Epidemiology and microbiology of prosthetic joint infections: a nine-year, single-center experience in Pavia, Northern Italy.

BACKGROUND: Prosthetic joint infections (PJIs) are a growing matter of concern due to their economic and social burden on health systems. In Italy, surgical data on PJIs are available in a national registry, but microbiological data are still scarce. MATERIALS AND METHODS: We performed a retrospective study at a single center with records of patients treated for primary PJIs of knee or hip from January 1, 2011, to May 30, 2018. Patients with infections of osteosynthesis means and external devices were excluded, as well as PJI recurrences and polytrauma patients. Infections were diagnosed according to IDSA and MSIS criteria. We collected data on demographics, risk factors and microbiology. All patients seen at our center undergo blood cultures and synovial fluid cultures, periarticular biopsy and prosthesis sonication by Bactosonic®. This was used only after 2014. Bacterial identification is achieved by MALDI-TOF, PHOENIX 100 and standard methods. Chi-square or Fisher tests were used to test statistical differences in proportions. RESULTS: Fifty-one patients matched our inclusion criteria. Of these, 16 (31.4%) were enrolled before 2014. The median age was 68.5 (range 22-88). The most common risk factors were obesity (34%), diabetes (21%) and chronic kidney disease (14%). Seventeen patients were diagnosed with a culture-negative PJIs (33.3%). Staphylococcus aureus was the most commonly isolated pathogen (14/51, 27.5%), followed by coagulase-negative staphylococci (7/51, 13.7%). Methicillin-resistant S. aureus rate was 28.6%. The rate of culture-negative PJIs dropped from 56 to 22% after 2014, with a significant difference between the two time periods (p = 0.016). CONCLUSIONS: The introduction of sonication dramatically increased our diagnostic accuracy. Our microbiological data are in line with those from other studies conducted in Italy.

The relative efficacy of 0.1% and 0.2% delmopinol mouthrinses in inhibiting the development of supragingival dental plaque and gingivitis in man.

Delmopinol, a 3-alkyl substituted N-hydroethyl morpholine, has shown potential as a mouthrinse for the management of dental plaque and treatment of gingivitis. Delmopinol has been shown to possess plaque inhibitory activity in several previous studies. The aims of this study were to: 1) compare the antiplaque, antigingivitis efficacy and safety of 0.1% and 0.2% delmopinol-containing mouthrinses (DMP) in a 2-week, randomized, parallel arm, vehicle controlled study; and 2) determine if a dose response antiplaque, antigingivitis effect could be found in this type of formulation. One hundred and thirty-three male subjects were randomly assigned to one of three groups, 0.1% DMP, 0.2% DMP, or vehicle control mouthrinses. At baseline all subjects received a clinical examination consisting of an intraoral soft tissue, plaque (Turesky modification of Quigley-Hein plaque index), and gingival index (modified gingival index) evaluations, and received a thorough oral prophylaxis. All subjects refrained from all forms of oral hygiene for the next 2 weeks, except for the use of the assigned mouthrinse. Subjects rinsed for 1 minute with their assigned mouthrinse twice daily under supervision for 2 weeks. Following 2 weeks of mouthrinse use, plaque and gingivitis scoring and soft tissue examinations were repeated. The results showed the mean plaque index at the 2-week examination was statistically related to the baseline value (P < 0.0003, ANOVA) and the concentration of DMP (P < 0.0001, ANOVA). In contrast, the gingivitis index was not related to the concentration of DMP (P > 0.05, ANOVA). No adverse effects were noted or reported during this clinical trial.

Management of the isolated deformed dentinoalveolar complex by subepithelial graft and resin-bonded fixed partial denture.

Two cases in which subepithelial connective tissue grafts were used as adjuncts to definitive prosthetic reconstruction have been presented. The method for managing the deformed dentinoalveolar complex in the anterior portion of the mouth was discussed. The improved appearance coupled with the resin-bonded fixed partial denture warrant the consideration of the subepithelial graft in selected cases.

Gliding motility and actinomycin D sensitivity of Fusobacterium nucleatum and other gram-negative rods.

Six strains of gram-negative anaerobic fusiform rods (Fusobacterium and Bacteroides spp.), isolated from deep subgingival locations in humans, were examined for (i) gliding motility in slide cultures, (iii) cell densities on nutrient agar surfaces, and (iii) sensitivity to actinomycin D. Known gliding (FBt) and nonmotile (NM) strains of Myxococcus xanthus served as controls for the gliding and cell density experiments. In the present study, three strains of gram-negative fusiforms from the oral cavity, identified as Fusobacterium nucleatum (1a and P-1) and Bacteroides sp. (P-14), demonstrated characteristics similar to the gliding control strain M. xanthus. The only gliding oral strain sensitive to actinomycin D was a Bacteroides sp. (P-14).