Sonication culture improves microbiological diagnosis of modular megaprostheses

Modular megaprostheses are known for high infection rates followed by high rates of revisions. Microbial biofilms growing adherently on prosthetic surfaces may inhibit the detection of the pathogens causing prosthetic joint infections. We sought to answer the following questions: Does sonication culture (SC) improve the microbiological diagnosis of periprosthetic infections of megaprostheses compared to conventional tissue culture (TC)? Which pathogens were detected on the surface of megaprostheses with either SC or TC and do the findings help to identify low‐grade infections? Included were 31 patients with modular megaprostheses, whose implant had been explanted due to suspected joint infection or revision surgery. SCs were performed according to the protocol by Trampuz et al. The diagnosis of infection was evaluated according to the definition of the Musculoskeletal Infection Society. The sensitivity of SC was 91.3% compared to 52.2% for TC and the specificity was 100% for SC and TC (p = 0.004). Under preoperative antibiotic therapy, the sensitivity of SC was 83.3% while the sensitivity of TC was 50%. Without preoperative antibiotic therapy the sensitivity of SC was 100% compared to 54.5% for TC. In nine cases, SCs detected microorganisms, while TC was negative. Detected bacteria were Staphylococcus epidermidis in four, Micrococcus species in one, Finegoldia magna in one, Brevibacterium casei in one, Pseudomonas fluorescens in one, and Enterococcus faecium in one. SC is a reliable method for dislodging pathogens from orthopedic implants. The SC of modular megaprostheses showed significantly higher pathogen detection than the periprosthetic TC, especially for low virulence pathogens. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1383–1387, 2017.

     

Antiseptic sutures: clinical evaluation of microbiological efficacy

The use of antiseptic sutures may constitute an interesting way to prevent early contamination of surgical wounds by microorganisms found in the environment and in the surgically sectioned cutaneous adnexa responsible for potential complications due to infection. This clinical study compares two different sutures: Polyglactin 910 plus Triclosan and Polyglactin 910. Twenty-nine patients (15 males and 14 females), aged between 22 and 53 years, were enrolled. All wounds were sutured half way using Polyglactin 910 plus Triclosan with the remaining half sutured using Polyglactin 910 of similar calibre. For each group, one or two stitches being removed on the third day, with the remaining stitches being removed on the seventh day, and then culture tests, biochemical tests and Polyglactin 910 plus Triclosan in vitro inhibition tests were conducted. Overall, 188 suture fragments were analysed. For the sutures removed after 3 days (30 for each group), the following observations were made: Polyglactin 910 plus Triclosan group, one contamination (3.3%) with Pseudomonas aeruginosa; and Polyglactin 910 group, 14 colonisations (46.6%), predominantly with Staphylococcus aureus. For the suture fragments removed on day 7 (128 in total), the following were observed: Polyglactin 910 plus Triclosan group (67 fragments), nine contaminations (13.4%) with a slight predominance of S. aureus (four cases) and P. aeruginosa (three); and Polyglactin 910 group (61 fragments), 56 contaminations (91.8%) with a marked predominance for S. aureus (43). Compared to Polyglactin 910, Polyglactin 910 plus Triclosan was less colonised by bacteria, thanks to the bacteriostatic effect of Triclosan. The reduced microbial colonisation of sutures may contribute towards better control of complications due to surgical wound infections.     

Acute salpingitis--laparoscopic and microbiological evaluation

The diagnosis as well as the severity of acute pelvic inflammatory disease (APID) can be difficult to assess clinically. A study was undertaken to compare the accuracy of clinical findings (Gainesville classification) with laparoscopic findings in 28 patients with APID in terms of: (i) establishing the correct diagnosis; (ii) determining the severity of the disease; and (iii) obtaining specimens to establish the causative organisms. The results were as follows: (i) (a) clinical diagnosis of APID was confirmed by laparoscopic evaluation in 78.6% of cases; (b) clinical staging of APID correlated with laparoscopic findings in 82.6% of cases; (ii) severity of the clinical staging of APID correlated with that of laparoscopic staging; and (iii) polymicrobial cause, as reported by other investigators, was confirmed. Laparoscopic evaluation was of importance in eliminating the inaccuracy of clinical diagnosis in 21.4% of cases and in establishing the causative organisms so that optimal treatment could be given and the long-term after-effects of APID reduced.     

Immediate evaluation of continuous medical education

OBJECTIVES: To analyse the results of the immediate evaluation of an European teaching session using a questionnaire provided by the French College of anaesthesiologists. STUDY DESIGN: Open evaluation. MATERIAL: Questionnaires completed after each topic by 50 participants of an European course including 15 lectures were collected. METHODS: The types of professional exercise and the medical practise reliable to the different topics were pointed out. The evaluation included 4 items noted from 1 to 10: new information for medical practise, definition of pedagogic objectives, quality of means used for teaching, interest for the treated subject. The global mean score for each item and for each speaker was calculated. Results were compared according to the professional mode of exercise, the own medical practise and the project to modify it in the future. RESULTS: Scores affected to items were significantly lower for participants exercising in PSPH compared to general and university hospitals and private clinics (p < 0.001). New information was better found in case of poor or absence of practise, but interest was improved when medical practise was frequent. 2/3 of the participants projected to modify their practise after the session. CONCLUSION: The analysis of medical evaluation should allow to determine an acceptable zone of quality which may be useful for accreditation. However, distorting results according to the professional mode of exercise and the own medical practise should encourage the development of adapted continuous medical education. Delayed evaluation may be necessary to objective the putative benefits of CME on medical practise.     

Human prostatic carcinoma in tissue culture: correlations between histological diagnosis and in vitro parameters

Prostatic cell biology is still largely unknown so that even the natural history of prostatic carcinoma is unpredictable. In order to correlate new observations with the prognosis of patients with prostatic carcinoma of various grades, we followed up 24 in vitro samples from surgical specimens of prostatic carcinoma. Fragments from 7 grade-I, 10 grade-II, 6 grade-III; and 1 grade-IV tumors were cultivated in Dulbecco's modified Eagle's medium supplemented with 10% fetal calf serum, 10% horse serum and 50 ng/ml each of hydrocortisone and insulin. Epithelial cells grown from the explants continued to grow for a maximum of 120 days and their morphology varied from a fairly regular monolayer of polygonal cells to irregular patterns of overlapping growth with many giant multinucleated cells. Although our data need a longer clinical follow-up time and larger numbers to achieve any statistical significance, the present findings seem to indicate rather clearly that a short life span in culture, a regular growth and a positive secretion activity is typical of low-grade tumors and that a longer life span, an irregular growth and a negative secretion in vitro are characteristics of high-grade tumors. A longer clinical follow-up of these patients will be important in the future to indicate whether these findings can be of any real prognostic value.     

Methods of microbiological diagnosis in periodontal disease

Microbiological findings together with clinical and radiological diagnosis are essential for rationale use of antibiotics in periodontal disease. Methods used for microbiological diagnosis are: microscopy, cultivation, gas liquid chromatography, PCR, immuno-assays (ELISA, immunofluorescence), FISH. Each of them has some advantages and disadvantages related to cost, accessibility, sensitivity, duration. The most used today are cultivation and PCR techniques.     

乳腺癌手术后即刻乳房重建患者的生活质量评价

目的对乳腺癌手术后即刻乳房重建患者的生活质量进行评价。 方法收集2017年11月—2019年11月在海南医学院第一附属医院乳腺胸部肿瘤外科接受乳房改良根治术的乳腺癌患者150例,根据手术方式分为根治术后即刻乳房重建组(根治＋重建组,n＝25)和根治术后未行即刻乳房重建组(单纯根治组,n＝125)。术后6个月时,应用欧洲癌症研究与治疗组织乳腺癌生活质量量表(EORTC QLQ-BR45)调查两组患者的生活质量,采用自制乳腺癌配偶问卷调查两组患者配偶的生活满意度,并进行组间比较。分析患者手术方式选择的影响因素。 结果生活质量调查分析发现：根治＋重建组患者在身体形象、性欲、未来预期方面的得分优于单纯根治组,差异有统计学意义(P<0.05)。自制问卷分析结果显示：根治＋重建组配偶在身体形象、自身性功能和感情家庭方面的得分优于单纯根治组配偶,差异有统计学意义(P<0.05)。Logistics回归分析结果显示：患者的年龄和经济水平与手术方式的选择有关(P<0.05)。 结论乳腺癌手术后即刻乳房重建患者的生活质量优于未行即刻乳房重建的患者。年龄和经济水平可能是乳腺癌患者手术方式选择的影响因素。     

The production of transgenic pigs for potential use in clinical xenotransplantation: microbiological evaluation

Debate over the infection hazards of pig-to-human xenotransplantation has focused mainly on the porcine endogenous retroviruses (PERV). However, hazards of exogenous infectious agents possibly associated with the xenograft have also been evaluated (Xenotransplantation 2000; 7: 143). We report the results of a health monitoring program demonstrating the exclusion of more than 80 potential pathogens from nine cohorts of pigs reared in a high welfare bioexclusion facility as potential xenograft source animals. A dynamic bacterial flora of pigs reared under barrier conditions was characterized, emphasizing the significance of monitoring for multiresistant antimicrobial sensitivity patterns. Evidence was found for exclusion of two commonly residual exogenous viruses, porcine cytomegalovirus and porcine lymphotropic herpesviruses, among a proportion of the cohorts tested. Finally, there was histopathological evidence for low grade pneumonitis among sentinel pigs, likely to have been associated with the use of quaternary ammonium disinfectants during the production process, indicating a need for review of toxicology data for disinfectant agents used in such bioexclusion systems. Intensive health monitoring programs, based upon regularly updated recommendations from the microbiological research community, will enable significant reductions in the potential hazards associated with pig-to-human xenotransplantation.     

Laparoscopic cholecystectomy: evaluation of some postoperative instrumental parameters

The Authors report a perspective study about 30 consecutive patients operated on for laparoscopic cholecistectomy to investigate the causes of some postoperative symptoms: the scapular ache, the persistent ache to the right side and the slight fever. Besides report the results of abdomen radiography and abdomen echography. The persistence of a moderate pneumoperitoneum not seem responsible for scapular ache; the absence of fluid under hepatic stuff not adduce good reason for right side ache and slight fever.     

The limping child: evaluation and diagnosis

A limp is a common reason for a child to present to the orthopaedist. Because of the long list of potential diagnoses, some of which demand urgent treatment, an organized approach to evaluation is required. With an understanding of normal and abnormal gait, a directed history and physical examination, and the development of a differential diagnosis based on the type of limp, the patient's age, and the anatomic site that is most likely affected, the orthopaedist can take a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignant condition is in the differential diagnosis. The C-reactive protein assay is the most sensitive early test for musculoskeletal infections; an abnormal value rapidly returns to normal with effective treatment. Imaging should begin with plain radiography. Ultrasonography is particularly valuable in assessing the irritable hip and guiding aspiration, if necessary.     

A novel intraoperative technique seeding morselized bone tissue into pediatric blood culture bottles improves microbiological diagnosis in patients with foot and ankle osteomyelitis

BackgroundOsteomyelitis, particularly cases involving the foot and ankle, is a challenging situation that frequently leads to amputations and major sequelae. Targeted antibiotics treating an identified pathogen are key to a successful outcome; however, traditional culture methods for bone tissue have poor sensitivity. This study prospectively compared a novel method for obtaining and processing infected bone tissue with the standard technique.Methods107 patients presenting with a diagnosis of osteomyelitis of the foot and ankle between 2008 and 2017 were prospectively included. Diagnosis was done according to clinical, laboratory and imaging findings. We obtained paired samples of bone tissue from all patients; they were processed through a usual culture method (UCM), but they were also morselized and seeded into pediatric blood culture bottles (PBCBs). We compared the culture yield and the number of agents detected using both the McNemar and the Mann–Whitney tests, respectively.ResultsWe studied 107 patients (63 with diabetic foot infection and 44 with nondiabetic osteomyelitis). The causative agent was identified in 60.7% of cases using the UCM and in 97.2% of cases using PBCBs (p < 0.001). We detected a mean of 1.05 ± 1.03 bacteria using the UCM and 1.67 ± 0.92 bacteria using PBCBs (p < 0.01).ConclusionCultures using morselized bone seeded in PBCBs identified the causative agent in a significantly larger percentage than the UCM. Additionally, this method identified a larger number of pathogen agents. A better agent identification method has advantages such as identifying more specific antibiotic treatment in these cases.     

Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy

Aim To evaluate the infectious complications, microorganism distribution and antibacterial treatment in patients who underwent percutaneous nephrolithotomy (PCNL). Patients and methods Three hundred and thirty-eight patients who were 17 years age or older who underwent PCNL between January 2001 and December 2002 have been evaluated retrospectively. Urine cultures obtained before, during and after PCNL and cultures of stone fragments, extracted during PCNL, were analyzed. Eighty-two patients, who have been referred to Section of infectious disease because of postoperative fever (Group 1; 58 males, 24 females, mean age: 45.5 years) and the remainder of patients (Group 2; 169 males, 87 females, mean age: 44.5 years) were compared in regard to infectious complications and microbiological culture results. Results The evaluation of peroperative urine cultures revealed that patients in Group 1 had more positive urine cultures than the other group. The analysis showed fever developed more frequently in patients with positive stone cultures and also in patients with positive peroperative urine. Overall, during the study period, five of 338 (1.5%) patients developed sepsis and none of them was lost due to sepsis. Comparison of two groups revealed that patients in Group 1 had a larger stone burden, longer operative time and longer postoperative hospital stay than patients in Group 2. Conclusion Fever and bacteriemia after PCNL are common, through progression to sepsis is rare. Recovery is possible with a high degree of suspicion, early intervention and intensive treatment. The results of cultures taken preoperatively, peroperatively and during the febrile period have great importance for decision of required changes during the treatment.