1
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Espíndola R, Vella V, Benito N, Mur I, Tedeschi S, Zamparini E, Hendriks JGE, Sorlí L, Murillo O, Soldevila L, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz MW, McNamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy FA, Liu WY, Lora-Tamayo J, Praena J, Ustianowski A, Cinconze E, Pellegrini M, Bagnoli F, Rodríguez-Baño J, Del-Toro-López MD. Incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infection in European hospitals: the COMBACTE-NET ARTHR-IS multi-centre study. J Hosp Infect 2023; 142:9-17. [PMID: 37797656 DOI: 10.1016/j.jhin.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. METHODS This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. RESULTS The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. CONCLUSIONS This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.
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Affiliation(s)
- R Espíndola
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - V Vella
- GlaxoSmithKline (GSK), Siena, Italy
| | - N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - I Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - S Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - E Zamparini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - J G E Hendriks
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands
| | - L Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - O Murillo
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - L Soldevila
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - M Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M C Ferrari
- Prosthetic-Joint Replacement Unit, Humanitas Research Hospital, Milano, Italy
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - I McNamara
- Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Escudero-Sanchez
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Arvieux
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - C Batailler
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - F-A Dauchy
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - W-Y Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | - J Lora-Tamayo
- Department of Internal Medicine (CIBERINFEC-CIBER de Enfermedades Infecciosas), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Praena
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Ustianowski
- Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
| | | | | | | | - J Rodríguez-Baño
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain
| | - M-D Del-Toro-López
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain.
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2
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Lalueza A, Lora-Tamayo J, de la Calle C, Sayas-Catalán J, Arrieta E, Maestro G, Mancheño-Losa M, Marchán-López Á, Díaz-Simón R, García-García R, Catalán M, García-Reyne A, de Miguel-Campo B, Lumbreras C. The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19. Rev Clin Esp 2022; 222:293-298. [PMID: 35512908 PMCID: PMC7888251 DOI: 10.1016/j.rceng.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
This observational retrospective study aimed to investigate the usefulness of Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), National Early Warning Score (NEWS), and quick NEWS in predicting respiratory failure and death among patients with COVID-19 hospitalized outside of intensive care units (ICU). We included 237 adults hospitalized with COVID-19 who were followed-up on for one month or until death. Respiratory failure was defined as a PaO2/FiO2 ratio ≤200 mmHg or the need for mechanical ventilation. Respiratory failure occurred in 77 patients (32.5%), 29 patients (12%) were admitted to the ICU, and 49 patients (20.7%) died. Discrimination of respiratory failure was slightly higher in NEWS, followed by SOFA. Regarding mortality, SOFA was more accurate than the other scores. In conclusion, sepsis scores are useful for predicting respiratory failure and mortality in COVID-19 patients. A NEWS score ≥4 was found to be the best cutoff point for predicting respiratory failure.
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Affiliation(s)
- A Lalueza
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - J Lora-Tamayo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain
| | - C de la Calle
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Sayas-Catalán
- Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain; Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Arrieta
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - G Maestro
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Mancheño-Losa
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, Spain
| | - Á Marchán-López
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Díaz-Simón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - R García-García
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Catalán
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A García-Reyne
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B de Miguel-Campo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Lumbreras
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain; Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, Spain
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3
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Lalueza A, Lora-Tamayo J, de la Calle C, Sayas-Catalán J, Arrieta E, Maestro G, Mancheño-Losa M, Marchán-López Á, Díaz-Simón R, García-García R, Catalán M, García-Reyne A, de Miguel-Campo B, Lumbreras C. [The early use of sepsis scores to predict respiratory failure and mortality in non-ICU patients with COVID-19]. Rev Clin Esp 2020; 222:293-298. [PMID: 33191944 PMCID: PMC7648653 DOI: 10.1016/j.rce.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022]
Abstract
El presente estudio retrospectivo observacional tiene como objetivo analizar la utilidad de las escalas SOFA (Sequential Organ Failure Assessment), qSOFA (Quick SOFA), NEWS (National Early Warning Score ) y Quick NEWS para predecir el fallo respiratorio y la muerte en pacientes con COVID-19 atendidos fuera de la Unidad de Cuidados Intensivos (UCI). Se incluyeron 237 adultos con COVID-19 hospitalizados seguidos durante un mes o hasta su fallecimiento. El fallo respiratorio se definió como un cociente PaO2/FiO2 ≤ 200 mmHg o la necesidad de ventilación mecánica. Setenta y siete pacientes (32,5%) desarrollaron fallo ventilatorio; 29 (12%) precisaron ingreso en UCI, y 49 fallecieron (20,7%). La discriminación del fallo ventilatorio fue algo mayor con la puntuación NEWS, seguida de la SOFA. En cuanto a la mortalidad, la puntuación SOFA fue más exacta que las otras escalas. En conclusión, las escalas de sepsis son útiles para predecir el fallo respiratorio y la muerte en COVID-19. Una puntuación ≥ 4 en la escala NEWS sería el mejor punto de corte para predecir fallo respiratorio.
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Affiliation(s)
- A Lalueza
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - J Lora-Tamayo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - C de la Calle
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - J Sayas-Catalán
- Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España.,Servicio de Medicina Respiratoria, Hospital Universitario 12 de Octubre, Madrid, España
| | - E Arrieta
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - G Maestro
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Mancheño-Losa
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España
| | - Á Marchán-López
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - R Díaz-Simón
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - R García-García
- Servicio de Medicina Respiratoria, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Catalán
- Unidad de Cuidados Intensivos, Hospital Universitario 12 de Octubre, Madrid, España
| | - A García-Reyne
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - B de Miguel-Campo
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Lumbreras
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.,Instituto de investigación del Hospital Universitario 12 de Octubre (i+12), Madrid, España.,Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Madrid, España
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4
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Muñoz-Gallego I, Mancheño M, Pérez-Montarelo D, Viedma E, Chaves F, Lora-Tamayo J. Staphylococcus aureus native arthritis over 10 years. Med Mal Infect 2020; 50:257-262. [DOI: 10.1016/j.medmal.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
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5
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Pintado V, Pazos R, Jiménez-Mejías ME, Rodríguez-Guardado A, Díaz-Pollán B, Cabellos C, García-Lechuz JM, Lora-Tamayo J, Domingo P, Muñez E, Domingo D, González-Romo F, Lepe-Jiménez JA, Rodríguez-Lucas C, Gil A, Pelegrín I, Chaves F, Pomar V, Ramos A, Alarcón T, Pérez-Cecilia E. Staphylococcus aureus meningitis in adults: A comparative cohort study of infections caused by meticillin-resistant and meticillin-susceptible strains. J Hosp Infect 2018; 102:108-115. [PMID: 30448277 DOI: 10.1016/j.jhin.2018.11.008] [Citation(s) in RCA: 6] [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] [Received: 09/12/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.
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Affiliation(s)
- V Pintado
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - R Pazos
- Infectious Diseases Service, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Biomedical Sciences and Medicine, Universidade do Algarve, Faro, Portugal
| | - M E Jiménez-Mejías
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | | | - B Díaz-Pollán
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - C Cabellos
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - J M García-Lechuz
- Clinical Microbiology Service, Hospital Universitario Miguel Servet, Zaragoza, Spain; Department of Clinical Microbiology, Hospital Gregorio Marañon, Madrid, Spain
| | - J Lora-Tamayo
- Internal Medicine Department, Hospital 12 de Octubre, Madrid, Spain
| | - P Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - E Muñez
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - D Domingo
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
| | - F González-Romo
- Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain
| | - J A Lepe-Jiménez
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - C Rodríguez-Lucas
- Infectious Diseases Unit, Hospital Central de Asturias, Oviedo, Spain
| | - A Gil
- Infectious Diseases Unit/Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | - I Pelegrín
- Infectious Diseases Service, Hospital Bellvitge, L'Hospitalet, Barcelona, Spain
| | - F Chaves
- Clinical Microbiology Department, Hospital 12 de Octubre, Madrid, Spain
| | - V Pomar
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Ramos
- Infectious Diseases Unit, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - T Alarcón
- Microbiology Service, Hospital de La Princesa, Madrid, Spain
| | - E Pérez-Cecilia
- Clinical Microbiology Service, Hospital Clínico San Carlos, Madrid, Spain
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Fiaux E, Titecat M, Robineau O, Lora-Tamayo J, El Samad Y, Etienne M, Frebourg N, Blondiaux N, Brunschweiler B, Dujardin F, Beltrand E, Loiez C, Cattoir V, Canarelli JP, Hulet C, Valette M, Nguyen S, Caron F, Migaud H, Senneville E. Outcome of patients with streptococcal prosthetic joint infections with special reference to rifampicin combinations. BMC Infect Dis 2016; 16:568. [PMID: 27737642 PMCID: PMC5064929 DOI: 10.1186/s12879-016-1889-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/22/2015] [Accepted: 10/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Outcome of patients with streptococcal prosthetic joint infections (PJIs) is not well known. METHODS We performed a retrospective multicenter cohort study that involved patients with total hip/knee prosthetic joint (THP/TKP) infections due to Streptococcus spp. from 2001 through 2009. RESULTS Ninety-five streptococcal PJI episodes (50 THP and 45 TKP) in 87 patients of mean age 69.1 ± 13.7 years met the inclusion criteria. In all, 55 out of 95 cases (57.9 %) were treated with debridement and retention of the infected implants with antibiotic therapy (DAIR). Rifampicin-combinations, including with levofloxacin, were used in 52 (54.7 %) and 28 (29.5 %) cases, respectively. After a mean follow-up period of 895 days (IQR: 395-1649), the remission rate was 70.5 % (67/95). Patients with PJIs due to S. agalactiae failed in the same proportion as in the other patients (10/37 (27.1 %) versus 19/58 (32.7 %); p = .55). In the univariate analysis, antibiotic monotherapy, DAIR, antibiotic treatments other than rifampicin-combinations, and TKP were all associated with a worse outcome. The only independent variable significantly associated with the patients' outcomes was the location of the prosthesis (i.e., hip versus knee) (OR = 0.19; 95 % CI 0.04-0.93; p value 0.04). CONCLUSIONS The prognosis of streptococcal PJIs may not be as good as previously reported, especially for patients with an infected total knee arthroplasty. Rifampicin combinations, especially with levofloxacin, appear to be suitable antibiotic regimens for these patients.
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Affiliation(s)
- E Fiaux
- Infectious Diseases Department, University Hospital of Rouen, Rouen, France
| | - M Titecat
- Laboratory of Microbiology, University Hospital of Lille, Lille, France
| | - O Robineau
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France
| | - J Lora-Tamayo
- Unit of Infectious Diseases Hospital 12 de Octubre of Madrid, Madrid, Spain
| | - Y El Samad
- Infectious Diseases Department, University Hospital of Amiens, Amiens, France
| | - M Etienne
- Infectious Diseases Department, University Hospital of Rouen, Rouen, France
| | - N Frebourg
- Laboratory of Microbiology, University Hospital of Rouen, Rouen, France
| | - N Blondiaux
- Laboratory of Microbiology, Gustave Dron Hospital of Tourcoing, Tourcoing, France
| | - B Brunschweiler
- Orthopaedic Surgery Unit, University Hospital of Amiens, Amiens, France
| | - F Dujardin
- Orthopaedic Surgery Unit, University Hospital of Rouen, Rouen, France
| | - E Beltrand
- Orthopaedic Surgery Unit, Gustave Dron Hospital of Tourcoing, Tourcoing, France
| | - C Loiez
- Laboratory of Microbiology, University Hospital of Lille, Lille, France
| | - V Cattoir
- Laboratory of Microbiology, University Hospital of Caen, Caen, France
| | - J P Canarelli
- Orthopaedic Surgery Unit, University Hospital of Amiens, Amiens, France
| | - C Hulet
- Orthopaedic Surgery Unit, University Hospital of Caen, Caen, France
| | - M Valette
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France
| | - S Nguyen
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France
| | - F Caron
- Infectious Diseases Department, University Hospital of Rouen, Rouen, France
| | - H Migaud
- Orthopaedic Surgery Unit, University Hospital of Lille, Lille, France
| | - E Senneville
- Infectious Diseases Department, Gustave Dron Hospital of Tourcoing, 135 rue du Président Coty, 59200, Tourcoing, France. .,French Reference Center for Osteo-Articular Infections (CRIOAC Lille-Tourcoing), Faculty Hospital of Lille, Lille, France.
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7
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López-Medrano F, Lora-Tamayo J, Fernández-Ruiz M, Losada I, Hernández P, Cepeda M, San Juan R, Chaves F, Aguado JM. Significance of the isolation of Staphylococcus aureus from a central venous catheter tip in the absence of concomitant bacteremia: a clinical approach. Eur J Clin Microbiol Infect Dis 2016; 35:1865-1869. [PMID: 27477854 DOI: 10.1007/s10096-016-2740-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/24/2016] [Indexed: 11/24/2022]
Abstract
The optimal approach following the isolation of Staphylococcus aureus from an intravascular catheter tip in the absence of concomitant bacteremia remains unclear. We aimed to determine the rate of delayed complications in these patients. We performed a retrospective observational study (during the period 2002-2012) including patients with a catheter tip culture yielding S. aureus. Patients were followed up for ≥6 months. The primary endpoint was the occurrence of delayed staphylococcal complications (either bacteremia and/or metastatic distant infections). A total of 113 patients were included (75 % male, median age 61 years): 46 and 67 with negative and positive blood cultures, respectively. We found a lower rate of delayed staphylococcal complications in cases with no bacteremia within 48 h since catheter removal than in cases of confirmed S. aureus catheter-related bacteremia (0.0 % vs. 25.4 %; p-value < 0.001). In the group without bacteremia, there was a subgroup of 15 patients (32.6 %) who did not receive antimicrobial treatment. Again, delayed complications occurred less commonly in this subgroup of patients without bacteremia (0.0 % vs. 25.4 %; p-value = 0.033). In contrast to patients with S. aureus catheter-related bacteremia, no delayed infectious complications were observed in patients with an isolated catheter tip culture yielding S. aureus and negative blood cultures within 48 h of catheter removal. Futures studies are needed to assess if the therapeutic approach could be different for this group of patients.
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Affiliation(s)
- F López-Medrano
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain. .,Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Centro de Actividades Ambulatorias, 2ª planta, bloque D. Avda. de Córdoba, s/n. Postal code 28041, Madrid, Spain.
| | - J Lora-Tamayo
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - I Losada
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P Hernández
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - M Cepeda
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - R San Juan
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - F Chaves
- Department of Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - J M Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Murillo O, Grau I, Lora-Tamayo J, Gomez-Junyent J, Ribera A, Tubau F, Ariza J, Pallares R. The changing epidemiology of bacteraemic osteoarticular infections in the early 21st century. Clin Microbiol Infect 2015; 21:254.e1-8. [DOI: 10.1016/j.cmi.2014.09.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/01/2014] [Accepted: 09/11/2014] [Indexed: 11/28/2022]
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Rodríguez-Pardo D, Pigrau C, Lora-Tamayo J, Soriano A, del Toro MD, Cobo J, Palomino J, Euba G, Riera M, Sánchez-Somolinos M, Benito N, Fernández-Sampedro M, Sorli L, Guio L, Iribarren JA, Baraia-Etxaburu JM, Ramos A, Bahamonde A, Flores-Sánchez X, Corona PS, Ariza J. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect 2014; 20:O911-9. [PMID: 24766536 DOI: 10.1111/1469-0691.12649] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/07/2014] [Accepted: 04/18/2014] [Indexed: 02/05/2023]
Abstract
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.
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Affiliation(s)
- D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lora-Tamayo J, Murillo O, Bergen PJ, Nation RL, Poudyal A, Luo X, Yu HY, Ariza J, Li J. Activity of colistin combined with doripenem at clinically relevant concentrations against multidrug-resistant Pseudomonas aeruginosa in an in vitro dynamic biofilm model. J Antimicrob Chemother 2014; 69:2434-42. [DOI: 10.1093/jac/dku151] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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11
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Murillo O, Roset A, Sobrino B, Lora-Tamayo J, Verdaguer R, Jiménez-Mejias E, Nolla J, de Colmenero J, Ariza J. Streptococcal vertebral osteomyelitis: multiple faces of the same disease. Clin Microbiol Infect 2014; 20:O33-8. [DOI: 10.1111/1469-0691.12302] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 06/06/2013] [Accepted: 06/16/2013] [Indexed: 11/28/2022]
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Garrigós C, Murillo O, Lora-Tamayo J, Vivas M, Tubau F, Cabellos C, Cabo J, Ariza J. RNAIII inhibiting peptide against foreign-body infection by methicillin-resistant Staphylococcus aureus. J Infect 2012; 65:586-8. [DOI: 10.1016/j.jinf.2012.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 09/20/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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Euba G, Lora-Tamayo J, Murillo O, Pedrero S, Cabo J, Verdaguer R, Ariza J. Pilot study of ampicillin-ceftriaxone combination for treatment of orthopedic infections due to Enterococcus faecalis. Antimicrob Agents Chemother 2009; 53:4305-10. [PMID: 19667290 PMCID: PMC2764214 DOI: 10.1128/aac.00444-09] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 06/05/2009] [Accepted: 07/31/2009] [Indexed: 11/20/2022] Open
Abstract
Serious Enterococcus faecalis infections usually require combination therapy to achieve a bactericidal effect. In orthopedic infections, the prognosis of enterococcal etiology is considered poor, and the use of aminoglycosides is questioned. The ampicillin-ceftriaxone combination has recently been accepted as alternative therapy for enterococcal endocarditis. After one of our patients with endocarditis and vertebral osteomyelitis was cured with ampicillin-ceftriaxone, we started a pilot study of orthopedic infections. Patients with infections due to E. faecalis (with two or more surgical samples or blood cultures) diagnosed during 2005 to 2008 were recruited. Polymicrobial infections with ampicillin- and ceftriaxone-resistant microorganisms were excluded. Patients received ampicillin (8 to 16 g/day)-ceftriaxone (2 to 4 g/day) and were followed up prospectively. Of 31 patients with E. faecalis infections, 10 received ampicillin-ceftriaxone. Including the first patient, 11 patients were treated with ampicillin-ceftriaxone: 3 with prosthetic joint infections, 3 with instrumented spine arthrodesis device infections, 2 with osteosynthesis device infections, 1 with foot osteomyelitis, and 2 with vertebral osteomyelitis and endocarditis. Six infections (55%) were polymicrobial. All cases except the vertebral osteomyelitis ones required surgery, with retention of foreign material in six cases. Ampicillin-ceftriaxone was given for 25 days (interquartile range, 15 to 34 days), followed by amoxicillin (amoxicilline) being given to seven patients (64%). One patient with endocarditis died within 2 weeks (hemorrhagic stroke) and was not evaluable. For one patient with prosthesis retention, the infection persisted; 9/10 patients (90%) were cured, but 1 patient was superinfected. Follow-up was for 21 months (interquartile range, 14 to 36 months). Ampicillin-ceftriaxone may be a reasonable synergistic combination to treat orthopedic infections due to E. faecalis. Our experience, though limited, shows good outcomes and tolerability and may provide a basis for further well-designed comparative studies.
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Affiliation(s)
- G Euba
- Infectious Diseases Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain.
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Casas S, Gasch O, Lora-Tamayo J, Reina D, Joanola X, Gonzalez L, Guerra M, Santin M. O472 Assessment and management of tuberculosis infection in patients due to start anti-TNF-a treatment. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Formiga F, Marcos E, Sole A, Valencia E, Lora-Tamayo J, Pujol R. Síndrome confusional agudo en pacientes ancianos ingresados por patología médica. Rev Clin Esp 2005; 205:484-8. [PMID: 16238958 DOI: 10.1157/13079762] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Delirium or acute confusional syndrome (ACS) is a frequent problem during hospitalization of elderly patients. We study the appearance of delirium and its characteristics in patients admitted to an internal medicine service. METHODS Prospective study of 148 patients over 64 years admitted due to medical condition (non-surgical) in the internal medicine service of the University Hospital of Bellvitge. Functionality was quantified with the Barthel index (BI) and comorbidity with the Charlson index (CI). The Confusional Assessment Method was used for the diagnosis of the ACS. RESULTS Seventy-seven (77) (52%) of the 148 patients were women, with a mean age of 78.5 years. The CI was 2.2. Mean of previous BI was 81.7. Mortality during admission was 8% (12 patients). A total of 42.5% of the patients (63) had ACS (30% prevalent). It was hyperactive in 68%, hypoactive in 16% and mixed in 16%. In 38% of the patients, the ACS had morning predominance and 62% it appeared after the evening. Advanced age was the only significant differences between patients with or without ACS (p < 0.001). There were no significant differences in the ACS percentage between patients who survived or who died (p = 0.36). CONCLUSIONS Frequency of appearance of the confusional picture is high in patients admitted to acute hospitals, it being more frequent in the elderly. Measures to prevent the confusional picture in elderly patients who are hospitalized should be increased.
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Affiliation(s)
- F Formiga
- UFISS Geriatría-Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona.
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Gilsanz FJ, Hernando P, Lora-Tamayo J. [Vertical nystagmus caused by barbiturates]. Rev Esp Anestesiol Reanim 1981; 28:215. [PMID: 7313233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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