Is the daily use of public transport facilities an enhanced epidemiological risk for diagnosing COVID-19 among healthcare workers with mild respiratory symptoms?

Introduction: Many people in Switzerland think that the daily use of the public transport facilities, during a pandemic peak wave, could be associated with an enhanced risk for Covid-19. Objectives: To investigate the association between the daily use of the public transport and acquisition of Covid-19 in Zurch during a peak wave of the pandemics. Methods: Retrospective cohort analysis of hospital-own databases at the Balgrist University Hospital in Zurich, between 1 October and 31 December 2020. We specifically interviewed our healthcare workers (HCW) about the use of public transport (with mandatory masking). Results: During the three most intensive months of the 2nd wave, we investigated 376 episodes of Covid-19-compatible respiratory symptoms and exposures among our HCW (median age 37 years), of which 94 (25%) revealed a positive PCR result for Covid-19. Overall, 225 HCW (225/376;60%) reportedly used the public transport (train, bus, tramway). In group comparison, the HCWs using the public transport system acquired no more Covid-19 than using a private transport (58/225 vs. 36/151;Pearson-chi2-test;p = 0.67). We added a logistic regression model with the outcome “Covid-19 infection” to adjust for the case-mix of different localizations or opportunities of potential contamination such as a documented exposure in the hospital, among the team members, in the family, or after a close contact to a PCR-confirmed case. In the multivariate results, using the public transport was irrelevant concerning the acquisition of Covid- 19 (odds ratio (OR) 0.98, 95%CI 0.59-1.62), in contrast, for example, to being exposed to a sick team member (OR 2.28, 95%CI 1.20-4.34). Conclusion: In Zurich, the daily use of public transport was not associated with an additional risk of being diagnosed with Covid-19 among the young population of HCWs, not even during the peak of a pandemic wave. Other factors are more relevant

Predicting the pathogen of diabetic toe osteomyelitis by two consecutive ulcer cultures with bone contact

In this study, we investigate the accuracy of two consecutive ulcer cultures with bone contact compared to bone biopsy for the diagnosis of diabetic toe osteomyelitis. The same nurse and orthopaedic surgeon obtained all samples: sample A-1: bone contact swabbing through the ulcer; sample A-2: a second culture swabbing from the bone surface within 24 h; sample B: surgical bone biopsy in the operating theatre. The kappa statistic measure between samples A-1 and A-2 (bone contact swabs) indicated 82.35% agreement. The sensitivity, specificity, positive and negative predictive values of the two samples A compared to B were 96%, 79%, 92% and 88%, respectively, for the causative pathogen. These results were similar with prior antibiotic treatment, discordant bone surface swabs or with monomicrobial infections. As a conclusion, two consecutive diabetic toe cultures with bone contact accurately predict the pathogen of diabetic toe osteomyelitis in 90% of cases

Predicting the pathogen of diabetic toe osteomyelitis by two consecutive ulcer cultures with bone contact

In this study, we investigate the accuracy of two consecutive ulcer cultures with bone contact compared to bone biopsy for the diagnosis of diabetic toe osteomyelitis. The same nurse and orthopaedic surgeon obtained all samples: sample A-1: bone contact swabbing through the ulcer; sample A-2: a second culture swabbing from the bone surface within 24 h; sample B: surgical bone biopsy in the operating theatre. The kappa statistic measure between samples A-1 and A-2 (bone contact swabs) indicated 82.35% agreement. The sensitivity, specificity, positive and negative predictive values of the two samples A compared to B were 96%, 79%, 92% and 88%, respectively, for the causative pathogen. These results were similar with prior antibiotic treatment, discordant bone surface swabs or with monomicrobial infections. As a conclusion, two consecutive diabetic toe cultures with bone contact accurately predict the pathogen of diabetic toe osteomyelitis in 90% of case

Management of Asymptomatic Bacteriuria, Urinary Catheters and Symptomatic Urinary Tract Infections in Patients Undergoing Surgery for Joint Replacement: A Position Paper of the Expert Group 'Infection' of swissorthopaedics.

In this position paper, we review definitions related to this subject and the corresponding literature. Our recommendations include the following statements. Asymptomatic bacteriuria, asymptomatic leukocyturia, urine discolouration, odd smell or positive nitrite sediments are not an indication for antimicrobial treatment. Antimicrobial treatment of asymptomatic bacteriuria does not prevent periprosthetic joint infection, but is associated with adverse events, costs and antibiotic resistance development. Urine analyses or urine cultures in asymptomatic patients undergoing orthopaedic implants should be avoided. Indwelling urinary catheters are the most frequent reason for healthcare-associated urinary tract infections and should be avoided or removed as soon as possible

Surgical Site Infections at Donor and Recipient Sites in Patients with Iliac Crest Harvesting For Autologous Bone Grafting - A Pilot Evaluation

Surgeons harvest the iliac crest for bone grafting. The epidemiology of surgical site infections (SSI) associated with this procedure at the donor, or recipient site, is unknown. We perform a retrospective pilot evaluation of adult patients undergoing first-time orthopedic surgery at the Balgrist University Hospital between 2014-2019. We excluded patients with infection at the index surgery, diabetic foot surgeries, superficial SSIs, and revision surgeries. We included 20,088 episodes of primary orthopedic surgery, of which 467 with iliac crest bone sampling (467/20,088; 2%). Only two iliac sites (2/467; 0.4%) become infected. In contrast, surgeries with iliac crest sampling yielded more SSIs at the recipient site than those without (1.9% vs. 0.8%; χ2-test; p<0.01). These patients equally revealed more co-morbidities such as a longer duration of surgery (median 127 vs. 79 minutes), when compared to the general orthopedic population. In multivariate logistic regression analysis with the outcome “ SSI at the recipient site”, the iliac harvesting was independently associated with deep SSIs requiring surgical revision (odds ratio 2.1; 95% confidence interval 1.1-4.2). In our pilot evaluation with 20,088 primary orthopedic surgeries, the SSI risk of the iliac harvest site was low. In contrast, surgeries with supplementary iliac crest harvesting revealed a higher SSI risk than the general orthopedic population, potentially due to a mix of local independent risks of grafting together with a prolonged surgery time. Keywords : Autologous bone grafting; Deep surgical site infections; Epidemiology; Iliac crest harvesting; Revision surger

Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints.

In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints