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Periprosthetic Joint infection is a terrible clinical challenge and growing healthcare economic burden. Ken Urish MD PhD, an adult reconstructive and arthroplasty orthopedic surgeon from the University of Pittsburgh shares more on the dilemma of Periprosthetic Joint Infection. PJI is associated with a lower survivorship compared to several common forms of cancer and is estimated to burden the healthcare system up to $1.8 billion by 2030. It is also estimated that 60-70% of PJI’s are most commonly initiated at the time of the operation though interoperative contamination. 1,2,3 Do you want to learn how to access the NanoCept™ Antibacterial Coating technology? Sign up by using the link below.  https://lnkd.in/ePCXeVZW The NanoCept™ coating, where applied, is intended to reduce bacterial contamination on the surface of the coated device components prior to implantation, by killing bacteria that are deposited onto the device surface from the operating environment. The device coating is not intended for the treatment of existing infections or prevention of future infections in patients. The potential clinical impact of bacterial reduction from the NanoCept™ coating, including prevention of infection or reduction of infection risk in patients, has not been evaluated in human clinical studies. 1. Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg. 2013;95:2177–2184 2. Premkumar et al. Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. Journal of Arthroplasty 36 (2021)1484-1489 3. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014 Apr;27(2):302-45. doi: 10.1128/CMR.00111-13. PMID: 24696437; PMCID: PMC3993098. CORP 12.10.24 v0

Pneumonia is defined as a lower respiratory tract infection with accompanying consolidation visible on chest x-ray. There are four main types of pneumonia: Community-acquired pneumonia (CAP) Hospital-acquired pneumonia (HAP) Aspiration pneumonia Immunocompromised pneumonia Aspiration Pneumonia Aspiration of the gastric contents into the pulmonary tissue will result in a chemical pneumonitis. However, this is not necessarily an infection, as only if any oropharyngeal bacteria are aspirated into the lung tissue as well will a lung infection result. Classically, any aspirated content will affect the right middle or lower lung lobes, due to the anatomy of the bronchi surgical patients, the main risk factors for an aspiration are: Reduced GCS (e.g. secondary to anaesthesia) Iatrogenic interventions (e.g. misplaced NG tube) Prolonged vomiting without NG tube insertion Underlying neurological disease Oesophageal strictures or fistula Post-abdominal surgery Much of the clinical features and investigations for an aspiration pneumonia will be the same as for HAP. Importantly, aspiration pneumonia should be suspected over a pneumonitis if there is evidence of an infective process developing. Management is mainly preventative, identifying the patients who are at an increased risk of aspirating and placing suitable precautions (e.g. NG tube feeding) in place until suitable. This will require involvement from both the nursing staff and the Speech and Language Therapists (SALT). Any pneumonitis only needs supportive measures, however an aspiration pneumonia will need antibiotic therapy, similar to that of HAP. Suction of any aspirated contents is rarely performed as has no real benefit to overall outcomes.

Case 10: The 37-year-old patient was presented with rescue service suspected of an outpatient acquired pneumonia. In condition after traumatic intracerebral bleeding, brain infarction in pons and Hydrocephalus occlusus, the patient is institutionalized in a stationary care facility. Laboratory mix shows a pronounced infectious constellation. Blood culture showed the detection of Staphylococcus aureus (MRSA). An extensive infection focus search was made. As an infection focus, an abscending inflammation of the penis was registered with detection of Staphylococcus aureus, Morganella morganii, Escherichia coli and Enterococcus faecalis. Resistance-oriented antibiotic therapy with vancomycin and meropenem has been established. The parapenile incision was carried out on the right hand side of median skrotal with the installation of a VAC association. Parapenil remains a wound of about 4 x 2 x 6 cm, with the wound surfaces impressing “greasy”. Furthermore, a dry skin defect of about 1.5 cm diameter is shown on the ventral penis shaft. Overall, no further or new necrosis is visible. Seven days later, a foudroyant disease picture develops in the sense of a Founier gangrene. Clinically impressing a livid-discolored scrotum as well as an edematous swollen penis. An abscess cavity projected after perineal next to the penis root with still intact threshold body. The large-area necroctomy of the penis root and scrotum as well as the rinsing of the wound cavity with Lavanid® takes place. Pathological working up of the tissue sample showed granulocytically demarked necrosis in the skin/subcutitis tissue of the penis root and scrotum, matching a Fournier gangrene. Diagnosis: Sepsis at Founier gangrene of the penis with detection of Staphylococcus aureus, Morganella morganii, Escherichia coli and Enterococcus faecalis Summary „You have just witnessed in our rooms a very sad spectacle. This pertains to a young man whose genital organs have become gangrenous.“ This is how the article “Gangrene Foudroyante de la Verge (Overhelming Gangrene)”, in which Jean-Alfred Fournier, a dermatologist and venerologist working in Paris, describes a gangrenous inflammation of the genital organs of a healthy young man in 1883. The Fournier gangrene is a special form of necrotising soft tissue infections and may affect the genital, perineal and perianal regions. Although Fournier is the name of the disease, it was documented for the first time by the Baurienne in 1764. In most cases, this is a polymicrobial infection by Enterobacteriaceae. Early and aggressive surgical and antimicrobial therapy reduces morbidity and mortality. The indication of surgical exploration must be given generous accordingly. Calculated antimicrobial therapy is carried out at an early stage, intravenously and at a sufficiently high dosage.

Title: Diabetic Foot Ulcers: INTRODUCTION: Diabetic foot ulcers are a debilitating and often devastating complication of diabetes mellitus. These ulcers are characterized by open sores or wounds that primarily occur on the feet. Their development is closely linked to the complications of diabetes, including neuropathy, poor circulation, and high blood sugar levels. If left untreated, diabetic foot ulcers can lead to severe complications, including infection, gangrene, and even amputation. This comprehensive article will delve into the intricate details of diabetic foot ulcers, exploring their causes, necessary investigations, treatment options, surgical interventions, recent advancements in treatment, and differential diagnosis. CAUSES OF DIABETIC FOOT ULCERS: Diabetic foot ulcers are the result of several interrelated factors, each of which plays a significant role in their development. 1.      Neuropathy: Diabetic neuropathy, or nerve damage, is a common complication of diabetes. It affects the peripheral nerves, particularly those in the feet. Neuropathy leads to a loss of sensation in the feet, making patients less aware of pain, pressure, or injury. Reduced sensation increases the likelihood of unnoticed trauma, such as stepping on a sharp object or developing friction blisters. 2.      Poor Circulation: Diabetes can lead to the narrowing of blood vessels and reduced blood flow, a condition known as peripheral arterial disease (PAD). Reduced blood flow limits the body's ability to deliver oxygen and nutrients to tissues in the feet, impairing the natural healing process. 3.      High Blood Sugar Levels: Elevated glucose levels in the blood can interfere with the body's ability to fight infection and heal wounds. High blood sugar levels also contribute to the thickening of blood vessels, further compromising blood flow to the extremities. 4.      Foot Deformities: Many individuals with diabetes develop foot deformities, such as bunions, hammertoes, or Charcot foot. These deformities can create areas of increased pressure and friction on the feet, increasing the risk of developing ulcers. 5.      Foot Trauma: Even minor injuries, such as a small cut, blister, or callus, can become ulcerated due to impaired healing mechanisms in diabetes. Without proper care, these injuries can progress to more serious ulcers. 6.      Infection: Bacterial or fungal infections can complicate diabetic foot ulcers, leading to cellulitis, abscess formation, or osteomyelitis (infection of the bone).

This study evaluates nosocomial infections in pediatric patients post-cardiac surgery, analyzing data from the National Center for Cardiovascular Diseases in China. Out of 4776 patients, the nosocomial infection rate was 2.1%, with multidrug-resistant organisms (MDROs) found in 36 patients. Pneumonia and sepsis were the most common infections, with pneumonia showing an incidence density of 7. #MultidrugResistantOrganisms #NosocomialInfections #PediatricCardiacSurgery #SurgicalOutcomes

This study evaluates nosocomial infections in pediatric patients post-cardiac surgery, analyzing data from the National Center for Cardiovascular Diseases in China. Out of 4776 patients, the nosocomial infection rate was 2.1%, with multidrug-resistant organisms (MDROs) found in 36 patients. Pneumonia and sepsis were the most common infections, with pneumonia showing an incidence density of 7. #MultidrugResistantOrganisms #NosocomialInfections #PediatricCardiacSurgery #SurgicalOutcomes

For many decades, patients recovering from wound closure have been instructed not to bathe. Although studies have shown that earlier postoperative bathing does not increase the risk of wound infection, it remains rare in practice for patients to be allowed earlier postoperative bathing. We performed this meta-analysis to determine how earlier bathing affected rates of wound infection, other complications, and patient satisfaction. This systematic review conforms to PRISMA guidelines. The PubMed, EMBASE, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception dates to December 31, 2022. We estimated pooled values for the efficacy of trial of earlier bathing versus delayed bathing using the odds ratio and their associated 95% CI, and we used the I 2 statistic to assess heterogeneity between studies contributing to these estimates. Of the 1813 articles identified by our search, 11 randomized controlled trials including 2964 patients were eligible for inclusion. The incidence of wound infection did not differ significantly between the earlier bathing and delayed bathing groups, nor did rates of other wound complications such as redness and swelling, or wound dehiscence. However, the incidence of hematoma in the delayed bathing group was higher than in the earlier bathing group. Reported patient satisfaction was significantly higher in the earlier bathing group. The medical community, health authorities, and government should create and disseminate clinical practice guidelines to guide patients to evidence-based beneficial treatment. Read more on 📄 Does earlier bathing increase the risk of surgical site infection? A meta-analysis of 11 randomized controlled trials https://bit.ly/4cbFy7f ✒️ Yu Ren, Hui Yu, Zhangfu Wang, Wenjun Pan, Lin Chen, and Hua Luo #OpenReviews #surgicalsiteinfection #infection #wound #woundcomplication #postoperative #bathing #orthopedics #orthopaedics #surgery #orthopedicsurgery #orthopaedicsurgery #openaccess #openaccessjournal

2.Title: “Post-Cardiovascular Surgery Complications: Investigating Fever, Chest Pain, and Leukocytosis after Triple Bypass Surgery – Diagnostic Research and Infection Management” Potential Causes of Post-CABG Infections: Infections following CABG surgery are not uncommon and can stem from several sources, including surgical site infections, sternal wound infections, endocarditis, or mediastinitis. The presence of fever, chest pain, and high WBC counts after two months warrants the investigation of these complications. 1. Surgical Site Infection (SSI): Infections at the incision site are a known risk after CABG, particularly in patients with comorbidities like diabetes or obesity. SSIs may be superficial or deep, extending into the sternum and chest cavity. Symptoms include localized redness, swelling, discharge, and tenderness. 2. Sternal Wound Infection (SWI): A more serious form of infection, SWI, may result from the disruption of the sternum during surgery. These infections can lead to osteomyelitis (bone infection) if not treated promptly. Fever, pain at the wound site, and elevated WBC counts are common indicators. 3. Mediastinitis: Mediastinitis is a deep infection of the mediastinum (the space between the lungs) that may occur after CABG. This is a life-threatening condition that requires immediate medical intervention. It typically presents with systemic symptoms such as fever, chest pain, and high WBC counts. 4. Endocarditis: Endocarditis, an infection of the heart valves or inner lining of the heart chambers, can occur post-surgery due to bacterial contamination. This can cause fever, malaise, heart murmurs, and systemic embolic events. It can be diagnosed through blood cultures and echocardiography. Courtesy to Dr. Natasha Alterman ,Cardiologist,Auckland City Hospital,USA

Case 9 The 45-year-old male patient presented himself to the rescue centre with deterioration in general condition, fever, chills and ascites. Clinically impresses the full image of decompensated liver cirrhosis of ethyltoxic genesis CHILD B. Blood cultures were removed and calculated antibiotic therapy with ceftriaxone and metronidazole was initiated. In the point of ascite spontaneous bacterial peritonitis could be ruled out. Despite optimization of therapy, renal function deteriorated, so that the indication of acute dialysis was made under suspicion of hepatorenal syndrome. Furthermore, a Demers catheter was implanted by the colleagues of visceral surgery. Following the inflammation parameters were increased with the beginning of sepsis. CT of Thorax and Abdomen remained unobtrusive. #Serratia spp. was detected in blood cultures. Transoesophageal #echocardiography showed an echo-dense flotating additional structure on the aortic valve corresponding to vegetation. Further Duke criteria could not be demonstrated. In aortic valve endocarditis with detection of Serratia marcescens, antibiotic therapy with meropenem was initiated. Since the detection of Serratia nematodiphila (2/2) and Serratia marcescens (3/3) was carried out after the installation of the Demers catheter and five positive blood cultures are present, a device-associated infection can be considered. Due to an assumed pathophysiological infectiological relationship, the Demers catheter was therefore explantated. The additional administration of quinolone and gentamycin was omitted with renal impairment. No further foci was found. In echocardiographic course control, the above-described additional structure on the aortic valve impressed as size-regulated. A final PET-CT showed no further inflammatory focus. Removed blood cultures subsequently remained sterile. Infectiological diagnosis: aortic valve #endocarditis with detection of Serratia marcescens Summary Serratia marcescens is a remarkable “miracle of Bolsena” (1263) and other blood miracles, which have been popular since the 13th century until the Reformation period. Serratia marcescens can thrive well on the hosts used for the Latin celebration since the 12th century and cause red discoloration, which gives the wrong impression of a host miracle. The International Collaboration on Endocarditis (ICE) Prospective Cohort Study reported non-#HACEK Gram-negative bacteria for example Serratia marcescens in 49 of 2761 (1.8%) IE cases. Recommended treatment is early surgery plus prolonged (6 weeks) therapy with bactericidal combinations of beta-lactams and aminoglycosides, sometimes with additional quinolones or cotrimoxazole. Because of their rarity and severity, these conditions should be discussed by the Endocarditis Team.

📃Scientific paper: Tunnel ultrasound can guide the use of peritoneal dialysis catheter exit site relocation by external splicing and cuff removal in refractory tunnel infection Abstract: Background Peritoneal dialysis (PD) catheter related infections continue to be a major cause of morbidity and transfer to hemodialysis (HD) in PD patients. The treatment of tunnel infection (TI) could be challenging, especially when the infection involves the superficial cuff requiring the removal of the catheter. To spare the patient the loss of the catheter and the transfer to HD, several mini-invasive surgical techniques have been proposed as rescue therapy. Furthermore, nowadays, the rapid growth of digital technology has enormously increased the diagnostic sensibility of the echo signal allowing to accurately defines the extent of the infectious process along the PD catheter tunnel. Methods Between 1st January 2020 and 31st December 2021 seven patients who underwent exit-site relocation by external splicing and cuff removal at our institution due to refractory TI were included in the study. All patients were followed until 12 months after the procedure. As soon as TI was defined refractory to the medical therapy, an ultrasonographic examination of the catheter tunnel was performed to define the extent of the infectious episode. Results Among the 7 infectious episodes, 4 were caused by P. aeruginosa , and 3 by S. aureus . Around the superficial cuff the hypo/anechoic collections detected by ultrasounds showed a mean diameter of 3.05 ± 0.79 mm. The exit-site relocation by external splicing and cuff removal was successful in all cases (7/7, 100%). Conclusions In... Continued on ES/IODE ➡️ https://etcse.fr/uqhx ------- If you find this interesting, feel free to follow, comment and share. We need your help to enhance our visibility, so that our platform continues to serve you.