Cutibacterium spp. isolated from orthopaedic implant-associated infection: A not-so-slowly growing organism.

INTRODUCTION: It has been reported that microbiological diagnosis of Cutibacterium spp. infection requires a prolonged incubation time (up to 14 days). We present our experience with regard to incubation time for detection of Cutibacterium spp. in orthopaedic samples over a 10-year period. METHODS: One hundred and nineteen samples were included in this retrospective study. Fifty-three were implants (having previously undergone sonication), 64 were periprosthetic tissue biopsies and two were synovial fluids. Atkins's criteria were used for interpreting the isolates. Quantification and number of days until a culture became positive for Cutibacterium spp. were evaluated. RESULTS: The median number of days to detection of a clinically significant isolate and a contaminant was 4 days. No clinically significant isolates grew after day eight. CONCLUSION: Most clinically significant isolates of Cutibacterium spp. are detected in the first 7 days of incubation, although a recommendation of prolonged incubation (up to 14 days) appears to be necessary for detecting other organisms.

[AmBisome, three challenges: Candida auris infection, central nervous system infection, and biofilm-associated infection]. / AmBisome, tres retos: infección por Candida auris, infección del sistema nervioso central e infección asociada a biopelículas.

The treatment of invasive fungal infections remains a challenge, both for the diagnosis and for the need of providing the appropriate antifungal therapy. Candida auris is a pathogenic yeast that is responsible for hospital outbreaks, especially in intensive care units; it is characterized by a high resistance to the antifungal agents and can become multidrug-resistant. At present, the recommended antifungal agents for the invasive infections with this pathogen are echinocandins, always after carrying out an antifungal susceptibility testing. In case of no clinical response or persistent candidemia, the addition of liposomal amphotericin B or isavuconazole may be considered. Both fungal infection of the central nervous system and that associated with biomedical devices remain rare entities affecting mainly immunocompromised patients. However, an increase in their incidence in recent years, along with high morbidity and mortality, has been shown. The treatment of these infections is conditioned by the limited knowledge of the pharmacokinetic properties of antifungals. A better understanding of the pharmacokinetic and pharmacodynamic parameters of the different antifungals is essential to determine the efficacy of the antifungal agents in the treatment of these infections.

Cutibacterium spp. isolated from orthopaedic implant-associated infection: A not-so-slowly growing organism / Cutibacterium spp. aislados de infecciones ortopédicas asociadas a implantes: Un microorganismo de crecimiento no tan lento

Introduction: It has been reported that microbiological diagnosis of Cutibacterium spp. infection requires a prolonged incubation time (up to 14 days). We present our experience with regard to incubation time for detection of Cutibacterium spp. in orthopaedic samples over a 10-year period. Methods: One hundred and nineteen samples were included in this retrospective study. Fifty-three were implants (having previously undergone sonication), 64 were periprosthetic tissue biopsies and two were synovial fluids. Atkins's criteria were used for interpreting the isolates. Quantification and number of days until a culture became positive for Cutibacterium spp. were evaluated. Results: The median number of days to detection of a clinically significant isolate and a contaminant was 4 days. No clinically significant isolates grew after day eight. Conclusion: Most clinically significant isolates of Cutibacterium spp. are detected in the first 7 days of incubation, although a recommendation of prolonged incubation (up to 14 days) appears to be necessary for detecting other organisms.(AU)

Introducción: Se ha reportado que el diagnóstico microbiológico de las infecciones por Cutibacterium spp. requiere un tiempo de incubación prolongado (hasta 14 días). Presentamos nuestra experiencia al respecto en muestras ortopédicas durante un período de 10 años. Métodos: Se incluyeron en este estudio retrospectivo 119 muestras de las que 53 fueron implantes (previa sonicación), 64 biopsias de tejido periprotésico y dos líquidos sinoviales. Para la interpretación se siguieron los criterios de Atkins. Se evaluó la cuantificación y el número de días hasta que el cultivo fue positivo para Cutibacterium spp. Resultados: La mediana del número de días para detectar un aislado clínicamente significativo y un contaminante fue de cuatro días. Ningún aislado clínicamente relevante creció después del día ocho. Conclusión: La mayoría de aislados clínicamente significativos de Cutibacterium spp. se detectan durante los siete primeros días de incubación, sin embargo, parece necesaria una incubación de hasta 14 días para la detección de otros microorganismos.(AU)

Osteochondroma of mandibular ramus and condylar neck: simultaneous resection and reconstruccion with personalized alloplastic joint prosthesis / Osteocondroma de la rama mandibular y cuello del cóndilo: resección y reconstrucción simultánea con prótesis articular personalizada aloplástica

Osteochondromas are benign osteogenic tumors that can attain great size, which may require resection and additional treatment to restore the jaw's shape and function. In this report, an osteochondroma located on the mandibular ramus and neck of the condyle was resected and reconstructed simultaneously through a total joint replacement. After the surgery, the patient remains asymptomatic and recovers opening and closing ranges, phonation and the masticatory function. The immediate reconstruction after resection is a good alternative to avoid a second operation and the presurgical virtual planning ensures the complete removal of the lesion using cutting guides and covering the entire defect with a customized alloplastic joint prosthesis.

Los osteocondromas son tumores osteogénicos benignos que pueden alcanzar grandes tamaños, los cuales requieren de resección quirúrgica y generalmente de algún tratamiento adicional para restaurar la forma y la función mandibular. En este caso, un osteocondroma localizado en la rama mandibular y el cuello del cóndilo fue reseccionado y reconstruido simultáneamente a través de un reemplazo articular total. Después de la cirugía, el paciente permanece asintomático y recupera los intervalos de apertura y cierre, la fonación y la función masticatoria. La reconstrucción inmediata después de la resección es una buena alternativa para evitar una segunda operación, y la planificación virtual prequirúrgica garantiza la eliminación completa de la lesión utilizando guías de corte y cubriendo todo el defecto con una prótesis articular aloplástica personalizada.

Prevalence and virulence factors of coagulase negative Staphylococcus causative of prosthetic joint infections in an orthopedic hospital of Mexico.

Objective: To determine the prevalence and virulence factors of coagulase-negative Staphylococci (CNS) in prosthetic joint infections (PJI). Method: CNS were isolated of 66 hip and knee PJI from Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, México City. Antimicrobial susceptibility and biofilm formation in CNS were determined; icaADBC, aap, bap and embp genes were determined by PCR. Results: Staphylococcus and Staphylococcus hominis were the most prevalent with 82 y 80% respectively. Staphylococcus lugdunensis, Staphylococcus haemolyticus, Staphylococcus capitis, Staphylococcus caprae, Staphylococcus sciuri and Staphylococcus lentus were less frequent. The majority of isolates were resistant to ß-lactam antibiotics, fluoroquinolone, and erythromycin. 41% of CNS were biofilm former and 59% were non-biofilm former (p = 0.0551). Biofilm former Staphylococcus epidermidis showed a high presence of icaADBC, aap and embp operons compared to the non-biofilm former isolates (p < 0.05). In contrast, non-S. epidermidis CNS had only the aap gen. Conclusion: S. haemolyticus, S. sciuri and S. lentus are new isolates of PJI not previously reported with virulence factors similar to CNS isolates.

Objetivo: Estudiar la prevalencia y los factores de virulencia de Staphylococcus coagulasa negativos (SCN) de infecciones de prótesis articular (IPA). Método: Los SCN se aislaron de 66 pacientes con IPA de cadera y rodilla procedentes del Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, de Ciudad de México. Se determinaron la sensibilidad antimicrobiana y la producción de biopelículas de los SCN. Los genes icaADBC, aap, bap y embp fueron detectados por reacción en cadena de la polimerasa en SCN. Resultados: La IPA de cadera fue el 80%. Se aislaron en alta proporción S. epidermidis (82%) y S. hominis (80%), y en baja frecuencia S. lugdunensis, S. haemolyticus, S. capitis, S. caprae, S. sciuri y S. lentus. La mayoría de los aislamientos fueron resistentes a los betalactámicos, las fluoroquinolonas y la eritromicina. La producción de biopelículas se determinó en el 41% de los SCN y el 59% fueron no productores de biopelículas (p = 0.0551). S. epidermidis productores de biopelículas tuvieron mayor presencia del operón icaADBC, aap y embp que los aislamientos no productores de biopelícula (p < 0.05). Los SCN no S. epidermidis presentaron únicamente el gen aap. Conclusiones: S. haemolyticus, S. sciuri y S. lentus son aislamientos nuevos de IPA no reportados que poseen factores de virulencia, igual que las otras especies de SCN aisladas.

Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC).

The incidence of prosthetic joint infection (PJI) is expected to increase in the coming years. PJI has serious consequences for patients, and high costs for the health system. The complexity of these infections makes it necessary to organize the vast quantity of information published in the last several years. The indications for the choice of a given surgical strategy and the corresponding antimicrobial therapy are specifically reviewed. The authors selected clinically relevant questions and then reviewed the available literature in order to give recommendations according to a pre-determined level of scientific evidence. The more controversial aspects were debated, and the final composition was agreed at an ad hoc meeting. Before its final publication, the manuscript was made available online in order that all SEIMC members were able to read it and make comments and suggestions.

Evaluation of a commercial multiplex PCR (Unyvero i60®) designed for the diagnosis of bone and joint infections using prosthetic-joint sonication.

BACKGROUND: The development of sonication protocols over the last few years has improved the sensitivity of conventional cultures for the diagnosis of prosthetic-joint infection (PJI). However, the development of a new, specifically designed kit for the molecular diagnosis of PJI could provide a major improvement in this field. METHODS: Prostheses retrieved from patients who underwent implant removal from May 2014 to May 2015 were sent for culture, and processed according to a previously defined protocol that included sonication. Furthermore, 180 microlitres of sonication fluid were used to carry out the multiplex PCR test (Unyvero i60 system®). A comparison of the sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, was performed. The study was approved by the Clinical Research Ethics Committee. RESULTS: The analysis included 88 prostheses from 68 patients (1.29 prostheses/patient). The type of prostheses studied were knee (n=55), total hip (n=26), partial hip (n=5), and shoulder (n=2). Twenty-nine patients were diagnosed with a PJI (15 delayed, 12 acute, and 2 haematogenous infections). In 24 cases, the result of the PCR was positive, all but 1 corresponding to patients with clinical criteria of PJI. Nine resistance mechanisms were detected from 5 samples. The Unyvero i60 system® showed slightly better results than traditional culture in terms of specificity and PPV. CONCLUSIONS: The Unyvero i60 system® may play a role in rapid diagnosis of PJI, due to its high specificity and PPV. However, despite these results, cultures have to be performed to detect organisms not detected by the system.

[Microbiological characteristics and patterns of resistance in prosthetic joint infections in a referral hospital]. / Características microbiológicas y patrones de resistencia en infecciones de prótesis articular en un hospital de referencia.

BACKGROUND: The prosthetic joint infection is the most feared and catastrophic complication for cause severe physical damage to patients and, generates high economic costs. OBJECTIVES: To describe the microbiological characteristics and to determine the resistance pattern in prosthetic joint infections in a reference hospital in Mexico. MATERIAL AND METHODS: Patients whose prosthetic devices were withdrawn due to suspicion of septic and aseptic loosening were included. Cultures were performed to identify microorganisms and susceptibility analysis. RESULTS: Of the 111 patients included, 55% were diagnosed with prosthetic joint infection, with the most frequent prosthesis being of the hip (43%). Positive cultures were obtained in 97% of the infected cases, of which 75% were monomicrobial infections. The most frequent bacterial species isolated were: Staphylococcus epidermidis (31%), Enterococcus faecalis (16%), Staphylococcus aureus (13%), and Escherichia coli (8%). The resistance patterns for the Staphylococcus genus were: oxacillin (79%), erythromycin (45%) and ciprofloxacin (37%). Enterococcus faecalis showed a high percentage of resistance to erythromycin and clindamycin (86%), and fluoroquinolones (43%). The large majority (86%) of Escherichia coli were extended spectrum beta-lactamases positive, in addition to having high resistance to fluoroquinolones (86%), trimethoprim/sulfamethoxazole (86%) and gentamicin (72%). CONCLUSION: The microbiological characteristics found in prosthetic joint infections vary according to the hospitals. In this series, a high proportion of coagulase-negative Staphylococci and Enterococcus spp. were found, as well as a high bacterial resistance.

Frisbee - the first artificial cervical disc of 3RD generation / Frisbee - o primeiro disco cervical artificial de 3ª geração / Frisbee - el primer disco cervical artificial de 3ra generación

OBJECTIVE: The current cervical disc arthroplasty is limited by postoperative facet joint arthritis, heterotopic ossification and segmental kyphosis. The total Frisbee disc, which has an upper convex/concave non-spherical surface and a lower flat sliding surface, is a new approach for improved outcomes. Prior to clinical application, safety and suitability tests are required. METHODS: The Frisbee is the first 3rd generation disc according to a new classification of total disc because it can precisely mimic the segmental ROM, including the soft limitation of axial rotation. The ISO 18192-1 test was carried out to determine the rate of wear debris. A FE model was used to assess the safety of prosthetic components. In the sagittal plane several variables to determine the most favorable lordotic angle were evaluated. RESULTS: Two angled prosthetic plates are safer than one sliding angled core to prevent the displacement. The lordosis of 7° of the Frisbee leads to kyphosis of no more than 2° without reduction of the ROM. The wear rate of the Frisbee is five times smaller compared to an FDA-approved disc with a spherical sliding surface. CONCLUSIONS: Based on the test results, the clinical application of Frisbee can now be studied. The postoperative kyphosis observed with other devices is not an issue with the Frisbee design. Physiological ROM is combined with the significant reduction of wear debris. For these reasons the Frisbee has the potential to provide a better balanced segmental loading reducing the degeneration of the joint surface and heterotopic ossification. .

OBJETIVO: A atual artroplastia de disco cervical é limitada pela artrite facetária pós-operatória, pela ossificação heterotópica e pela cifose segmentar. O disco Frisbee total, que tem face superior não-esférica convexo-côncava e face inferior plana e deslizante, é uma nova modalidade para melhores resultados. Antes da aplicação clínica, são necessários testes de segurança e adequação. MÉTODOS: O Frisbee é o primeiro disco de 3ª geração, de acordo com uma nova classificação de disco total, pois pode imitar precisamente a AM segmentar, incluindo a limitação suave da rotação axial. O teste ISO 18192-1 foi realizado para determinar a taxa de resíduos de desgaste. Um modelo de FE foi utilizado para avaliar a segurança dos componentes protéticos. No plano sagital, foram avaliadas diversas variáveis para determinar o ângulo de lordose mais favorável. RESULTADOS: Duas placas protéticas anguladas são mais seguras para evitar o deslocamento do que um núcleo angulado deslizante. A lordose de 7° do Frisbee leva a uma cifose de não mais de 2°, sem redução da AM. A taxa de desgaste do Frisbee é cinco vezes menor em comparação com um disco aprovado pela FDA, com superfície de deslizamento esférica. CONCLUSÕES: Com base nos resultados dos testes, a aplicação clínica do Frisbee pode, agora, ser estudada. A cifose pós-operatória, observada com outras próteses não constitui problema com o desenho do Frisbee. A AM fisiológica é combinada com a redução significativa dos detritos de desgaste. Por essas razões o Frisbee tem o potencial de fornecer uma carga segmentar mais equilibrada, reduzindo a degeneração da face articular e a ossi...

OBJETIVO: La actual artroplastia de disco cervical es limitada por la artritis facetaria posoperatoria, por la osificación heterotópica y por la cifosis segmentaria. El disco Frisbee total, que tiene faz superior no esférica, convexo-cóncava e faz interior plana y deslizante, es una nueva modalidad para mejores resultados. Antes de la aplicación clínica, se necesita de pruebas de seguridad y adecuación. MÉTODOS: El Frisbee es el primer disco de la tercera generación, de acuerdo con una nueva clasificación de disco total, pues puede imitar, con precisión, la AM segmentaria, incluyendo la limitación suave de la rotación axial. La prueba ISO 18192-1 fue realizada para determinar la tasa de residuos de desgaste. Un modelo de FE fue utilizado para evaluar la seguridad de los componentes protéticos. En el plano sagital, se evaluaron diversas variables para determinar el ángulo más favorable de lordosis. RESULTADOS: Dos placas protéticas anguladas son más seguras, para evitar el desplazamiento, que un núcleo angulado deslizante. La lordosis de 7mo del Frisbee lleva a una cifosis de no más de 2do, sin reducción de la AM. La tasa de desgaste del Frisbee es cinco veces menor en comparación con un disco aprobado por la FDA, con superficie esférica de deslizamiento. CONCLUSIONES: Con base en los resultados de las pruebas, la aplicación clínica del Frisbee puede ser estudiada en la actualidad. La cifosis posoperatoria, observada con otras prótesis, no es un problema con el diseño del Frisbee. La AM fisiológica se combina con la reducción significativa de los detritos de desgaste. Por esas razones, el Frisbee tiene el potencial para suministrar una carga segmentaria más equilibrada, reduciendo la degeneración de la fase articular y la osificación heterotópica. .

Reemplazo total bilateral de la articulación temporomandibular con sistema de microfijación: reporte de un caso / Bilateral Total Temporomandibular Joint replacement with Microfixation TMJ replacement system

La anquilosis de la articulación temporomandibular (ATM) es una patología de frecuencia variable, que puede ser causada por una gran diversidad de condiciones, tanto congénitas como adquiridas. De las causas adquiridas, los traumas y las infecciones son los que más frecuentemente se describen en la literatura. A la fecha, la anquilosis de la ATM se considera una de las indicaciones quirúrgicas de reemplazo articular. Se utilizan una gran variedad de materiales, tanto autógenos como aloplásticos, y cada uno ofrece determinados beneficios y desventajas. A continuación se presenta el caso de un paciente con anquilosis bilateral de la ATM, quien fue llevado a reemplazo total bilateral articular con material aloplástico...

Temporomandibular joint Ankylosis is a medical condition with variable frequency of presentation, caused by a diversity of both congenital and acquired conditions. Of the acquired causes, trauma and infections are most frequently described in the literature. To date, ankylosis of the temporomandibular joint, is considered one of the surgical indications for joint replacement. There’s use of a wide selection of materials, both autegenous and alloplastic, each offering certain advantages and disadvantages. Here is a case of a patient with bilateral temporomandibular joint ankylosis who was brought for bilateral total joint replacement with alloplastic material...

Protocolo combinado de 99mTc-Ciprofloxacina y 99mTc-MDP en el diagnóstico de osteomielitis y prótesis articular infectada / 99mTc-ciprofloxacin/99mTc-MDP combined protocol in the diagnosis of osteomyelitis and infected joint prosthesis

Introducción. El centellograma óseo con 99mTc-MDP es una técnica útil en el diagnóstico de osteomielitis, sin embargo, presenta especificidad limitada en presencia de patología ósea previa (osteomielitis complicada). La 99mTc-ciprofloxacina es uno de los radiofármacos más difundidos para la detección de infecciones óseas, aunque persisten controversias sobre su rendimiento diagnóstico. Objetivo. Determinar el valor clínico del protocolo combinado de centellograma con 99mTc-ciprofloxacina y 99mTc-MDP en el diagnóstico de osteomielitis complicada y prótesis articular infectada. Materiales y métodos 37 pacientes con sospecha clínica de osteomielitis complicada o prótesis infectada fueron estudiados mediante centellograma con 99mTc-ciprofloxacina y 99mTc-MDP. 26/37 pacientes presentaban fractura previa, 7 prótesis de rodilla y 4 prótesis de cadera. En todos ellos se realizó seguimiento clínico y bacteriológico. Resultados. El método presentó sensibilidad de 94 por ciento, especificidad de 79 por ciento, valor predictivo positivo de 81 por ciento y valor predictivo negativo de 94 por ciento, con una exactitud de 86 por ciento. Conclusiones. El protocolo combinado de 99mTc-ciprofloxacina y 99mTc-MDP presenta elevado rendimiento para el diagnóstico de osteomielitis complicada y prótesis articular infectada.

Introduction. Bone scintigraphy with 99mTc-MDP is a useful technique in the diagnosis of osteomyelitis, however, has limited specificity in the presence of previous bone pathology (complicated osteomyelitis). 99mTc-ciprofloxacin is one of the most widely used radiotracers for the detection of bone infection, although controversies persist on its diagnostic performance. Objective To determine the clinical value of 99mTc-ciprofloxacin/99mTc-MDP combined protocol in the diagnosis of complicated osteomyelitis and infected joint prosthesis. Materials and methods 37 patients with clinically suspected complicated osteomyelitis or infected prosthesis were studied with 99mTc-ciprofloxacin and 99mTc-MDP scintigraphy. 26/37 patients had previous fractures, 7 had knee replacements and 4 had hip replacements. All of the patients underwent clinical and bacteriological follow-up. Results. The method presented sensitivity of 94 percent, 79 percent specificity, 81 percent positive predictive value and 94 percent negative predictive value, with an accuracy of 86 percent. Conclusions. The combined protocol using 99mTc-ciprofloxacin/99mTc-MDP showed high diagnostic performance in complicated osteomyelitis and infected joint prosthesis.