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The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis - comparative analysis of custom-made versus commercially available nails. 抗生素水泥包覆钉治疗创伤后股骨和胫骨骨髓炎的有效性——定制钉与市售钉的比较分析
Q1 Medicine Pub Date : 2021-12-21 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-457-2021
Germán Garabano, Hernán Del Sel, Joaquin Anibal Rodriguez, Leonel Perez Alamino, Cesar Angel Pesciallo

Background: The first objective of this retrospective study was to assess infection control rates in patients with chronic post-traumatic osteomyelitis (CPTO) of the femur or tibia treated with antibiotic cement-coated nails. The second objective was to compare the efficacy of custom-made nails versus commercially available antibiotic-coated nails in terms of infection control and need for reoperation. Methods: We reviewed a consecutive series of CPTO patients treated with antibiotic-coated nails who had a minimum follow-up of 24 months. We recorded the characteristics of the initial injury, the type of nail used, cement-nail debonding, infecting microorganisms, operating time, infection control, need for reoperation, and failure rate. We performed a comparative analysis between nails manufactured in the operating room (i.e., custom-made) and those commercially available. Results: Thirty patients were included. The affected bones were the femur ( n = 15 ) and the tibia ( n = 15 ). Twenty-one of the 30 initial injuries were open fractures. Staphylococcus aureus was the most frequently isolated microorganism (50 %). Sixteen patients were treated with custom-made nails and 14 with commercially available antibiotic-coated nails. At the time of extraction, four out of five custom-made antibiotic-coated nails experienced cement-bone debonding. Commercial nails were associated with shorter operating times ( p < 0.0001 ). The overall infection control rate was 96.66 %. Eight (26.66 %) patients needed reoperation. There was one failure (3.33 %) in the group treated with custom-made antibiotic-coated nails. We did not find significant differences between nail types in terms of reoperation, infection control, and failure rate. Conclusions: The use of antibiotic cement-coated nails proved useful in CPTO treatment. Commercially available nails had significantly shorter operating times and did not present cement-bone debonding during removal. Our results seem to indicate that both nail types are similar in terms of infection control and reoperation rates.

背景:本回顾性研究的第一个目的是评估抗生素水泥包覆钉治疗股骨或胫骨慢性创伤后骨髓炎(CPTO)患者的感染控制率。第二个目的是比较定制指甲与市售抗生素涂膜指甲在感染控制和再次手术需求方面的疗效。方法:我们回顾了连续的一系列CPTO患者使用抗生素涂层指甲治疗,随访时间至少为24个月。我们记录了初始损伤的特点、使用的钉子类型、水泥钉脱粘、感染微生物、手术时间、感染控制、再次手术的需要和失败率。我们对手术室制造的钉子(即定制的)和市售的钉子进行了比较分析。结果:纳入30例患者。受影响的骨为股骨(n = 15)和胫骨(n = 15)。30名伤者中有21人是开放性骨折。金黄色葡萄球菌是最常见的分离微生物(50 %)。16名患者使用定制指甲治疗,14名患者使用市售抗生素涂层指甲治疗。在拔牙时,五分之四的定制抗生素涂层指甲经历了骨水泥脱粘。商用钉与较短的手术时间相关(p 0.0001)。总感染率为96.66 %。再次手术8例(26.66 %)。使用定制抗生素涂甲组有1例失败(3.33 %)。我们没有发现不同指甲类型在再手术、感染控制和失败率方面有显著差异。结论:抗生素骨水泥包覆钉是治疗CPTO的有效方法。市售钉的手术时间明显缩短,并且在移除过程中不出现骨水泥脱粘。我们的结果似乎表明,两种指甲类型在感染控制和再手术率方面是相似的。
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引用次数: 7
The pencil eraser swab technique to quantify Cutibacterium acnes on shoulder skin. 用铅笔橡皮拭子技术量化肩部皮肤上的痤疮杆菌。
Q1 Medicine Pub Date : 2021-12-17 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-451-2021
Vendela M Scheer, Malin Bergman Jungeström, Lena Serrander, Johan H Scheer, Anders Kalén

Introduction: Cutibacterium acnes is the most common cause of postoperative infections in orthopaedic shoulder surgery and is hard to eradicate with current measures. Newer strategies focus on reducing bacterial load on the skin before surgery. Several previous studies have used a large number of both described and undescribed sampling techniques. The purpose of this study was to compare three previously described swab techniques to obtain bacterial cultures: Levine's (L) technique, the Z technique and the pencil eraser swab (PES) technique. Methods: Three consecutive skin swabs were collected from the right shoulder, on 15 healthy male volunteers, using Levine's technique, Z technique and PES technique from each participant. To determine the number of living bacteria, serial dilutions were made, and after culturing for 5 d, viable count (VC) was expressed as CFU/mL (with CFU representing colony-forming unit). Results: The PES technique yielded significantly higher VC than the two others. PES: median 3700 CFU/mL, L: 200 CFU/mL and Z: 220 CFU/mL ( p = 0.003 ). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15. Conclusions: There is a need to harmonise sampling techniques of C. acnes in order to compare the efficacy of different measures to reduce the bacterial load on the skin before and during surgery. Of the three tested methods, the PES technique is simple and produces the highest bacterial counts.

导言:痤疮丙酸杆菌是肩部骨科手术中最常见的术后感染原因,而且很难通过现有措施根除。新策略的重点是在手术前减少皮肤上的细菌负荷。之前的一些研究使用了大量已描述和未描述的取样技术。本研究的目的是比较之前描述过的三种用于获取细菌培养的拭子技术:Levine(L)技术、Z 技术和铅笔橡皮拭子(PES)技术。研究方法使用 Levine's 技术、Z 技术和 PES 技术从 15 名健康男性志愿者的右肩连续采集三个皮肤拭子。为了确定活细菌的数量,对其进行连续稀释,培养 5 d 后,用 CFU/mL(CFU 代表菌落形成单位)表示活菌计数(VC)。结果:PES 技术产生的 VC 明显高于其他两种技术。PES:中位数为 3700 CFU/mL,L:200 CFU/mL,Z:220 CFU/mL(p = 0.003)。在阳性培养物的数量方面,两种方法之间没有明显差异。PES:14/15,L:11/15,Z:12/15。结论:有必要统一痤疮丙酸杆菌的取样技术,以便比较不同措施在手术前和手术中减少皮肤细菌负荷的效果。在三种测试方法中,PES 技术简单,细菌计数最高。
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引用次数: 0
Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis. 骨关节炎原发性全髋关节置换术后早期深部手术部位感染的危险因素评估。
Q1 Medicine Pub Date : 2021-12-08 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-443-2021
Jonathan Bourget-Murray, Rohit Bansal, Alexandra Soroceanu, Sophie Piroozfar, Pam Railton, Kelly Johnston, Andrew Johnson, James Powell

The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset ( 90  d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann-Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period ( p = 0.026 ). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI  >  30 kg m - 2 (odds ratio (OR) 3.42 [95 % CI 1.75-7.20]; p < 0.001 ), chronic renal disease (OR, 3.52 [95 % CI 1.17-8.59]; p = 0.011 ), and cardiac illness (OR, 2.47 [1.30-4.69]; p = 0.005 ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality ( p = 0.167 ) but was associated with an increased chance of 90 d readmission ( p < 0.001 ). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.

本研究的目的是确定原发性全髋关节置换术(THA)治疗骨关节炎后早发性(≤90 d)深部手术部位感染(SSI)的发生率、年趋势和围手术期结局,并确定危险因素。我们对2013年1月至2020年3月期间前瞻性收集的患者数据进行了回顾性研究。深度SSI的诊断基于疾病控制中心/国家医疗安全网络(CDC/NHSN)发布的定义。采用Mann-Kendall趋势检验检测单调趋势。次要结局为90 d死亡率和90 d再入院率。共有22例 685例患者接受了原发性骨关节炎THA治疗。共有46例患者在手术后90 d内确诊深部SSI,累计发生率为0.2 %。在7年的研究期间,年感染率下降(p = 0.026)。对15例 466例患者进行风险分析。与早发性深部SSI相关的危险因素包括:BMI > 30 kg m - 2(比值比(OR) 3.42[95 % CI 1.75-7.20];p 0.001),慢性肾脏疾病(OR, 3.52[95 % CI 1.17-8.59];p = 0.011),心脏病(OR, 2.47 [1.30-4.69];p = 0.005),按照加拿大卫生信息研究所的分类。早发性深部SSI与90 d死亡率无关(p = 0.167),但与90 d再入院的几率增加相关(p = 0.001)。本研究通过使用稳健的方法学过程,为骨关节炎THA术后早发性深SSI建立了可靠的基线感染率。早发性深SSI的几个危险因素是可能改变的,因此鼓励有这些危险因素的患者进行有针对性的术前干预。
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引用次数: 6
Immunological evaluation of patients with orthopedic infections: taking the Cierny-Mader classification to the next level. 骨科感染患者的免疫学评价:将cierney - mader分类提高到一个新的水平。
Q1 Medicine Pub Date : 2021-12-01 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-433-2021
Janet D Conway, Vache Hambardzumyan, Nirav G Patel, Shawn D Giacobbe, Martin G Gesheff

Introduction: Cierny-Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the "true" host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. Methods: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny-Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. Results: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts ( p = 0.002 ). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures ( p < 0.03 ). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection ( p = 0.0005 ). Conclusions: Adding immunologic evaluation to the Cierny-Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.

介绍:Cierny-Mader骨髓炎分类用于根据合并症标记A、B或C宿主。本研究的目的是定义骨科感染患者的“真实”宿主状态,使用血清学标记来量化其免疫系统在活跃感染时的能力。方法:回顾性分析2013年9月至2020年3月期间在单一外科医生诊所诊断为骨科感染并具有免疫学实验室结果的患者。所有患者均为A或B宿主,并接受手术根除感染。记录病史、体格检查和Cierny-Mader分类。实验室结果包括补体总、C3、C4、免疫球蛋白G (IgG)、免疫球蛋白M (IgM)、免疫球蛋白A (IgA)、免疫球蛋白E (IgE)、类风湿因子和抗中性粒细胞胞浆抗体(ANCA)。临床显著的结果被定义为标记异常。正常补体水平和正常IgG水平被认为是异常时,感染存在。结果:105例患者中,99例(94 %)有实验室异常记录。34例a型宿主中有33例(97 %)和71例b型宿主中有66例(93 %)存在明显的临床异常。105例患者中有11例(10.5% %)被血液学家正式诊断为原发性免疫缺陷。IgG缺乏,无论是低值还是正常值,在面对感染时占91% %(30 / 34)的a型宿主和86% %(56 / 71)的b型宿主。6例(5.7% %)患者接受IgG替代治疗。28例患者总补体水平异常(低或正常):7.4 % (2 / 34)A宿主和40 % (26 / 71)B宿主(p = 0.002)。B宿主的补体水平显著降低,无生长培养物显著增多(p 0.03)。14例复发性感染患者中有13例IgG水平低或正常。再感染组与未再感染组IgM差异有统计学意义(p = 0.0005)。结论:在cierney - mader分类中加入免疫学评价,可以更准确地确定患者的真实宿主状态,更好地量化骨科感染的风险和结局。免疫缺陷的A宿主应量化为B宿主。IgG缺乏症可在咨询血液学家/免疫学家认为适当时解决。复发性感染患者的IgM水平明显低于非复发性感染患者。
{"title":"Immunological evaluation of patients with orthopedic infections: taking the Cierny-Mader classification to the next level.","authors":"Janet D Conway,&nbsp;Vache Hambardzumyan,&nbsp;Nirav G Patel,&nbsp;Shawn D Giacobbe,&nbsp;Martin G Gesheff","doi":"10.5194/jbji-6-433-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-433-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Cierny-Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the \"true\" host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. <b>Methods</b>: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny-Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. <b>Results</b>: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.002</mn></mrow> </math> ). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.03</mn></mrow> </math> ). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.0005</mn></mrow> </math> ). <b>Conclusions</b>: Adding immunologic evaluation to the Cierny-Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8663624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39815915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Methylene blue for the diagnosis of a sinus tract in periprosthetic knee joint infection. 亚甲基蓝诊断假体周围膝关节感染的窦道。
Q1 Medicine Pub Date : 2021-11-16 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-423-2021
Simon Martin Heinrich, Parham Sendi, Martin Clauss
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引用次数: 1
Mid-term clinical results of chronic cavitary long bone osteomyelitis treatment using S53P4 bioactive glass: a multi-center study. 多中心研究S53P4生物活性玻璃治疗慢性腔型长骨骨髓炎中期临床效果
Q1 Medicine Pub Date : 2021-11-12 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-413-2021
Tom A G Van Vugt, Jeffrey Heidotting, Jacobus J Arts, Joris J W Ploegmakers, Paul C Jutte, Jan A P Geurts

Introduction: Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure. With the introduction of the antimicrobial biomaterial S53P4 bioactive glass (Bonalive®), chronic osteomyelitis can be treated in a one-stage procedure. This study evaluated the mid-term clinical results of patients treated with S53P4 bioactive glass for long bone chronic osteomyelitis. Methods: In this prospective multi-center study, patients from two different university medical centers in the Netherlands were included. One-stage treatment consisted of debridement surgery, implantation of S53P4 bioactive glass, and treatment with culture-based systemic antibiotics. If required, wound closure by a plastic surgeon was performed. The primary outcome was the eradication of infection, and a secondary statistical analysis was performed on probable risk factors for treatment failure. Results: In total, 78 patients with chronic cavitary long bone osteomyelitis were included. Follow-up was at least 12 months (mean 46; standard deviation, SD, 20), and 69 patients were treated in a one-stage procedure. Overall infection eradication was 85 %, and 1-year infection-free survival was 89 %. Primary closure versus local/muscular flap coverage is the only risk factor for treatment failure. Conclusion: With 85 % eradication of infection, S53P4 bioactive glass is an effective biomaterial in the treatment of chronic osteomyelitis in a one-stage procedure. A major risk factor for treatment failure is the necessity for local/free muscle flap coverage. These results confirm earlier published data, and together with the fundamentally different antimicrobial pathways without antibiotic resistance, S53P4 bioactive glass is a recommendable biomaterial for chronic osteomyelitis treatment and might be beneficial over other biomaterials.

慢性骨髓炎在骨科实践中是一个具有挑战性的疾病,传统上使用局部和全身抗生素在两阶段手术过程中治疗。随着抗菌生物材料S53P4生物活性玻璃(Bonalive®)的引入,慢性骨髓炎可以在一个阶段的过程中治疗。本研究评价了应用S53P4生物活性玻璃治疗长骨慢性骨髓炎患者的中期临床效果。方法:在这项前瞻性多中心研究中,纳入了来自荷兰两所不同大学医学中心的患者。一期治疗包括清创手术、S53P4生物活性玻璃植入和基于培养的全身抗生素治疗。如果需要,由整形外科医生缝合伤口。主要结局是根除感染,并对治疗失败的可能危险因素进行二次统计分析。结果:共纳入78例慢性腔型长骨骨髓炎患者。随访至少12个月(平均46个月;标准偏差,SD, 20), 69例患者接受一期治疗。总感染根除率为85 %,1年无感染生存率为89 %。初级闭合与局部/肌肉瓣覆盖是治疗失败的唯一危险因素。结论:S53P4生物活性玻璃是一种一期治疗慢性骨髓炎的有效生物材料,其感染根除率可达85% %。治疗失败的一个主要危险因素是局部/游离肌瓣覆盖的必要性。这些结果证实了早期发表的数据,再加上没有抗生素耐药性的根本不同的抗菌途径,S53P4生物活性玻璃是治疗慢性骨髓炎的推荐生物材料,可能比其他生物材料更有益。
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引用次数: 5
Value of ultrasound-guided aspiration of hip arthroplasties performed in an orthopedic clinic by orthopedic surgeons. 超声引导下人工髋关节置换术在骨科临床应用的价值。
Q1 Medicine Pub Date : 2021-11-10 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-393-2021
Holly Duck, Suzanne Tanner, Debra Zillmer, Douglas Osmon, Kevin Perry

Background: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. Methods: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. Results: Review of 349 hip aspirations demonstrated accuracy of 87 %, sensitivity of 83 %, specificity of 89 %, positive predictive value of 79 %, and negative predictive value 91 %. Surgical and aspiration cultures matched in 81 % of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69 % and 60 %, respectively. Specificity was 100 % for cultures obtained with lavage and 91 % for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85 % of aspirations, and cultures were obtained in 98 % of aspirates. Contamination rate was 2 %. Conclusion: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88 % accuracy results with this meticulous technique.

背景:全关节置换术和假体周围关节感染(PJIs)持续增加。超声引导下的抽吸可以产生有用的滑液用于分析,同时避免辐射暴露。这项研究提出了一种高产量的超声引导技术,并分析了吸入结果。方法:回顾性分析2016年5月至2019年4月进行的所有连续超声引导下的髋关节置换术。记录患者的人口统计信息、成分特征、引流窦的存在和炎症标志物。记录抽吸结果,包括体积、外观、灌洗使用、滑液白细胞计数、滑液中性粒细胞百分比和培养结果。记录手术结果、标本培养和外科医生对脓毒的描述。将所有再次手术患者的抽吸结果与手术标本结果进行比较。结果:回顾349例髋关节入路,准确性为87 %,敏感性为83 %,特异性为89 %,阳性预测值为79 %,阴性预测值为91 %。手术培养和误吸培养在81%( %)的病例中匹配。有血的抽吸液和灌洗后的抽吸液准确率较低,分别为69 %和60 %。洗胃培养特异性为100 %,吸血特异性为91 %。在85% %的吸出液中获得了滑膜白细胞计数和中性粒细胞百分比,在98% %的吸出液中获得了培养。污染率为2 %。结论:超声引导下的探查有助于PJI的诊断。当抽吸培养呈阳性时,使用灌洗获得液体是有帮助的。血性吸痰的准确性较低,但具有很高的特异性。低污染率和88 %的准确度结果与细致的技术。
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引用次数: 2
Fabrication of antibiotic-loaded dissolvable calcium sulfate beads: an in vitro mixing lab utilizing various antibiotic mixing formulas. 载抗生素可溶硫酸钙微球的制备:利用多种抗生素混合配方的体外混合实验室。
Q1 Medicine Pub Date : 2021-11-10 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-405-2021
Edward J McPherson, Matthew V Dipane, Madhav Chowdhry, Andrew J Wassef

Chronic periprosthetic joint infection (PJI) is a devastating complication that requires an aggressive eradication protocol. Local antimicrobial delivery via dissolvable calcium sulfate (CaSO 4 ) using small-sized beads (3-8 mm) has been utilized as an adjunctive treatment combined with implant exchange, radical debridement, and antimicrobial loaded acrylic spacers. The non-exothermic setting of CaSO 4 theoretically allows for any antimicrobial agent to be used, so long as mixing methods provide a consistent fabrication within a reasonable set time. This study performed the first in vitro mixing study, in which various antimicrobial agents, used singularly and in combination, were mixed with a synthetic CaSO 4 product to observe and document their interactions. The study was performed in a simulated operating room environment. We report a standard mix formula with set times, testing 22 different antimicrobial agents, combinations, and doses. For some antimicrobials and combinations, set times using the standard formula were either too fast or exceedingly slow. For these 14 antimicrobial agents and combinations, we were able to arrive at individualized mixing methods. We present all mixing formulas and set times. In all, we were able to establish mixing methods that incorporate all antimicrobial agents and combinations that we have seen utilized via surgeon-directed use.

慢性假体周围关节感染(PJI)是一种毁灭性的并发症,需要积极的根除方案。通过使用小颗粒(3-8 mm)的可溶硫酸钙(caso4)进行局部抗菌递送,已被用作辅助治疗,并结合种植体置换、根治清创术和抗菌丙烯酸垫片。caso4的非放热设置理论上允许使用任何抗菌剂,只要混合方法在合理的设定时间内提供一致的制造。本研究进行了第一次体外混合研究,将多种抗菌药物单独或联合使用,与合成的CaSO 4产品混合,观察并记录它们的相互作用。该研究是在模拟手术室环境中进行的。我们报告了一个标准的混合配方,设定时间,测试22种不同的抗菌剂,组合和剂量。对于一些抗菌剂和组合药物,使用标准配方的设定时间要么太快,要么太慢。对于这14种抗菌剂和组合,我们能够达到个性化的混合方法。我们给出了所有的混合公式和设定时间。总而言之,我们能够建立混合方法,将所有抗菌药物和我们在外科医生指导下使用的组合结合起来。
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引用次数: 3
Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications. 健康成人胸骨锁骨关节脓毒性关节炎:罕见的诊断和常见的并发症。
Q1 Medicine Pub Date : 2021-11-02 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-389-2021
Rui Barbeiro Gonçalves, André Grenho, Joana Correia, João Eurico Reis

We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.

我们报告一例复杂的胸锁关节脓毒性关节炎在一个以前健康的成人没有危险因素。一名83岁女性因右肩疼痛病史1周就诊,并在过去48小时内出现发热和虚脱 h。计算机断层扫描结果与右胸锁关节脓毒性关节炎合并关节周围脓肿一致。由骨科和胸外科医生组成的外科团队进行紧急外科清创,随后进行6周的抗生素治疗。本病例强调了一种罕见的脓毒性关节炎部位的诊断和手术治疗,但有常见的并发症,以及多学科合作的重要性。
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引用次数: 0
Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study. 髋关节和膝关节假体感染后两期翻修手术的长期疗效:一项观察性研究。
Q1 Medicine Pub Date : 2021-10-20 eCollection Date: 2021-01-01 DOI: 10.5194/jbji-6-379-2021
Yorrick P Bourgonjen, J Fred F Hooning van Duyvenbode, Bruce van Dijk, F Ruben H A Nurmohamed, Ewout S Veltman, H Charles Vogely, Bart C H van der Wal

Introduction: Two-stage revision surgery is the most frequently performed procedure in patients with a chronic periprosthetic joint infection (PJI). The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies. The aim of this study was to retrospectively evaluate the infection eradication rate in patients with chronic PJI treated with two-stage revision surgery of the hip or knee in primary and re-revision cases. Methods: All patients treated with a two-stage revision for chronic PJI between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last follow-up. Successful eradication is specified as no need for subsequent revision surgery or suppressive antibiotic treatment. Results: Forty-seven patients were treated with a two-stage revision. Infection eradication was achieved in 36 out of 47 cases. Thirty-eight patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27-186) months. For hip and knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in 29 out of 38 cases and after re-revision in 7 out of 9 cases. Conclusion: In this study, the infection eradication rate for two-stage revision surgery after PJI of the hip and knee in primary and re-revision cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection eradication rates at long-term follow-up of 128 (27-186) months.

两阶段翻修手术是慢性假体周围关节感染(PJI)患者最常进行的手术。目前文献中的感染根除率在54% %和100% %之间存在差异,这可能归因于不同的治疗策略。本研究的目的是回顾性评估慢性PJI患者在首次和再次翻修时接受髋关节或膝关节两期翻修手术治疗的感染根除率。方法:对2005年至2011年间所有接受两期翻修治疗的慢性PJI患者进行分析。检索患者和感染特征。最后随访时主要结果为成功根除感染。成功根除是指不需要后续的翻修手术或抑制性抗生素治疗。结果:47例患者接受了两期翻修。47例中有36例实现了感染根除。38例患者培养阳性:单微生物感染35例,多微生物感染3例。确定了9例培养阴性感染病例。伴随根除率分别为35例中26例、3例中2例和9例中8例。平均随访128(27-186)个月。髋部和膝关节翻修的根除率分别为31例中的22例和16例中的14例。38例初次关节置换术后感染根除29例,9例再次关节置换术后感染根除7例。结论:在本研究中,首次和再次翻修的髋关节膝关节PJI术后二期翻修手术的感染根除率为77 %。长期随访128(27-186)个月,未发现患者、感染和微生物特征对感染根除率的影响有统计学意义。
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引用次数: 2
期刊
Journal of Bone and Joint Infection
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