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Tatarelli P, Romani T, Santoro V, Spezia M, Gallo A, Ripamonti G, Carducci M, Trotti C, Parisini A, Nicolini LA, Mikulska M, Borrè S, Bassetti M. Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections. J Infect Chemother 2021; 27:1162-1168. [PMID: 33781690 DOI: 10.1016/j.jiac.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/13/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.
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Affiliation(s)
- P Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy.
| | - T Romani
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - V Santoro
- Public Health Department, Santa Maria Delle Croci Hospital, Ravenna, AUSL Romagna, Italy
| | - M Spezia
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Gallo
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - G Ripamonti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - M Carducci
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - C Trotti
- Centro Ortopedico di Quadrante and Madonna Del Popolo Hospital, Omegna, VB, Italy
| | - A Parisini
- Infectious Diseases SOC, A.S.O. SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - L A Nicolini
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - M Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - S Borrè
- Infectious Diseases Unit, Sant'Andrea Hospital, Vercelli, Italy
| | - M Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Hospital and IRCCS, University of Genoa, Genoa, Italy
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Tatarelli P, Magnasco L, Borghesi ML, Russo C, Marra A, Mirabella M, Sarteschi G, Ungaro R, Arcuri C, Murialdo G, Viscoli C, Del Bono V, Nicolini LA. Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study. Intern Emerg Med 2020; 15:645-654. [PMID: 31786751 PMCID: PMC7088538 DOI: 10.1007/s11739-019-02243-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 11/21/2019] [Indexed: 12/29/2022]
Abstract
Prevalence and clinical impact of viral respiratory tract infections (VRTIs) on community-acquired pneumonia (CAP) has not been well defined so far. The aims of this study were to investigate the prevalence and the clinical impact of VRTIs in patients with CAP. Prospective study involving adult patients consecutively admitted at medical wards for CAP and tested for VRTIs by real-time PCR on pharyngeal swab. Patients' features were evaluated with regard to the presence of VRTI and aetiology of CAP. Clinical failure was a composite endpoint defined by worsening of signs and symptoms requiring escalation of antibiotic treatment or ICU admission or death within 30 days. 91 patients were enrolled, mean age 65.7 ± 10.6 years, 50.5% female. 62 patients (68.2%) had no viral co-infection while in 29 patients (31.8%) a VRTI was detected; influenza virus was the most frequently identified (41.9%). The two groups were similar in terms of baseline features. In presence of a VRTI, pneumonia severity index (PSI) was more frequently higher than 91 and patients had received less frequently pre-admission antibiotic therapy (adjusted OR 2.689, 95% CI 1.017-7.111, p = 0.046; adjusted OR 0.143, 95% CI 0.030-0.670, p = 0.014). Clinical failure and antibiotic therapy duration were similar with regards to the presence of VRTI and the aetiology of CAP. VRTIs can be detected in almost a third of adults with CAP; influenza virus is the most relevant one. VRTI was associated with higher PSI at admission, but it does not affect patients' outcome.
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Affiliation(s)
- P Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy.
- Department of Infectious Diseases, Ospedale Santa Maria Delle Croci, Ravenna, Italy.
| | - L Magnasco
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - M L Borghesi
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - C Russo
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - A Marra
- Second Clinic of Internal Medicine, Department of Internal Medicine, San Martino Polyclinic Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - M Mirabella
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - G Sarteschi
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - R Ungaro
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - C Arcuri
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - G Murialdo
- Second Clinic of Internal Medicine, Department of Internal Medicine, San Martino Polyclinic Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - C Viscoli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - V Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy
| | - L A Nicolini
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
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Di Maio VC, Cento V, Di Paolo D, Aragri M, De Leonardis F, Tontodonati M, Micheli V, Bellocchi MC, Antonucci FP, Bertoli A, Lenci I, Milana M, Gianserra L, Melis M, Di Biagio A, Sarrecchia C, Sarmati L, Landonio S, Francioso S, Lambiase L, Nicolini LA, Marenco S, Nosotti L, Giannelli V, Siciliano M, Romagnoli D, Pellicelli A, Vecchiet J, Magni CF, Babudieri S, Mura MS, Taliani G, Mastroianni C, Vespasiani-Gentilucci U, Romano M, Morisco F, Gasbarrini A, Vullo V, Bruno S, Baiguera C, Pasquazzi C, Tisone G, Picciotto A, Andreoni M, Parruti G, Rizzardini G, Angelico M, Perno CF, Ceccherini-Silberstein F. HCV NS3 sequencing as a reliable and clinically useful tool for the assessment of genotype and resistance mutations for clinical samples with different HCV-RNA levels. J Antimicrob Chemother 2015; 71:739-50. [DOI: 10.1093/jac/dkv403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/29/2015] [Indexed: 12/22/2022] Open
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