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Perez-Jorge C.,IIS Fundacion Jimenez Diaz | Cordero J.,Hospital La Princesa | Marin M.,Hospital Gregorio Maranon | Estebana J.,IIS Fundacion Jimenez Diaz | Estebana J.,Bone and Joint Infection Unit
Journal of Clinical Microbiology | Year: 2012

Helcococcus kunzii was isolated by sonication and conventional cultures obtained from a case of infection following total knee prosthesis in an immunocompetent patient. The patient recovered uneventfully. This is the first known case of an H. kunzii prosthetic joint infection. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Sousa R.,Abel Salazar Biomedical Sciences Institute | Munoz-Mahamud E.,Bone and Joint Infection Unit | Da Costa L.D.,Abel Salazar Biomedical Sciences Institute | Casals C.,Bone and Joint Infection Unit | And 7 more authors.
Clinical Infectious Diseases | Year: 2014

Background. Infection is a major complication after total joint arthroplasty. The urinary tract is a possible source of surgical site contamination, but the role of asymptomatic bacteriuria (ASB) before elective surgery and the subsequent risk of infection is poorly understood. Methods. Candidates for total hip or total knee arthroplasty were reviewed in a multicenter cohort study. A urine sample was cultured in all patients, and those with ASB were identified. Preoperative antibiotic treatment was decided on an individual basis, and it was not mandatory or randomized. The primary outcome was prosthetic joint infection (PJI) in the first postoperative year. Results. A total of 2497 patients were enrolled. The prevalence of ASB was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P <. 001). The overall PJI rate was 1.7%. The infection rate was significantly higher in the ASB group than in the non-ASB group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P =. 001). In the ASB group, there was no significant difference in PJI rate between treated (3.9%) and untreated (4.7%) patients. The ASB group had a significantly higher proportion of PJI due to gram-negative microorganisms than the non-ASB group, but these did not correlate to isolates from urine cultures. Conclusions. ASB was an independent risk factor for PJI, particularly that due to gram-negative microorganisms. Preoperative antibiotic treatment did not show any benefit and cannot be recommended. © The Author 2014.

Esteban J.,Bone and Joint Infection Unit | Cordero-Ampuero J.,Hospital Universitario La Paz | Sandoval E.,Bone and Joint Infection Unit | Fernandez-Roblas R.,Bone and Joint Infection Unit | Gomez-Barrena E.,IdiPaz Hospital la Paz
Acta Orthopaedica | Year: 2012

Purpose: We wanted to improve the diagnosis of implant-related infection using molecular biological techniques after sonication. Methods: We studied 258 retrieved implant components (185 prosthetic implants and 73 osteosynthesis implants) from 126 patients. 47 patients had a clinical diagnosis of infection (108 components) and 79 patients did not (150 components). The fluids from sonication of retrieved implants were tested in culture and were also analyzed using a modified commercial PCR kit for detection of Gram-positive and Gram-negative bacteria (Geno- Type BC; Hain Lifescience) after extraction of the DNA. Results: 38 of 47 patients with a clinical diagnosis of infection were also diagnosed as being infected using culture and/or PCR (35 by culture alone). Also, 24 patients of the 79 cases with no clinical diagnosis of infection were identified microbiologically as being infected (4 by culture, 16 by PCR, and 4 by both culture and PCR). Comparing culture and PCR, positive culture results were obtained in 28 of the 79 patients and positive PCR results were obtained in 35. There were 21 discordant results in patients who were originally clinically diagnosed as being infected and 28 discordant results in patients who had no clinical diagnosis of infection. Interpretation: For prosthetic joint infections and relative to culture, molecular detection can increase (by one tenth) the number of patients diagnosed as having an infection. Positive results from patients who have no clinical diagnosis of infection must be interpreted carefully. Copyright © 2012 Nordic Orthopaedic Federation.

Perez-Jorge C.,Bone and Joint Infection Unit | Gomez-Barrena E.,IdiPaz Hospital La Paz Institute for Health Research | Horcajada J.-P.,University Pompeu Fabra | Puig-Verdie L.,Institute Hospital Del Mar dInvestigacions Mediques | Esteban J.,Bone and Joint Infection Unit
Expert Opinion on Pharmacotherapy | Year: 2016

Introduction: Despite many advances, the management of prosthetic joint infection is still a complex issue. Moreover, in recent years the problem of antimicrobial resistance has emerged as an important challenge. Areas covered: We analysed recent advances in different aspects of prosthetic joint infections. The importance of biofilms needs to be considered for antibiotic selection because, when embedded in these structures, bacteria acquire resistant behaviour. Moreover, the presence of resistance mechanisms in some species of organisms increases the difficulty of management. In this sense, the growing importance of methicillin-resistant staphylococci, multidrug-resistant Enterobacteriaceae or Pseudomonas aeruginosa is of increasing concern. Together with these organisms, others with constitutive resistance against most antibiotics (like Enterococcus sp., mycobacteria or fungi) represent a similar problem for selection of therapy. Research into new materials that can be used as drug carriers opens a new field for management of these infections and will likely come to the front line in the coming years. Expert opinion: Individualised therapies should carefully consider the aetiology, pathogenesis and antimicrobial susceptibility. Satisfactory clinical outcome could be further fostered by enhancing the multidisciplinary approach, with better collaboration in the antibiotic selection and the surgical management. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Tornero E.,Bone and Joint Infection Unit | Senneville E.,Gustave Dron Hospital of Tourcoing | Euba G.,Hospital Universitari Of Bellvitge | Petersdorf S.,University Clinic of Dusseldorf | And 16 more authors.
Clinical Microbiology and Infection | Year: 2014

The objective of this study was to review the characteristics and outcome of prosthetic joint infections (PJI) due to Enterococcus sp. collected in 18 hospitals from six European countries. Patients with a PJI due to Enterococcus sp. diagnosed between January 1999 and July 2012 were retrospectively reviewed. Relevant information about demographics, comorbidity, clinical characteristics, microbiological data, surgical treatment and outcome was registered. Univariable and multivariable analyses were performed. A total of 203 patients met the inclusion criteria. The mean (SD) was 70.4 (13.6) years. In 59 patients the infection was diagnosed within the first 30 days (29.1%) from arthroplasty, in 44 (21.7%) between 31 and 90 days, in 54 (26.6%) between 91 days and 2 years and in 43 (21%) after 2 years. Enterococcus faecalis was isolated in 176 cases (89%). In 107 (54%) patients the infection was polymicrobial. Any comorbidity (OR 2.53, 95% CI 1.18-5.40, p 0.01), and fever (OR 2.65, 95% CI 1.23-5.69, p 0.01) were independently associated with failure. The only factor associated with remission was infections diagnosed later than 2 years (OR 0.25, 95% CI 0.09-0.71, p 0.009). In conclusion, prosthetic joint infections due to Enterococcus sp. were diagnosed within the first 2 years from arthroplasty in >70% of the patients, almost 50% had at least one comorbidity and infections were frequently polymicrobial (54%). The global failure rate was 44% and patients with comorbidities, fever, and diagnosed within the first 2 years from arthroplasty had a poor prognosis. © 2014 European Society of Clinical Microbiology and Infectious Diseases.

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