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1.
Medicine (Baltimore) ; 99(4): e18891, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977899

RESUMO

The aim of this study was to determine whether the infection control rate of a modified debridement, antibiotics, and implant retention (DAIR) protocol (DAIR with antibiotic-impregnated cement beads) is comparable to that of 2-stage revision for acute periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). We also aimed to determine whether this modified DAIR technique produced better clinical results than those obtained using 2-stage revision in terms of functional outcome, range of motion (ROM), and patient satisfaction at 2 years after surgery.This retrospective comparative study included patients who underwent modified DAIR (7 patients, 9 knees) or 2-stage revision (8 patients, 9 knees) for acute PJI of the knee joint. Infection control rate, functional outcome measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, ROM and patient satisfaction were compared between the two groups.There was no difference in infection control rates between the modified DAIR and 2-stage revision groups (78% vs 78%, respectively). In contrast, surgical outcome in the modified DAIR group was tended to be better than 2-stage revision group, but it did not reach statistical significance. Median maximal range of flexion was 103° in the modified DAIR group and it was 90° in the 2-stage group (P = .191). In addition, the median WOMAC function score was 24 in the modified DAIR group and it was 30 in the 2-stage group (P = .076). Median patient satisfaction measured using visual analogue scale was 8 in the modified DAIR group and 5 in the 2-stage group (P = .069).The infection control rates of the modified DAIR protocol and 2-stage revision protocol were similar for the treatment of acute PJI of the knee joint. However, the modified DAIR protocol could not provide substantially increased functional outcomes and patient satisfaction compared to 2-stage revision. Therefore, the modified DAIR technique should be considered to be of limited use in patients with high surgical morbidity.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Cimentos para Ossos/uso terapêutico , Desbridamento/métodos , Infecções Relacionadas à Prótese , Vancomicina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
2.
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
3.
Medicine (Baltimore) ; 98(45): e17885, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702663

RESUMO

RATIONALE: Endograft infection following endovascular stent for aortic aneurysm is rare (0.6%-3%), but it results in high mortality rate of 25% to 88%. PATIENT CONCERNS: A 66-year-old hypertensive man underwent an endovascular stent graft for abdominal aortic aneurysm 18 months ago. Recurrent episodes of fever, chills, and abdominal fullness occurred 6 months ago before this admission. Laboratory data showed 20 mg/dL of C-reactive protein and abdominal computed tomography (CT) revealed an aortic endoleak at an urban hospital, so 4-day course of intravenous (IV) amoxicillin/clavulanic acid was given and he was discharged after fever subsided. He was admitted to our hospital due to fever, chills, and watery diarrhea for 1 day. Abdominal CT showed left psoas abscess associated with endograft infection. Blood culture grew Listeria monocytogenes. DIAGNOSIS: Left psoas abscess associated with endograft infection caused by bacteremia of Listeria monocytogenes. INTERVENTIONS: IV ampicillin with 8 days of synergistic gentamicin was prescribed and it created satisfactory response. Ampicillin was continued for 30 days and then shifted to IV co-trimoxazole for 12 days. OUTCOMES: He remained asymptomatic with a decline of CRP to 0.36 mg/dL and ESR to 39 mm/h. He was discharged on the 44th hospital day. Orally SMX/TMP was prescribed for 13.5 months. LESSONS: Only few cases of aortic endograft infection caused by Listeria monocytogenes had been reported. In selected cases, particularly with smoldering presentations and high operative risk, endograft retention with a prolonged antimicrobial therapy seem plausible as an initial therapeutic option, complemented with percutaneous drainage or surgical debridement if necessary.


Assuntos
Listeria monocytogenes/isolamento & purificação , Infecções Relacionadas à Prótese/diagnóstico , Abscesso do Psoas/diagnóstico , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Gentamicinas/uso terapêutico , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Abscesso do Psoas/tratamento farmacológico , Abscesso do Psoas/etiologia , Tomografia Computadorizada por Raios X
4.
Lakartidningen ; 1162019 Oct 21.
Artigo em Sueco | MEDLINE | ID: mdl-31638706

RESUMO

The Swedish National Guidelines for Bone and Joint Infections were revised during 2018. The work was carried out on behalf of the Swedish Society for Infectious Diseases. The study group consists of senior consultants in infectious diseases, supported by specialists in orthopedic surgery, clinical microbiology and allergology when needed. The study group emphasizes that implant associated infections are challenging and requires multidisciplinary cooperation, including, but not limited to, specialists in orthopedic surgery, infectious diseases, clinical microbiology and radiology for optimal treatment results. All aspects of the clinical management are equally important; selecting the optimal antibiotic prophylaxis in arthroplasty as well as fracture surgery, early diagnosis of infection, adequate treatment, follow-up, and finally a structured evaluation of outcome. Profound and updated knowledge of treatment of biofilm related infection is necessary to achieve optimal results in patients with implant-associated infections. Future challenges include improved decision support for combining surgical treatment with selection of proper antibiotics, as well as management of antibiotic resistance, drug-drug interactions and adverse effects of antibiotic treatment.


Assuntos
Infecções Relacionadas à Prótese , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Biofilmes , Humanos , Equipe de Assistência ao Paciente , Guias de Prática Clínica como Assunto , Infecções Relacionadas à Prótese/classificação , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Sociedades Médicas , Suécia
5.
J Cardiothorac Surg ; 14(1): 170, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533849

RESUMO

BACKGROUND: Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. CASE PRESENTATION: This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. CONCLUSIONS: This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.


Assuntos
Antibacterianos/uso terapêutico , Bioprótese/efeitos adversos , Endocardite Bacteriana/tratamento farmacológico , Firmicutes , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Administração Oral , Valva Aórtica/cirurgia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
6.
Bull Soc Pathol Exot ; 112(2): 114-118, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31478616

RESUMO

Implant of artificial penile nodule (APN) is a socio-cultural practice, linked to penitentiary environment in French Guiana. Physicians are often unfamiliar with its existence. Although serious complications remain low regarding the high prevalence of this practice, urgent cares could be required. Indeed, implant of nodule can have functional sequelae, and sometimes life-threatening consequences, especially if infection occurs and spreads. We have reported the case of a 23-year-old male who presented an infection of the penis after the implant of two APN. Removal of the nodules associated with oral antibiotics was needed. We also present CT-scan images of another patient, as an example of fortuitous discovery of these nodules. We finally discuss the various complications already described in literature.


Assuntos
Doenças do Pênis/diagnóstico , Prótese de Pênis/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Administração Oral , Antibacterianos/administração & dosagem , Remoção de Dispositivo , Guiana Francesa , Humanos , Masculino , Doenças do Pênis/tratamento farmacológico , Doenças do Pênis/cirurgia , Prisões , Desenho de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 57(8): 596-600, 2019 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-31422629

RESUMO

Objective: To investigate the microbiological test, antibiotic sensitivity and surgical treatment of periprosthetic joint infection(PJI) cases in post total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients. Methods: A retrospective cross-sectional survey was conducted on 318 patients who underwent THA or TKA in 9 clinical centers in Beijing from January 2014 to December 2016.The data of microbiology, antibiotic sensitivity and surgical treatment were collected.The average age of patients was (62.3±13.1) years old (range: 21-86 years old), including 145 males and 173 females.The body mass index was (25.6±3.8) kg/m (2) (range: 15.6-38.1 kg/m(2)). Results: In total, 318 patients had microorganisms detected by periprosthetic tissue culture or synovial fluid culture, 209 cases (65.7%) had Gram-positive bacteria, 29 cases (9.1%) had Gram-negative bacteria, 10 cases (3.1%) had fungi, 3 cases (0.9%) had non-tuberculous mycobacteria, 72 cases (22.6%) were negative, 69 cases (21.7%) had methicillin-resistant bacteria. The antibiotic sensitivity results showed that the overall resistance rate of penicillin, cefuroxime, amoxicillin+clavulanic acid was 79.9%, 69.9%, and 68.1%, respectively; meropenem, vancomycin, and linezolid resistance rate was 0. For the treatment methods of hip and knee PJI, two-stage revision surgery acounted for 72.9% (108/148) and 64.1% (109/170), respectively. One-stage revision surgery accounted for 21.6% (32/148) and 7.6% (13/170), and open debridement surgery accounted for 4.7%(7/148) and 26.4% (45/170). Conclusions: Gram-positive bacteria was still the main pathogen of PJI.The methicillin-resistant bacteria and rare bacteria should be payed attention to. The Majority of hip and knee PJI cases were treated by two-stage revision surgery.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Pequim , Estudos Transversais , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Adulto Jovem
8.
Z Orthop Unfall ; 157(5): 510-514, 2019 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-31387123

RESUMO

BACKGROUND: A key factor in the successful treatment of periprosthetic joint infection is the consistent antimicrobial therapy. Depending on the pathogen antimicrobial susceptibility, intravenous (i. v.) antibiotics may not be switched to oral medication at patient discharge, without risking a treatment failure. The implementation of an outpatient i. v. therapy using peripherally inserted central catheters (PICCs) allows for early discharge with continuation of adequate antimicrobial therapy. METHODS: We prospectively evaluated the systematic use of PICC in 11 patients with periprosthetic joint infection. Inclusion criterion was the detection of a pathogen that cannot be optimally treated with oral antibiotics according to the current treatment concept (Trampuz et al.). RESULTS: A total of 12 PICCs in 11 patients were analysed. An error or mechanical nerve irritation was not observed. The occurrence of a catheter-related bloodstream infection (CRBSI) was not recorded. None of our patients had PICC-associated infections, thrombophlebitis or thrombosis. One patient stopped therapy due to a lack of compliance. Ten patients successfully completed their treatment. At a mean follow-up of 29 months, successful infection eradication as measured by the Delphi criteria was achieved in 100%. CONCLUSION: Although the number of patients included in the study was small, our short-term results suggest a good applicability of PICCs in the outpatient i. v. antimicrobial therapy for treatment of periprosthetic joint infection. Catheter-associated complications could not be observed in our collective. The successful infection control in all cases despite proven difficult-to-treat infection is promising.


Assuntos
Antibacterianos/administração & dosagem , Cateterismo Periférico , Infecções Relacionadas à Prótese/tratamento farmacológico , Administração Intravenosa , Idoso , Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia
10.
Foot Ankle Int ; 40(1_suppl): 48S-52S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322933

RESUMO

RECOMMENDATION: We recommend tailoring the antibiotic in cement spacers to the infecting organism if it has been identified, as is typically done in total knee and hip arthroplasty. Otherwise, broad-spectrum antibiotics may be utilized. Medical comorbidities should always be considered, especially with regard to renal function and allergy profile. A thermostable antibiotic should be added to cement. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Antibacterianos/uso terapêutico , Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Artroplastia de Substituição do Tornozelo/instrumentação , Cimentos para Ossos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia
11.
Foot Ankle Int ; 40(1_suppl): 46S-47S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322964

RESUMO

RECOMMENDATION: Though literature specific to total ankle arthroplasty (TAA) is lacking, based on recommendations for the management of hip and knee arthroplasties, the choice of antibiotic should be made based on the identification and sensitivities of the infecting organism(s). Dosing, frequency, and route of administration of antibiotics may be determined in consultation with an infectious disease specialist and by taking into account the patient's weight and comorbidities, such as renal impairment and the antibiogram. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Antibacterianos/uso terapêutico , Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Artroplastia de Substituição do Tornozelo/instrumentação , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia
12.
Foot Ankle Int ; 40(1_suppl): 48S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322965

RESUMO

RECOMMENDATION: Culture-directed antibiotic therapy is recommended for patients undergoing operative treatment of infected total ankle arthroplasty (TAA). Routine administration of suppressive antibiotics in patients with an ankle prosthesis in place is not warranted; however, in certain clinical circumstances, this may be of benefit. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Antibacterianos/uso terapêutico , Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Artroplastia de Substituição do Tornozelo/instrumentação , Humanos , Infecções Relacionadas à Prótese/etiologia
13.
Orthopedics ; 42(4): 211-218, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323104

RESUMO

Molded antibiotic shoulder spacers allow for intraoperative customization of antibiotics and multiple size options. The purpose of this study was to evaluate the efficacy of an anatomic intraoperatively molded spacer in the two-stage treatment of infection and to assess the safety of early rehabilitation when the capsule and rotator cuff are present. During 2014 and 2015, 27 shoulders were treated with a molded antibiotic cement spacer as part of a two-stage treatment. Indications included periprosthetic joint infection (n=18), native shoulder infection (n=8), and infection after internal fixation (n=1). All patients were followed for a minimum of 2 years. Mean follow-up time was 29.6 months. Patients were allowed to perform motion exercises (group I; n=16) or were instructed to avoid motion (group II; n=11) after spacer implantation, depending on the condition of their rotator cuff. Infection was eradicated in 23 of the 27 shoulders (85%). At most recent follow-up, pain scores were lower in group I. Mean final elevation was 115° in group I compared with 93° in group II. Mean final active external rotation was 36°, with no difference between the groups. In 3 (4%) shoulders with significant proximal humeral bone loss, the spacer became rotationally unstable. An anatomic intraoperatively molded spacer can be implanted safely in two-stage treatment for deep infection and has a reasonable rate of eradication. When adequate capsule and rotator cuff tissue is present, early motion in between stages can be safely recommended with a trend toward improved forward elevation at final follow-up and may facilitate the second stage reimplantation. [Orthopedics. 2019; 42(4):211-218.].


Assuntos
Antibacterianos/administração & dosagem , Fixação Interna de Fraturas/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Reimplante , Rotação , Manguito Rotador/microbiologia , Manguito Rotador/cirurgia , Articulação do Ombro/microbiologia , Resultado do Tratamento
15.
S Afr Med J ; 109(6): 378-381, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31266554

RESUMO

The systemic fluoroquinolones (FQs) have recently been reported to be associated with significant side-effects in susceptible individuals. This has prompted the Food and Drug Administration (FDA) in the USA and the European Medicines Agency (EMA) to issue warnings regarding their use. The FQs should not be used for common bacterial infections, such as urinary tract infections, travellers' diarrhoea and upper and lower respiratory tract infections, unless it is not possible to use another oral agent. There are situations, however, in which these agents are not only effective, but their benefit outweighs the risk. These include the management of conditions such as acute prostatitis, typhoid fever, prosthetic joint infections, multidrug-resistant tuberculosis, certain hospital-acquired infections and situations where the organism is susceptible to FQs, which could then be administered orally. Alternatively, the patient would have to be admitted to hospital for parenteral therapy.


Assuntos
Infecção Hospitalar/tratamento farmacológico , Fluoroquinolonas/efeitos adversos , Prostatite/tratamento farmacológico , Infecções Relacionadas à Prótese/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Febre Tifoide/tratamento farmacológico , Aneurisma Dissecante/induzido quimicamente , Ansiedade/induzido quimicamente , Fluoroquinolonas/uso terapêutico , Alucinações/induzido quimicamente , Humanos , Prótese Articular , Masculino , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Psicoses Induzidas por Substâncias/etiologia , Ruptura/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Síndrome , Tendinopatia/induzido quimicamente
16.
Int Heart J ; 60(4): 983-985, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31257331

RESUMO

Infective endocarditis (IE) is a lethal complication inpatients with congenital heart disease. We report a case of percutaneous implanted pulmonary valve IE in a 49-year-old female. She underwent a previous surgery for tetralogy of Fallot with transannular patching of the right ventricular outflow tractat the age of 18 years. Echocardiography showed chronic moderate to severe pulmonary regurgitation with right heart enlargement. She underwent transcatheter pulmonary valve implantation with a 26 mm Venus-P valve (Venus Medtech, Shanghai, China) in order to release pulmonary insufficiency. Two months after implantation, she presented with recurrent chills and febrile for one week, and percutaneous implanted pulmonary valve IE was diagnosed. According to the antibiotic susceptibility test, she was given penicillin and gentamycin. At 12 months follow-up, TTE showed vegetation completely disappeared and the valve functioned normally. The patient recovered uneventfully without any complications like recurrent IE.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Endocardite/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/diagnóstico , Tomografia Computadorizada por Raios X
17.
Int J Antimicrob Agents ; 54(4): 456-462, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31319190

RESUMO

Carbapenemase-producing Enterobacteriaceae (CPE) are emerging multidrug-resistant bacteria responsible for invasive infections, including prosthetic joint infections (PJIs). Local administration of colistin may provide bactericidal concentrations in situ. This study evaluated the efficacy of a colistin-impregnated cement spacer, alone and in combination with systemic antibiotics, in a rabbit model of CPE-PJI. Elution of 3 MIU of colistimethate sodium (CMS) in 40 g of poly(methyl methacrylate) cement was studied in vitro. In vivo, 5 × 108 CFU of KPC-producing Klebsiella pneumoniae (colistin and meropenem MICs of 1 mg/L and 4 mg/L, respectively) were injected close to a prosthetic knee. Surgical debridement and prosthesis removal were performed 7 days later, and rabbits were assigned to six treatment groups (11-13 rabbits each): drug-free spacer; colistin-loaded spacer; colistin intramuscular (i.m.); colistin i.m. + colistin spacer; colistin i.m. + meropenem subcutaneous (s.c.); and colistin i.m. + meropenem s.c. + colistin spacer. Systemic treatment was administered at doses targeting pharmacokinetics in humans, and rabbits were euthanised 7 days later to evaluate bacterial counts in infected bones. In vitro, CMS elution was low (<0.1% at 24 h) but reached a local concentration of ≥20 mg/L (>20 × MIC). In vivo, combinations of local and systemic colistin, with or without meropenem, were the only regimens superior to the control group (P ≤ 0.05) in terms of viable bacterial counts and the proportion of rabbits with sterile bone, with no emergence of colistin-resistant strains. Colistin-loaded cement spacer in combination with systemic antibiotics were the most effective regimens in this CPE-PJI model.


Assuntos
Antibacterianos/administração & dosagem , Artrite/tratamento farmacológico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Colistina/administração & dosagem , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Infecções Relacionadas à Prótese/tratamento farmacológico , Animais , Artrite/microbiologia , Artrite/cirurgia , Desbridamento , Modelos Animais de Doenças , Feminino , Injeções Intra-Articulares , Injeções Intramusculares , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/cirurgia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Coelhos , Resultado do Tratamento
18.
Eur J Pharm Biopharm ; 142: 322-333, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31295503

RESUMO

The purpose of this work was the development of antibacterial delivery systems for vancomycin, with potential application in the prevention or treatment of orthopedic implant infections. Previous studies have shown tandem thermal gelling and Michael addition cross-linking of hydrogels based on methacrylate, acrylate or vinylsulfone triblock copolymers of PEG-p(HPMAm-lac1-2) and thiolated hyaluronic acid. In this work we exploited these α-ß unsaturated derivatives of PEG-p(HPMAm-lac1-2) triblock copolymers and used them in combination with thiolated hyaluronic acid as controlled delivery systems for vancomycin. It was found that the antibiotic was sustainably released from the hydrogel networks for at least 5 days with release kinetics depending on diffusion and dissociation of the positively charged vancomycin from the negatively charged hyaluronic acid. The release of vancomycin could be tailored mainly by HA-SH solid content and degree of thiolation. The developed hydrogels were demonstrate efficacious in preserving the structural and functional integrity of the encapsulated drug by physical immobilization within the gel network and ionic interaction with hyaluronic acid, thereby preventing vancomycin deamidation processes. Furthermore, the antimicrobial activity of vancomycin loaded hydrogels was assessed, demonstrating retention of inhibitory activity towards Staphylococcus aureus during formulation and release, with slightly increased activity of vancomycin encapsulated in hydrogels of higher HA-SH content as compared to controls.


Assuntos
Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacologia , Hidrogéis/química , Infecções Relacionadas à Prótese/tratamento farmacológico , Vancomicina/química , Vancomicina/farmacologia , Acrilatos/química , Antibacterianos/química , Antibacterianos/farmacologia , Ácido Hialurônico/química , Metacrilatos/química , Ortopedia/métodos , Polietilenoglicóis/química , Polímeros/química , Próteses e Implantes/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos
19.
J Infect Chemother ; 25(9): 669-680, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31182331

RESUMO

Abdominal aortic graft infections (AGIs) occur in 1-5% of aortic prosthetic placements. It can result in limb amputation, pseudo-aneurysm formation, septic emboli, aorto-enteric fistulae, septic shock and death. The most frequently involved pathogens are methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci, followed by Enterobacteriaceae and uncommon bacteria. In case of gut involvement the presence of fungi has to be considered. Computed tomography angiography is actually the gold standard diagnostic imaging but magnetic resonance is a valid alternative. Nuclear medicine imaging is commonly used to improve sensitivity and specificity. Signs and symptoms are often aspecific and blood cultures can be negative, requiring alternative ways to detect the microorganism responsible for infection, such as 16S rRNA gene sequencing and molecular rapid diagnostic tests. Curative surgical intervention is the first choice approach, with in-situ reconstruction providing by far the best outcome and xenopericardial bovine patch as a promising option. For patients unable to undergo major surgery, the outcome of conservative approach remains uncertain but usually provides for life-long suppressive therapy. However, in selected cases an attempt of stopping antibiotic treatment after 3-6 months can be done. Given the difficulty in their management, we performed a review of AGIs, in order to raise awareness on clinical presentation, current available diagnostic tools, prophylaxis, surgical and anti-infective treatment of AGIs.


Assuntos
Aorta Abdominal/cirurgia , Prótese Vascular/efeitos adversos , Infecções Relacionadas à Prótese , Biofilmes , Prótese Vascular/microbiologia , Contaminação de Equipamentos , Humanos , Pesquisa Interdisciplinar , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco
20.
Cornea ; 38(10): 1328-1331, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31246677

RESUMO

PURPOSE: Tsukamurella is an important and emerging organism that causes opportunistic human infection. We present the largest case series of Tsukamurella species-associated ophthalmic infections, with an emphasis on clinical spectrum, risk factors, treatment, and outcome. METHODS: A case series of culture-positive Tsukamurella species in ocular microbiological specimens was identified retrospectively from 2005 to 2018. Tsukamurella species were identified by phenotypic, molecular, and genotypic methods. Diagnoses were clinical and were supplemented by microbiological findings. Treatment including antibiotic type, number of antibiotics, treatment duration, and clinical outcome was documented. RESULTS: Eleven cases of culture-positive Tsukamurella ocular infection were identified. Of these 54.5% (6/11) of cases resulted in conjunctivitis, 18% (2/11) of cases resulted in keratitis, and 9% (1/11) of cases resulted in blepharitis. One case of canaliculitis and 1 case of postenucleation ocular implant-related infection were reported, which were both novel findings. The presence of ocular implant and preexisting ocular surface diseases such as exposure keratopathy and ectropion were thought to be predisposing factors. We have demonstrated that treatment of Tsukamurella ocular conjunctivitis, keratitis, and blepharitis was effective using a combination therapy of 2 antibiotics (fluoroquinolone, fusidic acid, or chloramphenicol). Canaliculitis and ocular implant infection required further addition of oral antibiotics (macrolide or doxycycline), canaliculotomy, and removal of the infected implant for satisfactory management. CONCLUSIONS: Tsukamurella tyrosinosolvens and Tsukamurella pulmonis were found to be the predominant species that caused ocular infection. Ocular manifestation of Tsukamurella has a wider spectrum than that previously reported. A high-level of suspicion and a low threshold for microbiological sampling in cases with prolonged ocular surface infection are recommended to diagnose Tsukamurella infections.


Assuntos
Infecções por Actinomycetales/microbiologia , Actinomycetales/isolamento & purificação , Enucleação Ocular/efeitos adversos , Infecções Oculares Bacterianas/microbiologia , Implantes Orbitários/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Actinomycetales/genética , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , DNA Bacteriano/análise , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Implantes Orbitários/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Estudos Retrospectivos
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