Fungal Prosthetic Joint Infection: A Case Series and Review of the Literature.

INTRODUCTION: Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes. METHODS: A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed. RESULTS: Candida was the most common isolate, and a two-stage revision was the most commonly employed surgical modality. The type of surgical intervention had a statistically significant relationship with outcome (P = 0.022). CONCLUSIONS: Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.

Prosthetic joint infections may be caused by fungal organisms, but as this is rare, it is not known how to best treat these infections. This study explores the types of fungal organisms involved in these infections, options for surgical and medical treatment, and patient outcomes. We analyzed records over 12 years at two health systems and the currently published works on this topic. A total of 289 records were analyzed. The fungus Candida was the most common infectious cause, and a two-stage revision surgery was most commonly performed. We found that the type of surgical intervention was correlated with the patient outcome and that two-stage revision with a long course of antifungal medications is preferred in these infections.

A Needs Assessment for Infectious Diseases Consultation in Community Hospitals.

INTRODUCTION: Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. METHODS: Patients aged 18 years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. RESULTS: 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807 days of antimicrobial therapy. CONCLUSIONS: Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.

Successful use of amoxicillin-clavulanate acid in a patient with severe wound infection with wound communication secondary to Actinomyces.

INTRODUCTION: Actinomyces is a common genus of bacteria that is typically found in the oral cavity, gastrointestinal tract, and genitourinary tract, as well as on the skin. Gleimia europaea (formerly A europaeus) is a facultative anaerobic gram-positive rod that has been well associated with abscesses of the groin, axilla, and breast, as well as with decubitus ulcer. Infection with this species usually involves multiple abscesses communicating through sinus tracts. Treatment typically requires a prolonged course of penicillin or amoxicillin (up to 12 months). CASE REPORT: A 62-year-old male patient presented with a PI with fistulous tract and tunneling infected with Actinomyces, which was successfully treated with amoxicillin-clavulanic acid. CONCLUSIONS: The outcomes in this case support the use of surgical debridement, meticulous wound care, and appropriate antibiotic coverage to achieve accelerated wound healing of sacral PI with actinomycotic involvement.

Ethical Implications of the Fecal Microbiota Transplantation: Disclosure of a False-Positive HIV Test.

Fecal microbiota transplantation (FMT) has gained popularity as an effective therapeutic option for Clostridioides difficile infection (CDI). Since its FDA recognition as a treatment modality for recurrent CDI in 2013, screening protocols for FMT donor stool have been in flux. However, extensive health questionnaires, in combination with serological and stool assays, have become mainstays in the donor screening process, although ethical implications are yet to be thoroughly considered. Herein, we present the case of a family member found to have a false-positive HIV test during the donor screening process and discuss potential ethical ramifications associated with FMT stool donation.

Bilateral emphysematous pyelonephritis.

A 57-year-old man presenting with bilateral flank pain and hematuria was found to have severe bilateral emphysematous pyelonephritis. The patient was managed with a conservative approach consisting of systemic antimicrobials and decompression via percutaneous nephrostomy tubes with piperacillin-tazobactam instillations via nephrostomy and made a full recovery.

Spontaneous Pneumothorax Following COVID-19 Pneumonia.

Patient presents with dyspnea after recovering from COVID-19 pneumonia and is found to have pneumothorax. This represents an under-reported sequelae of COVID-19.