Search Results (7)

Background and objectives: Hemiarthroplasty (HA) remains one of the most common treatments for displaced femoral neck fractures in the elderly, providing pain relief, early mobilization and a low reoperation risk. Acetabular erosion is a recognized late complication of this procedure, but early cartilage wear and its potential relationship with infection remain poorly understood. The aim of this study was to describe the clinical and microbiological characteristics of patients who required conversion to total hip arthroplasty (THA) because of acetabular erosion and to analyze the possible role of unexpected infection as a contributing factor. Materials and methods: A retrospective observational study was performed including all patients treated between 2007 and 2019 who underwent conversion of a failed HA to THA due to acetabular erosion after femoral neck fracture. Microbiological analysis was performed in all cases through multiple intraoperative samples. Patients were classified into two groups, with and without infection, according to positive microbiological cultures. Results: Forty-four patients were included, with a median age of 80.5 years (74–85). The median time to acetabular erosion was 25.4 months (10.4–47.4). Infection was identified in six patients (13.6%), all within the first six months after fracture (p = 0.029). The median time to erosion was shorter in infected patients (4.0 versus 29.8 months, p < 0.001). No other demographic, functional, or implant-related variables were associated with infection. There were three re-revisions, two due to recurrent dislocation and one periprosthetic infection in a hip without unexcepted positive culture. All patients with positive intraoperative culture were successfully managed with antibiotherapy. Postoperative functional scores improved significantly in both groups. Fifteen patients (34.1%) died during follow-up. Conclusions: Early acetabular erosion after hemiarthroplasty may represent a manifestation of previously unrecognized low-grade infection, particularly in frail elderly patients. Despite advanced age and multiple comorbidities, conversion to THA achieved significant functional improvement with an acceptable complication rate. Prospective studies with larger populations are warranted to confirm the relationship between infection and early acetabular cartilage loss. Full article

Endophthalmitis incidence and clinical characteristics was reported to change during COVID-19 pandemic, due to multiple influencing factors, such as prolonged lockdown periods, persistent immune suppression following SARS-CoV-2 infection, and mask wearing. We conducted a retrospective eight-year study, during January 2016 and December 2023, that aims to investigates the differences in terms of etiology, clinical characteristics and outcomes in cases with acute endophthalmitis, admitted before (2016–2019) and during COVID-19 pandemic (2020–2023). The two study subgroups were homogenous in term of age, gender distribution, associated comorbidities, and addressability. During COVID-19 pandemic there were significant delays in presentation (p = 0.02), more cases of endogenous endophthalmitis (p = 0.025), and patients presented a more intense systemic inflammatory reaction (p < 0.01). Moreover, undiagnosed cases of diabetes were more frequent in pandemic group, and were associated with endogenous endophthalmitis (59.3% vs. 16.6%, p < 0.001). The were differences in etiology between the two subgroups, the first cases of hypervirulent Klebsiella pneumoniae endogenous endophthalmitis reported in our center. The outcomes were comparable in terms of hospital stay and rate of evisceration. However, the visual function was worse in the pandemic group, which may be correlated with the specific differences in etiology and delayed presentation. Early diagnosis and prompt initiation of large spectrum antibiotherapy are essential to preserve vision. Full article

Describe the characteristics of ventilation-acquired pneumonia (VAP) and potential risk factors in critically ill SARS-CoV-2 patients admitted in three French public hospitals during the first year of the COVID-19 pandemic. We conducted a monocentric retrospective study in seven Marseille intensive care units (ICUs) aiming to describe VAP characteristics and identify their risk factors. VAP patients were compared to a non-VAP control group. From March to November 2020, 161 patients admitted for viral-induced acute respiratory failure (ARF) requiring invasive mechanical ventilation (IMV) were included. This cohort was categorized in two groups according to the development or not of a VAP during their stay in ICU. 82 patients (51%) developed ventilation-acquired pneumonia. Most of them were men (77%) and 55% had hypertension. In the VAP population, 31 out of 82 patients (38%) had received dexamethasone and 47% were administered antibiotic course prior to ICU admission. An amount of 88% of respiratory infections were late VAPs with a median delay of 10 days from the onset of IMV. Gram negative bacteria were responsible for 62% of VAPs with Pseudomonas spp. being the most documented bacteria. Less than a third of the ICU-acquired infections were due to multidrug resistant (MDR) bacteria mainly displaying AmpC cephalosporin hyper production resistance phenotype. Multivariate analysis revealed that early Dexamethasone administration in ICU, male sex, older age and ROX score were risk factors for VAP whereas pre-ICU antimicrobial treatment and higher IGS 2 were protective factors. VAP is a frequent ICU-related complication affecting half of patients infected with SARS-CoV-2 and requiring IMV. It was responsible for increased morbidity due to a longer ICU and hospital stay. VAP risk factors included demographic factors such as age and sex. Dexamethasone was associated with a threefold greater risk of developing VAP during ICU stay. These results need to be comforted by large multi-centric studies before questioning the only available and effective treatment against SARS-CoV-2 in ICU patients. Full article

In cystic fibrosis (CF), the respiratory disease is the main factor that influences the outcome and the prognosis of patients, bacterial infections being responsible for severe exacerbations. The etiology is often multi-microbial and with resistant strains. The aim of this paper is to present current existing antibiotherapy solutions for CF-associated infections in order to offer a reliable support for individual, targeted, and specific treatment. The inclusion criteria were studies about antibiotherapy in CF pediatric patients. Studies involving adult patients or those with only in vitro results were excluded. The information sources were all articles published until December 2021, in PubMed and ScienceDirect. A total of 74 studies were included, with a total number of 26,979 patients aged between 0–18 years. We approached each pathogen individual, with their specific treatment, comparing treatment solutions proposed by different studies. Preservation of lung function is the main goal of therapy in CF, because once parenchyma is lost, it cannot be recovered. Early personalized intervention and prevention of infection with reputable germs is of paramount importance, even if is an asymmetrical challenge. This research received no external funding. Full article

Enterobacterales bloodstream infections are life-threatening and require rapid, targeted antibiotherapy based on antibiotic susceptibility testing (AST). A new method using Muller-Hinton Rapid-SIR (MHR-SIR) agar (i2a, Montpellier, France) allows complete direct AST (dAST) to be read from positive blood culture bottles (BCBs) for all Enterobacterales species after 6–8 h of incubation. We evaluated (i) the performance of dAST from positive BCBs on MHR-SIR agar using two different inoculum protocols; (ii) the categorical agreement between dAST results obtained with MHR-SIR agar vs. those obtained with Muller-Hinton (MH) agar; and (iii) the ability of the MHR-SIR medium to detect β-lactam resistant Enterobacterales. Finally, we estimated the saved turnaround time (TAT) with MHR-SIR compared with MH agar in our 24/7 laboratory. Our results showed that the most suitable inoculation protocol for dAST on MHR-SIR agar was 1 drop of BCB/5 mL H₂O. For monomicrobial Enterobacterales BCBs, dAST performed on MHR-SIR medium showed 99.3% categorical agreement with AST on MH agar. Furthermore, MHR-SIR agar allows early detection of β-lactam resistance mechanisms, including AmpC hyperproduction, extended-spectrum β-lactamase, and carbapenemase. Finally, TAT reduction in our 24/7 laboratory was 16 h, enabling a significantly faster provision of antibiotic advice. Full article

The review aims to document the new emerging hypervirulent Klebsiella pneumoniae (Kp) endogenous endophthalmitis (EKE) in terms of incidence, microbiological characterization of the pathogenic agent, associated risk factors, management, and outcomes. Hypervirulent (hv) strains of KP (hvKp) induce invasive liver abscesses (LA) with specific clinical features. Up to 80–90% of cases have hepatic liver abscess as a primary focus of infection, followed by renal or lung hvKp infections. However, the incidence of EKE in patients with KPLA varied between 3.4% (19) and 12.6% (13), with a total of 95 cases of endophthalmitis in 1455 cases of KPLA (6.5%). Severe visual loss was encountered in 75% of cases, with 25% bilateral involvement. Intravitreal antibiotics are the mainstay therapeutic approach. Pars plana vitrectomy is a subject of controversy. HvKp strains present mostly natural “wild-type” antibiotic resistance profile suggestive for community-acquired infections, being highly susceptive to the third and fourth generation of cephalosporins and carbapenems. Antimicrobial resistance in hypervirulent strains was recently documented via plasmid transfer and may result in extremely difficult to treat cases. Global dissemination of these strains is a major epidemiologic shift that should be considered in the diagnostic and therapeutic management of patients with endogenous endophthalmitis. Ophthalmologic screening in patients with KPLA and other hvKp infections and a multidisciplinary therapeutic approach is extremely important for early diagnosis and preservation of the visual function. Full article

Acute otitis media (AOM) is one of the most common bacterial infections in children. Empiric antibiotherapy leads to increasing antimicrobial resistance rates among otopathogens and may impair the correct development of the microbiota in early life. In this context, probiotics seem to be an attractive approach for preventing recurrent AOM (rAOM) through the restoration of the middle ear and nasopharyngeal microbiota. The aim of this study was the selection of a probiotic strain (Lactobacillus salivarius PS7), specifically tailored for its antagonism against otopathogens. Since L. salivarius PS7 was safe and displayed a strong antimicrobial activity against otopathogens, its efficacy in preventing rAOM was assessed in a trial involving 61 children suffering from rAOM. Children consumed daily ~1 × 10⁹ CFU of L. salivarius PS7, and the number of AOM episodes were registered and compared with that observed in the previous 6 and 12 months. The microbiota of samples collected from the external auditory canal samples was quantitatively and qualitatively assessed. The number of AOM episodes during the intervention period decreased significantly (84%) when compared to that reported during the 6 months period before the probiotic intervention. In conclusion, L. salivarius PS7 is a promising strain for the prevention of rAOM in infants and children. Full article