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Azad MA, Patel R. Practical Guidance for Clinical Microbiology Laboratories: Microbiologic diagnosis of implant-associated infections. Clin Microbiol Rev 2024:e0010423. [PMID: 38506553 DOI: 10.1128/cmr.00104-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
SUMMARYImplant-associated infections (IAIs) pose serious threats to patients and can be associated with significant morbidity and mortality. These infections may be difficult to diagnose due, in part, to biofilm formation on device surfaces, and because even when microbes are found, their clinical significance may be unclear. Despite recent advances in laboratory testing, IAIs remain a diagnostic challenge. From a therapeutic standpoint, many IAIs currently require device removal and prolonged courses of antimicrobial therapy to effect a cure. Therefore, making an accurate diagnosis, defining both the presence of infection and the involved microorganisms, is paramount. The sensitivity of standard microbial culture for IAI diagnosis varies depending on the type of IAI, the specimen analyzed, and the culture technique(s) used. Although IAI-specific culture-based diagnostics have been described, the challenge of culture-negative IAIs remains. Given this, molecular assays, including both nucleic acid amplification tests and next-generation sequencing-based assays, have been used. In this review, an overview of these challenging infections is presented, as well as an approach to their diagnosis from a microbiologic perspective.
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Affiliation(s)
- Marisa Ann Azad
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robin Patel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Boeykens K, Duysburgh I, Verlinden W. Prevention and management of minor complications in percutaneous endoscopic gastrostomy. BMJ Open Gastroenterol 2022; 9:bmjgast-2022-000975. [PMID: 35851280 PMCID: PMC9297220 DOI: 10.1136/bmjgast-2022-000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background Percutaneous endoscopic gastrostomy (PEG) was developed by Ponsky-Gauderer in the early 1980s. These tubes are placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition but can also be used for drainage or decompression. The tubes consist of an internal and external retention device. It is a generally safe technique but major or minor complications may arise during and after tube placement. Method A narrative review of the literature investigating minor complications after PEG placement. Results This review was written from a clinical viewpoint focusing on prevention and management of minor complications and documented with real cases from more than 21 years of clinical practice. Conclusions Depending on the literature the incidence of minor complications after gastrostomy placement can be high. To decrease associated morbidity, prevention, early recognition and popper management of these complications are important.
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Beck JP, Grogan M, Bennett BT, Jeyapalina S, Agarwal J, Bartow-McKenney C, Bugayev J, Kubiak E, Sinclair S, Grice E. Analysis of the Stomal Microbiota of a Percutaneous Osseointegrated Prosthesis: A Longitudinal Prospective Cohort Study. J Orthop Res 2019; 37:2645-2654. [PMID: 31317568 DOI: 10.1002/jor.24421] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/10/2019] [Indexed: 02/04/2023]
Abstract
Percutaneous osseointegrated (OI) prostheses (POPs) are used to skeletally attach artificial limbs in amputees. While any permanent percutaneous interface is at risk of becoming infected by the resident microbiota colonizing the stoma, most of these patients remain infection-free. Avoidance of infection likely depends upon a mechanically and/or biologically stable skin-to-implant interface. The ultimate question remains, "why do some stomata become infected while others do not?" The answer might be found in the dynamic bacterial communities of the patient and within the stomal site itself. This study is an appendix to the first Food and Drug Administration approved prospective early feasibility study of OI prosthetic docking, in which, 10 transfemoral amputees were implanted with a unique POP device. In this analytical, longitudinal cohort study, each patient's skin and stomal microbiota were analyzed from the initial surgery to 1 year following the second-stage surgery. During each follow-up visit, three swab samples-stomal, device thigh skin and contralateral thigh skin-were obtained. DNA was extracted, and bacterial 16S ribosomal RNA (rRNA) genes were amplified and sequenced to profile microbial communities. The stomal microbiota were distinct from the microbiota on the adjacent thigh skin and the skin of the contralateral thigh, with a significantly increased abundance of Staphylococcus aureus within the stoma. Early on stomal microbiota were characterized by high diversity and high relative abundance of obligate anaerobes. Over time, the stomal microbiota shifted and stabilized in communities of lower diversity dominated by Streptococcus, Corynebacterium, and/or Staphylococcus spp. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2645-2654, 2019.
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Affiliation(s)
- James Peter Beck
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Orthopaedic and Plastic Surgery Research Laboratory, University of Utah, DVA SLC HCS, Research 151, 500 Foothill Drive, Salt Lake City, Utah, 84148
| | - Max Grogan
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Brian T Bennett
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Sujee Jeyapalina
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Jay Agarwal
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Casey Bartow-McKenney
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Julia Bugayev
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
| | - Erik Kubiak
- Department of Orthopaedics, University of Nevada, Las Vegas, Nevada
| | - Sarina Sinclair
- Department of Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Orthopaedic and Plastic Surgery Research Laboratory, University of Utah, DVA SLC HCS, Research 151, 500 Foothill Drive, Salt Lake City, Utah, 84148
| | - Elizabeth Grice
- Departments of Dermatology and Microbiology, University of Pennsylvania, 1007 BRB II/III, 421 Curie Blvd, Philadelphia, Pennsylvania, 19104
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