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Tsang STJ, van Rensburg AJ, Ferreira N. Is there a role for suppression of infection in managing fracture-related infection following intra-medullary nailing? Injury 2024; 55:111602. [PMID: 38735275 DOI: 10.1016/j.injury.2024.111602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 12/17/2023] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The management of fracture-related infection has undergone radical progress following the development of international guidelines. However, there is limited consideration to the realities of healthcare in low-resource environments due to a lack of available evidence in the literature from these settings. Initial antimicrobial suppression to support fracture union is frequently used in low- and middle-income countries despite the lack of published clinical evidence to support its practice. This study aimed to evaluate the outcomes following initial antimicrobial suppression to support fracture union in the management of fracture-related infection. METHODS A retrospective review of consecutive patients treated with initial antimicrobial suppression to support fracture healing followed by definitive eradication surgery to manage fracture-related infections following intramedullary fixation was performed. Indications for this approach were; a soft tissue envelope not requiring reconstructive surgery, radiographic evidence of stable fixation with adequate alignment, and progression towards fracture union. RESULTS This approach was associated with successful treatment in 51/55 (93 %) patients. Fracture union was achieved in 52/55 (95 %) patients with antimicrobial suppression alone. Remission of infection was achieved in 54/55 (98 %) patients following definitive infection eradication surgery. Following antibiotic suppression, 6/46 (13 %) pathogens isolated from intra-operative samples demonstrated multi-drug resistance. CONCLUSION Initial antimicrobial suppression to support fracture healing followed by definitive infection eradication surgery was associated with successful treatment in 93 % of patients. The likelihood of remission of infection increases when eradication surgery is performed in a healed bone. This approach was not associated with an increased risk of developing multi-drug-resistant infections compared to contemporary bone infection cohorts in the published literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Shao-Ting Jerry Tsang
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa
| | - Adrian Jansen van Rensburg
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, Republic of South Africa.
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2
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Jia Q, Zheng H, Lin J, Guo J, Fan S, Alimujiang A, Wang X, Fu L, Xie Z, Ma C, Wang J. Optimizing diagnosis and surgical decisions for chronic osteomyelitis through radiomics in the precision medicine era. Front Bioeng Biotechnol 2024; 12:1315398. [PMID: 38798953 PMCID: PMC11127625 DOI: 10.3389/fbioe.2024.1315398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction: Chronic osteomyelitis is a complex clinical condition that is associated with a high recurrence rate. Traditional surgical interventions often face challenges in achieving a balance between thorough debridement and managing resultant bone defects. Radiomics is an emerging technique that extracts quantitative features from medical images to reveal pathological information imperceptible to the naked eye. This study aims to investigate the potential of radiomics in optimizing osteomyelitis diagnosis and surgical treatment. Methods: Magnetic resonance imaging (MRI) scans of 93 suspected osteomyelitis patients were analyzed. Radiomics features were extracted from the original lesion region of interest (ROI) and an expanded ROI delineated by enlarging the original by 5 mm. Feature selection was performed and support vector machine (SVM) models were developed using the two ROI datasets. To assess the diagnostic efficacy of the established models, we conducted receiver operating characteristic (ROC) curve analysis, employing histopathological results as the reference standard. The model's performance was evaluated by calculating the area under the curve (AUC), sensitivity, specificity, and accuracy. Discrepancies in the ROC between the two models were evaluated using the DeLong method. All statistical analyses were carried out using Python, and a significance threshold of p < 0.05 was employed to determine statistical significance. Results and Discussion: A total of 1,037 radiomics features were extracted from each ROI. The expanded ROI model achieved significantly higher accuracy (0.894 vs. 0.821), sensitivity (0.947 vs. 0.857), specificity (0.842 vs. 0.785) and AUC (0.920 vs. 0.859) than the original ROI model. Key discriminative features included shape metrics and wavelet-filtered texture features. Radiomics analysis of MRI exhibits promising clinical translational potential in enhancing the diagnosis of chronic osteomyelitis by accurately delineating lesions and identifying surgical margins. The inclusion of an expanded ROI that encompasses perilesional tissue significantly improves diagnostic performance compared to solely focusing on the lesions. This study provides clinicians with a more precise and effective tool for diagnosis and surgical decision-making, ultimately leading to improved outcomes in this patient population.
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Affiliation(s)
- Qiyu Jia
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hao Zheng
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jie Lin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Jian Guo
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Sijia Fan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | | | - Xi Wang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lanqi Fu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Zengru Xie
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chuang Ma
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junna Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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3
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Causative Pathogens Do Not Differ between Early, Delayed or Late Fracture-Related Infections. Antibiotics (Basel) 2022; 11:antibiotics11070943. [PMID: 35884197 PMCID: PMC9312187 DOI: 10.3390/antibiotics11070943] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Fracture-related infections (FRIs) are classically considered to be early (0−2 weeks), delayed (3−10 weeks) or late (>10 weeks) based on hypothesized differences in causative pathogens and biofilm formation. Treatment strategies often reflect this classification, with debridement, antimicrobial therapy and implant retention (DAIR) preferentially reserved for early FRI. This study examined pathogens isolated from FRI to confirm or refute these hypothesized differences in causative pathogens over time. Cases of FRI managed surgically at three centres between 2015−2019 and followed up for at least one year were included. Data were analysed regarding patient demographics, time from injury and pathogens isolated. Patients who underwent DAIR were also analysed separately. In total, 433 FRIs were studied, including 51 early cases (median time from injury of 2 weeks, interquartile range (IQR) of 1−2 weeks), 82 delayed cases (median time from injury of 5 weeks, IQR of 4−8 weeks) and 300 late cases (median time from injury of 112 weeks, IQR of 40−737 weeks). The type of infection was associated with time since injury; early or delayed FRI are most likely to be polymicrobial, whereas late FRIs are more likely to be culture-negative, or monomicrobial. Staphylococcus aureus was the most commonly isolated pathogen at all time points; however, we found no evidence that the type of pathogens isolated in early, delayed or late infections were different (p = 0.2). More specifically, we found no evidence for more virulent pathogens (S. aureus, Gram-negative aerobic bacilli) in early infections and less virulent pathogens (such as coagulase negative staphylococci) in late infections. In summary, decisions on FRI treatment should not assume microbiological differences related to time since injury. From a microbiological perspective, the relevance of classifying FRI by time since injury remains unclear.
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4
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Zhang Z, Liu P, Wang W, Wang S, Li B, Li J, Yang B, Li M, Li Q, Yang H, Huang Z, Liu L. Epidemiology and Drug Resistance of Fracture-Related Infection of the Long Bones of the Extremities: A Retrospective Study at the Largest Trauma Center in Southwest China. Front Microbiol 2022; 13:923735. [PMID: 35903480 PMCID: PMC9315197 DOI: 10.3389/fmicb.2022.923735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To describe the demographic characteristics, risk factors, and bacterial resistance of fracture-related infection (FRI) of the long bones of the extremities. Materials and Methods This single-center study retrospectively evaluated patients with FRI of the long bones of the extremities at West China Hospital between January 2012 and December 2017, and analyzed the demographic characteristics, risk factors, distribution of pathogenic bacteria, and bacterial drug resistance. Results Among 9,900 patients, 535 patients (5.4%) were diagnosed with FRI. The most common site of FRI was tibiofibular (298, 55.7%), with 424 cases (79.2%) of open fractures, and 282 cases (52.7%) due to traffic injuries. The 41–50 years age group had the highest incidence of FRI with 157 (29.3%) cases. Overall, 546 strains of 52 types of bacteria were detected in FRI patients, with 105 strains of multidrug-resistant (MDR) bacteria. Methicillin-resistant Staphylococcus aureus (48, 8.8%) and extended-spectrum-β-lactamase Escherichia coli (32, 5.8%) accounted for the largest proportion. Multivariate logistic regression analysis showed that sex (odds ratio [OR] 1.813; 95% confidence interval [CI], 1.071∼3.070; P = 0.027) and fracture type (OR 3.128; 95% CI, 1.683∼5.815; P < 0.001) were independent risk factors for monomicrobial infection (MI). Female sex (OR 4.190; 95% CI, 1.212∼14.486; P = 0.024) was an independent risk factor for polymicrobial infection (PI). Conclusion This study clarified the infection rates, changes in the bacterial spectrum, and drug resistance characteristics, and risk factors of FRI of the long bones of the extremities in the largest trauma center in southwest China.
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Affiliation(s)
- Zhengdong Zhang
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu, China
- *Correspondence: Zhengdong Zhang,
| | - Pan Liu
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenzhao Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bohua Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Banyin Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Mingxin Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Zeyu Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Zeyu Huang,
| | - Lei Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- Lei Liu,
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5
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Yin X, Fang Z, Fang Y, Zhu L, Pang J, Liu T, Zhao Z, Zhao J. Antimicrobial Photodynamic Therapy Involving a Novel Photosensitizer Combined With an Antibiotic in the Treatment of Rabbit Tibial Osteomyelitis Caused by Drug-Resistant Bacteria. Front Microbiol 2022; 13:876166. [PMID: 35531297 PMCID: PMC9073078 DOI: 10.3389/fmicb.2022.876166] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Osteomyelitis is deep tissue inflammation caused by bacterial infection. If such an infection persists, it can lead to dissolution and necrosis of the bone tissue. As a result of the extensive use of antibiotics, drug-resistant bacteria are an increasingly common cause of osteomyelitis, limiting the treatment options available to surgeons. Photodynamic antibacterial chemotherapy has attracted increasing attention as a potential alternative treatment. Its advantages are a broad antibacterial spectrum, lack of drug resistance, and lack of toxic side effects. In this study, we explored the impact of the new photosensitizer LD4 in photodynamic antimicrobial chemotherapy (PACT), both alone and in combination with an antibiotic, on osteomyelitis. A rabbit tibial osteomyelitis model was employed and microbiological, histological, and radiological studies were performed. New Zealand white rabbits (n = 36) were randomly divided into a control group, antibiotic group, PACT group and PACT + antibiotic group for treatment. In microbiological analysis, a reduction in bacterial numbers of more than 99.9% was recorded in the PACT group and the PACT + antibiotic group 5 weeks after treatment (p < 0.01). In histological analysis, repair of the damaged bone tissue was observed in the PACT group, and bone repair in the PACT + antibiotic group was even more significant. In radiological analysis, the X-ray Norden score showed that the severity of bone tissue defects or destruction followed the pattern: PACT + antibiotic group < PACT group < antibiotic group < control group.
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Affiliation(s)
- Xiujuan Yin
- School of Clinical Medicine, Hebei University, Baoding, China
| | - Ziyuan Fang
- School of Clinical Medicine, Hebei University, Baoding, China
| | - Yan Fang
- School of Clinical Medicine, Hebei University, Baoding, China
| | - Lin Zhu
- School of Clinical Medicine, Hebei University, Baoding, China
| | - Jinwen Pang
- School of Clinical Medicine, Hebei University, Baoding, China
| | - Tianjun Liu
- Tianjin Key Laboratory of Biomedical Material, Institute of Biomedical Engineering, Peking Union Medical College, Chinese Academy of Medical Sciences, Tianjin, China
| | - Zhanjuan Zhao
- School of Basic Medicine, Hebei University, Baoding, China
| | - Jianxi Zhao
- Department of Radiology, Affiliated Hospital of Hebei University, Baoding, China
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Gritsch L, Granel H, Charbonnel N, Jallot E, Wittrant Y, Forestier C, Lao J. Tailored therapeutic release from polycaprolactone-silica hybrids for the treatment of osteomyelitis: antibiotic rifampicin and osteogenic silicates. Biomater Sci 2022; 10:1936-1951. [PMID: 35258044 DOI: 10.1039/d1bm02015c] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The treatment of osteomyelitis, a destructive inflammatory process caused by bacterial infections to bone tissue, is one of the most critical challenges of orthopedics and bone regenerative medicine. The standard treatment consists of intense antibiotic therapies combined with tissue surgical debridement and the application of a bone defect filler material. Unfortunately, commercially available candidates, such as gentamicin-impregnated polymethylmethacrylate cements, possess very poor pharmacokinetics (i.e., 24 hours burst release) and little to no regenerative potential. Fostered by the intrinsic limitations associated with conventional treatments, alternative osteostimulative biomaterials with local drug delivery have recently started to emerge. In this study, we propose the use of a polycaprolactone-silica sol-gel hybrid material as carrier for the delivery of rifampicin, an RNA-polymerase blocker often used to treat bone infections, and of osteostimulative silicate ions. The release of therapeutic agents from the material is dual, offering two separate and simultaneous effects, and decoupled, meaning that the kinetics of rifampicin and silicate releases are independent from each other. A series of hybrid formulations with increasing amounts of rifampicin was prepared. The antibiotic loading efficacy, as well as the release profiles of rifampicin and silicates were measured. The characterization of cell viability and differentiation of rat primary osteoblasts and antibacterial performance were also performed. Gram-positive Staphylococcus aureus and Gram-negative Pseudomonas aeruginosa and Escherichia coli were selected due to their high occurrence in bone infections. Results confirmed that rifampicin can be successfully loaded within the hybrids without significant degradation and that it is possible to tailor the antibiotic release according to need. Once in a physiological environment, the rapid release of silicates was associated with optimal cell proliferation and the overexpression of osteoblastic differentiation. Simultaneously, rifampicin is delivered over the course of several weeks with significant inhibition of all tested strains. In particular, the materials caused a growth reduction of 7-10 orders of magnitude in Staphylococcus aureus, the major strain responsible for osteomyelitis worldwide. Our data strongly suggest that PCL/silica hybrids are a very promising candidate to develop bone fillers with superior biological performance compared to currently available options. Thanks to their unique synthesis route and their dual tailored release they can promote bone regeneration while reducing the risk of infection for several weeks upon implantation.
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Affiliation(s)
- Lukas Gritsch
- Laboratoire de Physique de Clermont, UMR CNRS 6533, Université Clermont Auvergne, 4 avenue Blaise Pascal, 63178 Aubière, France.
| | - Henri Granel
- Unité de Nutrition Humaine UMR 1019 INRAE, Université Clermont Auvergne, 28 place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - Nicolas Charbonnel
- Université Clermont Auvergne, CNRS, LMGE, 63000 Clermont-Ferrand, France
| | - Edouard Jallot
- Laboratoire de Physique de Clermont, UMR CNRS 6533, Université Clermont Auvergne, 4 avenue Blaise Pascal, 63178 Aubière, France.
| | - Yohann Wittrant
- Unité de Nutrition Humaine UMR 1019 INRAE, Université Clermont Auvergne, 28 place Henri-Dunant, 63001 Clermont-Ferrand, France
| | | | - Jonathan Lao
- Laboratoire de Physique de Clermont, UMR CNRS 6533, Université Clermont Auvergne, 4 avenue Blaise Pascal, 63178 Aubière, France.
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Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, Lawrence C, Bauer T, Herrmann JL, De Truchis P, Noussair L, Cremieux AC. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrob Agents 2021; 59:106497. [PMID: 34906675 DOI: 10.1016/j.ijantimicag.2021.106497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022]
Abstract
Antibiotic treatment of native osteomyelitis caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) is a challenge. Limited epidemiological and outcome data are available. This retrospective cohort study included osteomyelitis patients with ESBL-PE infections treated in a reference centre for bone and joint infections (BJIs) between 2011-2019. Twenty-nine patients with native BJI (mean age, 44.4 ± 15.7 years) were analysed. Fifteen cases were paraplegic patients with ischial pressure sores breaching the hip capsule. Other cases included eight other hip infections, four tibial infections and two foot infections. Infections were mostly polymicrobial (n = 23; 79.3%), including Staphylococcus aureus (n = 13; 8 methicillin-resistant). Klebsiella pneumoniae (n = 13) was the most frequent ESBL-producing species identified, followed by Escherichia coli (n = 10), including 3 E. coli/K. pneumoniae co-infections, and Enterobacter spp. (n = 9). ESBL-PE were rarely susceptible to fluoroquinolones (n = 4; 13.8%). Most therapies were based on carbapenems (n = 22) and combination therapies (n = 19). The median duration of treatment was 41 (5-60) days. Primary control of the infection was achieved in 62.1% (18/29) of cases and up to 86.2% after second look surgeries, after a median follow-up of 6 (1-36) months. Infection with ESBL-producing K. pneumoniae was associated with failure (P = 0.001), whereas age, infection location, prior colonisation and antimicrobial therapy were not found to be predictors of outcome. ESBL-PE native BJIs are often polymicrobial and fluoroquinolone-resistant infections caused by K. pneumoniae, highlighting the need for expert centres with pluridisciplinary meetings with experienced surgeons.
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Affiliation(s)
- B Davido
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France.
| | - A Saleh-Mghir
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - M Rottman
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - K Jaffal
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - E Salomon
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - F Bouchand
- Pharmacie Hospitalière, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - C Lawrence
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - T Bauer
- Service d'Orthopédie, Université Paris-Saclay, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - J L Herrmann
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
| | - P De Truchis
- Service des Maladies Infectieuses, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - L Noussair
- Laboratoire de Microbiologie, Université Paris-Saclay, Hôpital Raymond-Poincaré, AP-HP, Garches, France
| | - A C Cremieux
- Service de Maladies Infectieuses, Université Paris Nord, Hôpital Saint-Louis, AP-HP, Paris, France; UMR UVSQ INSERM U1173, UFR Simone Veil des Sciences de la Santé, Montigny-le-Bretonneux, France
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8
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Wang B, Xiao X, Zhang J, Han W, Hersi SA, Tang X. Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China. J Orthop Surg Res 2021; 16:490. [PMID: 34384457 PMCID: PMC8357967 DOI: 10.1186/s13018-021-02629-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/24/2021] [Indexed: 11/12/2022] Open
Abstract
Objective This study aimed to explore the epidemiological and microbiological characteristics of fracture-related infection (FRI), analyze the drug resistance characteristics of major pathogens, and provide timely and relatively complete clinical and microbiological data for antimicrobial treatment of FRI. Methods The clinical and microbiological data of patients with FRI from January 1, 2011, to December 31, 2020, were collected from three tertiary hospitals in Northeast China. The automatic microbial analysis system was used for strain identification and drug susceptibility testing, and the drug susceptibility results were determined in accordance with the latest Clinical and Laboratory Standards Institute (CLSI) criteria (as applicable each year). Results A total of 744 patients with FRI were enrolled. The incidence of FRI was about 1.5%, and 81.7% were male patients, with an average age of 48.98 ± 16.01 years. Open fractures accounted for 64.8%. Motor crush (32.8%) and falling (29.8%) were the main causes of injuries. The common sites of infection were the tibia and fibula (47.6%), femur (11.8%), foot (11.8%), and hand (11.6%). A total of 566 pathogenic bacteria were cultured in 378 patients with positive bacterial cultures, of which 53.0% were Gram-positive bacteria and 47.0% were Gram-negative bacteria. The most common pathogen at all sites of infection is Staphylococcus aureus. Staphylococcus aureus had a high resistance rate to penicillin (PEN), erythromycin (ERY), and clindamycin (CLI), exceeding 50%. Methicillin-resistant Staphylococcus aureus (MRSA) was more than 80% resistant to CLI and ERY. Conclusions The incidence of FRI in Northeast China was at a low level among major medical centers nationwide. Staphylococcus aureus was still the main pathogen causing bone infections, and the proportion of MRSA was lower than reported abroad, but we have observed an increase in the proportion of infections. Enterobacteriaceae have a higher resistance rate to third-generation cephalosporins and quinolones. For Enterobacteriaceae, other sensitive treatment drugs should be selected clinically.
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Affiliation(s)
- Baisheng Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China.,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Xiaoguang Xiao
- Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China
| | - Jingdong Zhang
- Department of Orthopedics, Northeast International Hospital, Shenyang, Liaoning, 110004, People's Republic of China
| | - Wenfeng Han
- Department of Orthopedics, The General Hospital of Northern Theater Command, Shenyang, Liaoning, 110016, People's Republic of China
| | - Salad Abdirahman Hersi
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China.,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, 116011, People's Republic of China. .,Dalian Medical University, Dalian, Liaoning, 116044, People's Republic of China.
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9
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Zhang F, Wang B, Liu S, Chen Y, Lin Y, Liu Z, Zhang X, Yu B. Bacillus subtilis revives conventional antibiotics against Staphylococcus aureus osteomyelitis. Microb Cell Fact 2021; 20:102. [PMID: 34001083 PMCID: PMC8130150 DOI: 10.1186/s12934-021-01592-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/08/2021] [Indexed: 11/28/2022] Open
Abstract
As treatment of Staphylococcus aureus (S. aureus) osteomyelitis is often hindered by the development of antibiotic tolerance, novel antibacterial therapeutics are required. Here we found that the cell-free supernatant of Bacillus subtilis (B. subtilis CFS) killed planktonic and biofilm S. aureus, and increased S. aureus susceptibility to penicillin and gentamicin as well. Further study showed that B. subtilis CFS suppressed the expression of the genes involved in adhesive molecules (Cna and ClfA), virulence factor Hla, quorum sensing (argA, argB and RNAIII) and biofilm formation (Ica and sarA) in S. aureus. Additionally, our data showed that B. subtilis CFS changed the membrane components and increased membrane permeabilization of S. aureus. Finally, we demonstrated that B. subtilis CFS increased considerably the susceptibility of S. aureus to penicillin and effectively reduced S. aureus burdens in a mouse model of implant-associated osteomyelitis. These findings support that B. subtilis CFS may be a potential resistance-modifying agent for β-lactam antibiotics against S. aureus.
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Affiliation(s)
- Fan Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bowei Wang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Shiluan Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuhui Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihuang Lin
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zixian Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianrong Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. .,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. .,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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10
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Molines-Barroso RJ, García-Morales E, Sevillano-Fernández D, García-Álvarez Y, Álvaro-Afonso FJ, Lázaro-Martínez JL. Culture Concordance in Different Sections of the Metatarsal Head: Interpretations of Microbiological Results. INT J LOW EXTR WOUND 2021; 22:270-277. [PMID: 33909483 DOI: 10.1177/15347346211003722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Microbiological cultures of per-wound bone biopsies have shown a lack of correlation and a high rate of false-negative results when compared with bone biopsy cultures in diabetic foot osteomyelitis. The selection of samples from the area of active osteomyelitis, which contains a complete census of the microorganisms responsible for the infection, is essential to properly guide antimicrobial treatment. We aimed to comparatively evaluate the quantitative and qualitative cultures taken from different areas, in metatarsal heads resected for osteomyelitis. For this purpose, we consecutively selected 13 metatarsal heads from 12 outpatients with plantar ulcers admitted to our diabetic foot unit. Metatarsal heads were divided transversally into 3 portions: plantar (A), central (B), and dorsal (C), and the 39 resulting samples were cultured. Qualitative and quantitative microbiological analysis was performed, and the isolated species and bacterial load, total and species specific, were compared between the 3 metatarsal bone segments. The primary outcome of the study was the bacterial diversity detected in the different bone sections. Cultures were positive in 12 of the 13 included metatarsal heads (92%). A total of 34 organisms were isolated from all specimens. Ten of the 12 cultures (83%) were polymicrobial. Ten of the 13 metatarsal heads (77%) had identical microbiological results in each of the 3 bone sections. The largest number of microorganisms was found in the central section. The overall concordance between sections was 91%. The predominant microorganisms were coagulase-negative staphylococci (41%). Statistical differences were not found in the bioburden between sections (range 3.25-3.41 log10 colony-forming unit/g for all sections; P = .511). The results of our study suggest that microorganisms exhibit a high tendency to spread along the metatarsal bone and that the degree of progression along the bone is species dependent. The central portions of metatarsal bones tend to accumulate a higher diversity of species. Thus, we recommend this area of bone for targeted biopsy in patients with suspected osteomyelitis.
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Affiliation(s)
- Raul Juan Molines-Barroso
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Esther García-Morales
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Sevillano-Fernández
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Yolanda García-Álvarez
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco J Álvaro-Afonso
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- 16734Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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11
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Lin B, Guo Q, Ren H, Liu Y, Huang K. MRI Manifestations and Diagnostic Value of Chronic Osteomyelitis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5585676. [PMID: 33791083 PMCID: PMC7984882 DOI: 10.1155/2021/5585676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 11/17/2022]
Abstract
If chronic osteomyelitis is not treated promptly and thoroughly, the wound will not heal for a long time, and the affected limb will be dysfunctional or disabled. In severe cases, it may even require amputation. In this article, a total of 50 patients with chronic osteomyelitis who meet the inclusion criteria were selected from January 2019 to March 2020 and were divided into two groups based on patient compliance, namely, a treatment group and a control group. The results of this group of studies showed that osteomyelitis is mostly manifested as limited diffusion, showing high signal on DWI, and ADC value is significantly higher than that of normal bone area. The normal bone area did not show obvious focal abnormal signals on the conventional MRI image. The ADC value of the measured patient's osteomyelitis area was compared with the ADC value of the normal bone area. The ADC value was significantly higher than that of the normal bone area, and the difference was statistically significant. Studies have shown that membrane induction technology is superior to the bone handling group in terms of limb function scores and results satisfaction in the treatment of chronic osteomyelitis bone defects. Membrane induction technology has a low complication rate, a small number of X-ray examinations, a short healing time, and a high functional score. However, bone handling technology has a long treatment process, long fixation time and healing time, nail channel infection, joint stiffness, nerve damage, and many other complications.
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Affiliation(s)
- Bingyuan Lin
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Qiaofeng Guo
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Haiyong Ren
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Yiyang Liu
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
| | - Kai Huang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
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12
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Huang J, Xu Q, Liu F, Xiong H, Yang J. Enterobacter cloacae infection of the shoulder in a 52-year-old woman without apparent predisposing risk factor: a case report and literature review. BMC Infect Dis 2021; 21:13. [PMID: 33407223 PMCID: PMC7789740 DOI: 10.1186/s12879-020-05699-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background Enterobacter cloacae (E. cloacae) is one of the commensal flora in the human intestinal tract and a prevalent nosocomial pathogen, which rarely causes infectious osteoarthritis in immunocompetent patients without recent trauma or surgery. Here, we report the first case of septic monoarthritis of the shoulder caused by E. cloacae in an immunocompetent patient. Case presentation A 52-year-old female with a 6-year history of right shoulder pain was referred to our emergency department due to fever, acute severe shoulder pain, and swelling. Blood test showed elevated inflammatory markers. The patient denied any recent invasive surgical procedure and trauma. She was misdiagnosed with a frozen shoulder, and the anti-inflammatory painkiller celecoxib for symptomatic treatment was ineffective. Magnetic resonance imaging (MRI) showed a shoulder joint abscess and supraspinatus tendon tear. The joint aspirate culture showed E. cloacae. After late diagnosis, she was treated with levofloxacin and underwent surgical debridement and irrigation. Her follow-up data revealed that she did not suffer from shoulder swelling and severe pain. Conclusion This is a rare case of E. cloacae infected arthritis of the shoulder in an immunocompetent patient with a rotator cuff tear, indicating that even if the symptoms and age of the patients match the characteristics of frozen shoulder, the possibility of septic arthritis should be considered in the presence of fever and increasing inflammatory markers. The cases of our literature review suggest that the patients subjected to invasive procedure may develop a subsequent E. cloacae osteoarticular infection, regardless of being asymptomatic after the procedure.
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Affiliation(s)
- Jingjie Huang
- The Sixth Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China.,Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Qiliang Xu
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Fuyifei Liu
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Hao Xiong
- Department of Orthopedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junxing Yang
- Department of Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China.
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13
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Shin CH, Lim C, Kim TS, Choi EH, Cho TJ, Choi IH, Yoo WJ. Effective and Rapid Microbial Identification in Pediatric Osteoarticular Infections Using Blood Culture Bottles. J Bone Joint Surg Am 2020; 102:1792-1798. [PMID: 33086346 DOI: 10.2106/jbjs.20.00219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The detection and identification of pathogenic microorganisms are essential for the treatment of osteoarticular infection. However, obtaining a sufficient amount of specimen from pediatric patients is often difficult. Herein, we aimed to demonstrate the effectiveness of the blood culture bottle (BCB) system in pediatric osteoarticular infections. We hypothesized that our BCB culture method is superior to the conventional swab and tissue culture methods in terms of required specimen size, incubation time, and microbial identification rate. METHODS We analyzed the prospectively collected data of pediatric patients who underwent surgical treatment for osteoarticular infections between August 2016 and October 2019. Four needles were dipped in the infected fluid or tissue during the surgical procedure as soon as the infected area was exposed and were used to inoculate 2 aerobic pediatric BCBs and 2 anaerobic general BCBs. We also collected 2 conventional swab samples and 2 tissue samples from the identical area. The microbial identification rate and the time required for identification were compared between BCB, swab, and tissue cultures. RESULTS Forty patients constituted the study group; 13 patients had osteomyelitis, 17 patients had septic arthritis, and 10 patients had both. Of these 40 patients, the microbial identification rate was higher with BCB cultures (27 [68%]) than with swab cultures (18 [45%]; p = 0.004) or tissue cultures (15 [38%]; p < 0.001). Nine samples (9 patients [23%]) were only positive in the BCB culture. Positive microbial growth was not detected with conventional culture methods when microorganisms did not grow on the BCB culture. Compared with swab culture (4.3 ± 1.1 days; p < 0.001) or tissue culture (4.4 ± 1.1 days; p < 0.001), the BCB culture reduced the time required for microbial identification (3.5 ± 0.9 days). CONCLUSIONS In pediatric osteoarticular infections, the BCB culture system improved the microbial identification rate, reduced the time to identification, and permitted a smaller-volume specimen, compared with traditional culture systems. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chang Ho Shin
- Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Tae-Joon Cho
- Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - In Ho Choi
- Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Won Joon Yoo
- Divisions of Pediatric Orthopaedics (C.H.S., T.-J.C., I.H.C., and W.J.Y.), and Pediatrics (E.H.C.), Seoul National University Children's Hospital, Seoul, Republic of Korea
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14
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Zhou Y, Zhang T. Trends in bacterial resistance among perioperative infections in patients with primary ovarian cancer: A retrospective 20-year study at an affiliated hospital in South China. J Int Med Res 2020; 48:300060520928780. [PMID: 32495662 PMCID: PMC7273797 DOI: 10.1177/0300060520928780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background We aimed to analyze the epidemiological and drug-resistance trends among bacterial cultures from perioperative infections in patients with primary ovarian cancer. Methods Medical and bacteriological records for patients with ovarian cancer patients who developed perioperative infections after primary cytoreductive surgery from 1999 to 2018 were reviewed retrospectively. Results The incidence of perioperative infections and the culture-positive percentage among patients in the first 10 years were 20.2% and 29.3%, respectively, and the equivalent rates in the second 10 years were 18.0% and 33.5%. The most commonly isolated pathogens in both year-groups were Escherichia coli and Enterococcus spp., but the respective percentages differed between the groups. Some strains of Staphylococcus aureus and Enterococcus spp. in the second 10-year group were resistant to linezolid and vancomycin, and ciprofloxacin resistance among Gram-negative bacteria isolates also increased in this group. However, resistance of Gram-negative bacteria to imipenem and meropenem was low among in both groups. Conclusion The pathogen distribution in perioperative infections in patients with primary ovarian cancer undergoing cytoreductive changed slightly from 1999 to 2018, and the antibiotic resistance of the main isolated pathogens increased. These results indicate the importance of periodic bacterial surveillance of surgical infections in these patients.
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Affiliation(s)
- Yanlin Zhou
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.,Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Tingting Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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15
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Bai Y, Liu Q, Gu J, Zhang X, Hu S. Analysis of Urinary Pathogen Cultures and Drug Sensitivity in Patients with Urinary Stones for Five Consecutive Years in Xiangya Hospital, China. Infect Drug Resist 2020; 13:1357-1363. [PMID: 32494167 PMCID: PMC7227811 DOI: 10.2147/idr.s241036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To analyze pathogen distribution and drug sensitivity in patients with urinary calculi and thereby gain insight into the most appropriate antibacterial drugs for perioperative therapy. Materials and Methods From January 2014 to December 2018, the results of mid-stream urine pathogen culture and drug sensitivity tests were evaluated retrospectively for 353 patients with urinary calculi. SPSS software version 23.0 was used to analyze the data. Results A total of 353 strains of pathogens were isolated from urine culture. Among these, 278 (79%) strains belonged to the top 10 most frequently isolated pathogens, comprising 209 (75.2%) Gram-negative bacilli and 69 (24.8%) Gram-positive cocci. Escherichia coli was the most frequently isolated pathogen overall and the most frequently isolated Gram-negative bacillus, and Enterococcus faecalis was the most frequently isolated Gram-positive coccus. Drug sensitivity levels were effectively unchanged for less commonly used drugs, whereas drug resistance rates remained high for commonly used drugs such as ampicillin trihydrate, ampicillin/sulbactam, cefazolin, ceftriaxone, aztreonam, levofloxacin and ciprofloxacin. Conclusion E. coli and E. faecalis remain the most common Gram-negative bacillus and Gram-positive coccus uropathogens, respectively, in patients with urinary calculi. Mid-stream urine pathogen culture and drug sensitivity tests should be used to select appropriate antibacterial drugs before treatment, particularly for perioperative patients with urinary calculi.
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Affiliation(s)
- Yao Bai
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.,Medizinische Klinik and Poliklinik IV, Klinikum Der Universität München, Munich, Germany
| | - Qingxia Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jie Gu
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China.,Martini-Klinik Prostate Cancer Center, Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Xiaobo Zhang
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Sheng Hu
- Xiangya International Medical Center, Department of Geriatrics Urology, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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16
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Nosé BD, Boysen WR, Kahokehr AA, Inouye BM, Eward WC, Hendershot EF, Peterson AC. Extirpative Cultures Reveal Infectious Pubic Bone Osteomyelitis in Prostate Cancer Survivors With Urinary-Pubic Symphysis Fistulae (UPF). Urology 2020; 142:221-225. [PMID: 32389815 DOI: 10.1016/j.urology.2020.04.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the infectious features of patients with urinary pubic symphysis fistula (UPF) and their association with osteomyelitis. METHODS We conducted a review of our quality improvement database for 36 patients with UPF undergoing bone resection and extirpative surgery from October 2012 to January 2019. An assessment of bone and urine cultures was carried out along with surgical, radiologic, and demographic data. We analyzed descriptive statistics and used Fisher Exact Tests and unpaired Welch t tests to assess for associations with positive bone cultures. RESULTS In our cohort, 33 patients (91.7%) had positive bone cultures with the 3 most common organisms being candida (22.0%), enterococcus (18.0%), and pseudomonas (10.0%). There was a correlation between positive preoperative urine culture and positive bone culture (P <.01), with 63.0% of those with positive urine cultures growing the same organism on bone culture. CONCLUSION In this series, 91.7% of patients undergoing extirpative surgery for UPF at our institution have positive bone cultures at time of pubic bone debridement. Additionally, we demonstrate a statistically significant correlation between positive urine cultures and positive bone cultures in these patients. This supports the need for a multidisciplinary approach including infectious disease, orthopedic surgery and reconstructive urology in order to address this complex clinical condition.
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Affiliation(s)
- Brent D Nosé
- Genitourinary Cancer Survivorship Program, Division of Urology, Duke University Medical Center, Durham, NC
| | - William R Boysen
- Genitourinary Cancer Survivorship Program, Division of Urology, Duke University Medical Center, Durham, NC
| | - Arman A Kahokehr
- Genitourinary Cancer Survivorship Program, Division of Urology, Duke University Medical Center, Durham, NC
| | - Brian M Inouye
- Genitourinary Cancer Survivorship Program, Division of Urology, Duke University Medical Center, Durham, NC
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | | | - Andrew C Peterson
- Genitourinary Cancer Survivorship Program, Division of Urology, Duke University Medical Center, Durham, NC
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17
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Shenoy PA, Vishwanath S, Bhat SN, Mukhopadhyay C, Chawla K. Microbiological profile of chronic osteomyelitis with special reference to anaerobic osteomyelitis in a tertiary care hospital of coastal Karnataka. Trop Doct 2020; 50:198-202. [PMID: 32345150 DOI: 10.1177/0049475520921283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Chronic osteomyelitis is a relapsing, persistent, low-grade inflammation of bone caused by various infectious agents. The present study, conducted over a two-year period, on specimens received from cases of chronic osteomyelitis was, to determine the frequency of isolation of aerobic and anaerobic bacteria and to analyse their antimicrobial susceptibility pattern. Specimens were processed for Gram stain, aerobic and anaerobic culture, and were identified according to standard techniques. Significant growth was observed in 102/204 specimens, in which aerobic growth was observed in 62 (60.8%) and anaerobic in 40 (39.2%). Resistance to metronidazole and clindamycin was observed in 6.7% and 30% of the anaerobic isolates, respectively. None of these were resistant to meropenem. A significant proportion of anaerobic isolates were found to be resistant to commonly used empirical drugs, such as clindamycin, thus necessitating a need for routine anaerobic susceptibility testing.
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Affiliation(s)
- Padmaja A Shenoy
- Associate Professor, Department of Microbiology, Kasturba Manipal Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shashidhar Vishwanath
- Associate Professor, Department of Microbiology, Kasturba Manipal Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shyamasunder N Bhat
- Professor and Head, Department of Orthopaedics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chiranjay Mukhopadhyay
- Professor, Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Kiran Chawla
- Professor and Head, Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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