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1.
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
3.
Pediatr Clin North Am ; 67(1): 59-69, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31779837

RESUMO

Pediatric populations are prone to infections and most can be managed appropriately in a primary care setting. There are, however, some infectious processes that require intervention or management from an orthopedic surgeon. The most serious infectious processes in the pediatric population from an orthopedic standpoint are osteomyelitis and septic arthritis. Early recognition of these conditions and prompt referral of serious infections, as well as the ability to differentiate which infections should be referred for specialist evaluation is critical.


Assuntos
Artrite Infecciosa/microbiologia , Doenças Musculoesqueléticas/microbiologia , Osteomielite/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Criança , Humanos , Osteomielite/diagnóstico , Osteomielite/terapia
4.
J Foot Ankle Surg ; 58(6): 1293-1297, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31679684

RESUMO

We report an uncommon case of septic arthritis of the ankle from a Streptococcus pneumoniae infection and provide an update of the literature reported since 2002. A 58-year-old female presented to the hospital with right ankle pain and an inability to bear weight. She reported a history of productive cough, vomiting, diarrhea, and subjective fevers 4 days earlier. Streptococcus pneumonia was identified in her ankle aspirate, and she was treated urgently with operative incision and debridement, followed by postoperative intravenous antibiotics. At her 7-week follow-up, she demonstrated complete resolution of symptoms and near-complete recovery of range of motion. This case demonstrates the importance of early identification, as the majority of patients recover fully with prompt treatment. The literature review included 44 cases of pneumococcal septic arthritis and found that the knee was the most commonly affected joint, followed by the shoulder and ankle. Blood cultures were positive for S. pneumoniae in 27 of 38 adults (71%) and 4 of 6 children (67%). Comorbid conditions were present in 32 of 38 adults (84%) and 4 of 7 children (57%), the most frequent of which were alcoholism and osteoarthritis in adults and malignancy or immunosuppression in children. Additionally, roughly half of included adults had an extra-articular focus of pneumococcal disease, most frequently pneumonia. Operative treatment was undertaken in 32 of 38 adults (84%) and all 7 children. Of adults with data available, 24 of 33 (73%) recovered with complete joint function, compared with 5 of 7 children (71%).


Assuntos
Artrite Infecciosa/terapia , Infecções Pneumocócicas/diagnóstico , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Tosse/microbiologia , Desbridamento , Diarreia/microbiologia , Feminino , Febre/microbiologia , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/terapia , Streptococcus pneumoniae
5.
BMC Musculoskelet Disord ; 20(1): 445, 2019 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-31604445

RESUMO

BACKGROUND: Abscess formation in the subscapularis muscle is a rare clinical condition. Few reports are available regarding the treatment methods and surgical approaches for subscapularis intramuscular abscesses. Here, we describe a case of subscapularis intramuscular abscess that was treated successfully via surgical drainage using a new approach, the "dorsal subscapularis approach". CASE PRESENTATION: A 67-year-old woman presented to our hospital with complaints of fever and disturbance of consciousness. Two days prior to visiting our hospital, right shoulder pain and limited range of motion in the shoulder were noted. Cerebrospinal fluid examination and contrast-enhanced computed tomography (CT) imaging on admission revealed a right subscapularis intramuscular abscess with concomitant bacterial meningitis. The patient's clinical symptoms improved after antibiotic administration for 3 weeks, but the right shoulder pain persisted. Contrast-enhanced CT imaging performed after antibiotic administration revealed an abscess in the right shoulder joint space, in addition to a capsule of the abscess in the right subscapularis muscle. We performed open surgical drainage for the abscess, which had spread from the subscapularis muscle to the glenohumeral joint. Using the deltoid-pectoral approach, we detected exudate and infected granulation tissue in the joint cavity. Furthermore, we separated the dorsal side of the subscapularis muscle from the scapula using a raspatory and detected infected granulation tissue in the subscapularis muscle belly. We performed curettage and washed as much as possible. After surgery, antibiotic administration continued for 2 weeks. The patient's right shoulder pain subsided and CT performed 2 months after surgery revealed no recurrence of infection. CONCLUSIONS: The present case indicated that a subscapularis intramuscular abscess could lead to severe concomitant infections of other organs via the hematogenous route. Thus, early detection and treatment are necessary. Moreover, in this case, surgical drainage using a dorsal subscapularis approach was beneficial to treating the abscess, which had spread from the subscapularis muscle to the glenohumeral joint.


Assuntos
Abscesso/terapia , Artrite Infecciosa/terapia , Drenagem/métodos , Meningite Pneumocócica/terapia , Miosite/terapia , Dor de Ombro/cirurgia , Abscesso/sangue , Abscesso/complicações , Abscesso/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artrite Infecciosa/sangue , Artrite Infecciosa/complicações , Artrite Infecciosa/microbiologia , Feminino , Humanos , Meningite Pneumocócica/sangue , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/microbiologia , Miosite/microbiologia , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/microbiologia , Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/microbiologia , Articulação do Ombro/cirurgia , Dor de Ombro/etiologia , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
BMJ Case Rep ; 12(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31619399

RESUMO

Over the last decade, there has been a concerning increase in the number of invasive meningococcal serotype W infections in Europe. Although sepsis and meningitis are the most feared complications, focal complications of systemic disease such as pneumonia, pericarditis and arthritis can also occur. We present a rare case of isolated meningococcal W135 arthritis of the hip without invasive meningococcal disease in a 6-year-old patient.


Assuntos
Artrite Infecciosa/microbiologia , Articulação do Quadril/microbiologia , Infecções Meningocócicas/complicações , Neisseria meningitidis/isolamento & purificação , Antibacterianos/uso terapêutico , Artrite Infecciosa/terapia , Criança , Terapia Combinada , Diagnóstico Diferencial , Feminino , Febre , Articulação do Quadril/cirurgia , Humanos , Infecções Meningocócicas/terapia , Neisseria meningitidis Sorogrupo W-135/efeitos dos fármacos
7.
In Vivo ; 33(5): 1625-1633, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471415

RESUMO

BACKGROUND/AIM: Prosthetic joint infections (PJI) are difficult to diagnose and treat. For a correct diagnosis, an array of information has to be processed and weighted. Successful treatment depends on the diagnosis, timing, and surgical strategy paired with treatment of the infectious agent. The complexity and interdisciplinarity needed cause difficulties concerning decision-making, the communication between disciplines, and the execution of a treatment strategy. The aim of this study was to develop a software platform to enhance the collection of information for the diagnosis of PJI, the interdisciplinary decision-making process, the communication between team members, and continuous evaluation of treatment. PATIENTS AND METHODS: In regular planning sessions with an information technology (IT) specialist, a concept for an IT solution was chosen and the tool was designed in an interdisciplinary approach. RESULTS: The tool has been used as a trial version since June 2017. It consists of 14 user interfaces with 431 items. A total of 117 patients with 118 infections have been entered and the strategy decided upon and communicated using 298 infection board documents outlining the treatment. The tool is now being used to organize the infections board agenda, schedule patient case discussions, document the relevant data and treatment plan, as well as communicate with the other teams involved in the treatment. CONCLUSION: Using the developed tool enables the infections team to work collaboratively and under division of labor on each case, rendering the work flow more efficient for each team member.


Assuntos
Assistência ao Convalescente , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Informática Médica/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Interpretação Estatística de Dados , Sistemas de Gerenciamento de Base de Dados , Gerenciamento Clínico , Gestão da Informação em Saúde/métodos , Humanos , Masculino
8.
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
9.
Arch Orthop Trauma Surg ; 139(10): 1461-1470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432205

RESUMO

BACKGROUND: The simultaneous occurrence of periprosthetic fracture (PPF) and periprosthetic joint infection (PJI) is among the most devastating complications in arthroplasty and carries the risk of limb loss. For the first time, this study will describe the characteristics, treatment concepts, and outcomes of this complication. METHODS: Patients were consecutively included who were treated at our specialized interdisciplinary department between 2015 and 2016 with a PJI and an additional PPF of the hip. The treatment algorithm followed a three-step procedure: the complete removal of any foreign material (step 1), fracture stabilization by plate, intramedullary rod osteosynthesis or cerclages using an additional spacer (step 2), and reimplantation of a new prosthesis (step 3). RESULTS: Overall, eight cases [four male, four female, mean age 77 years (55-91)] were included. The mean follow-up was 34 ± 8 months. The fractures included one PPF Vancouver B1, three B2/3, and four type C. Most frequent microbes were CNS (Coagulase-negative staphylococci) (n = 4), Cutibacterium (n = 2) and Staphylococcus aureus (n = 2). Mixed infections (≥ 2 microorganisms) occurred in five cases. The time between explanation and reimplantation was 42 ± 34 (range 7-123) days. A re-infection took place in one, a re-revision in four cases, and in five cases fracture healing was noticed. In all eight cases, freedom from the infection and limb preservation could be achieved. CONCLUSION: PPF in the case of a PJI is a devastating situation and a huge challenge. Extremity preservation should be the primary goal. The described procedure offers a possible solution.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Periprotéticas/terapia , Complicações Pós-Operatórias/terapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artrite Infecciosa/microbiologia , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/cirurgia , Complicações Pós-Operatórias/microbiologia , Estudos Prospectivos
10.
Orthop Clin North Am ; 50(4): 461-470, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466662

RESUMO

Septic arthritis in children is a surgical emergency, and prompt diagnosis and treatment are mandatory. If diagnosed quickly and treated correctly, the outcomes can be good. With delay in diagnosis and without proper treatment, outcomes often are quite devastating, with growth disturbance and joint destruction.


Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Terapia Combinada/métodos , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Desbridamento , Diagnóstico Precoce , Humanos , Prognóstico , Resultado do Tratamento
11.
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
13.
Medicine (Baltimore) ; 98(27): e16015, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277095

RESUMO

The aim of this study was to describe the clinical features of bone and joint infections (BJI) due to Panton-Valentine Leukocidin producing (PVL+) Staphylococcus aureus (SA) in French Guiana.A multicenter study that consists of a retrospective charts review of children admitted for PVL+ S. aureus BJI between January 2010 and December 2015.Six patients with SA-PVL BJI were identified during the study period: 2 osteomyelitis, 1 septic arthritis, and 3 disseminated BJI. The median age was 11 years old (4-14 years), and fever lasted for 3.2 days (2-5 days) before diagnosis. An open skin wound preceded the BJI in 5/6 patients. One patient presented with a septic thrombophlebitis of the femoral-popliteal vein on admission. Methicillin-susceptible Staphylococcus aureus (MSSA) were identified for all patients. Three patients had complications: 2 cases of necrotizing pneumonia and 2 pericarditis, with 1 death caused by cardiac tamponade.SA-PVL BJI was not frequent. Strains were susceptible to methicillin, but responsible of severe BJI. Early diagnosis and a multidisciplinary management of these infections are essential to prevent further complications.


Assuntos
Artrite Infecciosa/microbiologia , Toxinas Bacterianas/análise , Exotoxinas/análise , Leucocidinas/análise , Osteomielite/microbiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Artrite Infecciosa/terapia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Guiana Francesa , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Osteomielite/terapia , Estudos Retrospectivos , Infecções Estafilocócicas/terapia
14.
Rheumatol Int ; 39(10): 1783-1787, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31352560

RESUMO

To investigate the clinical manifestations and outcomes of musculoskeletal (MSK) nontuberculous mycobacterium (NTM) infections. This study was a retrospective cohort study using the Siriraj Hospital database from 2005 to 2017. Enrolled were all patients aged 15 or older who had an MSK infection with NTM identified in synovial fluid, pus, or tissue by an acid-fast bacilli stain, culture, or polymerase chain reaction. Of 1529 cases who were diagnosed with NTM infections, 39 (2.6%) had an MSK infection. However, only 28 patients met our inclusion criteria. Their mean age (SD) was 54.1 (16.1) years, and half were male. Of this cohort, 25% had previous musculoskeletal trauma, 18% prior bone and joint surgery, 14% prosthetic joint replacement, and 11% HIV infection. The median symptom duration (IQR) was 16 (37.4) weeks. The most common MSK manifestation was arthritis (61%), followed by osteomyelitis (50%), tenosynovitis (25%), and spondylodiscitis (14%). The most common organism was M. abscessus (18%), and M. kansasii (18%), followed by M. intracellulare (14%), M. marinum (14%), M. fortuitum (7%), and M. haemophilum (7%). In addition to medical treatment, most patients underwent surgery (82%), comprising debridement, osteotomy, prosthesis removal, and amputation, while 18% received only medical treatment. The treatment outcomes were complete recovery in 46%, improvement with some residual disability and deformities in 29%, and death in 3.6%. Musculoskeletal NTM infections were uncommon. Most patients had underlying joint disease or were immunocompromised hosts. Surgical management, as an adjunct to medical therapy, was necessary.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/terapia , Discite/terapia , Infecções por Mycobacterium não Tuberculosas/terapia , Micobactérias não Tuberculosas/efeitos dos fármacos , Procedimentos Ortopédicos , Osteomielite/terapia , Tenossinovite/terapia , Adulto , Idoso , Antibacterianos/efeitos adversos , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/mortalidade , Terapia Combinada , Bases de Dados Factuais , Discite/diagnóstico , Discite/microbiologia , Discite/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Infecções por Mycobacterium não Tuberculosas/mortalidade , Micobactérias não Tuberculosas/isolamento & purificação , Procedimentos Ortopédicos/efeitos adversos , Osteomielite/diagnóstico , Osteomielite/microbiologia , Osteomielite/mortalidade , Recuperação de Função Fisiológica , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Tenossinovite/diagnóstico , Tenossinovite/microbiologia , Tenossinovite/mortalidade , Tailândia , Fatores de Tempo , Resultado do Tratamento
15.
J Plast Surg Hand Surg ; 53(6): 341-346, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31287352

RESUMO

Domestic cat bites are common and are often treated by simple wound care with good outcome. However, delayed presentation may lead to significant morbidity or even mortality. Twenty cases of cat bites to the hand and wrist were retrospectively reviewed between 2014 and 2018. Data included patient demographics, anatomical site of injury, microbiology results, method of treatment and surgical outcome. The subjects were 18 females and two males aged 27-86 years (mean age of 58 years). Eleven patients (Group A) were presented within 48 hours of their injury. Nine patients (Group B) presented later than 48 hours. Of these, 78% (n = 7) underwent multiple operations secondary to septic arthritis, osteomyelitis, necrotising fasciitis and deep collection. Mean length of hospital stay was 3.4 days in Group A, and 9.2 days in Group B, (p < .01). Four patients underwent digital or ray amputations. The index finger was the most common site of injury (45%). Almost 40% of cases had flexor tendon sheath infection of the fingers. Pasteurella species was isolated from 35% of infected wounds. Mean duration of antibiotic treatment and length of hospital stay were significantly longer in Group B (p < .05). Delayed presentation of infected cat bites increased the likelihood of more complicated surgeries such as amputation. Diabetic fingers with established peripheral neuropathy were more likely to undergo amputation. We recommend that any symptomatic cat bites to the upper limb, especially hand and wrist, must be treated promptly, essentially within 48 hours of injury, particularly in immunocompromised population.


Assuntos
Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Animais , Antibacterianos/uso terapêutico , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Gatos , Complicações do Diabetes , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/epidemiologia , Osteomielite/microbiologia , Osteomielite/terapia , Pasteurella/isolamento & purificação , Infecções por Pasteurella/epidemiologia , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Tempo para o Tratamento , Reino Unido/epidemiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapia
16.
BMC Musculoskelet Disord ; 20(1): 272, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159792

RESUMO

BACKGROUND: The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. METHODS: We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. RESULTS: Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. CONCLUSIONS: Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/terapia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Adulto , Fatores Etários , Idoso , Artrite Infecciosa/sangue , Artrite Infecciosa/microbiologia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Artroplastia do Joelho/instrumentação , Artroplastia do Joelho/métodos , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Feminino , Seguimentos , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/sangue , Osteoartrite do Quadril/microbiologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/sangue , Osteoartrite do Joelho/microbiologia , Osteoartrite do Joelho/terapia , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/sangue , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Falha de Tratamento
17.
Bull Hosp Jt Dis (2013) ; 77(2): 140-145, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31128585

RESUMO

INTRODUCTION: Primary meningococcal septic arthritis (PMSA) is an unusual manifestation of meningococcal disease. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcemia and isolation of Neisseria meningitidis in synovial fluid and blood culture. Diagnosis and early treatment, combining antibiotic and joint drainage, are fundamental. CASE PRESENTATION: We present the case of a healthy 17-year-old male who presented with history of an acute onset, painful knee accompanied by fever. N. meningitidis was cultured from the synovial fluid. He was treated with arthroscopic lavage and intravenous ceftriaxone for 2 weeks. He was discharged 7 days after admission receiving outpatient intravenous ceftriaxione for 6 days and was ultimately transitioned to oral ciprofloxacin for 2 weeks thereafter. At the final follow-up visit, he had returned to sports activity with a normal knee joint. LITERATURE REVIEW: We have done an exhaustive literature review in PubMed. Forty-four articles were included, with a total of 46 patients, to which we added ours. We collected the available demographic data, analytical values, culture tests, treatment, and evolution. PURPOSES AND CLINICAL RELEVANCE: This case illustrates an unusual presentation of N. meningitidis infection. Diagnostic suspicion is essential. Joint washing and antibiotics are the mainstays of treatment. Early and proper treatment prevents complications and mortality. Our main objective was to evaluate the diagnostics tools and treatment in PMSA. As a secondary objective, we evaluated the cases with negative cultures in order to evaluate the criteria for the diagnostic suspicion of PMSA.


Assuntos
Artrite Infecciosa , Artroscopia/métodos , Ceftriaxona/administração & dosagem , Articulação do Joelho , Infecções Meningocócicas , Neisseria meningitidis/isolamento & purificação , Líquido Sinovial/microbiologia , Irrigação Terapêutica/métodos , Administração Intravenosa , Adolescente , Antibacterianos/administração & dosagem , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/fisiopatologia , Artrite Infecciosa/terapia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/microbiologia , Masculino , Infecções Meningocócicas/diagnóstico , Infecções Meningocócicas/fisiopatologia , Infecções Meningocócicas/terapia , Recuperação de Função Fisiológica , Volta ao Esporte , Resultado do Tratamento
19.
Ned Tijdschr Geneeskd ; 1632019 05 16.
Artigo em Holandês | MEDLINE | ID: mdl-31120220

RESUMO

Prosthetic joint infection A prosthetic joint infection (PJI) is a serious complication that can lead to lengthy hospitalization, significant limitations in mobility, and a reduced quality of life. For acute PJI, the aim is to cure the infection whilst retaining the prosthesis; this can be achieved by means of thorough surgical debridement, cleaning of the artificial material, replacement of exchangeable prosthesis parts and adjuvant antibiotic therapy. In cases of chronic PJI, the prosthetic joint needs to be replaced. For patients in whom surgery is not feasible, or who refuse surgical intervention, chronic suppressive antibiotic therapy can be applied if the infection persists. In order to increase the likelihood of a favourable outcome, it is important to take a multidisciplinary approach.


Assuntos
Artrite Infecciosa/terapia , Infecções Relacionadas à Prótese/terapia , Antibacterianos/uso terapêutico , Desbridamento/métodos , Humanos , Implantação de Prótese/métodos , Qualidade de Vida , Amplitude de Movimento Articular
20.
Tech Hand Up Extrem Surg ; 23(3): 133-137, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30973488

RESUMO

Septic arthritis of the small joints of the hand usually occurs secondary to bacterial inoculation through penetrating injury to the joint, or direct spread of infection from paronychia, felon, or pyogenic flexor tenosynovitis. Surgical treatment involves drainage and irrigation and may involve debridement if there is an open wound. We describe a method of continuous irrigation of septic joints of the hand postoperatively in the ward setting using an intravenous cannula placed within the joint and connected to an intravenous giving set with delivery of physiological fluid using a pump driver. Modifications of the technique are described for distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints and illustrated in each joint by 3 case studies. In addition to the irrigation, intravenous antibiotics were administered. All patients healed well with a full return of joint motion, no radiologic change, and a mean QuickDASH score of 4.8 at a mean follow-up duration of 3.6 months. This is a safe and simple technique that can be performed in patients with suspected or confirmed septic arthritis and carries minimal morbidity.


Assuntos
Artrite Infecciosa/terapia , Articulação da Mão/microbiologia , Irrigação Terapêutica/métodos , Adulto , Idoso , Antibacterianos/uso terapêutico , Artrite Infecciosa/microbiologia , Cateteres , Feminino , Humanos , Masculino , Irrigação Terapêutica/instrumentação
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