Osteomielitis postraumática difícil de tratar: papel del Clostridium celerecrescens / A review of difficult-to-treat post-traumatic osteomyelitis: Role of Clostridium celerecrescens

OBJETIVO: Se ha realizado una revisión sobre las infecciones producidas por Clostridium celerecrescens que aparecen recogidas en la literatura. C. celerecrescens es un patógeno emergente relacionado con infecciones de heridas traumáticas que progresan a infecciones profundas y osteomielitis. MÉTODOS: En la literatura solo se han encontrado 4 casos con suficientes datos para ser analizados; nosotros añadimos un nuevo caso y experiencia en el manejo de la infección. La identificación se realizó mediante espectrometría desorción/ionización láser asistida por matriz acoplada a un detector de tiempo de vuelo (MALDI-TOF) o mediante galería API. Se realizó secuenciación del ARNr 16S en todos los casos. RESULTADOS: La identificación de la bacteria fue discrepante según el método utilizado debido a las similitud fenotípica y genética con otras especies del mismo género. La identificación mediante MALDI-TOF y galerías API no resulta adecuada para la determinación a nivel de especie, siendo necesaria la secuenciación del ARNr 16S. El tratamiento de la infección incluye combinaciones de antibióticos complejas y tratamiento quirúrgico junto con curas de piel y partes blandas debido a la persistencia de la bacteria a lo largo del tiempo. CONCLUSIÓN: El presente estudio manifiesta el potencial patogénico de C. celerecrescens en infecciones postraumáticas y la necesidad de mejorar el tratamiento de estas infecciones

PURPOSE: We reviewed the clinical features of post-traumatic infections produced by Clostridium celerecrescens reported in the literature. C. celerecrescens is an emerging pathogen involved in traumatic wound infection that progresses to deep infection and osteomyelitis. METHODS: We found only 4 cases reported in the literature with enough data to be analysed and we added our own case and experience with this type of infection. The identification was performed by matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI TOF) or API gallery, and 16S rRNA gene sequencing were performed to confirm identification in all cases. RESULTS: Identification of the bacteria is discrepant according to the method used due to the genetic and phenotypic similarities of other species of the genus. Identification through MALDI-TOF and API gallery is not suitable for determining the specie, confirmation by 16S rRNA sequencing being necessary. Treatment of the infection included complex antibiotic combinations and surgical treatment together with skin and soft tissue dressings due to the persistence of the pathogen over time. CONCLUSION: This report supports the pathogenic role of C. celerecrescens in post-traumatic infections and the need to improve the management of these difficult-to-treat infections

A review of difficult-to-treat post-traumatic osteomyelitis: Role of Clostridium celerecrescens. / Osteomielitis postraumática difícil de tratar: papel del Clostridium celerecrescens.

PURPOSE: We reviewed the clinical features of post-traumatic infections produced by Clostridium celerecrescens reported in the literature. C. celerecrescens is an emerging pathogen involved in traumatic wound infection that progresses to deep infection and osteomyelitis. METHODS: We found only 4 cases reported in the literature with enough data to be analysed and we added our own case and experience with this type of infection. The identification was performed by matrix-assisted desorption ionization-time of flight mass spectrometry (MALDI TOF) or API gallery, and 16S rRNA gene sequencing were performed to confirm identification in all cases. RESULTS: Identification of the bacteria is discrepant according to the method used due to the genetic and phenotypic similarities of other species of the genus. Identification through MALDI-TOF and API gallery is not suitable for determining the specie, confirmation by 16S rRNA sequencing being necessary. Treatment of the infection included complex antibiotic combinations and surgical treatment together with skin and soft tissue dressings due to the persistence of the pathogen over time. CONCLUSION: This report supports the pathogenic role of C. celerecrescens in post-traumatic infections and the need to improve the management of these difficult-to-treat infections.

Tratamiento de las fracturas del femur distal con el tornillo dinámico condileo / Treatment of the distal femur fractures wth the dynamic condylar screw

Se presentan 58 fracturas de femur distal tratadas mediante tornillo dinámico condileo (DCS). La edad media fue de 54,4 años El tiempo medio de consolidación fue de 111,8 dias. En los pacientes en los que se utilizó injerto se obtuvo consolidación más temprana (p<0,0175) . Hubo dos pseudoartrosis y un caso de fallo de la fijación correspondiente al único caso en el que solo se habian fijado siete corticales proximales al foco de fractura. La flexión Media conseguida fue de 113,7º siendo menor de 90º en tres casos. Los resultados fueron excelentes en 19 casos (32,8 por ciento), buenos en 23 (39,7 por ciento), regulares en 13 (22,4 por ciento) y malos en 3 casos (5,2 por ciento). (AU)

[Transfusion and pre-deposit autotransfusion in orthopedic and traumatologic surgery]. / Transfusión y autotransfusión predepósito en cirugía ortopédica y traumatológica.

PURPOSE: We present a retrospective study about the transfusional needs and the results of the preoperative autologous donation programme in our centre during 1996, in the Orthopaedic and Traumatologic Surgery Service's patients (SOT). PATIENTS AND METHODS: During 1996 the SOT Service carried out 592 major programmed surgical procedures with implants: hip prostheses (HP), knee prostheses (KP) and spinal column fixings (SCF). We've reviewed transfusion forms of the Blood Bank and the preoperative autologous donation forms of the patients sent to us. We've analysed the data with the EpiInfo 6.04 of CDC. Atlanta and SSPS programmes, using the chi 2 of Pearson's Test for qualitative variables and T-Student's test for 2 quantitative variables. RESULTS: The put 387 HP, 118 KP and 87 SCF. 1399 units of blood were administered to 437 patients: 310 HP, 64 KP and 63 SCF. The units/patient (U/P) mean was: 3.3 in HP, 2.3 in PTR and 3.5 in SCF. They sent 99 patients to be programmed for autotransfusion, of which 15 were excluded. The patients' number and the surgical procedures were: 39 HP, 7 KP and 38 SCF. They solicited 247 units (2.9 U/P) and we took out 91.4% of these and the programme was finished in the 73.8% of patients. They transfused 311 U, autologous 176, to 91.6% of programmed patients. Only autologous blood was received by 48% of transfused patients without any statistically significant differences (SSD) (p > 0.05) between the different prostheses. The difference among the transfusion needs of HP and SCF and over KP is SSD (p < 0.001), being non significant between HP and SCF. The probability of getting an autotransfusion programme is bigger in SCF, with a SSD (p < 0.001) of SCF over the HP and the KP and non significant between the last two. The probability of being transfused is greater in the programmed autotransfusion group, this being SSD (p < 0.001), as much of global form as comparing separately each type of prostheses. In the programmed autotranfusion group there are no SSD (p > 0.05) between the type of prostheses and the probability of being transfused, finding the same SSD when we compare the U/P mean and each type of prostheses. The opposite occurred to the patients programmed, it is SSD (p < 0.001) as much of global form as comparing the U/P means in each type of prostheses. Finally, between the global U/P transfused global in the patients that we did an autotransfusion on and those we didn't the difference is SSD (p < 0.001), seeing the same SSD comparing the U/P means in each type of prostheses between both groups. CONCLUSIONS: Given that the autotransfusion is safer than the homologous transfusion and the high percentage of this type of patients that need transfusion, 80% of HP, 54% of KP and 73% of SCF 72%, it would be desirable to enlarge the autotransfusion preoperative programme because it is only carried out on 14.18% of this type of procedures.