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1.
Medicine (Baltimore) ; 99(24): e20549, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541477

RESUMO

BACKGROUND: Despite rapid reports on the correlation between body mass index (BMI) and periprosthetic joint infection (PJI) after total joint arthroplasty, some have conducted regression tests or meta-analyses with controversial results. In this study, we systematically meta-analyzed relevant trials and carefully evaluated the correlation for verification. METHODS: Literature on the correlation between BMI and PJI following total joint arthroplasty was retrieved in PubMed, Embase and Cochrane Library due September 2019. Stata 13.0 software was adopted for data synthesis and analyses of publication bias and sensitivity. Random-effect models were used to summary the overall estimate of the multivariate adjusted odds ratio (OR)/hazard ratio/rate ratio with 95% confidence intervals (CIs). RESULTS: A total of 29 observational studies representing 3,204,887 patients were included. The meta-analysis revealed that the risk of postoperative PJI significantly increased by 1.51 times in the obese group (OR = 1.51; 95% CI = 1.30-1.74 for the obese group vs. the non-obese group), and by 3.27 times in the morbid obese group (OR = 3.27; 95% CI = 2.46-4.34 for the morbid obese group vs the non-morbid obese group). A significant association remained consistent, as indicated by subgroup analyses and sensitivity analyses. CONCLUSION: Our findings demonstrate that postoperative PJI is positively correlated with BMI, with obese patients showing a greater risk of developing PJI than non-obese patients. Similarly, morbid obese patients present a higher risk of PJI than non-morbid obese patients. However, this conclusion needs to be corroborated by more prospective studies.


Assuntos
Artrite Infecciosa/etiologia , Índice de Massa Corporal , Obesidade/complicações , Infecções Relacionadas à Prótese/etiologia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
2.
BMC Infect Dis ; 20(1): 185, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111171

RESUMO

BACKGROUND: Staphylococcus aureus (S. aureus) arthritis is one of the most detrimental joint diseases known and leads to severe joint destruction within days. We hypothesized that the provision of auxiliary immunoregulation via an expanded compartment of T regulatory cells (Tregs) could dampen detrimental aspects of the host immune response whilst preserving its protective nature. Administration of low-dose interleukin 2 (IL2) preferentially expands Tregs, and is being studied as a treatment choice in several autoimmune conditions. We aimed to evaluate the role of IL2 and Tregs in septic arthritis using a well-established mouse model of haematogenously spred S. aureus arthritis. METHODS: C57BL/6 or NMRI mice we intravenously (iv) injected with a defined dose of S. aureus LS-1 or Newman and the role of IL2 and Tregs were assessed by the following approaches: IL2 was endogenously delivered by intraperitoneal injection of a recombinant adeno-associated virus vector (rAAV) before iv S. aureus inoculation; Tregs were depleted before and during S. aureus arthritis using antiCD25 antibodies; Tregs were adoptively transferred before induction of S. aureus arthritis and finally, recombinant IL2 was used as a treatment starting day 3 after S. aureus injection. Studied outcomes included survival, weight change, bacterial clearance, and joint damage. RESULTS: Expansion of Tregs induced by IL2 gene therapy prior to disease onset does not compromise host resistance to S. aureus infection, as the increased proportions of Tregs reduced the arthritis severity as well as the systemic inflammatory response, while simultaneously preserving the host's ability to clear the infection. CONCLUSIONS: Pre-treatment with IL2 gene therapy dampens detrimental immune responses but preserves appropriate host defense, which alleviates S. aureus septic arthritis in a mouse model.


Assuntos
Artrite Infecciosa/prevenção & controle , Terapia Genética , Interleucina-2/genética , Staphylococcus aureus/patogenicidade , Animais , Anticorpos Monoclonais/uso terapêutico , Artrite Infecciosa/etiologia , Dependovirus/genética , Modelos Animais de Doenças , Feminino , Vetores Genéticos/metabolismo , Interleucina-2/metabolismo , Subunidade alfa de Receptor de Interleucina-2/imunologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/isolamento & purificação , Proteínas Recombinantes/uso terapêutico , Linfócitos T Reguladores/citologia , Linfócitos T Reguladores/imunologia , Linfócitos T Reguladores/metabolismo
3.
PLoS One ; 15(3): e0229947, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163456

RESUMO

INTRODUCTION: Previous research suggested that patients have increased risk of infection with increased time from presentation with a femoral neck fracture to treatment with a hip hemiarthroplasty (HHA). The purpose of this study was to determine if rates of prosthetic joint infections within 3 months of surgery was affected by the time from patient presentation with a femoral neck fracture to the time of treatment with HHA. MATERIALS AND METHODS: Acute hip fractures treated with HHA between 2005 and 2017 at three centres in Norway were enrolled in the study. Multi-trauma patients were excluded. Univariable analysis was performed to determine any significant effect of pre-operative waiting time on infection rate. Two pre-planned analyses dichotomizing pre-operative waiting time cut-offs were performed. RESULTS: There were 2300 patients with an average age of 82 (range, 48-100) years included of which 3.4% experienced a prosthetic joint infection within 3 months. The primary analysis found no significant difference in infection rate depending on time to surgery (OR = 1.06 (95% CI 0.94-1.20, p = 0.33)). The secondary analyses showed no significant differences in infection rates when comparing pre-operative waiting time of <24 hours vs ≥24 hours (OR = 0.92 (95% CI 0.58-1.46, p = 0.73)) and <48 hours vs ≥48 hours (OR = 1.39 (95% CI 0.81-2.38, p = 0.23)). CONCLUSION: Based off of a large retrospective Norwegian database of hip fractures there did not appear to be a significant difference in infection rate based on pre-operative wait time to surgery.


Assuntos
Artrite Infecciosa/epidemiologia , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/efeitos adversos , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Seguimentos , Hemiartroplastia/instrumentação , Hemiartroplastia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
4.
J Shoulder Elbow Surg ; 29(2): 411-419, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31952561

RESUMO

BACKGROUND: Periprosthetic joint infection (PJI) of the elbow is a relatively common complication after total elbow arthroplasty (TEA), and its treatment is frequently variable. Few articles have provided direct comparisons of outcomes, making it difficult to draw conclusions from the available literature. This systematic review synthesizes the English-language literature on elbow PJI to quantify treatment outcomes. METHODS: The PubMed and Scopus databases were searched in December 2018. Our review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Keywords included "elbow replacement infection" and "elbow arthroplasty infection." A total of 1056 titles were identified; after application of the exclusion criteria, 41 studies met the screening criteria and underwent full-text review. Fifteen articles were included for the final analysis regarding demographic characteristics, risk factors, infecting organisms, success of eradication of infection based on surgical method, and functional outcomes of specific treatment regimens. RESULTS: Among the 15 articles selected, there were 309 TEA infections. Staphylococcus aureus was the most frequently isolated organism (42.4%), followed by coagulase-negative staphylococci (32.6%). Risk factors for the development of elbow PJI included rheumatoid arthritis, steroid use, an immunocompromised state, and previous elbow surgery. The rate of successful infection eradication was highest with 2-stage revision (81.2%) and lowest with irrigation and débridement for component retention (55.8%). The level of evidence was IV in 14 studies and III in 1 study. CONCLUSIONS: In this systematic review of TEA infections, Staphylococcus species represent the most common infecting organism. Two-stage revision was the most effective treatment for elbow PJI, showing the lowest recurrence rate for infection.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Substituição do Cotovelo/efeitos adversos , Prótese de Cotovelo/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Antibacterianos/uso terapêutico , Artrite Infecciosa/etiologia , Desbridamento , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
5.
AJR Am J Roentgenol ; 214(1): 171-176, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573855

RESUMO

OBJECTIVE. The diagnosis of early prosthetic joint infection (PJI)-defined as within 6 weeks after a total knee arthroplasty (TKA)-can be difficult because of expected postsurgical changes and elevated inflammatory markers. The role of radiographic evaluation in this situation carries unclear clinical significance. This study had three primary aims: first, to determine when soft-tissue gas is no longer an expected postoperative radiographic finding; second, to determine whether soft-tissue gas is predictive of early PJI; and, third, to determine whether the presence of soft-tissue gas correlates with specific patient characteristics and microbiology culture results. MATERIALS AND METHODS. This retrospective study was of patients who underwent TKA from 2008 to 2018 with available imaging between 5 days and 6 weeks after TKA and no interval intervention before imaging. All confirmed early PJIs were included (n = 24 cases; 15 patients). For comparison, patients who underwent TKA but did not have a PJI (n = 180 cases; 150 patients) were selected randomly. Radiographs were reviewed by two readers. A two-tailed p < 0.05 was considered significant. RESULTS. Soft-tissue gas was identified on postoperative radiography of 13 of 24 (54.2%) cases (mean ± standard error of the mean [SEM], 28.3 ± 2.3 days after TKA) with early PJI and four of 180 (2.2%) cases (mean ± SEM, 15.3 ± 7.3 days after TKA) without PJI (p < 0.0001; odds ratio, 52.0 [95% CI, 14.7-156.9]). The presence of soft-tissue gas on radiography 14 days after TKA had a sensitivity of 0.54 (95% CI, 0.35-0.72) and specificity of 0.99 (95% CI, 0.97-1.00) for early PJI. Staphylococcus species were the dominant organisms; cases with soft-tissue gas showed a wider variety of microbiology species (p < 0.01). CONCLUSION. Postoperative soft-tissue gas present on radiography performed 14 days or more after TKA is predictive of early PJI and is associated with a wider spectrum of microorganisms.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Idoso , Feminino , Gases , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(12): 1566-1571, 2019 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-31823560

RESUMO

Objective: To summarize the research progress of two-stage revision for periprosthetic joint infection (PJI) after hip and knee arthroplasties. Methods: The related literature on two-stage revision for PJI was summarized, and the new progress in the choice of spacers, systemic antibiotic therapy, and risk factors were analyzed. Results: Two-stage revision is a common way to treat infection after hip and knee arthroplasties. The types of spacers used in the one-stage operation are diverse and each has its own advantages and disadvantages. Non-articular spacers are mainly used for the patients with poor soft tissue conditions around the joints and severe bone defects. But the joint mobility is not good after the placement of the spacer. Articular spacers can restore the affected joint movement after operation, which is beneficial to the joint mobility after two-stage operation. The use of antibiotics is an indispensable part of the treatment process, and the effectiveness of short-term antibiotic treatment is similar to long-term treatment. Identifying the relevant risk factors that influence the prognosis of the two-stage revision can help preoperative management and reduce the recurrence rate of infection. Conclusion: There are still controversies about the choice of spacers and systemic antibiotic therapy during the two-stage revision and treatment of PJI. The factors affecting the prognosis of the two-stage revision need to be explored and the further high-quality research is needed.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Humanos , Articulação do Joelho , Infecções Relacionadas à Prótese/tratamento farmacológico , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos
7.
Rev Soc Bras Med Trop ; 53: e20190328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31859955

RESUMO

Rat-bite fever is a rarely diagnosed illness caused by Streptobacillus moniliformis . Although this disease is distributed worldwide, there have been few cases reported in Europe. Here, we report a case of vertebral osteomyelitis and sternoclavicular septic arthritis caused by S. moniliformis in a Portuguese patient previously bitten by a rat. Laboratory diagnosis was performed using molecular identification. This is the first case report of rat-bite fever in Portugal. The case described here serves as a reminder for physicians to consider this diagnosis in patients who have developed fever syndromes after being in contact with rodents.


Assuntos
Artrite Infecciosa/etiologia , Mordeduras e Picadas/complicações , Vértebras Lombares/diagnóstico por imagem , Osteomielite/etiologia , Febre por Mordedura de Rato/complicações , Articulação Esternoclavicular/diagnóstico por imagem , Idoso , Animais , Artrite Infecciosa/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Osteomielite/diagnóstico por imagem , Febre por Mordedura de Rato/diagnóstico , Ratos
8.
BMC Musculoskelet Disord ; 20(1): 613, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864332

RESUMO

BACKGROUND: The two-stage revision protocol represents the current gold standard for treating infected total knee replacement implants. Allowing early mobility with weight-bearing between staged procedures will enable early restoration to knee function. So, the mechanical performance of knee spacers is a key issue. Commercially available moulds are often used as they are easy to prepare and produce smoother surfaces of the articulating parts. However, they are costly, and only for single use. A cost-effective alternative is the surgeon-made hand-moulded spacers. In this study, we wanted to determine how the hand-moulded spacers will compare biomechanically with the commercially available COPAL spacers. METHODS: Seven cadaveric knees were implanted with knee spacers fabricated using COPAL knee moulds. The same surgeon implanted eight cadaveric knees with hand-moulded spacers. In the first test protocol, an axial load was applied at 200 mm/min till failure. In the second test protocol, the knees were cyclically loaded in five steps of 1000 cycles each from 30-400 N, 30-600 N, 30-800 N, 30-1000 N, 30-1200 N at 1.5 Hz. RESULTS: COPAL knee spacers demonstrated a maximum load and mean stiffness of 5202 (± 486.9) N and 1098 (± 201.5) N/mm respectively. The hand-moulded knee spacers demonstrated a mean stiffness of 4509 (± 1092.6) N and 1008.7 (± 275.4) N/mm respectively. The maximum axial displacement was 1.19 ± 0.57 mm and 0.89 ± 0.30 mm for specimens implanted with COPAL knee spacers and hand-moulded spacers respectively. The differences between COPAL and hand-moulded knee spacers were not statistically different. CONCLUSIONS: Our study demonstrated that dynamic knee spacers may be able to withstand more than the touch-down load permitted in previous studies, and this may allow more weight-bearing during ambulation. Previous studies have demonstrated that hand-moulded knee spacers have similar advantages to commercially available dynamic spacers with respect to mobility, pain, bone loss, and reinfection rate. Given that ambulation with weight-bearing up to 1200 N is permitted during rehabilitation, it may be more cost-effective to fabricate hand-moulded spacers in revision total knee arthroplasty.


Assuntos
Artrite Infecciosa/cirurgia , Articulação do Joelho/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/instrumentação , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/etiologia
9.
PLoS One ; 14(10): e0223402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31581252

RESUMO

BACKGROUND: The number of periprosthetic joint infections (PJI) after total knee arthroplasty (TKA) is increasing annually. Animal models have been used to clarify their clinical characteristics and the infection mechanism of pathogenic bacteria, However, since the prosthesis design of animal models is not uniform, it is difficult to simulate the environment of clinical PJI. OBJECTIVES: To retrospect the progress on the prosthesis design of animal models of PJI after TKA and to summarize the criteria for evaluating a clinically representative model of PJI. METHODS: This systematic review was reported on the basis of Systematic Reviews and Meta-Analyzes (PRISMA). Pubmed, EMbase, Cochrane Library, Web of Science, Wanfang Data and China National Knowledge Infrastructure were researched for animal models of PJI after TKA from database establishment to April 2019 according to Chinese and English retrieval words, including "periprosthetic joint infections and total knee arthroplasty," "periprosthetic joint infections and model," "periprosthetic joint infections and biofilm," and "total knee arthroplasty and model." RESULTS: A total of 12 quantitative studies were enrolled in our study finally: 8 representative studies described prosthesis designs used in PJI animal models, 4 studies described prosthesis designs in non-infected animal models which were suitable for infection models. The major problems need to be dealed with were prosthesis, installation location, material, the function of separating the articular and medullary cavity, fixation manner, and the procedure of preserving the posterior cruciate ligament. CONCLUSION: A highly representative design of the animal prosthesis of PJI should meet the following criteria: the surface of the prosthesis is smooth with the formation of biofilm, composed of titanium-6Al-4V or cobalt-chromium-molybdenum alloy; prosthesis can bear weight and is highly stable; and it can connect the joint cavity and medullary cavity simultaneously. To reach a more reliable conclusion, further experiments and improvements are required.


Assuntos
Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/etiologia , Animais , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/prevenção & controle , Modelos Animais de Doenças , Humanos , Impressão Tridimensional , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/prevenção & controle , Radiografia , Estudos Retrospectivos
10.
BMC Infect Dis ; 19(1): 887, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651256

RESUMO

BACKGROUND: Arthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus. CASE PRESENTATION: A 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution. CONCLUSION: The incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01-3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.


Assuntos
Artrite Infecciosa/microbiologia , Artroscopia/efeitos adversos , Bacteriemia/tratamento farmacológico , Meniscectomia/efeitos adversos , Osteoartrite do Joelho/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Bacteriemia/etiologia , Desbridamento/métodos , Feminino , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Streptococcus/patogenicidade , Líquido Sinovial/microbiologia , Adulto Jovem
11.
Iowa Orthop J ; 39(1): 173-177, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413691

RESUMO

Background: Although the rate of non-fatal gunshot wounds (GSW) has increased, few studies have compared the effectiveness of operative and nonoperative treatment with specific focus on infection. We compared the risk of septic arthritis in patients with traumatic arthrotomies caused by GSW treated operatively with irrigation and debridement versus nonoperatively with antibiotics and wound care. Methods: From 2009 to 2016, 46 patients at our institution sustained traumatic arthrotomies from low-velocity GSW with at least 90-day follow-up. Medical records were reviewed for demographic information, imaging, type and duration of antibiotics, details of operative and nonoperative interventions, and evidence of infection at follow-up visits. We measured the rate of septic arthritis using a 2-tailed t test. Results: The knee was the most commonly affected joint (34 patients; 73.9%). Eight patients (17.4%) were treated nonoperatively and 38 (82.6%) were treated operatively. In the nonoperative group, one patient (12.5%) developed a superficial wound infection that resolved with oral antibiotics. In the operative group, one patient (2.6%) developed a superficial wound infection requiring operative irrigation and debridement. There was no statistically significant difference in risk of infection between the two groups (P = 0.32). No patient developed septic arthritis. Conclusions: In select patients, nonoperative treatment with wound care and antibiotics may be sufficient for preventing infection after GSW-related traumatic arthrotomies. Findings of randomized studies and treatment algorithms are needed to further evaluate this relatively common injury.Level of Evidence: IV.


Assuntos
Artrite Infecciosa/terapia , Tratamento Conservador/métodos , Fraturas Intra-Articulares/cirurgia , Articulações/lesões , Articulações/cirurgia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Artrite Infecciosa/etiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/terapia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Traumatismos do Joelho/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/diagnóstico , Adulto Jovem
12.
Ital J Pediatr ; 45(1): 88, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331358

RESUMO

BACKGROUND: Acute otitis media is one of the most common infectious diseases in the paediatric age and although its complications such as acute mastoiditis have become rare thanks to improvements in therapeutic approaches, possible serious complications such as septic arthritis of the temporomandibular joint may develop. A prompt diagnosis and adequate treatment are essential to achieving the best outcome and avoiding serious sequelae. We describe a case occurring in a previously healthy 6-year-old female and review the literature currently available on this topic. CASE PRESENTATION: The patient presented a right temporomandibular septic arthritis with initial mandibular bone involvement secondary to acute otitis media. She presented with torcicollis, trismus, right preauricular swelling over the temporomandibular joint and was successfully treated with antibiotic treatment alone. CONCLUSIONS: Septic arthritis of the temporomandibular joint is a rare complication of acute otitis media or acute mastoiditis in children. It should be suspected in patients presenting with trismus, preauricular swelling or fever. No guidelines on the diagnosis and treatment of this infectious disease are currently available.


Assuntos
Artrite Infecciosa/etiologia , Otite Média/complicações , Transtornos da Articulação Temporomandibular/etiologia , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Criança , Feminino , Humanos , Transtornos da Articulação Temporomandibular/tratamento farmacológico
13.
Am J Phys Med Rehabil ; 98(12): 1106-1109, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31268888

RESUMO

OBJECTIVE: Despite the ubiquity of intra-articular and bursal injections for the treatment of joint pain and bursitis, relatively little literature is available on the prevalence of infection after these procedures. The aim of this study was to identify the number of infections recalled by sports medicine physicians who perform injections of large joints and bursae at least once per month. DESIGN: A survey of physician members of the American Medical Society for Sports Medicine identified the reported number of recalled infections for each large joint/bursal location. RESULTS: Of a total of 554 physicians, only 31 infections were recalled by 27 physicians. Only 4.87% of all physicians were aware of an infection after an injection during their career. On average, one infection was recalled of 170 physician-years in practice. No differences in infection rates were observed when comparing primary specialties (P = 0.281). CONCLUSIONS: This study, the largest to date, demonstrates that sports medicine physicians rarely encounter infections after large joint and bursa injections. Though rare, because of their catastrophic nature, risk mitigation strategies should be maintained.


Assuntos
Bolsa Sinovial/efeitos dos fármacos , Bolsa Sinovial/microbiologia , Bursite/tratamento farmacológico , Glucocorticoides/administração & dosagem , Injeções Intra-Articulares/métodos , Artrite Infecciosa/etiologia , Bursite/complicações , Humanos , Injeções Intra-Articulares/efeitos adversos , Medicina Esportiva , Resultado do Tratamento
14.
Pediatr Emerg Care ; 35(7): 509-513, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31261255

RESUMO

Septic arthritis is an emergent condition caused by bacterial infection of a joint space. The most common etiology is hematogenous spread from bacteremia, but it can also occur from direct inoculation from bites, injection injuries, cellulitis, abscesses, or local trauma. Septic arthritis occurs most frequently in the lower extremities, with the hips and knees serving as the most common locations. The most sensitive findings include pain with motion of the joint, limited range of motion, tenderness of the joint, new joint swelling, and new effusion. Laboratory testing and imaging can support the diagnosis, but the criterion standard is diagnostic arthrocentesis. Treatment involves intravenous antibiotics and joint decompression.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa , Descompressão Cirúrgica , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Bacteriemia/complicações , Mordeduras e Picadas/complicações , Criança , Terapia Combinada , Humanos , Lactente , Infusões Intravenosas , Líquido Sinovial/imunologia
15.
Infect Control Hosp Epidemiol ; 40(9): 1013-1018, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31311611

RESUMO

BACKGROUND: In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported. METHODS: An infection prevention assessment of the implicated facility's practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections. RESULTS: We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility. DISCUSSION: Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination. CONCLUSIONS: This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.


Assuntos
Artrite Infecciosa/etiologia , Infecções Bacterianas/etiologia , Contaminação de Equipamentos , Injeções Intra-Articulares/efeitos adversos , Osteoartrite do Joelho/tratamento farmacológico , Surtos de Doenças , Humanos , New Jersey
17.
Ann R Coll Surg Engl ; 101(7): 514-518, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155899

RESUMO

INTRODUCTION: Mortality rates following hip arthroplasty range between 10% and 40% after 12 months. A higher rate is attributed to postoperative complications, of which surgical site infection is one of the most significant. In an effort to reduce surgical site infection following arthroplasty, antibiotics can be added to the cement used. The primary aim of this study was to determine whether dual antibiotic impregnated cement can reduce the rate of deep surgical site infection in patients following cemented arthroplasty for fractured neck of femur compared with single antibiotic impregnated cement. The secondary aim was to compare the rate of superficial surgical site infection in single compared with dual antibiotic cement. MATERIALS AND METHODS: A total of 206 patients were included. Group 1 included 108 retrospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using single antibiotic impregnated cement. Group 2 included 98 prospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using dual antibiotic impregnated cement. The rates of deep and superficial surgical site infection were investigated. RESULTS: Group 1 had a deep surgical site infection rate of 2.9% (n = 3), Group 2 had a deep surgical site infection rate of 0% (n = 0). Group 1 had a superficial surgical site infection rate of 3.7% (n = 4), Group 2 had a superficial surgical site infection rate of 5.1% (n = 5). CONCLUSION: Dual antibiotic cement reduced the rate of deep surgical site infection compared with conventional single antibiotic cement in arthroplasty for fractured neck of femur. Only a marginal difference in superficial surgical site infection was observed.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/epidemiologia , Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/uso terapêutico , Infecções Relacionadas à Prótese/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia/métodos , Artrite Infecciosa/etiologia , Artrite Infecciosa/prevenção & controle , Quimioterapia Combinada/métodos , Feminino , Fraturas do Colo Femoral/mortalidade , Fraturas do Colo Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Taxa de Sobrevida , Resultado do Tratamento
18.
Scand J Rheumatol ; 48(5): 393-397, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31146626

RESUMO

Objective: The aim of this study was to evaluate the risk of septic arthritis (SA) in patients who received an intra-articular (IA) glucocorticoid (GC) injection and to describe the characteristics of these patients. Methods: All patients undergoing IA procedures at the orthopaedic and rheumatological departments on the Danish island of Funen from January 2006 to December 2013 were identified in the central database and included by register extraction. Patients who developed a clinically inflamed joint and positive synovial fluid culture within 14 days after IA GC injection were considered as having SA. Retrospectively, data on age, gender, affected joint location, bacterial agent, pre-existing inflammatory disorder, and death within 30 days were extracted from the patient files. According to local recommendations, a non-touch sterile technique was used for IA procedures. Patients were informed about the risk of SA and advised to seek medical attention on suspicion of infection or lack of improvement. Results: In total, 22 370 IA procedures were performed. Among these, 14 118 GC injections and 8252 arthrocenteses were undertaken. Only 11 patients were diagnosed with SA (0.08%, 95% confidence interval 0.03-0.12). Risk factors for SA were male gender, age, and pre-existing joint disease. Conclusion: We found a low frequency of SA subsequent to IA GC injections. Older patients with pre-existing joint disease are at higher risk of developing SA.


Assuntos
Artrite Infecciosa/epidemiologia , Artrocentese/efeitos adversos , Glucocorticoides/efeitos adversos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Artrite Reumatoide/terapia , Dinamarca/epidemiologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Injeções Intra-Articulares/efeitos adversos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
19.
Knee Surg Sports Traumatol Arthrosc ; 27(7): 2322-2327, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30968239

RESUMO

PURPOSE: A frequent reason for revision surgery after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) is periprosthetic joint infection (PJI). The efficacy of intrawound VP in preventing PJI after primary TKA or UKA is rarely reported. The purpose of this study was to investigate the efficacy and side effects of local high-dose VP application to the joint to prevent PJI in TKA and UKA. METHODS: From 2010 to 2017, 166 consecutive patients that underwent primary TKA or UKA were enrolled. Seventy-five patients (92 knees) did not receive VP (control group), while 90 patients (110 knees, VP group) received VP (intrawound, 1 g) before capsule closure during TKA and UKA. Aseptic wound complications, such as skin erosion, wound dehiscence, and prolonged wound healing, were evaluated within 3 months post-operatively. PJI was assessed within a year post-operatively. RESULTS: Seven patients (7.6%) in the control group and five patients (4.5%) in the VP group had PJI. No significant differences existed in the PJI rates between the groups. Aseptic operative wound complications occurred in 4 patients (4.3%) and 13 patients (11.8%), whereas prolonged operative wound healing occurred in 3 patients (3.3%) and 14 patients (12.7%) of patients in the control and VP group, respectively. Operative wound complications were significantly frequent in the VP group. CONCLUSIONS: Intrawound VP administration does not decrease PJI occurrence in primary TKA and significantly causes aseptic wound complications. The use of intrawound VP for the prevention of PJI after primary TKA and UKA is not recommended. LEVEL OF EVIDENCE: Level II.


Assuntos
Antibacterianos/efeitos adversos , Artrite Infecciosa/prevenção & controle , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Deiscência da Ferida Operatória/etiologia , Vancomicina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Artrite Infecciosa/etiologia , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Período Pós-Operatório , Vancomicina/administração & dosagem
20.
BMC Infect Dis ; 19(1): 331, 2019 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-30999879

RESUMO

BACKGROUND: Prosthetic joint infections remain a significant cause of morbidity and are frustrating for patients and physicians alike. Unusual causes of infection may be seen in selected circumstances and a high index of suspicion and a careful history are required to ensure an accurate and timely diagnosis can be made. CASE PRESENTATION: We present a case of Mycobacterium bovis prosthetic joint infection secondary to intravesicular Bacillus Calmette-Guérin (BCG) treatment for prior bladder cancer definitively identified by spoligotyping. A favorable clinical outcome was observed following surgical intervention and a 12-month course of anti-mycobacterial therapy. CONCLUSIONS: BCG therapy, a live attenuated strain of M. bovis, has become the mainstay of adjunctive therapy for bladder cancer and infectious complications, including those affecting the musculoskeletal system, may be seen years after initial therapy. An awareness of this complication and appropriate discussions with the institution's microbiology laboratory may allow for an accurate and timely identification.


Assuntos
Artrite Infecciosa/diagnóstico , Vacina BCG/uso terapêutico , Neoplasias da Bexiga Urinária/terapia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Vacina BCG/efeitos adversos , Quadril/diagnóstico por imagem , Humanos , Masculino , Mycobacterium bovis/fisiologia
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