ABSTRACT
OBJECTIVE: Several factors have been associated with the prognosis of prosthetic joint infection (PJI) treated with surgical debridement, antibiotic therapy, and implant retention (DAIR). There is no evidence about the right empirical antibiotic treatment when the causal microorganism is not still identified. METHODS: We conducted a retrospective observational study in patients with PJI treated with DAIR between 2009 and 2018 in our center. We analyze the risk factors related with their prognosis and the influence of active empirical antibiotic therapy against causative microorganisms in final outcomes. RESULTS: A total of 80 PJI cases treated with DAIR, from 79 patients (58.7% women, mean age 76.3 years), were included in the study period. Among the cases in which empirical antibiotic therapy were active against the causative microorganisms, the success rate was 46/65 (69.2%) vs 1/15 when not (6.7%, OR 31.5, p = 0.001). Factors related to the success or failure of the DAIR were analyzed with multivariate analysis. We found that active empirical antibiotic treatment remained statistically significant as a good prognostic factor (OR 0.04, p <0.01). CONCLUSIONS: Empirical antibiotic treatment could be an important factor in the prognosis of PJI treated with DAIR. To identify cases at risk of infection by multidrug resistant microorganisms could be useful to guide empirical antibiotic therapy.
Subject(s)
Arthritis, Infectious , Prosthesis-Related Infections , Aged , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/drug therapy , Debridement , Female , Humans , Male , Prosthesis-Related Infections/drug therapy , Retrospective Studies , Treatment OutcomeABSTRACT
Counseling is a technique used in psychology that has shown a major impact on health: in deep, it is the methodology recommended by the Worl Health Organization to help HIV-infected patients. Although it has been translated to spanish by assisted counseling or helping relationship, counseling covers a broader concept. It is defined as an interactive process based on communication in which the clinician helps the patients to think about their own health and to take appropiate decisions based on their values and interests. In short, counseling is a tool to enhance communication with the patient, resulting very useful during clinical interview in pharmaceutical care programs in order to improve pharmacotherapy and patient safety.
El counseling es una técnica empleada en psicología que ha demostrado tener un gran impacto en sanidad; de hecho, es la metodología recomendada por la Organización Mundial de la Salud para dar apoyo a los pacientes infectados por VIH. A pesar de que se ha traducido en castellano por «consejo asistido ¼ o «relación de ayuda¼, el counseling abarca un concepto mucho más amplio ya que se define como un proceso interactivo basado en la comunicación en el que el profesional sanitario ayuda al paciente a reflexionar sobre su estado de salud y así conseguir que éste tome las decisiones adecuadas en función de sus valores e intereses. En definitiva, el counseling se perfila como una herramienta de mejora en la comunicación con el paciente, resultando de gran utilidad durante la entrevista clínica en los programas de Atención Farmacéutica con el fin de mejorar la farmacoterapia y la seguridad del paciente.
