Enterobacter cloacae Infection After Surgical Treatment of Ankle Fractures, a Multicenter Observational Study.

BACKGROUND: Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. METHODS: We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. RESULTS: A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P = .008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P = .017). CONCLUSION: A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. LEVEL OF EVIDENCE: Level V, mechanism-based reasoning.

Urinary Tract Infection and Antimicrobial Susceptibility of Bacterial Isolates in Saint Joseph Kitgum Hospital, Kitgum, Uganda.

A cross-sectional study of microorganisms isolated from mid-stream urine samples obtained from 139 patients with suspected urinary tract infection (UTI) who presented leukocyturia was conducted from April to June 2019 at Saint Joseph Kitgum Hospital (Uganda). All microorganisms were identified by MALDI-TOF mass spectrometry in a laboratory in Spain. Antimicrobial susceptibility was determined on site using the disc diffusion method (Kirby-Bauer test) and these results were subsequently compared with those obtained in Spain using the Becton Dickinson Phoenix M50 device. The overall prevalence of UTI with bacterial growth was 64.0% (n = 89) (95% CI, 56.1-72.0), and 11 presented mixed infection. As a result, 100 microorganisms were isolated. The most common uropathogens were Enterococcus spp. (57%) and Escherichia coli (28%). Nitrofurantoin was the most effective drug (81.7% in Gram-positive and 87.3% in Gram-negative bacteria), followed by imipenem (94.2% and 74.5%, respectively). The highest resistance rates were observed for amoxicillin and ciprofloxacin (66.2% and 44.6%, respectively). Given the increasing trend toward antibiotic resistance, there is a need for bacteriological cultures and continuous surveillance of uropathogen antibiotic susceptibility. Use of amoxicillin and ciprofloxacin as empirical treatments for UTIs should be discontinued in Uganda. The findings of this study may be useful for clinicians, as they may improve empirical treatment.

Risk Factors of DAIR Failure and Validation of the KLIC Score: A Multicenter Study of Four Hundred Fifty-Five Patients.

Background: Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure. Patients and Methods: A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, ≤2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, ≥7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed. Results: A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels, Staphylococcus aureus, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success. Conclusions: Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.

Evolución del resultado positivo del QuantiFERON®-TB Gold in Tube (QFT-GIT) y características asociadas en trabajadores sanitarios con infección tuberculosa latente en un hospital terciario / Evolution of Quanti FERONR-TB Gold in Tube (QFT-GIT) positive result and associated features from health care workers with latent tuberculosis infection in a tertiary hospital

Los test de liberación del Interferon Gamma complementan o reemplazan a la prueba de tuberculina (PT) en el diagnóstico de infección latente tuberculosa (ILTB), pero son objeto de controversia debido a sus posibles reversiones. Nuestro objetivo es describir la evolución del QuantiferonR-TB Gold in Tube (QFT-GIT) tras un resultado positivo en trabajadores sanitarios con ILTB y los factores posiblemente relacionados con la persistencia, o no, del resultado en un periodo de seis años. Analizamos los datos de 46 trabajadores, de ellos 60,9% mujeres, siendo los grupos más frecuentes enfermeros, médicos y auxiliares de enfermería. 32,6% pertenecían a departamentos considerados de alto riesgo, 26% reportaron quimioprofilaxis previa. Observamos reversión del QFT-GIT en un 32,6% de ellos. Encontramos menor riesgo significativo de reversión en relación a un mayor resultado de la PT en milímetros, sin relación significativa entre reversiones y quimioprofilaxis. Es importante continuar investigando para resolver los interrogantes relacionados con las posibles reversiones del QFT-GIT (AU)

The Interferon Gamma release assays complement or replace the tuberculin skin test (TST) for diagnosis of latent tuberculosis infection (LTBI), but are currently in controversy due to its reversions possibility. Our goal is to describe the evolution of QuantiFERONR- TB Gold in Tube (QFT-GIT) following a positive result in healthcare workers with LTBI and possible related factors to the persistence, or not, of the result in a period of six years. We analyzed data from 46 workers, 60.9% of them women, the most common groups were nurses, doctors and nursing assistants, 32.6% of them belonged to considered high risk departments, and 26% reported previous chemoprophylaxis. We found 32.6% QFT-GIT reversions and less significant reversion risk in relation to a higher result of TST in millimetres, without significant relation between reversions and chemoprophylaxis. It is important to continue researching to resolve questions related to possible QFT-GIT reversions (AU)

Mycobacterium malmoense, ¿ha llegado para quedarse? / Mycobacterium malmoense. Is It Here to Stay?

No disponible

Recomendaciones sobre bioseguridad en el laboratorio de micobacterias y revisión de la normativa / Biosafety recommendations in the mycobacteriology laboratory and review of legislation

Para la microbiología clínica, Mycobacterium tuberculosis supone un microorganismo cuya manipulación es difícil, ya que entraña el riesgo de exponerse a un patógeno de transmisión principalmente aérea que requiere una contención de nivel 3. En estos momentos, la mayoría de los accidentes en el laboratorio de micobacterias puede reducirse mediante la práctica de procedimientos microbiológicos adecuados, el uso de dispositivos de contención y protección y un diseño de las instalaciones apropiado. La legislación actual contempla el grado de responsabilidad de las instituciones sanitarias y del personal del laboratorio, y define específicamente el nivel de bioseguridad requerido para el procesamiento de muestras para micobacterias. El respeto a las recomendaciones en contención primaria y secundaria, así como el control sistemático del personal de laboratorio y la elaboración de planes de actuación frente a accidentes, contribuyen a minimizar los riesgos de ser infectado y proteger a la comunidad

In clinical microbiology, Mycobacterium tuberculosis is a difficult microorganism to manipulate because of the risk of exposure to this mostly air-borne transmitted pathogen which requires level 3 biosafety. At present, most laboratory accidents involving mycobacteria can be reduced by carrying out suitable microbiologic procedures, the use of safety and protection devices, and the design of appropriate installations. Current legislation defines the level of responsibility of healthcare institutions and laboratory personnel and specifically stipulates the level of biosafety required for processing specimens containing mycobacteria. Adherence to primary and secondary safety recommendations, systematic monitoring of laboratory personnel, and the design of proactive plans to prevent accidents help to minimize the risk of infection and provide adequate protection for the community