Pub Date : 2021-12-21eCollection Date: 2021-01-01DOI: 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 ( ) and the tibia ( ). 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 ( ). 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.
{"title":"The effectiveness of antibiotic cement-coated nails in post-traumatic femoral and tibial osteomyelitis - comparative analysis of custom-made versus commercially available nails.","authors":"Germán Garabano, Hernán Del Sel, Joaquin Anibal Rodriguez, Leonel Perez Alamino, Cesar Angel Pesciallo","doi":"10.5194/jbji-6-457-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-457-2021","url":null,"abstract":"<p><p><b>Background</b>: 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. <b>Methods</b>: 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. <b>Results</b>: Thirty patients were included. The affected bones were the femur ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>15</mn></mrow> </math> ) and the tibia ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>15</mn></mrow> </math> ). 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 ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0001</mn></mrow> </math> ). 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. <b>Conclusions</b>: 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.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39818618","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}
Pub Date : 2021-12-17eCollection Date: 2021-01-01DOI: 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 ( ). 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.
{"title":"The pencil eraser swab technique to quantify <i>Cutibacterium acnes</i> on shoulder skin.","authors":"Vendela M Scheer, Malin Bergman Jungeström, Lena Serrander, Johan H Scheer, Anders Kalén","doi":"10.5194/jbji-6-451-2021","DOIUrl":"10.5194/jbji-6-451-2021","url":null,"abstract":"<p><p><b>Introduction</b>: <i>Cutibacterium acnes</i> 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. <b>Methods</b>: 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). <b>Results</b>: 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 ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.003</mn></mrow> </math> ). There was no significant difference between the methods regarding the number of positive cultures. PES: 14/15, L: 11/15 and Z: 12/15. <b>Conclusions</b>: There is a need to harmonise sampling techniques of <i>C. acnes</i> 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.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39818220","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}
Pub Date : 2021-12-08eCollection Date: 2021-01-01DOI: 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 ( 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 ( ). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI 30 kg m (odds ratio (OR) 3.42 [95 % CI 1.75-7.20]; ), chronic renal disease (OR, 3.52 [95 % CI 1.17-8.59]; ), and cardiac illness (OR, 2.47 [1.30-4.69]; ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality ( ) but was associated with an increased chance of 90 d readmission ( ). 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。
{"title":"Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis.","authors":"Jonathan Bourget-Murray, Rohit Bansal, Alexandra Soroceanu, Sophie Piroozfar, Pam Railton, Kelly Johnston, Andrew Johnson, James Powell","doi":"10.5194/jbji-6-443-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-443-2021","url":null,"abstract":"<p><p>The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset ( <math><mrow><mo>≤</mo> <mn>90</mn></mrow> </math> 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 ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.026</mn></mrow> </math> ). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI <math><mo>></mo></math> 30 kg m <math><msup><mi></mi> <mrow><mo>-</mo> <mn>2</mn></mrow> </msup> </math> (odds ratio (OR) 3.42 [95 % CI 1.75-7.20]; <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ), chronic renal disease (OR, 3.52 [95 % CI 1.17-8.59]; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.011</mn></mrow> </math> ), and cardiac illness (OR, 2.47 [1.30-4.69]; <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.005</mn></mrow> </math> ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality ( <math><mrow><mi>p</mi> <mo>=</mo> <mn>0.167</mn></mrow> </math> ) but was associated with an increased chance of 90 d readmission ( <math><mrow><mi>p</mi> <mo><</mo> <mn>0.001</mn></mrow> </math> ). 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.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8672450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39828003","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}
Pub Date : 2021-12-01eCollection Date: 2021-01-01DOI: 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 ( ). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures ( ). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection ( ). 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.
{"title":"Immunological evaluation of patients with orthopedic infections: taking the Cierny-Mader classification to the next level.","authors":"Janet D Conway, Vache Hambardzumyan, Nirav G Patel, Shawn D Giacobbe, 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}