Orthopedic Implant-Associated Infection by Multidrug Resistant Enterobacteriaceae

Autor: Alicia Macías-Valcayo, Bernadette Pfang, Raul Parron-Cambero, Julia García-Lasheras, Jaime Esteban, Joaquín García-Cañete, Antonio Blanco, Álvaro Auñón
Jazyk: angličtina
Rok vydání: 2019
Předmět:
medicine.medical_specialty
Klebsiella pneumoniae
medicine.medical_treatment
Population
lcsh:Medicine
03 medical and health sciences
0302 clinical medicine
orthopedic implant-associated infection
Internal medicine
bone and joint infection
medicine
Infection control
030212 general & internal medicine
prosthetic joint infection
education
0303 health sciences
education.field_of_study
Debridement
biology
030306 microbiology
business.industry
Incidence (epidemiology)
lcsh:R
Retrospective cohort study
General Medicine
biology.organism_classification
orthopedic implant-associated infection
bone and joint infection
prosthetic joint infection
multidrug resistant Enterobacteriaceae
multidrug resistant Gram-negative bacilli
Orthopedic surgery
Implant
business
multidrug resistant Gram-negative bacilli
multidrug resistant Enterobacteriaceae
Zdroj: Journal of Clinical Medicine
Volume 8
Issue 2
Journal of Clinical Medicine, Vol 8, Iss 2, p 220 (2019)
ISSN: 2077-0383
DOI: 10.3390/jcm8020220
Popis: Introduction: Orthopedic implant-associated infections caused by multidrug-resistant Enterobacteriaceae are a growing challenge for healthcare providers due to their increasing incidence and the difficulties of medical and surgical treatment. Material and Methods: A retrospective observational study of all cases of multidrug resistant Enterobacteriaceae orthopedic implant-associated infection diagnosed in a tertiary European hospital from December 2011 to November 2017 was carried out. Clinical records were reviewed using a previously designed protocol. Data analysis was performed with IBM®
SPSS®
version 22. Results: 25 patients met inclusion criteria. The infected implants included 10 prosthetic joints, seven osteosyntheses, six combinations of prosthetic joint and osteosynthesis material, and two spacers. Of the multidrug resistant Enterobacteriaceae obtained on culture, 12 were extended-spectrum beta-lactamase-producing Escherichia coli, three OXA-48-producing Klebsiella pneumoniae, nine extended-spectrum beta-lactamase-producing Klebsiella pneumoniae, and one extended-spectrum beta-lactamase-producing Proteus mirabilis. Combination antimicrobial therapy was employed in all cases but two. Overall, 16 (64%) patients underwent implant removal. The rate of infection control in the overall implant removal group was 100% compared to 33% in the implant retention group. A strong relationship between implant removal and infection control was observed (p = 0.001). Discussion: Implant removal is strongly associated with infection control. However, in some cases, patient age and comorbidity contraindicate hardware extraction. Potential objectives for future studies should be geared towards targeting the population in which debridement, antibiotic therapy, and implant retention can be used as a first-line therapeutic strategy with a reasonable probability of achieving infection control.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje