isolamento & purificação , Genoma Bacteriano/genética , Prótese de Quadril/efeitos adversos , Prótese de Quadril/microbiologia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Resultado do Tratamento
8.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472800

RESUMO

Staphylococcus-associated glomerulonephritis (SAGN) occurs as a complication of staphylococcal infection elsewhere in the body. Dermatomyositis (DM) can be associated with glomerulonephritis due to the disease per se. We report a case of a 40-year-old male patient with DM who presented with acute kidney injury, and was initially pulsed with methylprednisolone for 3 days, followed by dexamethasone equivalent to 1 mg/kg/day prednisolone. He was subsequently found to have SAGN on kidney biopsy along with staphylococcus bacteraemia and left knee septic arthritis. With proof of definitive infection, intravenous immunoglobulin 2 g/kg over 2 days was given and steroids were reduced. He was treated with intravenous vancomycin. With treatment, the general condition of the patient improved. On day 38, he developed infective endocarditis and died of congestive heart failure subsequently. Undiagnosed staphylococcal sepsis complicating a rheumatological disease course can lead to complications like SAGN, infective endocarditis and contribute to increased morbidity and mortality, as is exemplified by our case.


Assuntos
Lesão Renal Aguda/diagnóstico , Artrite Infecciosa/diagnóstico , Bacteriemia/diagnóstico , Dermatomiosite/tratamento farmacológico , Glomerulonefrite/patologia , Glucocorticoides/uso terapêutico , Infecções Estafilocócicas/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Dermatomiosite/fisiopatologia , Endocardite Bacteriana , Evolução Fatal , Glomerulonefrite/etiologia , Glomerulonefrite/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico
9.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462004

RESUMO

Rothia mucilaginosa is a Gram-positive aerobic coccus usually found in the oral and respiratory tract. Septic arthritis is an uncommon condition, but is an orthopaedic emergency. A rare case of knee septic arthritis due to R. mucilaginosa is presented. Patient management and outcomes are discussed, and learning points from this case are outlined to help manage any further cases that may arise.


Assuntos
Artrite Infecciosa/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Articulação do Joelho/microbiologia , Micrococcaceae/isolamento & purificação , Feminino , Humanos , Pessoa de Meia-Idade
10.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462043

RESUMO

Group A streptococcus (GAS) causes a wide variety of infections in the paediatric population, ranging from pharyngitis to rare but severe invasive diseases, such as bacterial arthritis and osteomyelitis. Dental neglect is a type of child neglect in which caregivers fail to provide adequate care and treatment for dental diseases. This results in poor oral hygiene and can lead to complications including sepsis. We report the case of a 4-year-old boy, suffering from child neglect, presenting with GAS pharyngitis and subsequent bacterial arthritis in the right ankle, osteomyelitis in the right talus and abscess in the right calcaneus. He was first treated with penicillin, which was changed to clindamycin because of a suspected drug-induced rash. He was discharged after 6 weeks of intravenous therapy when symptoms had resolved and inflammatory markers were within the normal range. The case highlights that dental neglect may present a risk for subsequent invasive infections.


Assuntos
Artrite Infecciosa/microbiologia , Higiene Bucal , Osteomielite/microbiologia , Faringite/microbiologia , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Artrite Infecciosa/diagnóstico , Pré-Escolar , Humanos , Masculino , Osteomielite/diagnóstico , Faringite/diagnóstico
11.
BMJ Case Rep ; 14(1)2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468512

RESUMO

We describe the case of Mycoplasma hominis septic arthritis in a 58-year-old woman with a history of rheumatoid arthritis and ulcerative colitis on immunosuppressive therapy with rituximab. Treatment with anti-CD20 antibodies (eg, rituximab) leads to an immediate depletion of B cells and hence risk of reductions in immunoglobulins and increased risk of infections. This effect may last long after drug cessation. M. hominis is commensal to the genitourinary tract in sexually active adults. Extragenital M. hominis infections including septic arthritis are rare, but hypogammaglobulinaemia is a predisposing factor. As M. hominis requires extended culture, special media or PCR analysis, it is not tested routinely, which in many cases delays diagnosis and correct treatment. In our case, a diagnosis of M. hominis septic arthritis was made after 9 weeks by PCR analysis and culture of joint fluid. The patient responded well to an 8-week treatment course of moxifloxacin and doxycycline.


Assuntos
Agamaglobulinemia/complicações , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite Reumatoide/complicações , Infecções por Mycoplasma/diagnóstico , Mycoplasma hominis/isolamento & purificação , Artrite Infecciosa/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/complicações
12.
BMC Infect Dis ; 21(1): 13, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407223

RESUMO

BACKGROUND: Enterobacter cloacae (E. cloacae) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by E. cloacae in an immunocompetent patient. CASE PRESENTATION: A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed E. cloacae. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain. CONCLUSION: This is a rare case of E. cloacae infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent E. cloacae osteoarticular infection, regardless of being asymptomatic after the procedure.


Assuntos
Artrite Infecciosa/diagnóstico , Enterobacter cloacae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Dor de Ombro/diagnóstico , Ombro/microbiologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Desbridamento , Diagnóstico Tardio , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/cirurgia , Feminino , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Levofloxacino/uso terapêutico , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Dor de Ombro/microbiologia , Resultado do Tratamento
13.
Z Rheumatol ; 80(2): 184-188, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33336292

RESUMO

Septic arthritis and spondylodiscitis, especially in immunocompromised patients, constitute a major differential diagnosis of joint or back pain. This results in the invasion of a joint or spinal disc and its adjacent vertebral body by a pathogen. In most cases this is manifested as unspecific symptoms, such as local joint or back pain, fever and malaise. If this is clinically suspected the bacterial infection of the joint can be confirmed by joint puncture and blood culture. For the diagnosis of spondylodiscitis magnetic resonance imaging should be used for visualization. In addition to adequate pain treatment and empirical antibiotic treatment, an arthroscopic removal of infected intra-articular tissue and debris is imperative. When complications caused by spondylodiscitis arise a surgical removal and stabilization should be performed. The following case report presents the findings of septic polyarthritis and spondylodiscitis in an immunocompromised patient with an HIV infection and provides insights into the occurrence of complications due to the delay of adequate treatment.


Assuntos
Artrite Infecciosa , Discite , Artrite Infecciosa/complicações , Artrite Infecciosa/diagnóstico , Diagnóstico Diferencial , Discite/complicações , Discite/diagnóstico , Infecções por HIV , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética
14.
J Orthop Res ; 39(2): 348-355, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33331672

RESUMO

Synovial fluid is important for the preoperative etiological diagnosis of suspected periprosthetic joint infection (PJI) or septic arthritis (SA). GENECUBE, an automated real-time polymerase chain reaction (PCR) assay, was used to detect bacterial mecA (methicillin resistance) and was compared with microbiological cultures for preoperatively diagnosing PJI and SA in 74 patients suspected of these infections and thus earmarked for surgery. PJI and SA were diagnosed in 21 and 6 cases, respectively, using modified ICM 2018 diagnostic criteria. Microbiological cultures determined methicillin-resistant staphylococcus (MRS) as the causative organism in six samples, which were all positive in the GENECUBE assay. Significantly also, the GENECUBE assay detected six MRS infections in culture-negative but infection-diagnosed patients, and in one inconclusive case, suggesting a higher sensitivity of this assay. Compared with microbiological culture, the sensitivity and specificity of the GENECUBE assay for mecAwas 100% and 92.2%, respectively. However, GENECUBE also produced invalid results in three cases, suggesting possible PCR inhibitors in the synovial fluid samples. We additionally validated the accuracy of pan-bacterial real-time PCR targeting 16S rRNA and other tests. Pan-bacterial real-time PCR was as effective as preoperative bacterial culture testing, although the α-defensin assay had the highest sensitivity at 100%. Hence, fully automated real-time PCR targeting of the bacterial mecA gene improves the etiological diagnosis of PJI and SA by reducing the testing time and lowering the false-positive detection rates. A screening approach for α-defensin followed by bacterial mecA gene testing in synovial fluids is therefore a more efficient method of preoperatively diagnosing PJI and SA.


Assuntos
Artrite Infecciosa/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Líquido Sinovial/química , Genes Bacterianos , Humanos , Resistência a Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Reação em Cadeia da Polimerase em Tempo Real/estatística & dados numéricos
15.
Bone Joint J ; 103-B(1): 39-45, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380187

RESUMO

AIMS: Metagenomic next-generation sequencing (mNGS) is useful in the diagnosis of infectious disease. However, while it is highly sensitive at identifying bacteria, it does not provide information on the sensitivity of the organisms to antibiotics. The purpose of this study was to determine whether the results of mNGS can be used to guide optimization of culture methods to improve the sensitivity of culture from intraoperative samples. METHODS: Between July 2014 and October 2019, patients with suspected joint infection (JI) from whom synovial fluid (SF) was obtained preoperatively were enrolled. Preoperative aspirated SF was analyzed by conventional microbial culture and mNGS. In addition to samples taken for conventional microbial culture, some samples were taken for intraoperative culture to optimize the culture method according to the preoperative mNGS results. The demographic characteristics, medical history, laboratory examination, mNGS, and culture results of the patients were recorded, and the possibility of the optimized culture methods improving diagnostic efficiency was evaluated. RESULTS: A total of 56 cases were included in this study. There were 35 cases of JI and 21 cases of non-joint infection (NJI). The sensitivity, specificity, and accuracy of intraoperative microbial culture after optimization of the culture method were 94.29%, 76.19%, and 87.5%, respectively, while those of the conventional microbial culture method were 60%, 80.95%, and 67.86%, respectively. CONCLUSION: Preoperative aspirated SF detected via mNGS can provide more aetiological information than preoperative culture, which can guide the optimization and improve the sensitivity of intraoperative culture. Cite this article: Bone Joint J 2021;103-B(1):39-45.


Assuntos
Artrite Infecciosa/diagnóstico , Técnicas Bacteriológicas/normas , Sequenciamento de Nucleotídeos em Larga Escala , Metagenômica , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Sensibilidade e Especificidade
17.
Medicine (Baltimore) ; 99(44): e22938, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126360

RESUMO

RATIONALE: Sternoclavicular joint septic arthritis is an unusual disease in healthy adults, and Staphylococcus aureus is the most common causative pathogen. The current treatment of choice is surgery with sternoclavicular joint resection and pectoralis flap closure, especially when the disease is complicated by osteomyelitis and abscess. PATIENT CONCERNS: Here, we report a 76-year-old woman without risk factors who visited our hospital for pain and redness, swelling on the left anterior chest wall. DIAGNOSIS: Magnetic resonance imaging showed infectious arthritis in the left SCJ, with multiple abscess pockets at the subcutaneous layer of anterior chest wall communicating with the joint cavity. Streptococcus agalactiae was isolated from blood culture. INTERVENTION: She was treated with 6 weeks of antibiotic therapy. OUTCOMES: After antibiotic treatment, she was successfully treated without recurrence. LESSONS: Besides surgery, medical treatment should also be considered for sternoclavicular joint septic arthritis, depending on patient status and the causative pathogen. Physicians should be aware of this rare disease to facilitate its prompt diagnosis and management.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Articulação Esternoclavicular , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Testes de Sensibilidade Microbiana , Articulação Esternoclavicular/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/diagnóstico por imagem , Streptococcus agalactiae/efeitos dos fármacos
18.
PLoS One ; 15(9): e0239290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970712

RESUMO

BACKGROUND: The aim of this prospective study was to use direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) to rapidly diagnose periprosthetic joint infections (PJIs). METHOD: Synovial fluid was taken from 77 patients (80 joints, 41 hips and 39 knees) who met the International Consensus Meeting criteria for PJI, and inoculated into blood culture bottles (BCBs) and onto conventional swabs. Positive blood cultures were analyzed using either direct or routine MALDI-TOF MS. Pathogen identification and the time to identification was recorded. Differences between groups were analyzed using the Kruskal-Wallis test and Bonferroni's post-hoc test. RESULTS: Direct and routine MALDI-TOF MS both detected 64 positive results (80%), compared to 47 (59%) by conventional swabs (p = 0.002). Direct MALDI-TOF MS identified 85.3% of the gram-positive organisms and 92.3% of the gram-negative organisms. No fungi were identified by direct MALDI-TOF MS. In 17 BCBs that were flagged positive, identification by direct MALDI-TOF MS failed. Among the positive results in the direct MALDI-TOF MS group, Staphylococcus aureus accounted for 47%, followed by Staphylococcus epidermidis (17%), Escherichia coli (9%) and Klebsiella pneumoniae (9%). The median time to microorganism identification was significantly shorter with direct MALDI-TOF MS (12.7 h, IQR: 8.9-19.6 h) than with routine MALDI-TOF MS (39.5 h, IQR: 22.8-46.0 h) or swabs (44.4 h, IQR: 27.2-72.6 h) (p < 0.0001). In pairwise comparisons, there were significant differences in the time of microorganism identification between direct MALDI-TOF MS and routine MALDI-TOF MS (p < 0.0001) or swab culture (p < 0.0001). There was no significant difference between routine MALDI-TOF MS and swab culture (p = 0.0268). CONCLUSION: Compared with current laboratory practice, direct MALDI-TOF MS shortened the time to microorganism identification and had superior results compared to conventional swabs, except for fungi. Further studies should investigate whether the earlier administration of appropriate antimicrobial agents can improve the treatment outcomes of PJIs.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Líquido Sinovial/metabolismo , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/genética , Artrite Infecciosa/microbiologia , Infecções Bacterianas/genética , Infecções Bacterianas/microbiologia , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Feminino , Humanos , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/genética , Infecções Relacionadas à Prótese/microbiologia , Manejo de Espécimes , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade , Líquido Sinovial/microbiologia
19.
Orthopade ; 49(8): 660-668, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32737513

RESUMO

BACKGROUND: Septic arthritis is an acute emergency. It occurs more frequently in patients with pre-existing degenerative or chronic inflammatory joint diseases than in the general population. The causative microorganisms can be introduced in various ways. DIAGNOSTICS: A rapid diagnosis is of great importance for the success of the therapy. In the clinical examination, the typical signs of inflammation are noticeable. The gold standard is the aspiration of synovial fluid and the subsequent laboratory and microbiological investigation. THERAPY: A prerequisite for successful therapy is the early initiation of an antimicrobial pathogen-specific treatment and the surgical alleviation of the joint.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Drenagem/métodos , Ligamentos/cirurgia , Complicações Pós-Operatórias/microbiologia , Líquido Sinovial/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Infecções Bacterianas/microbiologia , Doença Crônica , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Inflamação/etiologia , Inflamação/microbiologia , Líquido Sinovial/metabolismo
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