Rate Of Acute Infection Research Articles

Modeling of randomized hepatitis C vaccine trials: Bridging the gap between controlled human infection models and real-word testing

Abstract Global elimination of chronic hepatitis C (CHC) remains difficult without an effective vaccine. Since injection drug use is the leading cause of hepatitis C virus (HCV) transmission in Western Europe and North America, people who inject drugs (PWID) are an important population for testing HCV vaccine effectiveness in randomized-clinical trials (RCTs). However, RCTs in PWID are inherently challenging. To accelerate vaccine development, controlled human infection (CHI) models have been suggested as a means to identify effective vaccines. To bridge the gap between CHI models and real-world testing, we developed an agent-based model simulating a two-dose vaccine to prevent CHC in PWID, representing 32,000 PWID in metropolitan Chicago and accounting for networks and HCV infections. We ran 500 trial simulations under 50% and 75% assumed-vaccine efficacy (aVE) and sampled HCV infection status of recruited in silico PWID. The mean estimated vaccine efficacy (eVE) for 50% and 75% aVE was 48% (standard deviation (SD ±12) and 72% (SD±11), respectively. For both conditions, the majority of trials (∼71%) resulted in eVEs within 1SD of the mean, demonstrating a robust trial design. Trials that resulted in eVEs >1SD from the mean (lowest eVEs of 3% and 35% for 50% and 75% aVE, respectively), were more likely to have imbalances in acute infection rates across trial arms. Modeling indicates robust trial design and high success rates of finding vaccines to be effective in real-life trials in PWID. However, with less effective vaccines (aVEs∼50%) there remains a higher risk of concluding poor vaccine efficacy due to post-randomization imbalances.

The Prevalence of Toxoplasma Gondii Infection in Duhok, Kurdistan Region, Iraq

Toxoplasmosis is a parasitic infection, with widespread gestational and congenital transmission rates globally, consequently, it is regarded as a public health concern and an overlooked medical condition. Human infection occurs through various routes, including the ingestion of oocysts found in cat feces, consumption of raw or undercooked meat containing the parasite, and vertical transmission from an infected pregnant mother to her fetus. Objective. The aim of this study is to determine the prevalence of Toxoplasma gondii infection among individuals in various age groups and genders in Duhok City. Methods. In this research, 2251 individuals of various ages and genders visited the central laboratory in Duhok Сity, Kurdistan Region, Iraq, and peripheral blood samples were taken from individuals to identify specific anti-Toxoplasma gondii IgM and IgG antibodies using serological test (ELISA test). Results. Based on the findings of this study, it was observed that the prevalence of toxoplasmosis among females with infections detected in both IgM and IgG was 0.3 % and 20.6 %, respectively, and in males, the rate of infection with IgG was found to be 0.3 %, while no infections were detected with IgM. Also, among female individuals, the study recorded a 0.3 % infection rate for toxoplasmosis, which encompassed both IgM and IgG cases. Conclusions. Based on this study, it can be concluded that Toxoplasma infection is more common in females than in males, chronic toxoplasmosis appears to be more prevalent than acute infection with the highest rate of acute infections was found in the age group of 21–40 years.

Post-Operative Complications Associated with Long-Term NSAID or Long-Term Opioid Use Prior to Lumbar Spinal Fusion Surgery

ObjectiveLower back pain (LBP) has been implicated as a significant cause of chronic pain in the United States, often requiring analgesic use. In this study, we investigate the trends in long-term preoperative NSAID (LTN) and Opioid (LTO) use in patients with low back pain in the United States, and the resultant postoperative complications following lumbar fusion. MethodsIn this retrospective cohort study of patients with lumbar pathologies, multivariate population-based regression models were developed using the 2010–2017 National Readmission Database. Short-term complications (30-, 90-day) and long-term complications (180-, 300-day) were analyzed at readmission. ResultsOf patients diagnosed with LBP (N = 1427,190) we found a rise in LTO users and a fall in LTN users following 2015. We identified 654,264 individuals who received a lumbar spine fusion, of which 22,975 were LTN users and 11,213 were LTO users. LTO users had significantly higher total inpatient charges (p-value<0.0001) and LOS (p-value<0.0001), while LTN users had lower rates of acute infection (OR: 0.993, 95% CI: 0.987–0.999, p = 0.017) and acute posthemorrhagic anemia (OR: 0.957, 95% CI: 0.935–0.979, p < 0.001) at primary admission. Readmission analysis showed that LTN use had significantly lower odds of readmission compared to LTO use at all time points (p < 0.01 for all). LTN use had significantly higher odds of hardware failure (OR: 1.134, 95% CI: 1.039–1.237, p = 0.005) within 300-days of receiving a lumbar fusion. ConclusionsLTO users had significantly higher readmission rates compared to LTN. In addition, we found that LTN use was associated with significantly higher odds of hardware failure at long-term follow-up in patients receiving lumbar fusion surgery.

Epidemiological characteristics of acute hepatitis A, 2013–2016: a cross-sectional study in Morocco

Background Hepatitis A virus (HAV) is the common cause of acute hepatitis worldwide. Indeed, hepatitis A is endemic in developing countries such in Morocco and most residents are exposed in childhood. The characterisation of circulating strains of HAV remains crucial to understand the virological evolution and geo-temporal characteristics, which are essential for controlling infections and outbreaks. The purpose of the current study was the detection and characterisation of HAV strains circulating in Morocco by performing serological test, RT-PCR, sequencing and phylogenetic analysis. Methods In this cross-sectional study, 618 suspected acute hepatitis cases were examined by Architect HAV abIgM. Of the 162 positives, 64 underwent RNA extraction. None of the suspected cases was immune to HAV and none of them had received a blood transfusion. Samples found positive by RT-PCR using primers targeting the VP1/VP2A junction and the VP1/VP3 capsid region of HAV were subjected to sequencing and phylogenetic analyses. Results HAV Acute infection rate was 26.2% [95% CI, 22.8–29.9], while viraemia reached 45% (29/64) after amplification of the VP3/VP1 region. Phylogenetic analysis of the VP1/2A segment revealed the presence of sub-genotypes IA and IB. Eighty-seven percent of the strains belonged to the subgenotype IA, while twelve percent to IB subgenotype. Conclusion This first molecular study of acute hepatitis A in Morocco provided information about genetic diversity of HAV, revealing the co-circulating of only two subgenotypes (IA and IB). Notably, subgenotype IA was found to be the predominant subgenotype in Morocco.

The influence of frailty on perioperative outcomes in patients undergoing surgical resection of liver metastases: a nationwide readmissions database study.

Liver metastases arise frequently from primary colorectal, pancreatic, and breast cancers. Research has highlighted the patient's frailty status as an important predictor of outcomes, but the literature evaluating the role of frailty in patients with secondary metastatic disease of the liver remains limited. Using predictive analytics, we evaluated the role of frailty in patients who underwent hepatectomy for liver metastases. We used the Nationwide Readmissions Database from 2016-2017 to identify patients who underwent resection of a secondary malignant neoplasm of the liver. Patient frailty was evaluated using the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining diagnosis indicator. Propensity score matching was performed and Mann-Whitney U testing was used to analyze complication rates. Receiver operating characteristic (ROC) curves were created following creation of logistic regression models for predicting discharge disposition. Frail patients reported significantly higher rates of nonroutine discharges, longer inpatient stays, greater costs, higher rates of acute infection, posthemorrhagic anemia, urinary tract infection (UTI), deep vein thrombosis (DVT), wound dehiscence and readmission, and greater mortality (P<0.05). Predictive models for patient discharge disposition, DVT and UTI demonstrated that the use of frailty status and age improved the area under the ROC curves significantly compared to models using age alone. Frailty was found to be significantly correlated with higher rates of medical complications during inpatient stay following hepatectomy in patients with liver metastasis. The inclusion of patient frailty status in predictive models improved their predictive capacity compared to those using age alone.

Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty.

One of the most important challenges faced by orthopedic surgeons is periprosthetic joint infection (PJI). PJI is a common cause for total joint arthroplasty failure with an incidence of 0.3-1.9%. PJI can be devastating for the patient and extremely costly for the healthcare system. There is concern that a major cause of PJI is intra-operative colonization and recent studies have shown a decrease in PJI with the use of dilute povidone-iodine (Betadine®, Avrio Health L.P, Stamford, CT) irrigation prior to wound closure. This study presents our experience with the use of dilute Betadine® irrigation prior to wound closure and its effect on our post-operative hip and knee arthroplasty acute infection rate. Retrospective chart review performed at our hospital looking at PJI amongst patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2013 and 2017 comparing different irrigation methods (n = 3232). The study group (n = 1207) underwent irrigation prior to wound closure with dilute Betadine for 3min and the control group (n = 1511) underwent irrigation using normal saline (NS). Using a logistic regression model where the following variables were adjusted for; ASA, age, sex, foley insertion, surgical duration and diabetes mellitus status a statistical significant reduction was seen in any infection (OR 0.45 [0.22; 0.89], p value < 0.05) and SSI (OR 0.30 [0.13; 0.70], p value 0.01) with the Betadine group. No significant reduction was seen with deep infections with the Betadine group compared to the NS group. PJI is a devastating complication following total joint arthroplasty and we found Betadine compared to NS irrigation provides an inexpensive and simple method to lower any PJI and more specifically SSI in THA and TKA. III.

Impact of the first COVID-19 lockdown in Germany on the rate of acute infections during intensive chemotherapy for Hodgkin lymphoma

PurposeEvidence on the effect of self-protection via social distancing and wearing face-masks on infections during chemotherapy is currently not available. We asked if the occurrence of acute infections during chemotherapy for advanced-stage Hodgkin lymphoma (HL) decreased when COVID-19 protection measures were in effect.MethodsWe analyzed the occurrence of infections during all documented eBEACOPP cycles starting between 01 March and 30 June of 2017 to 2020 in patients treated within the GHSG HD21 study in Germany and compared the infection rates and characteristics by logistic regression models and means of descriptive statistics.ResultsWe analyzed 911 cycles of 313 adult patients treated with 4 to 6 cycles of eBEACOPP. We found a significant decrease in the occurrence of infections during chemotherapy for HL during COVID-19 lockdown from 131 (19.6%) of 670 cycles in 2017–2019 to 30 (12.6%) of 239 cycles during COVID-19 lockdown [OR 0.574 (95% CI 0.354–0.930), P = 0.024]. The strongest effect was evident for unspecified infections with 39 cycles (5.8%) during 2017–2019 in comparison to 5 cycles (2.1%) during COVID-19 lockdown. 20 (24.1%) of 83 patients had an infection during the COVID-19 lockdown versus 99 (43.2%) of 229 patients in the years 2017–2019 (P = 0.0023).ConclusionThe significant decrease of infections during chemotherapy for HL during COVID-19 lockdown reveals the protective measures’ potential to shield patients from transmissible pathogens. We conclude that these measures could be recommended for HL patients at risk for infections during chemotherapy.

Chest CT Has Higher Yield for Infection than CT Sinus in Febrile Neutropenic Patients

ObjectiveChest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting. MethodsReports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed. Infection as reported was characterized as acute or worsening, improving, stable, indeterminate or negative. Results were tabulated and Pearson's chi-square test was used for comparison analysis. ResultsAbsence of infection on CT sinus was significantly higher than CT chest (86.1% vs. 58.5%; P<0.001). Conversely, CT chest had significantly higher incidence of acute or worsening infection than CT sinus (28.7% vs. 11.6%; P<0.001). CT chest also showed significantly higher incidence of improving infection compared to CT sinus (6.2% vs. 1.1%; P<0.001). There was no significant difference between incidence of stable infection on CT chest and CT sinus (1.1% vs. 0.2%; P=0.059). Infection was indeterminate in 5.5% of CT chest vs. 1% on CT sinus (P<0.001). ConclusionsCT chest showed significantly higher diagnostic yield for acute infection than CT sinus, suggesting that sinusitis is less likely to be the source of fever than chest infections in febrile neutropenic patients. The majority of CT studies showed absence of infection, raising the question of the overall utility of routine surveillance CT imaging among this subset of patients.

1005 Antibiotic-Impregnated Calcium Sulfate Beads Are Not Effective in the Primary Prevention of Infection in Open Femur and Tibia Fractures

Abstract Introduction Infection is a major complication of open fractures. Antibiotic-impregnated calcium sulfate (AICS) beads are widely used as an adjuvant to systemic antibiotics. Whilst their efficacy in the secondary prevention of infection is established, we present the first retrospective study evaluating AICS beads in the primary prevention of infection in open fractures. Method 214 open femur and tibia fractures in 207 patients were reviewed over a seven-year period. 148 fractures received only systemic antibiotic prophylaxis. 66 fractures also received AICS beads. The occurrence of acute infection (wound infection and acute osteomyelitis) was recorded, as well as that of long-term complications (chronic osteomyelitis, non-union and death). Results Fractures that received AICS with systemic antibiotics had an overall acute infection rate of 42% (28/66), compared to 43% (63/148) in fractures that received only systemic antibiotics (p &amp;gt; 0.05). There was no significant difference in infection rate even when fractures were stratified by Gustilo-Anderson grade. There was also no significant difference in the rate of long-term complications. Conclusions Our results indicate that the adjuvant use of AICS beads is not effective for the primary prevention of acute infection or long-term complications in open leg fractures. Further research is needed to elucidate the factors influencing the outcomes of AICS use.

The structural basis of African swine fever virus core shell protein p15 binding to DNA.

African swine fever (ASF) is an acute, hemorrhagic, and highly contagious disease caused by African swine fever virus (ASFV). The mortality rate of acute infection up to 100% have posed an unprecedented challenge of the swine industry. Currently no commercial antiviral drug is available for the control and treatment of ASFV. The structural resolution of ASFV virions reveals the details of ASFV morphogenesis, providing a new perspective for the research and promotion of the development of ASFV vaccines. Although the architecture of ASFV have been solved via cryo-EM, the structural details of four of the five viral layers remain unclear (except the outer capsid). In this study, we resolved the crystal structure of the ASFV core shell protein p15. The secondary structural elements of a protomer include four α-helix structures and six antiparallel β-strands. Further analysis revealed that ASFV p15 forms disulfide-linked trimers between the Cys9 from one protomer and Cys30 from other protomer. Additionally, the nucleic acid-binding property was characterized by electrophoretic mobility shift assay. Two critical amino acid Lys10 and Lys39 have been identified which is essential to the nucleic acid-binding affinity of ASFV p15. Together, these findings may provide new insight into antiviral drug development.

The impact of COVID-19 on a tertiary care pediatric emergency department.

The restrictive measures required to face the recent outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impact patterns of healthcare utilization. Our aim was to provide an insight into the change in the use of a pediatric emergency department (ED) during the SARS-CoV-2 pandemic. The medical records of the children seen in our pediatric ED during March and April 2020 were retrospectively reviewed. Consequently, these were compared to the medical records of 2018 and 2019 from the same time period and from other control periods (January–February 2019 and 2020, and July–August 2018 and 2019). The total number of ED visits declined by 73% from 2019 to 2020 (3051 vs 818). Significant variations were observed in the distribution of children between triage categories: the proportion of patients who was given a green-code showed a 0.59-fold decrease in comparison to 2019 (95% CI 0.5–0.69), while a relative increase in the proportion of yellow codes was observed (OR 1.46, 95% CI 1.2–1.78).Conclusion: Quarantine measures significantly impacted on the total number of patients and on the reasons for visiting them in our pediatric ED. This substantial decrease in pediatric care may either be due to lower rates of acute infections because of social distancing, or to parents’ or caregivers’ reticence to risk exposure to SARS-CoV-2 in a health-care setting.What is known:• A recent outbreak of a novel coronavirus responsible for a severe acute respiratory syndrome is spreading globally.• Restrictive measures may impact patterns of healthcare utilization, as observed in other previous outbreaks.What is new:• This study shows significant variations in the distribution of children among triage categories during the COVID-19 pandemic.• Discharge diagnosis was significantly different as well, in particular a relative increase in the proportion of children presenting with traumatic injuries and a decrease of viral infections were observed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00431-020-03909-9.

Effect of COVID-19 on surgical management of open fractures and infection rates: A tertiary care experience in Indian set-up

BackgroundOpen fractures form one of the most common musculoskeletal injuries and are often complicated by infection. In this unprecedented situation, the additional infection rates, further add to the burden of the already compromised healthcare setup. The present study is done to see the effect of COVID-19 on management of open fractures. MethodsA retrospective evaluation of patients with open fractures from March 25th, 2020 to July 21st, 2020 (group 1) and March 25th, 2019 to July 21st, 2019 (group 2) was performed. These patients were assessed for demographic details, diagnosis, type of surgery, delay from injury to admission, delay from admission to surgery, postoperative hospital stay, acute infection rates, readmission rates and associated injuries. ResultsA total of 52 patients with 59 open fractures in 2020 and 89 patients with 101 open fractures in 2019 met the inclusion criteria. The mean age was 34.76 years and 32.74 years in 2020 and 2019 respectively. Road side accidents were predominant in both the groups, comprising of 38 (73.07%) and 67 (75.28%) respectively(n.s.); adult patients were 42 (80.76%) and 79 (88.76%) respectively(n.s.); paediatric patients were 10 (19.23%) and 10 (11.23%) respectively(n.s.); tibia was the most common bone involved, comprising of 14 (23.72%) and 27 (26.73%) open fractures respectively(n.s.); external fixator was the most commonly used implant during COVID-19 time with 42 (71.18%) and 51 (50.49%) respectively(p = 0.005); the infection rate was 25.42% and 20.79% respectively(n.s.); the time for administration of first intravenous antibiotic dose was on 6.75 h and 4.04 h respectively(p < 0.0001); average time between the admission and surgical debridement was 24.04 h and 19.32 h respectively(n.s.); referral cases were 33 (63.46%) and 44 (49.43%) respectively(n.s.); re-admission rates were 7/52 (13.46%) and 10/89(11.23%) respectively(n.s.). ConclusionDespite the decrease in total trauma cases, a delay in presentation to the emergency room/administration of first dose of antibiotic and increase in temporary fixation in form of external fixator was observed. Further, an increase in infection rates, referral cases and readmission rates were observed, though not statistically significant.

Chlamydia pneumoniae Infection in Patients Hospitalised for Community-acquired Pneumonia in Southern Jordan

AbstractPurpose:Chlamydia pneumoniae is associated with human respiratory diseases. Few reports examined the involvement of this bacterium in community-acquired pneumonia (CAP) in Jordan. This study investigates for the first time the role of C. pneumoniae in the establishment of CAP among nationals residing the southern part of Jordan. Materials and Methods: Nasopharyngeal and sera samples were collected from 70 hospitalised CAP patients and 63 healthy controls from Al-Karak Governorate and examined using the microimmunofluorescence and polymerase chain reaction techniques. The overall prevalence of C. pneumoniae infection was estimated by detecting the chlamydial immunoglobulin G (IgG) antibodies at a titre of 1:16. Rate of acute infection was estimated by detecting chlamydial DNA in nasopharyngeal samples and IgG and IgM at titres of 1:512 and 1:16, respectively. Results: A higher overall seroprevalence of C. pneumoniae IgG was detected in CAP patients than controls (44.3% vs. 30.2%). The rate of acute infection in the entire CAP patients, based on IgG titre of 1:512, was 7.14% compared to 1.58% in the controls. Approximately, three-fold increase in the rate of acute infection was observed in CAP cases, seropositive at IgG titre of 1:16, compared to seropositive controls (16.1% vs. 5.3%). Interestingly, chlamydial IgM antibodies were detectable in 27.1% compared to only 3.2% of the controls. The presence of chlamydial nucleic acids was confirmed in 40% of CAP patients and in 7.9% of controls. Conclusions: The present findings clearly suggest a role of C. pneumoniae in the aetiology of CAP in Southern Jordan. However, coinfections with other respiratory pathogens should not be excluded.

Length of Stay, Discharge Disposition, and 90-Day Complications and Revisions Following Primary Total Hip Arthroplasty: A Comparison of the Direct Anterior, Posterolateral, and Direct Superior Approaches

BackgroundThe direct anterior (DA) approach is becoming increasingly popular for primary total hip arthroplasty (THA). The aim of this study is to evaluate early postoperative complication and revision rates based on surgical approach, comparing DA, posterolateral (PL), and direct superior (DS) approaches. MethodsAfter institutional review board approval, a total joint arthroplasty database from a single institution was used to identify all patients who underwent elective primary THA between July 2013 and November 2017 with a DA, PL, or DS hip approach. Patients were followed for complications out to 90 days postsurgery. Patients were divided into groups based on surgical approach and compared on length of stay, discharge disposition, and 90-day complication and revision rates. ResultsThere were 5341 THA procedures performed, with 3162 PL, 1846 DA, and 333 DS approaches. Length of stay was shorter for DS (1.7 ± 0.9 days) and DA (1.8 ± 0.9 days) than for PL approaches (2.3 ± 1.4 days, P < .001) The DS approach had the highest rate of home discharges (93.1%), but the highest short-term revision rate (1.5%, P = .011). The DA approach had the lowest intraoperative fracture rate (0.1%, P = .019) but the highest incidence of postoperative fractures (1.3%, P = .021). There were no differences in readmission (P = .056), 90-day events (P = .062), emergency department visits (P = .210), dislocations (P = .090), combined perioperative fractures (P = .289), venous thromboembolic events (P = .059), or acute infection rates (P = .287). ConclusionIn the era of bundled payments, the DA, PL, and DS approaches can all be effectively used. Level of EvidenceLevel III; retrospective comparative study.

Changes In Seroprevalence And Acute Infection Rates After Vaccination And Herd Immunity In A Pediatric Hospital In The Southeastern Anatolia Region Of Turkey: Effects Of Adding Hepatitis A Vaccine To The Extended National Immunization Program

Aim: This study was designed to compare rates of acute HAV infection and HAV seroprevalence in patients aged 0-6 years and 7-15 years in a pediatric hospital before and after the HAV vaccine was added to the national immunization program in 2012.Material and Methods: A total of 16,917 serum samples were evaluated in the study. Sera of the 5520 patients (3,208 of 0-6 years, 2,312 of 7-15 years) were collected during 2011 and analyzed for anti-HAV IgM and anti-HAV IgG with chemiluminescent assay (period 1). After that a total of 11,397 sera of the patients (5,473 of 0-6 years and 5,924 of 7-15 years) were collected between 1 July 2014 and 31 December 2016 and analyzed for anti-HAV IgM and anti-HAV total (period 2).Results: In period 1, rates of acute HAV infection and seropositivity were 26.87% and 19.25% in the 0-6 years , and 42.39% and 41.52% in the 7-15 years. Prior to routine vaccination, 54.03% of patients in the 0-6 age group and 16.08% of patients in the 7-15 age groups were susceptible to HAV infection.In period 2, Anti-HAV IgM positivity rates in 2014, 2015, and 2016 were 14.06%, 3.92%, and 2.46% in the 0-6 age group and 16.85%, 6.80%, and 4.48% in the 7-15 age group, respectively. Seropositivity rates were 43.66%, 59.55%, and 66.09% in the 0-6 age group and 45.67%, 55.41%, and 54.04% in the 7-15 age group, respectively. After routine vaccination, rates of children who were susceptible to HAV infection decreased from 42.28% and 36.52 % to 31.45% in the 0-6 years and increased from 37.48%, 37.79% to 41.48% in the 7-15 years. Considering the data as a whole, the most striking finding was that the acute infection rate in the 0-6 years was decreased firstly by 47.67% and then by 85.42% and 90.85% compared to the pre-vaccination period. However, a progressive decline was also observed in the 7-15 years compared to the pre-vaccination period; the rate decreased by 60.25%, 83.96%, and 89.43%, respectively in period 2. This fall in infection rates among a non-target group of HAV vaccination can be attributed to the effect of the vaccine on immunity.Conclusion: Adding HAV vaccine to the routine immunization program effectively reduced rates of acute infection, demonstrating the contribution of vaccination to herd immunity. Studies showing the efficacy of vaccination programs are essential for raising public awareness.

Is There a Role for Preclosure Dilute Betadine Irrigation in the Prevention of Postoperative Infection Following Total Joint Arthroplasty?

BackgroundConflicting evidence exists surrounding the use of preclosure irrigation solutions in primary total joint arthroplasty (TJA). We aimed to determine the role of dilute betadine lavage in preventing early infection after primary TJA. MethodsWe retrospectively reviewed primary TJAs between 2010 and 2018. Dilute betadine lavage was introduced to our practice in November 2014. We included 3513 total hip arthroplasties, 3932 total knee arthroplasties, and 1033 hip resurfacings (HRs). In group 1 (n = 5588), surgical wounds were irrigated with saline; group 2 used dilute betadine solution (n = 2890). Subanalyses using propensity matching based on known risk factors of infection—age, body mass index, American Society of Anesthesiologists grade, diabetes, and procedure—were completed. ResultsThere were 48 acute infections in group 1 (0.9%) and 23 in group 2 (0.8%) (P = .762). HR without betadine had the highest acute infection prevalence (P = .028). When groups in the whole cohort were propensity score–matched, group 1 had more acute infections than group 2 (P = .033). The effect of betadine was isolated to HR patients. After excluding HR cases, betadine continued to reduce the acute infection rate when compared with the no betadine group, but this was not statistically significant (0.4% vs 0.8%; P = .101). Likewise, we did not find a significant difference in total hip arthroplasty and total knee arthroplasty patients (P = .796). ConclusionThere was a decreased infection rate in the betadine group overall when groups were propensity-matched. Because the reduction in the acute infection rate was clinically significant, we feel this practice is an effective means to prevent infections.

Optimum surgical treatment for tricuspid valve infective endocarditis: An analysis of the Society of Thoracic Surgeons national database

ObjectiveThe incidence of intravenous drug–associated tricuspid valve endocarditis in the United States is rapidly increasing. Our goal was to evaluate the outcomes of isolated tricuspid valve operations using the Society of Thoracic Surgeon Adult Cardiac Surgical Database. MethodsFrom July 2011 to December 2016, 1613 patients with intravenous drug–associated tricuspid valve endocarditis underwent isolated tricuspid valve operations for endocarditis. Patients were stratified on the basis of type of tricuspid valve operation: valvectomy in 119 (7%), repair in 532 (33%), and replacement in 962 (60%). Risk factors and 30-day outcomes were compared among groups using Kruskal–Wallis and Pearson's chi-square tests. Multivariable logistic regression evaluated risk-adjusted operative mortality and morbidity by operative technique. ResultsAge, gender, race, and renal function were comparable among groups. Compared with the repair and replacement groups, the valvectomy group had a higher rate of acute infection (90% vs 79%, 84%; P < .01), Model for End-Stage Liver Disease score (10.17 vs 8.44, 9.74, P < .01), and urgent/emergency surgery (91% vs 75%, 83%; P < .01), respectively. Operative mortality was higher in those undergoing valvectomy (16%) (P < .01) compared with repair (2%) or replacement (3%). After risk adjustment, valvectomy was associated with a higher risk of operative mortality compared with repair (odds ratio, 3.82; P < .01), whereas there was no difference in operative mortality between repair and replacement (odds ratio, 0.95; P = .89). ConclusionsThis contemporary series of intravenous drug–associated tricuspid valve endocarditis reveals that valvectomy is an independent predictor of operative mortality. When anatomically possible, repair should be the preferred management for tricuspid valve endocarditis to avoid recurrent valve infection and prosthetic valve degeneration.

Peripheral Vascular Disease is Associated with Increased Risk of Acute Postoperative Infection and Failure of Total Ankle Replacements

Category:Ankle ArthritisIntroduction/Purpose:Peripheral vascular disease (PVD) is often cited as a contraindication for total ankle replacement (TAR); however, there are no studies looking at its impact on postoperative complications. The primary purpose of our study was to identify whether preoperative PVD increased the rate of infection, postoperative irrigation and debridement, or failure of the implant in patients undergoing total ankle arthroplasty using a large dataset.Methods:The PearlDiver Database was used to identify Medicare patients who underwent a TAR from 2005 to 2014 using ICD- 9 and CPT codes. The cohort was queried for postoperative infections within 90 days, subsequent irrigation and debridement, and failure of TAR. Failure of TAR was defined was a revision, conversion to tibiotalar arthrodesis, lower extremity amputation, or implant removal. A diagnosis of preoperative PVD only included those patients who had PVD as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to TAR. Preoperative co-morbidities including prior corticosteroid injections, diabetes mellitus, smoking, rheumatoid arthritis, congestive heart failure, hypertension, obesity, and end-stage renal disease requiring dialysis were taken into consideration. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after TAR.Results:10,698 Medicare patients who underwent a primary TAR were identified. 334 patients had a postoperative infection within 90 days of their TAR and 95 of those patients required an irrigation and debridement. Patients with a preoperative diagnosis of PVD had the highest acute infection rate at 10.5% as well as the highest incidence of failure at 12.3%. Multivariable logistic regression modeling demonstrated that patients with PVD had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, 95% CI 1.45-5.13, P<0.01). Preoperative PVD was the most important risk factor for requiring an irrigation and debridement postoperatively (OR 4.87, 95% CI 1.94–10.6, P<0.001) (Table 1) and placed patients at the highest risk of TAR failure (OR 2.67, 95% CI 1.43–4.63, P<0.001).Conclusion:Our study suggests that a preoperative diagnosis of PVD has significant negative effects on outcomes following TAR. Preoperative PVD is an independent risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant.

The effect of early broad-spectrum versus delayed narrow-spectrum antibiotic therapy on the primary cure rate of acute infection after osteosynthesis

PurposeInfection near metal implants is a problem that presents challenging treatment dilemmas for physicians. The aim of this study was to analyse the efficacy of two treatment protocols for acute fracture-related infections.MethodsSeventy-one patients in two level-1 trauma centres in the Netherlands were retrospectively included in this study. These trauma centres had different standardised protocols for acute infection after osteosynthesis: 39 patients were selected from protocol A and 32 from protocol B. Both protocols involve immediate surgical debridement and soft tissue coverage, but differ in antibiotic approach: (A) immediate empirical combination antibiotic therapy with rifampicin, or (B) postponed (1–5 days) targeted antibiotic therapy. The primary outcome of these protocols was success, defined as a fracture healing in the absence of infection. The secondary outcome was antibiotic resistance patterns. Logistic regression was conducted on patients and treatment-related factors in association with primary success.ResultsPrimary success was achieved in 72% of protocol A patients, in 47% of those in protocol B (P = 0.033), and with prolongation of treatment success was achieved in 90% and 78% of patients, respectively. Protocol A exhibited a better primary success rate (adjusted OR 3.45, CI 1.13–10.52) when adjusted for age and soft tissue injury. There was no significant difference in antibiotic resistance between the two protocols.ConclusionBoth protocols yielded high overall success rates. Immediate empirical antibiotics can be used safely without additional bacterial resistance and may contribute to increased success rates.

Distribution of Toxoplasma gondii IgM and IgG antibody seropositivity among age groups and gestational periods in pregnant women.

Background: Toxoplasmosis is a globally distributed parasitic disease. The present study aimed to estimate the prevalence and geographic distribution of toxoplasmosis as well as evaluate the role of animal contact in disease development and determine the percentage of toxoplasmosis-associated IgM and IgG seropositivity among different age groups. In addition, it aimed to estimate the proportion of toxoplasma IgM seropositivity among pregnancy trimesters. Methods: A total of 500 pregnant women were included in this study. From each participant, a 5-ml venous blood sample was collected and centrifuged to obtain serum that was tested for Toxoplasma gondii IgM and IgG antibodies using immunochromatographic testing and ELISA. Results: The overall seroprevalence of toxoplasmosis was 24.8%, with rates of acute infection of 8%. Among positive cases of every trimester, 54.34% of first trimester positive cases had a serologic marker for acute toxoplasmosis. Among the overall positive cases, out of the 35 pregnant women with previous history of cow/buffalo contact and toxoplasmosis, 45.7% were seropositive for toxoplasma IgM; and out of 15 women with prior history of dog contact, 33.3% had a serological marker of acute toxoplasmosis. Conclusions: In this study, there is a high prevalence of toxoplasmosis and contact with domestic animals is a risk factor of this illness. Therefore, it is necessary to test every pregnant woman for toxoplasmosis and distinguish the type of infection, as well as the conduction of public health education programs to generate the awareness.