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1.
Ann Vasc Surg ; 70: 449-458, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32634568

RESUMO

BACKGROUND: The aim of this study is to assess the incidence, clinical manifestations, management, and prognosis of graft infection after bypass surgery with prosthetic conduit for infectious femoral artery pseudoaneurysms (IFAPs) in patients with a history of intravenous drug use (IVDU). METHODS: A single-center retrospective chart review of IVDU presenting with graft infections after previously being treated with extra-anatomic prosthetic conduit bypass surgery for IFAPs between 2009 and 2019 was performed. Relevant clinical data and patient demographics were collected and analyzed. All patients underwent procedures consisting of graft removal with analysis of operative details and complications. RESULTS: Of all 122 patients who underwent IFAP resection with extra-anatomic prosthetic bypass, the incidence of graft infection was 38.5% (47 patients, 48 grafts) with an average age of 35.7 ± 7.3 years. The average interval between bypass surgery and infectious symptoms was 9.2 ± 2.5 months and average time from bypass to graft removal was 13.6 ± 3.4 months. The most common presentation was repeated or unhealable chronic ulcers with sinus formation or purulence either within the bypass area or along the graft conduit route (43, 89.6%). Occlusion of the infected bypass graft occurred in nearly all cases (46, 95.8%). Severe hemorrhage occurred in only 1 case (2.1%). After graft removal, the stumps were ligated in the majority of patients (33, 68.8%) with 15 patients (31.2%) not amenable to ligation due to a difficult dissection. The average time of operation was 35.4 ± 8.7 min with an average blood loss of 35.8 ± 6.7 mL. There were no significant complications such as infection reoccurrence, severe limb ischemia, amputation, or death observed postoperatively. CONCLUSIONS: Patients who receive bypass surgery with prosthetic conduit for IFAPs carry a high incidence of graft infection and subsequent occlusion. However, the presenting symptoms are generally mild, and the incidence of fatal complications is rare. This study suggests that a safe treatment option consists of direct graft removal without reconstruction. Additionally, the procedure proved to be relatively convenient and straightforward, which provides further support toward the strategy of treating IFAPs in IVDUs with pseudoaneurysm resection and prosthetic conduit bypass surgery.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Artéria Femoral/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo/efeitos adversos , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Humanos , Ligadura , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
Vasc Endovascular Surg ; 55(1): 95-99, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32875968

RESUMO

Aortoenteric fistula after endovascular aortic repair for an abdominal aortic aneurysm is a rare but severe complication. Particularly, a case of inflammatory abdominal aortic aneurysm is extremely rare and there are only 3 reported cases. A 70-year-old man underwent endovascular aortic repair for impending rupture of an inflammatory abdominal aortic aneurysm and was medicated steroids for approximately 2 years. Four years after endovascular aortic repair, he developed endograft infection with an aortoduodenal fistula and a left psoas abscess. He underwent total endograft excision, debridement, in situ reconstruction of the aorta using prosthetic grafts with omental coverage, and digestive tract reconstruction to prevent leakage. Pseudomonas aeruginosa was detected in the infected aortic sac. The patient has not experienced recurrence of infection in the 35 months since his operation.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Duodenopatias/microbiologia , Procedimentos Endovasculares/efeitos adversos , Fístula Intestinal/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções por Pseudomonas/microbiologia , Abscesso do Psoas/microbiologia , Fístula Vascular/microbiologia , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Desbridamento , Remoção de Dispositivo , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Procedimentos Endovasculares/instrumentação , Humanos , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/cirurgia , Masculino , Omento/cirurgia , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia , Infecções por Pseudomonas/diagnóstico por imagem , Infecções por Pseudomonas/cirurgia , Abscesso do Psoas/diagnóstico por imagem , Abscesso do Psoas/cirurgia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
4.
Bone Joint J ; 102-B(12): 1682-1688, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33249903

RESUMO

AIMS: The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. METHODS: A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better. RESULTS: A total of 162 chronic PJIs were included in the study. After a mean follow-up of 57.3 months (12.1 to 115.7), 18 patients (11.1%) did not undergo reimplantation, due either to medical issues (10), the patient's choice (4), or death (4). When only considering those who underwent reimplantation, the success rate was 80.6%. However, when those who did not undergo reimplantation were included, the success rate dropped to 71.6%. Advanced age, American Society of Anesthesiologists grade ≥ III, McPherson's C host, and Gram-negative related PJI were independent risk factors for retention of the spacer. The mortality was higher in the non-reimplanted group. CONCLUSION: The real success rate of two-stage revision may not be as high as previously reported. The exclusion of patients who do not undergo reimplantation resulted in a 9% overestimation of the success rate in this series. Many comorbidity-related risk factors for retention of the spacer were identified, as well as higher death rates in this group. Efforts should be made to optimize these patients medically in order to increase reimplantation and success rates, while decreasing mortality. Cite this article: Bone Joint J 2020;102-B(12):1682-1688.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Doença Crônica , Desbridamento , Feminino , Seguimentos , Gentamicinas/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Vancomicina/administração & dosagem
5.
Medicine (Baltimore) ; 99(41): e22494, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031285

RESUMO

INTRODUCTION: Sneathia sanguinegens(S sanguinegens) is a gram-negative rod-shaped bacterium mostly reported to cause a perinatal infection, and there are no reports of S sanguinegens in prosthetic joint infection (PJI). The purpose of this report is to describe a very rare case of PJI after total hip arthroplasty (THA) caused by S sanguinegens. PATIENT CONCERNS: A 79-year-old woman presented with right coxalgia, inability to walk, and a fever of 39°C. She had undergone THA 28 years earlier for osteoarthritis of the hip. DIAGNOSES: The diagnosis was acute late-onset PJI, because blood tests revealed marked inflammatory reaction and computed tomography showed an abscess at the right hip joint; synovial fluid analysis resulted in detection of a gram-negative bacillus. INTERVENTION: Surgical debridement with retention of the implant and antibiotic therapy was performed. OUTCOMES: One month after surgery, polymerase chain reaction (PCR) assay showed that the pathogen was 99.9% likely to be S sanguinegens. There has been no recurrence of infection or loosening of the implant in the 2 years since her surgery. LESSONS: PCR should facilitate detection of previously unknown pathogens and potentially novel bacterial species.


Assuntos
Fusobactérias , Infecções por Bactérias Gram-Negativas/complicações , Infecções Relacionadas à Prótese/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Feminino , Fusobactérias/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia
6.
Medicine (Baltimore) ; 99(41): e22584, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031309

RESUMO

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.


Assuntos
Endocardite/microbiologia , Implante de Prótese de Valva Cardíaca , Infecções Relacionadas à Prótese/microbiologia , Trichosporon/isolamento & purificação , Tricosporonose/microbiologia , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada , Endocardite/diagnóstico por imagem , Endocardite/terapia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Reoperação , Tricosporonose/diagnóstico por imagem , Tricosporonose/terapia
8.
Clin Orthop Surg ; 12(3): 318-323, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32904007

RESUMO

Backgroud: Antibiotic-loaded bone cement (ALBC) is commonly used in total knee arthroplasty (TKA), especially among high-risk patients. While previous studies have reported on the efficacy of ALBC in reducing the rate of periprosthetic joint infection (PJI), its impact on antibiotic resistance has not been determined. The purpose of this study was to investigate antibiotic resistance among organisms causing PJIs after TKA in which ALBC was utilized. Methods: A retrospective review from December 1998 through December 2017 identified 36 PJIs that met inclusion criteria. Patients with culture-negative infection and unknown cement type were excluded. Patient characteristics, infecting organism, and antibiotic susceptibilities were recorded. ABLC included an aminoglycoside in all cases. Results: There was no difference in the type of PJI between the 2 groups. Staphylococcus species was the most commonly isolated, with 9 of 16 cases (56.3%) using non-ALBC and 14 of 20 (65.0%) cases using ALBC. Of those infected with Staphylococcus, there was no significant difference in antibiotic susceptibilities between groups. Overall, there were only 3 cases where the infecting organism was aminoglycoside resistant (standard cement, 1; ALBC, 2). Conclusions: These results suggest that the use of ALBC does not increase the risk of antibiotic resistance or affect the pattern of infection, even as the use of ALBC continues to increase, particularly among high-risk patients.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Artroplastia do Joelho , Cimentos para Ossos , Resistência Microbiana a Medicamentos , Infecções Relacionadas à Prótese/tratamento farmacológico , Gentamicinas/uso terapêutico , Humanos , Prótese do Joelho , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Tobramicina/uso terapêutico
9.
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
11.
Ann Thorac Cardiovasc Surg ; 26(6): 369-372, 2020 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-32741883

RESUMO

Endograft infection after abdominal endovascular aortic repair is a rare but catastrophic complication associated with high perioperative mortality and postoperative recurrent infection. The optimal surgical treatment is still controversial, particularly regarding in situ or extra-anatomical revascularization. Herein, we describe a successful surgically treated case of a patient with an endograft infection complicated with abscess formation in the retroperitoneal space around the right common iliac artery. We performed an aortobifemoral bypass grafting using the reversed L-shaped technique by rerouting the right leg of the new prosthesis to avoid the infected area. The patient is doing well 1 year after surgery without recurrent infection. This technique was considered to be advantageous because revascularization could be performed remotely from the infected area.


Assuntos
Abscesso Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Remoção de Dispositivo , Procedimentos Endovasculares/efeitos adversos , Aneurisma Ilíaco/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/microbiologia , Idoso , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Espaço Retroperitoneal , Resultado do Tratamento
12.
Plast Reconstr Surg ; 146(2): 301-308, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740580

RESUMO

BACKGROUND: Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution. METHODS: The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant. RESULTS: Povidone-iodine resulted in reductions of the bacterial load by a factor of 10 to 10 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies. CONCLUSIONS: Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biofilmes/efeitos dos fármacos , Implante Mamário/efeitos adversos , Implantes de Mama/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Bacitracina/administração & dosagem , Benzenossulfonatos/administração & dosagem , Implante Mamário/instrumentação , Cefazolina/administração & dosagem , Combinação de Medicamentos , Gentamicinas/administração & dosagem , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Povidona-Iodo/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Soluções , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificação , Irrigação Terapêutica/métodos
13.
Sci Rep ; 10(1): 13053, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32747743

RESUMO

Locally applied vancomycin is increasingly being used in primary hip and knee arthroplasty to reduce the risk of infection. Despite encouraging initial results, considerable debate remains on the basis of the data currently available. In particular, it has been unclear up to now whether local vancomycin is suitable to further reduce the risk of infection even if the rate of infection is already low (< 1%). In this monocentric retrospective cohort study, all primary total hip and knee arthroplasties performed between 2013 and 2018 were included. After a change in procedure at the hospital, 1 g vancomycin powder was applied intraarticularly before wound closure. The remaining perioperative procedure was constant over the investigation period. The follow-up was one year. The presence of an infection according to the currently valid MSIS criteria was defined as the endpoint. In patients with TKA two infections (0.3%) were observed under vancomycin prophylaxis in contrast to 44 infections (1.3%) in the control group (p = 0.033). In patients with THA two infections (0.5%) were observed under vancomycin prophylaxis and 48 infections (1.1%) in the control group without local vancomycin but this difference was statistically not significant. No wound complications requiring revision were observed as a result of the vancomycin. On the basis of the results of this study, intraarticular application of vancomycin powder in total hip and knee arthroplasty may be considered. Prospective randomized studies have to confirm this promising results prior a common recommendation.Level of Evidence III Retrospective cohort study.


Assuntos
Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Bactérias/efeitos dos fármacos , Bactérias/crescimento & desenvolvimento , Índice de Massa Corporal , Estudos de Casos e Controles , Humanos , Injeções Intra-Articulares , Pós , Infecções Relacionadas à Prótese/microbiologia , Vancomicina/farmacologia
14.
AJR Am J Roentgenol ; 215(3): 568-581, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32783556

RESUMO

OBJECTIVE. The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. CONCLUSION. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Artrocentese , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Artrite Infecciosa/microbiologia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Líquido Sinovial/microbiologia
15.
Ann Vasc Surg ; 69: 453.e5-453.e10, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32653615

RESUMO

To report a case of acute arm ischemia and prosthetic shoulder infection treated by extra-anatomical great saphenous vein graft with external vascular scaffolding. A 65 year-old man with multiple surgical interventions for soft tissue sarcoma of the right shoulder, local radiotherapy with residual brachial plexus neuropraxia, was referred to our attention for signs of arm ischemia. Two weeks before, the patient was submitted to prosthetic shoulder replacement complicated with prosthetic infection. Considering the mechanism of vascular injury, an open surgical revascularization was planned with a deliberate avoidance of the natural anatomic pathway to reduce the risk of graft infection. Consequently, after the complete removal of infected shoulder prosthesis and placement of antibiotic spacer, an axillarbrachial artery bypass using great saphenous vein was performed using a new braided cobalt chrome kink resistant external vascular support to prevent compression, also considering the extra-anatomical position of the graft. At 12 months' follow-up, patient was in good clinical condition with complete resolution of arm ischemia; computed tomographic angiography and duplex scan revealed patency of the graft with excellent distal perfusion. The new external vascular support seems to be useful and feasible for preventing compression of extra-anatomical venous bypass.


Assuntos
Artroplastia do Ombro/efeitos adversos , Artroplastia do Ombro/instrumentação , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Remoção de Dispositivo , Isquemia/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Veia Safena/transplante , Prótese de Ombro/efeitos adversos , Extremidade Superior/irrigação sanguínea , Idoso , Ligas de Cromo , Humanos , Isquemia/diagnóstico por imagem , Isquemia/etiologia , Isquemia/fisiopatologia , Masculino , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Fluxo Sanguíneo Regional , Resultado do Tratamento , Grau de Desobstrução Vascular
16.
J Vis Exp ; (160)2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32658180

RESUMO

Spine implant infections portend poor outcomes as diagnosis is challenging and surgical eradication is at odds with mechanical spinal stability. The purpose of this method is to describe a novel mouse model of spinal implant infection (SII) that was created to provide an inexpensive, rapid, and accurate in vivo tool to test potential therapeutics and treatment strategies for spinal implant infections. In this method, we present a model of posterior-approach spinal surgery in which a stainless-steel k-wire is transfixed into the L4 spinous process of 12-week old C57BL/6J wild-type mice and inoculated with 1 x 103 CFU of a bioluminescent strain of Staphylococcus aureus Xen36 bacteria. Mice are then longitudinally imaged for bioluminescence in vivo on post-operative days 0, 1, 3, 5, 7, 10, 14, 18, 21, 25, 28, and 35. Bioluminescence imaging (BLI) signals from a standardized field of view are quantified to measure in vivo bacterial burden. To quantify bacteria adhering to implants and peri-implant tissue, mice are euthanized and the implant and surrounding soft tissue are harvested. Bacteria are detached from the implant by sonication, cultured overnight and then colony forming units (CFUs) are counted. The results acquired from this method include longitudinal bacterial counts as measured by in vivo S. aureus bioluminescence (mean maximum flux) and CFU counts following euthanasia. While prior animal models of instrumented spine infection have involved invasive, ex vivo tissue analysis, the mouse model of SII presented in this paper leverages noninvasive, real time in vivo optical imaging of bioluminescent bacteria to replace static tissue study. Applications of the model are broad and may include utilizing alternative bioluminescent bacterial strains, incorporating other types of genetically engineered mice to contemporaneously study host immune response, and evaluating current or investigating new diagnostic and therapeutic modalities such as antibiotics or implant coatings.


Assuntos
Próteses e Implantes/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Coluna Vertebral , Infecções Estafilocócicas , Animais , Modelos Animais de Doenças , Camundongos , Camundongos Endogâmicos C57BL , Staphylococcus aureus/fisiologia
17.
J Card Surg ; 35(8): 2073-2076, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652630

RESUMO

BACKGROUND: Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS: A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION: Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.


Assuntos
Antibacterianos/administração & dosagem , Cardiomiopatias/terapia , Quimioterapia Adjuvante/métodos , Coração Auxiliar/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Adulto , Sulfato de Cálcio/administração & dosagem , Cefadroxila/administração & dosagem , Cefazolina/administração & dosagem , Desbridamento , Formas de Dosagem , Quimioterapia Combinada , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Staphylococcus aureus , Tobramicina/administração & dosagem , Resultado do Tratamento , Vancomicina/administração & dosagem
18.
Bone Joint J ; 102-B(7): 899-903, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600139

RESUMO

AIMS: To evaluate the histopathological examination of peri-implant tissue samples as a technique in the diagnosis of postoperative spinal implant infection (PSII). METHODS: This was a retrospective analysis. Patients who underwent revision spinal surgery at our institution were recruited for this study. PSII was diagnosed by clinical signs, histopathology, and microbiological examination of intraoperatively collected samples. Histopathology was defined as the gold standard. The sensitivity for histopathology was calculated. A total of 47 patients with PSII and at least one microbiological and histopathological sample were included in the study. RESULTS: PSII occurred in approximately 28% of the study population. Histopathology showed a sensitivity of 51.1% in the diagnosis of PSII. The most commonly found pathogens were Cutibacterium acnes and gram-positive staphylococci. CONCLUSION: Histopathology has low sensitivity for detecting PSII. In particular, infections caused by low-virulence microorganisms are insufficiently detected by histopathology. Cite this article: Bone Joint J 2020;102-B(7):899-903.


Assuntos
Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/patologia , Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propionibacterium acnes/isolamento & purificação , Reoperação , Estudos Retrospectivos , Sensibilidade e Especificidade , Staphylococcus/isolamento & purificação
19.
Bone Joint J ; 102-B(7_Supple_B): 3-10, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600192

RESUMO

AIMS: Current treatments of prosthetic joint infection (PJI) are minimally effective against Staphylococcus aureus biofilm. A murine PJI model of debridement, antibiotics, and implant retention (DAIR) was used to test the hypothesis that PlySs2, a bacteriophage-derived lysin, can target S. aureus biofilm and address the unique challenges presented in this periprosthetic environment. METHODS: The ability of PlySs2 and vancomycin to kill biofilm and colony-forming units (CFUs) on orthopaedic implants were compared using in vitro models. An in vivo murine PJI model of DAIR was used to assess the efficacy of a combination of PlySs2 and vancomycin on periprosthetic bacterial load. RESULTS: PlySs2 treatment reduced 99% more CFUs and 75% more biofilm compared with vancomycin in vitro. A combination of PlySs2 and vancomycin in vivo reduced the number of CFUs on the surface of implants by 92% and in the periprosthetic tissue by 88%. CONCLUSION: PlySs2 lysin was able to reduce biofilm, target planktonic bacteria, and work synergistically with vancomycin in our in vitro models. A combination of PlySs2 and vancomycin also reduced bacterial load in periprosthetic tissue and on the surface of implants in a murine model of DAIR treatment for established PJI. Cite this article: Bone Joint J 2020;102-B(7 Supple B):3-10.


Assuntos
Bacteriófagos , Enzimas/farmacologia , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Animais , Antibacterianos/farmacologia , Bacteriólise , Biofilmes , Contagem de Colônia Microbiana , Desbridamento , Modelos Animais de Doenças , Técnicas In Vitro , Camundongos Endogâmicos C57BL , Infecções Relacionadas à Prótese/microbiologia , Vancomicina/farmacologia
20.
Bone Joint J ; 102-B(7_Supple_B): 11-19, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600194

RESUMO

AIMS: Failure of irrigation and debridement (I&D) for prosthetic joint infection (PJI) is influenced by numerous host, surgical, and pathogen-related factors. We aimed to develop and validate a practical, easy-to-use tool based on machine learning that may accurately predict outcome following I&D surgery taking into account the influence of numerous factors. METHODS: This was an international, multicentre retrospective study of 1,174 revision total hip (THA) and knee arthroplasties (TKA) undergoing I&D for PJI between January 2005 and December 2017. PJI was defined using the Musculoskeletal Infection Society (MSIS) criteria. A total of 52 variables including demographics, comorbidities, and clinical and laboratory findings were evaluated using random forest machine learning analysis. The algorithm was then verified through cross-validation. RESULTS: Of the 1,174 patients that were included in the study, 405 patients (34.5%) failed treatment. Using random forest analysis, an algorithm that provides the probability for failure for each specific patient was created. By order of importance, the ten most important variables associated with failure of I&D were serum CRP levels, positive blood cultures, indication for index arthroplasty other than osteoarthritis, not exchanging the modular components, use of immunosuppressive medication, late acute (haematogenous) infections, methicillin-resistant Staphylococcus aureus infection, overlying skin infection, polymicrobial infection, and older age. The algorithm had good discriminatory capability (area under the curve = 0.74). Cross-validation showed similar probabilities comparing predicted and observed failures indicating high accuracy of the model. CONCLUSION: This is the first study in the orthopaedic literature to use machine learning as a tool for predicting outcomes following I&D surgery. The developed algorithm provides the medical profession with a tool that can be employed in clinical decision-making and improve patient care. Future studies should aid in further validating this tool on additional cohorts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):11-19.


Assuntos
Desbridamento , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Irrigação Terapêutica , Falha de Tratamento , Fatores Etários , Idoso , Algoritmos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Proteína C-Reativa/análise , Feminino , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Imunossupressores/efeitos adversos , Aprendizado de Máquina , Masculino , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Dermatopatias Bacterianas/complicações
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