Acute Hematogenous Periprosthetic Hip Infection by Gemella morbillorum, Successfully Treated with Debridement, Antibiotics and Implant Retention : A Case Report and Literature Review of Osteoarticular Gemella morbillorum Infections

Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as endocarditis, meningitis or brain abscesses, and very rarely can cause osteoarticular infections. Herein, a case report of an acute hematogenous prosthetic hip infection caused by Gemella morbillorum, successfully treated with a DAIR and beta-lactam antibiotic therapy, is presented. We provide a literature review of the other orthopedic-related infections caused by this microorganism

Adherence to a reliable PJI diagnostic protocol minimizes unsuspected positive cultures rate

The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol. This is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons' discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery). Based on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001). A thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures

Diagnosi i anàlisi de la petjada de carboni en el cicle de vida dels residus municipals a la Vall d'Alinyà

La gestió i el tractament dels residus ha esdevingut una de les problemàtiques ambientals de la societat actual, que genera uns impactes greus sobre el medi. En aquest projecte s'analitza l'impacte associat a les emissions de CO2eq produïdes en la gestió i tractament dels residus municipals d'una zona rural difosa, la Vall d'Alinyà. Aquesta està situada a la comarca de l'Alt Urgell i es caracteritza per tenir una baixa densitat de població, uns nuclis poblacionals disseminats i grans distàncies entre els punts de recollida i tractament. A més de la situació de l'any 2012, s'ha analitzat l'impacte de l'aplicació del nou pla de residus de Catalunya (PRECAT20). Les emissions s'han analitzat mitjançant l'eina innovadora d'anàlisi ambiental ZWCO2, que segueix un protocol de càlcul per a la identificació i quantificació dels gasos d'efecte hivernacle al llarg del cicle de vida de la gestió dels residus municipals. Els resultats indiquen una petjada de carboni per habitant elevada l'any 2012 en comparació amb Catalunya i l'Alt Urgell, vuit vegades per sobre. Això és degut a que els mètodes de tractament de la fracció resta i les emissions associades al transport són diferents a la zona d'estudi. Com a conclusió principal es pot afirmar que l'aplicació del PRECAT20 no comporta una disminució de la petjada de carboni, ja que les emissions evitades de la recollida selectiva es compensen amb les emissions generades associades a l'increment dels viatges realitzats. Per disminuir la petjada de carboni cal millorar les tècniques de tractament de la fracció resta i/o aplicar la captació de biogàs al dipòsit controlat, arribant a una reducció del 50% de la petjada de carboni.The waste management and treatment has become one of the actual environmental problem in our society, and this problem generates serious environmental problems. In this project it is analysed the impact associated to the CO2eq emissions that are produced by the management and treatment of municipal waste in a diffuse rural area. In this study the diffuse rural area is la Vall d'Alinyà. Vall d'Alinyà is located in Alt Urgell and it has some features like a low population density, population centers scattered and long distances between the treatment points and the collection points. The CO2 emissions produced by the management and treatment of municipal waste in a diffuse rural area is analysed by the ZWCO2 software. The software follows a protocol for the identification and quantification of greenhouse gas emissions throughout the life cycle management of municipal waste. The results indicate that there is an increase of eight times the footprint by the year 2012 compared to Alt Urgell and Catalonia. This is because the methods of treatment and the remaining fraction of emissions associated with transport are different in the study area. The main conclusion we can say that the application of PRECAT20 plan not involve a reduction in carbon footprint, since the emissions avoided by selective collection offset the emissions associated with the increase in trips. To reduce the carbon footprint needed to improve treatment techniques other waste fraction and / or apply the landfill biogas capture, reaching a 50% reduction in carbon footprint.La gestión y el tratamiento de los residuos se ha convertido en una de las problemáticas ambientales de la sociedad actual, que genera unos impactos graves sobre el medio. En este proyecto se analiza el impacto asociado a las emisiones de CO2eq producidas en la gestión y tratamiento de los residuos municipales de una zona rural difusa, la Vall d'Alinyà. Está situada en la comarca del Alt Urgell y se caracteriza por tener una baja densidad de población, unos núcleos poblacionales diseminados y grandes distancias entre los puntos de recogida y tratamiento. Además de la situación del año 2012, se ha analizado el impacto de la aplicación del nuevo plan de residuos de Cataluña (PRECAT20). Las emisiones se han analizado mediante la herramienta innovadora de análisis ambiental ZWCO2, que sigue un protocolo de cálculo para la identificación y cuantificación de los gases de efecto invernadero a lo largo del ciclo de vida de la gestión de los residuos municipales. Los resultados indican una huella de carbono por habitante elevada el año 2012 en comparación con Cataluña y el Alt Urgell, ocho veces por encima. Esto es debido a que los métodos de tratamiento de la fracción resto y las emisiones asociadas al transporte son diferentes en la zona de estudio. Como conclusión principal se puede afirmar que la aplicación del PRECAT20 no conlleva una disminución de la huella de carbono, ya que las emisiones evitadas de la recogida selectiva se compensan con las emisiones generadas asociadas al incremento de los viajes realizados. Para disminuir la huella de carbono es necesario mejorar las técnicas de tratamiento de la fracción resto y/o aplicar la captación de biogás en el depósito controlado, llegando a una reducción del 50% de la huella de carbono

Rates and Predictors of Treatment Failure in Staphylococcus aureus Prosthetic Joint Infections According to Different Management Strategies: A Multinational Cohort Study—The ARTHR-IS Study Group

Introduction: Guidelines have improved the management of prosthetic joint infections (PJI). However, it is necessary to reassess the incidence and risk factors for treatment failure (TF) of Staphylococcus aureus PJI (SA-PJI) including functional loss, which has so far been neglected as an outcome. Methods: A retrospective cohort study of SA-PJI was performed in 19 European hospitals between 2014 and 2016. The outcome variable was TF, including related mortality, clinical failure and functional loss both after the initial surgical procedure and after all procedures at 18 months. Predictors of TF were identified by logistic regression. Landmark analysis was used to avoid immortal time bias with rifampicin when debridement, antibiotics and implant retention (DAIR) was performed. Results: One hundred twenty cases of SA-PJI were included. TF rates after the first and all surgical procedures performed were 32.8% and 24.2%, respectively. After all procedures, functional loss was 6.0% for DAIR and 17.2% for prosthesis removal. Variables independently associated with TF for the first procedure were Charlson >= 2, haemoglobin 30 kg/m(2) and delay of DAIR, while rifampicin use was protective. For all procedures, the variables associated with TF were haemoglobin < 10 g/dL, hip fracture and additional joint surgery not related to persistent infection. Conclusions: TF remains common in SA-PJI. Functional loss accounted for a substantial proportion of treatment failures, particularly after prosthesis removal. Use of rifampicin after DAIR was associated with a protective effect. Among the risk factors identified, anaemia and obesity have not frequently been reported in previous studies. [GRAPHICS]

Factors predictius en el pronòstic de les fractures de 2 i 3 parts de l’húmer proximal tractades de forma conservadora

Aquesta tesi estudia els factors predictius dels resultats funcionals i de la percepció de la qualitat de vida, de pacients que han presentat una fractura desplaçada de dos i tres parts de l’húmer proximal i han estat tractats de forma conservadora. Com a objectiu principal de l’estudi, pretenem valorar la influència del desplaçament en var i valg del cap humeral en els resultats finals, i com a objectius secundaris, la influència del sexe, les comorbilitats i l’edat dels pacients en els resultats després d’un any de seguiment. D’un total de 223 pacients amb fractura de l’húmer proximal que van acudir de forma consecutiva als serveis d’urgències, finalment 111 han estat inclsosos en l’estudi. A tots ells se’ls ha realitzat una RX en projecció anteroposterior i lateral en el pla de l’escàpula, i una TAC en visions axial, coronal i sagital. Han estat classificats d’acord els criteris de Neer en fractures de 2 i 3 parts ( es van excloure les fractures en 4 parts) i tots ells tractats de forma conservadora. El seguiment ha estat d’un any. S’han analitzat les següents variables: edat, sexe, lateralitat, comorbilitat, relació cefalo diafisària, puntuació del test de Constant Murley global i desglossat per a l’extremitat afectada i la contralateral , puntuació del Constant relatiu individual i qüestionari SF-36 en tots els seus dominis a l’any. Es tracta de 94 dones i 17 homes, d’edat mitja 72.4 anys. 62 fractures de 2 parts ( 52 del coll quirúrgic i 10 de la tuberositat gran) i 49 fractures de 3 parts ( 23 en posició cefàlica en var i 26 en valg). El 50,5% dels pacients tenien comorbilitats associades. Constant mig de la sèrie 65.23 punts. Angle cefalodiafisari mig 137.23 graus. Escales física i mental del SF-36, 39,38 i 44,55 punts respectivament. Com a resultats analitzats: les fractures de 3 parts en var, són les que tenen pitjors resultats funcionals ( Constant mig 57.43 punts) i els pitjors resultats de guany percentual respecte l’extremitat contralateral ( 74.53%). Les fractures de 2 parts del coll quirúrgic i de 3 parts en valg tenen resultats comparables ( Constant 63.44 i 62.38 respectivament). Les fractures en 2 parts de la tuberositat gran tenen els millors resultats ( Constant mig 79.43) No hem pogut establir una relació estadísticament significativa de l’angle cefalodiafisari, com a predictiu dels resultats en cap de les correlacions entre els grups. Els valors de Constant i SF-36 empitjoren significativament amb l’edat. Les comorbilitats afecten significativament els resultats finals. El sexe femení presenta pitjors resultats en l’ítem força del test de Constant. Com a conclusions: el desplaçament en var o valg no és un factor predictiu dels resultats. L’edat i les comorbilitats són factors predictius negatius dels resultats. El sexe no és un factor predictiu dels resultats.We analyze the predictive factors affecting functional results and quality of life perception of the patients who underwent a displaced 2 and 3 parts fracture of the proximal humerus, and have been conservatively treated. As a main objective, we want to assess the influence of the varus and valgus displacement of the humeral head in the outcome, and as secondary objectives, the influence of the sex, comorbidities and age of the patients in the results after one-year follow-up. One hundred and eleven patients have been included in the study. All of them have been checked with and anteroposterior and lateral x-ray views of the shoulder, as well a CT scan in the sagital, coronal and axial views. They were classified, according to the Neer criteria, between 2 and 3 part fractures ( 4 part fractures were excluded) and the whole series was conservatively treated. Follow-up one year. We have analyzed the following variables: age, sex, laterality, comorbidities, shaft-head relation, global and itemized Constant Murley score for both, the affected and the contralateral shoulder , the individual relative Constant score and the SF-36 questionnaire at one year follow-up. There were 94 women and 17 men, mean age 72 years, 62 two part fractures ( 52 surgical neck , 10 great tuberosity) and 49 three part fractures ( 23 in varus and 26 in valgus, according to the position of the humeral head). 50.5% of the patients had associated comorbidities. Mean Constant of 65.23 for the series. Mean shaft-head angle 137.23 degrees. Mental and Physical SF-36 scale, of 39.38 and 44.55 respectively. Results: the three part varus fractures, had the worst functional results ( Constant 57.43) and the poor recovery results comparing with the contralateral shoulder ( 74.53%). The surgical neck fractures and the three part valgus fractures had comparable outcomes ( Constant 63.44 and 62.38 respectively). The two part fractures affecting the great tuberosity had the best results ( Constant 79.43). We couldn’t find any correlation between the humeral head-shaft angle with the outcomes in all the groups. Constant and SF-36 scores, become worst with age. Comorbidities significantly affect the final results. Conclusions: the varus and valgus displacement of the humeral head, are not a predictive factors of the results. The age and comorbidities are negative predictive factors of the outcome. Gender is not a predictive factor of the results

Factors predictius en el pronòstic de les fractures de 2 i 3 parts de l'húmer proximal tractades de forma conservadora

Aquesta tesi estudia els factors predictius dels resultats funcionals i de la percepció de la qualitat de vida, de pacients que han presentat una fractura desplaçada de dos i tres parts de l'húmer proximal i han estat tractats de forma conservadora. Com a objectiu principal de l'estudi, pretenem valorar la influència del desplaçament en var i valg del cap humeral en els resultats finals, i com a objectius secundaris, la influència del sexe, les comorbilitats i l'edat dels pacients en els resultats després d'un any de seguiment. D'un total de 223 pacients amb fractura de l'húmer proximal que van acudir de forma consecutiva als serveis d'urgències, finalment 111 han estat inclsosos en l'estudi. A tots ells se'ls ha realitzat una RX en projecció anteroposterior i lateral en el pla de l'escàpula, i una TAC en visions axial, coronal i sagital. Han estat classificats d'acord els criteris de Neer en fractures de 2 i 3 parts ( es van excloure les fractures en 4 parts) i tots ells tractats de forma conservadora. El seguiment ha estat d'un any. S'han analitzat les següents variables: edat, sexe, lateralitat, comorbilitat, relació cefalo diafisària, puntuació del test de Constant Murley global i desglossat per a l'extremitat afectada i la contralateral , puntuació del Constant relatiu individual i qüestionari SF-36 en tots els seus dominis a l'any. Es tracta de 94 dones i 17 homes, d'edat mitja 72.4 anys. 62 fractures de 2 parts ( 52 del coll quirúrgic i 10 de la tuberositat gran) i 49 fractures de 3 parts ( 23 en posició cefàlica en var i 26 en valg). El 50,5% dels pacients tenien comorbilitats associades. Constant mig de la sèrie 65.23 punts. Angle cefalodiafisari mig 137.23 graus. Escales física i mental del SF-36, 39,38 i 44,55 punts respectivament. Com a resultats analitzats: les fractures de 3 parts en var, són les que tenen pitjors resultats funcionals ( Constant mig 57.43 punts) i els pitjors resultats de guany percentual respecte l'extremitat contralateral ( 74.53%). Les fractures de 2 parts del coll quirúrgic i de 3 parts en valg tenen resultats comparables ( Constant 63.44 i 62.38 respectivament). Les fractures en 2 parts de la tuberositat gran tenen els millors resultats ( Constant mig 79.43) No hem pogut establir una relació estadísticament significativa de l'angle cefalodiafisari, com a predictiu dels resultats en cap de les correlacions entre els grups. Els valors de Constant i SF-36 empitjoren significativament amb l'edat. Les comorbilitats afecten significativament els resultats finals. El sexe femení presenta pitjors resultats en l'ítem força del test de Constant. Com a conclusions: el desplaçament en var o valg no és un factor predictiu dels resultats. L'edat i les comorbilitats són factors predictius negatius dels resultats. El sexe no és un factor predictiu dels resultats.We analyze the predictive factors affecting functional results and quality of life perception of the patients who underwent a displaced 2 and 3 parts fracture of the proximal humerus, and have been conservatively treated. As a main objective, we want to assess the influence of the varus and valgus displacement of the humeral head in the outcome, and as secondary objectives, the influence of the sex, comorbidities and age of the patients in the results after one-year follow-up. One hundred and eleven patients have been included in the study. All of them have been checked with and anteroposterior and lateral x-ray views of the shoulder, as well a CT scan in the sagital, coronal and axial views. They were classified, according to the Neer criteria, between 2 and 3 part fractures ( 4 part fractures were excluded) and the whole series was conservatively treated. Follow-up one year. We have analyzed the following variables: age, sex, laterality, comorbidities, shaft-head relation, global and itemized Constant Murley score for both, the affected and the contralateral shoulder , the individual relative Constant score and the SF-36 questionnaire at one year follow-up. There were 94 women and 17 men, mean age 72 years, 62 two part fractures ( 52 surgical neck , 10 great tuberosity) and 49 three part fractures ( 23 in varus and 26 in valgus, according to the position of the humeral head). 50.5% of the patients had associated comorbidities. Mean Constant of 65.23 for the series. Mean shaft-head angle 137.23 degrees. Mental and Physical SF-36 scale, of 39.38 and 44.55 respectively. Results: the three part varus fractures, had the worst functional results ( Constant 57.43) and the poor recovery results comparing with the contralateral shoulder ( 74.53%). The surgical neck fractures and the three part valgus fractures had comparable outcomes ( Constant 63.44 and 62.38 respectively). The two part fractures affecting the great tuberosity had the best results ( Constant 79.43). We couldn't find any correlation between the humeral head-shaft angle with the outcomes in all the groups. Constant and SF-36 scores, become worst with age. Comorbidities significantly affect the final results. Conclusions: the varus and valgus displacement of the humeral head, are not a predictive factors of the results. The age and comorbidities are negative predictive factors of the outcome. Gender is not a predictive factor of the results

Acute Hematogenous Periprosthetic Hip Infection by Gemella morbillorum, Successfully Treated with Debridement, Antibiotics and Implant Retention: A Case Report and Literature Review of Osteoarticular Gemella morbillorum Infections

Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as endocarditis, meningitis or brain abscesses, and very rarely can cause osteoarticular infections. Herein, a case report of an acute hematogenous prosthetic hip infection caused by Gemella morbillorum, successfully treated with a DAIR and beta-lactam antibiotic therapy, is presented. We provide a literature review of the other orthopedic-related infections caused by this microorganism

Acute hematogenous periprosthetic hip infection by Gemella morbillorum, successfully treated with debridement, antibiotics and implant retention: A case report and literature review of osteoarticular Gemella morbillorum infections

Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as endocarditis, meningitis or brain abscesses, and very rarely can cause osteoarticular infections. Herein, a case report of an acute hematogenous prosthetic hip infection caused by Gemella morbillorum, successfully treated with a DAIR and beta-lactam antibiotic therapy, is presented. We provide a literature review of the other orthopedic-related infections caused by this microorganism

Functional outcomes and complications of patients contaminated with Cutibacterium acnes during primary reverse shoulder arthroplasty: study at two- and five-years of follow-up

International audiencePurpose: The objective of the study was to compare the functional outcomes and the complication rate of the patients with C. acnes contamination at the end of the primary reverse shoulder arthroplasty (RSA) surgery to those patients without C. acnes contamination.Method: A total of 162 patients were included. In all cases, skin and deep tissue cultures were obtained. A molecular typing characterization of the C. acnes strains was performed. Functional outcomes were assessed with the Constant score at the two and five year follow-up and all complications were also recorded.Results: A total of 1380 cultures were obtained from the 162 primary RSA surgeries. Of those, 96 turned out to be positive for C. acnes. There were 25 patients with positive cultures for C. acnes. The overall postoperative Constant score was not significantly different between those patients having C. acnes-positive cultures and those with negative cultures at the two and five year follow-up (59.2 vs. 59.6 at two years, p 0.870, and 59.5 vs. 62.4 at five years, p 0.360). Patients with positive cultures presented a higher complication rate (p 0.001) with two infections, one revision surgery, and one dislocation.Conclusion: Patients ending up with C. acnes-positive cultures after primary shoulder arthroplasty surgery do not have worse clinical outcomes when compared to patients having negative cultures, but a greater number of complications were found in those patients with C. acnes-positive cultures