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Mahlouly J, Lhopitallier L, Suttels V, Mueller L, Wernly D, Borens O, Steinmetz S. Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report. BMC Infect Dis 2020; 20:767. [PMID: 33069221 PMCID: PMC7568409 DOI: 10.1186/s12879-020-05497-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ureaplasma urealyticum is an intra-cellular bacterium frequently found colonizing the genital tract. Known complications include localized infections, which can result in premature deliveries. Septic arthritis due to U. urealyticum in healthy patients is exceptionally rare, although opportunistic septic arthritis in agammaglobulinemic patients have been reported. However, there are no reports of septic arthritis due to U. urealyticum following caesarean section or in the post-partum period. Case presentation A 38-year-old immunocompetent woman presented with severe right shoulder pain, 1 month following emergency caesarean section at 26 weeks of gestation for pre-eclampsia and spontaneous placental disruption with an uncomplicated post-operative recovery. Our suspicion of septic arthritis was confirmed with abundant pus following arthrotomy by a delto-pectoral approach. Awaiting culture results, empirical antibiotic treatment with intravenous amoxicilline and clavulanic acid was initiated. In spite of sterile cultures, clinical evolution was unfavorable with persistent pain, inflammation and purulent drainage, requiring two additional surgical débridement and lavage procedures. The 16S ribosomal RNA PCR of the purulent liquid was positive for U. urealyticum at 2.95 × 106 copies/ml, specific cultures inoculated a posteriori were positive for U. urealyticum. Levofloxacin and azithromycine antibiotherapy was initiated. Susceptibility testing showed an intermediate sensibility to ciprofloxacin and clarithromycin. The strain was susceptible to doxycycline. Following cessation of breastfeeding, we started antibiotic treatment with doxycycline for 4 weeks. The subsequent course was favorable with an excellent functional and biological outcome. Conclusions We report the first case of septic arthritis due to U. urealyticum after caesarean section. We hypothesize that the breach of the genital mucosal barrier during the caesarean section led to hematogenous spread resulting in purulent septic arthritis. The initial beta-lactam based antibiotic treatment, initiated for a purulent arthritis, did not provide coverage for cell wall deficient organisms. Detection of 16S rRNA allowed for a correct microbiological diagnosis in a patient with an unexpected clinical course.
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Affiliation(s)
- Jaad Mahlouly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Loic Lhopitallier
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Véronique Suttels
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Linda Mueller
- Institute of Microbiology, University of Lausanne, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Diane Wernly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Khan FU, Fang Y, Khan Z, Khan FU, Malik ZI, Ahmed N, Khan AH, Rehman A. Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220960547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Globally, surgical site infections are one of the common infections which lead to a large amount of mortality and morbidity in postsurgical care. The risk for surgical site infection is multidimensional which includes mainly; patient, surgery, and hospital-related factors. This study is aimed to determine the burden of SSIs along with contributed risk factors. A prospective observational cross-sectional study was conducted in one of the largest public-sector hospitals in Pakistan. A total of 412 patients were recruited in the study with full consent and monitored for 30 days after surgery with direct and indirect surveillance. Overall, in seven different surgical procedures the incidence (29.8%) rate of SSI was observed; in appendectomy ( n = 17, 4.1%), exploratory laparotomy ( n = 51, 12.6%), laparoscopic cholecystectomy ( n = 12, 2.90%), mesh repair ( n = 17, 4.01%), thyroidectomy (5, 1.2%), transurethral resection of the prostate ( n = 11, 2.6%), and transurethral resection of the bladder (10, 2.4%). The average SSI rate in every single procedure was about 18 (4.27%) per surgical procedure out of 123 (29.85%) SSI cases. Types of SSI identified were superficial, deep incisional and organ/space ( n = 76, 18.4%, n = 23, 5.5%, and n = 24, 5.7%). Incidence of SSIs during admission, at readmission, and post-surveillance cases were ( n = 50, 12.1%, n = 25, 6.0% and n = 48, 11.6%). Associated risk factors found contributed to the incidence of SSI ( p < 0.05). Pre-operative ( n = 348, 84.5%) and 6 (1.5%) surgical patients did not received the post-operative antibiotics. The P. aeruginosa ( n = 15, 12.1%) and S. aureus (13, 10.5%). Cefoperazone and sulbactam were the most prescribed antibiotics. Associated risk factors and treatment outcomes of surgical patients have a direct association with the incidence of SSI. Hospital-based antimicrobial stewardship, implementation of surgical guidelines, patient care, and education are needed to develop at wards level in hospitals.
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Affiliation(s)
- Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
| | - Zakir Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacology, Institute of Health Sciences, Cukurova University, Adana, Turkey
| | - Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Health Science Centre, Xi’an Jiaotong University, China
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Zafar Iqbal Malik
- Shaheed Zulfiqar Ali Bhutto Medical University, and General Surgical Wards, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Naveed Ahmed
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Amir Hayat Khan
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden Penang, Malaysia
| | - Asim.ur. Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Rasa K, Kilpatrick C. Implementation of World Health Organization Guidelines in the Prevention of Surgical Site Infection in Low- and Middle-Income Countries:What We Know and Do Not Know. Surg Infect (Larchmt) 2020; 21:592-598. [PMID: 32478641 DOI: 10.1089/sur.2020.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background: In low- and middle-income countries (LMICs), infection is the most frequent complication in surgical procedures, and surgical site infections (SSIs) globally are the most frequent health-care-associated infections (HAIs). Preventing SSI is an important target for overall quality improvement and patient safety as well as supporting the infection prevention and control (IPC) global agenda. Methods: In 2018, the World Heath Organization (WHO) presented the first Global Guidelines for the Prevention of Surgical Site Infections. The WHO also simplified SSI surveillance materials and included process measures, critical to addressing the barriers existing in LMICs. Because surveillance activities alone will not lead to improvements and implementation is more challenging than guideline development, the WHO then outlined a novel, step by step approach for implementation based on its tried and tested improvement approach for IPC measures. These documents have been reviewed and summarized to achieve wider reach in the surgical community. Results: The WHO implementation guidance notes examples of current practice against the WHO SSI prevention guideline recommendations and considers LMIC settings. It identifies the related problem that needs to be addressed if the recommendation is not being applied consistently and reliably. It breaks down the steps required to make an improvement applying key elements known as the multi-modal improvement strategy. Conclusions: Implementation of IPC guidance documents and tools published by global organizations and national governments continues to be a challenge, especially for LMICs. Successful approaches need to include a science-based approach to implementation and improvement, as well as joined up working and learning across IPC and surgical communities. Real improvements can be only achieved, based on WHO workforce recommendations, with IPC programs including the staff to execute these programs and using a proven approach.
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Affiliation(s)
- Kemal Rasa
- Department of Surgery, Anadolu Medical Center, Kocaeli, Turkey
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