Reinfection Rate Research Articles

Outcomes of single- vs two-stage primary joint arthroplasty for septic arthritis: a systematic review and meta-analysis.

Septic arthritis (SA) is an intra-articular infection caused by purulent bacteria and the only effective method is surgical intervention. Two-stage arthroplasty is considered the gold standard treatment for SA, but recent studies have found that single-stage arthroplasty can achieve the same efficacy as two-stage arthroplasty. This study aimed to compare the efficacy of single- vs two-stage arthroplasty in the treatment of (acute or quiescent) SA. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature on the treatment of SA using single- and two-stage arthroplasty from the date of database inception to November 10, 2022. Data on reinfection rates were expressed as odds ratios and 95% CIs. Seven retrospective studies with a total of 413 patients were included. Pooled analysis showed no difference in the reinfection rate between single- and two-stage arthroplasty. Subgroup analysis found no difference between the single- and two-stage arthroplasty groups in the incidence of purulent infection of the hip and knee. Cumulative meta-analysis showed gradual stabilization of outcomes. Based on our meta-analysis of available retrospective studies, we found no significant difference in reinfection rates between single- and two-stage arthroplasty for SA. Further prospective cohort studies are needed to confirm our results, although our meta-analysis provides important insights into the current literature on this topic.

A Cross-sectional Study of Clinical Characteristics and Outcomes among Adults with Laboratory-confirmed SARS-CoV-2 Infection with Omicron Variant

The emergence of the SARS-CoV-2 Omicron variant has raised concerns due to its increased transmissibility and potential implications on clinical characteristics and outcomes in infected individuals. The aims of this report were to study the profile of SARS-CoV-2 infection with omicron variant, investigate the infection outcome, reinfection rates with associated factors, antibody levels, and explore the associations between biochemical markers and disease severity. This prospective cohort study was conducted in Duhok city in the Northern of Iraq. All volunteers with confirmed SARS-CoV-2 RT–PCR and confirmed Omicron infection who were older than 18 years old and agreed to participate were recruited for this study. The study was carried out from January to April 2022. There were 234 cases of confirmed SARS-CoV-2 RT–PCR Omicron infection. The mean age was 48.12±17.3 years, 43.2% were vaccinated, and 40.2% were male. Among the recruited patients, 99.1% recovered and did not need hospitalization. In this study, (38.9%) had a history of previously confirmed COVID-19 infection. Reinfection was significantly higher in females than males (p=0.04; OR= 0.56). It was found that the IgG antibody levels were higher in patients who received Pfizer-BioNTech than in those who received other vaccines (p=0.001). The levels of IgG were also significantly higher in patients with mild infection (p=0.046), whereas the levels of D-dimer were significantly higher in patients with severe cases of the infection compared to those with mild or moderate cases (p=0.001). Additionally, the levels of C-reactive protein (CRP) were observed to be higher in individuals with moderate cases of infection than in mild and severe cases (0.001). Individuals who contracted the Omicron strain generally had positive outcomes. Reinfection with the Omicron variant was relatively high. IgG levels were higher in patients with mild disease, implying that they were associated with decreased disease severity. We found significant associations between D-dimer levels and the severity of the disease. Additional research is required to investigate the long-term effects of Omicron infection.

Association between post-COVID-19 status and perioperative morbidity and mortality: protocol for an ambispective cohort study

IntroductionWith COVID-19 bringing persistent impact on the worldwide population, perioperative management after SARS-CoV-2 infection needs to be revisited in the new period of different circulating coronavirus variants, vaccination status, increased...

Articulating Hip Spacers with a Constrained Acetabular Liner: Effect of Acetabular Bone Loss and Cementation Quality.

Articulating hip spacers for periprosthetic joint infection (PJI) offer numerous advantages over static spacers such as improved patient mobilization, hip functionality, and soft tissue tension. Our study aimed to determine complication rates of a functional articulating spacer using a constrained liner to determine the role of acetabular cementation mantle and bone loss on the need for second-stage surgery. A retrospective review of 103 patients was performed and demographic information, spacer components and longevity, spacer-related complications, reinfection rates, and grade of bone loss and acetabular cement mantle quality were determined. There was no significant difference in spacer-related complications or reinfection rate between PJI and native hip infections. 33 of 103 patients (32.0%) elected to retain their spacers. Between patients who retained their initial spacer and those who underwent reimplantation surgery, there was not a significant difference in cement mantle grade (p = 0.52) or degree of bone loss (p = 0.78). Functional articulating antibiotic spacers with cemented constrained acetabular liners demonstrate promising early results in the treatment of periprosthetic and native hip infections. The rate of dislocation events was low. Further efforts to improve cement fixation may help decrease the need for second-stage reimplantation surgery.

1083 Evaluating Adherence to Best Practice for Tissue Sampling in Diabetic Foot Surgery: A Quality-Improvement Study

Abstract Aim To evaluate adherence to national guidelines (National Institute for Health and Care Excellence – NICE) in tissue sampling during diabetic foot surgery, and to assess the clinical course of minor diabetic foot amputations in relation to bone microbiology and antibiotic therapy. Method Between 2020 and 2022, three separate cycles of a plan-do-study-act (PSDA) audit were completed to evaluate the efficacy of a teaching programme and an online operation note proforma. Data were collected retrospectively with the primary outcome measures being the proportion of clinically clean bone samples sent and subsequent impact on changes to targeted antibiotic therapy. Secondary outcomes included the rates of re-infection and re-intervention. Results A total of 106 patients were sampled (PDSA 1, n = 52; PDSA 2, n = 27; PDSA 3, n = 27). Following the implementation of a departmental teaching programme the proportion of clinically clean bone samples increased from 68% (PDSA 1, n = 40) to 75% (PDSA 2, n = 12) with a further increase to 89% (PDSA 3, n = 24) after implementation of the online proforma (p = 0.140). Microbiology results prompted necessary changes to targeted antibiotic therapy in 58% of patients (PDSA 1, n = 33) increasing to 95% throughout the study (PDSA 3, n = 19). Targeted antibiotic therapy was associated with comparable rates of re-infection compared to non-targeted therapy (PDSA 3, 5% / 12.5%, respectively) but overall lower rates of re-intervention (PDSA 3, 63% / 47%, respectively). Conclusions Both interventions were associated with increased rates of clinically clean intra-operative bone sampling. Lower rates of re-intervention were observed in patients who subsequently received targeted antibiotic therapy.

Prosthetic joint infections following a total knee arthroplasty: A retrospective analysis

Background: Total knee arthroplasty, especially, has been a resort for many individuals plagued with deforming joint pathologies, alleviating pain, and improving joint mobility, but is not without complications. Prosthetic joint infection (PJI) is the most commonly occurring early and late complication of total knee arthroplasty. In one study, they observed that even though the rate of PJI after TKA is 0.6-0.9%, the financial burden is enormous. Therefore, it is imperative for surgeons to find the ideal management strategies, both non-surgical and surgical, to tackle PJI. Here, we conducted this study to demonstrate the occurrence of PJI following an uneventful arthroplasty, and the management strategies in a tertiary care hospital. Methods and materials: This was a retrospective study performed in the Department of Orthopaedics, Kanachur Institute of Medical sciences, between January 2021 to January 2023. The case records of all patients with culture proven prosthetic joint infection was identified. Demographic details, surgery performed, type of implant, duration of surgery, ICU stay, intra-operative and post-operative complications were recorded in a semi-structured pro forma. The data was analysed using SPSS v20. A p value < 0.05 was considered statistically significant. Results: The most common presenting complaint in the patients was pain and fever > 38 degrees C (67.5%), followed by discharge from wound site (34.23%). Four patients required ICU admission due to features of sepsis, and 2 patients died following the revision surgery. Most common organism isolated was Staphylococcus aureus in the synovial fluid cultures. We found that there was a statistically significant difference in the operative time between single staged and two staged procedure, but there was no correlation between that and the re-infection rates. Conclusion: PJI following TKA is a dreadful complication, which requires swift diagnosis and prompt management. Most patients present with pain initially, which should alert the treating physician towards an ongoing inflammatory process in the joint. Appropriate antibiotics, single stage/two-staged surgical correction and adequate limb movement restriction can aid in reducing risk of morbidity while maintaining functionality in the operated joint.

Effects of Severe Acute Respiratory Syndrome Coronavirus Vaccination on Reinfection: A Community-Based Retrospective Cohort Study.

Coronavirus disease 2019 (COVID-19) is a disease that is characterized by frequent reinfection. However, the factors influencing reinfection remain poorly elucidated, particularly regarding the effect of COVID-19 vaccination on preventing reinfection and its effects on symptomatology and the interval until reinfection. This retrospective cohort study examined patients with severe acute respiratory syndrome coronavirus reinfection between January 2020 and February 2022. This study included patients aged >17 years who were reinfected at least 90 days between two infections with severe acute respiratory syndrome coronavirus. The main outcome measure was a reduction in symptoms during reinfection, and reinfection interval. Overall, 712 patients (average age: 40.52 ± 16.41 years; 312 males) were included. The reduction rate of symptoms at reinfection than that at first infection was significantly higher in the vaccinated group than in the unvaccinated group (p < 0.001). The average reinfection interval was 265.81 days. The interval between the first and second infection was 63.47 days longer in the vaccinated group than in the unvaccinated group. The interval was also 57.23 days, significantly longer in the asymptomatic group than in the symptomatic group (p < 0.001). Besides its role in preventing severe acute respiratory syndrome coronavirus infection, vaccination reduces the rate of symptomatic reinfection and increases the reinfection interval; thus, it is necessary to be vaccinated even after a previous infection. The findings may inform the decision to avail COVID-19 vaccination.

The rates and symptoms of natural and breakthrough infection pre- and post- Covid-19 non-mRNA vaccination at various peaks amongst Iranian healthcare workers

Background/AimsThe aim of this study was to determine the rate of natural and breakthrough infection and related symptoms of Covid-19 amongst Iranian healthcare workers (HCWs) who were vaccinated by different non-mRNA-based vaccines at peak points.MethodsIn this cross-sectional study, the RT-PCR test was performed for a total of 10,581 HCWs suspicious of Covid-19 infection. For each HCW, the frequency of SARS-CoV-2 infection and the time of transmission based on vaccination administration time and schedule were examined during different waves of the pandemic. Based on these findings, the study patients were divided into three groups: natural, natural/breakthrough, and breakthrough.ResultsIn total, 53% of the HCWs were exposed to SARS-CoV-2 infection between 1 and 5 times within two years after the current pandemic, while 20.7% and 32.3% experienced natural and breakthrough SARS-CoV-2 infection, respectively. Only 6% of the breakthrough-infected HCWs had naturally contracted SARS-CoV-2 infection during the initial waves. The highest natural peaks of infection occurred during the interval administration of the first and second dose of the first vaccination series, while the single highest peak of breakthrough infection belonged to the Omicron wave. It occurred simultaneously with the administration of the third vaccination dose. On the other hand, the highest rate of reinfection was observed amongst people who had received the Sinopharm and Bharat vaccines full-doses.ConclusionThis study compared the clinical differences between the two peaks of Omicron and Delta. This study indicates the rates of natural and breakthrough SARS-CoV-2 infections according to vaccination schedules and different waves of the pandemic.

Comparison of COVID-19 epidemic among Czech dentists and the Czech general population

Dentists are one of the professional groups most at risk for COVID-19 infection. Enhanced protective measures in dentistry have been adopted worldwide; however, it is unclear to what extent they were sufficient. To assess whether the protective measures outweighed the high infection risk, we compared COVID-19-related data between Czech dentists and the general Czech population. The data was obtained through a survey study attended by 15.8% of Czech Dental Chamber members. Data of the general population were acquired from the Czech Ministry of Health database. By the end of May 2022, COVID-19 full vaccination and 1st booster dose rates among study participants were 85.8% and 70.1%, respectively, which is significantly higher (p < 0.0001) compared to the Czech general population aged over 24 years (74.9% and 49.4%, respectively). To the same date, PCR/Antigen test verified COVID-19 prevalence among participants was 41.7%, and 49.9% among the general population (p < 0.0001). Prevalence and reinfection rates among individuals who received the 1st booster were significantly lower than among individuals without the booster or full vaccination (p < 0.0001). Persons who received the booster showed a faster return to work, shorter and different types of complications. Willingness to future vaccination was positive among 79.7% of respondents. Mandatory vaccination for healthcare workers and the general population was supported by 62.0% and 49.0%, respectively. The results showed that the high risk of COVID-19 infection associated with dentistry did not lead to higher COVID-19 prevalence among respondents compared to the general population.

Floating Knee Arthrodesis After Prosthetic Knee Infection: A Report of 48 Cases

BackgroundKnee arthrodesis is a means of avoiding above-knee amputation after a prosthetic joint infection (PJI). The objective of this study was to analyze the results of floating knee arthrodesis in patients who had a history of aprosthetic knee infection. The analysis consisted of determining reinfection rates, functional results, and the survival of arthrodesis. MethodsThere were 48 patients who underwent a cemented floating knee arthrodesis in cases of PJI retrospectively included in the study, having been operated on between 2012 and 2020. In addition to being evaluated clinically, analytically, and radiographically, the patients were assessed functionally by means of a newly-created scale. ResultsAt a mean follow-up of 4 years (1 year to 9 years), 7 patients suffered reinfection (14.6%). The recurrence of infection was not observed to be significantly affected by sex (P = .16), age(P = .09), or the type of surgery previously undergone (P = .18), nor was the McPherson Host Grade (P = .4) observed to have a significant effect. Patients who had a McPherson Limb Grade 3 were more likely to suffer reinfection than those with a McPherson Limb Grade 2 (P = .034). There were 26 patients (54%)fully evaluated and scored on the Knee Arthrodesis Functional Scale(BAOR). For 11 patients (42%), the results were evaluated as excellent, for 11 (42%) acceptable, for 3 (12%) low, and for 1(4%) poor. ConclusionThe arthrodesis nail is an effective and safe procedure for patients who have a recurrent PJI, providing an effective alternative when the criteria for a new revision total knee arthroplasty are not met.

The Effects of Vaccines on the Sequelae Rates of Recurrent Infections and the Severity of Pulmonary COVID-19 Infection by Imaging.

Although vaccines have been shown to reduce the number of COVID-19 infection cases significantly, vaccine-related reactions, long COVID-19 syndrome, and COVID-19 infection following vaccination continue to be a burden on healthcare services and warrant further scientific research. The purpose of this study was to research the severity of pulmonary COVID-19 infection following vaccination and the sequelae rates of recurrent infections in vaccinated cases by imaging. Patients who underwent follow-up CTs at 1 month, 3 months, and 6 months in our hospital with a diagnosis of COVID-19 were scanned retrospectively. Furthermore, all essential information was gathered from patients' immunization records. The major findings of our study were: (1) sequelae were frequently observed in unvaccinated cases; (2) the correlation between vaccination status and the severity of sequelae was significant; (3) there was not any significant relationship between the vaccine type and the severity of sequelae; and (4) hematocrit, hemoglobin, and lymphocyte parameters may be used as predictors of sequelae rates. COVID-19 infection, although reduced in prevalence following the development of vaccines, still remains a public health concern because of reinfection. Vaccination not only appears to protect against primary infection, but also seems to reduce reinfection and sequalae rates following reinfection.

A Systematic Review of Short-Term Outcomes of Leadless Pacemaker Implantation After Transvenous Lead Removal of Infected Cardiac Implantable Electronic Device

The outcomes of leadless pacemaker (LP) implantation after transvenous lead removal (TLR) of infected cardiac implantable electronic devices (CIEDs) are not well-established. This study sought to describe the outcomes of LP implantation after TLR of infected CIED. We conducted a literature search using PubMed and Embase for a combination of terms including LP implantation, transvenous lead extraction, TLR, transvenous lead explant, infected CIED, infected pacemaker, and infected implantable cardioverter defibrillator. The inclusion criterion was LP implantation after TLR of infected CIED. The exclusion criterion was TLR for noninfectious reasons. Study end points included procedural complications and LP infection during follow-up. Of 132 publications reviewed, 13 studies with a total of 253 patients (74±14 years of age, 174 [69%] males) were included. The most common indication of the initial device implantations was a high-degree atrioventricular block (n=100 of 253, 39.5%). Of the 253 patients included, 105 patients (41.5%) underwent concomitant LP implantation during the TLR procedure, and 36 patients (14.2%) had temporary transvenous pacing as a bridge from TLR to LP implantation. Of the 148 patients with data on the type of CIED infection, 56.8% had systemic CIED infection and 43.2% had isolated pocket infection. Staphylococcus aureus was the most common causative organism in 33% of the reported patients. The LP was implanted an average of 5.4±10.7 days after TLR of infected CIED. During the LP implantation, 1 patient (0.4%) had unsuccessful implantation because of an intraprocedural complication requiring sternotomy. After LP implantation, 2 patients (0.8%) developed groin hematoma, 2 patients (0.8%) developed femoral arteriovenous fistula, and 1 patient (0.4%) developed pericardial effusion requiring pericardiocentesis. During a mean follow-up of 11.3±10.6 months, 3 patients (1.2%) developed pacemaker syndrome, 1 patient (0.4%) developed acute on chronic heart failure exacerbation, and only 1 patient (0.4%) developed LP-related infection requiring LP retrieval. This study suggests that LP implant is feasible and safe after removal of infected CIED with cumulative adverse events at 4% and a reinfection rate of 0.4%. Large prospective studies are needed to better evaluate the best timing of LP implantation after TLR of an infected CIED.

COVID-19 reinfection among health care workers in a tertiary care center in north Kerala: a descriptive study

Background: Reinfection rates due to Covid-19 is on a rise. Prevention, identification, and management of these patients will be essential to reduce morbidity and mortality. Objective of this study was to determine the proportion of SARS COV-2 reinfection among health care workers, to determine the meantime interval between primary infection and reinfection and to compare the symptomatology during Primary infection and reinfection. Methods: A descriptive study was conducted among healthcare workers who tested positive for COVID-19 from 1st July 2020 to 31st October 2021 which accounted for 704, of which 36 met the criteria for reinfection. Details of the health care workers who tested positive for COVID-19 was collected from regional PEID cell data base. Data was collected from study subjects using telephonic interviews. Data was analyzed using SPPSS Version 21. Results: Out of the 704 study subjects, 36 (5.11%) met the criteria for reinfection. Mean age was 29.6±9.7 years. Of the 36 cases of reinfection, 36.1% were asymptomatic during the primary infection compared to 2.8% during the second one. Cough and fever were present in 41.7% and 83.3% respectively during reinfection compared to 11.1% and 33.3% in primary infection. Mean time interval between primary infection and reinfection was 244.6±75.6 days. During the time period between primary infection and reinfection 4 (11.1%) had symptoms. Conclusions: Reinfection is possible in individuals who had primary infection with COVID-19. Reinfection can be symptomatically more severe. So regardless of history of infection with COVID-19 all individuals must strictly adhere to Covid protocol.

Outcomes after débridement, antibiotics, and implant retention for prosthetic joint infection in shoulder arthroplasty

Patients who undergo total shoulder arthroplasty usually have excellent long-term outcomes. However, a subset of patients is diagnosed with a prosthetic joint infection (PJI) requiring revision procedures and prolonged recovery. The purpose of this study was to evaluate rates of recurrent shoulder PJI in patients undergoing débridement, antibiotics, and implant retention (DAIR), single-stage revision, and 2-stage revision. We also sought to compare outcomes and complications across procedures. Retrospective chart review was conducted for patients diagnosed with PJI after primary shoulder arthroplasty between January 2010 and August 2021. Patients were included if they underwent treatment with DAIR, single-stage revision, or 2-stage revision. Demographic information, surgical details, complications, laboratory data, postoperative antibiotic regimen, and infectious pathogen were collected. Postoperative patient-reported outcomes were collected: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, Shoulder Activity Scale, and PROMIS Upper Extremity. Chi-square, t test, and 1-way analysis of variance were used as appropriate to evaluate each factor. Sixty-five patients were included in the study, 26% treated with DAIR, 9% treated with single-stage revision, and 65% treated with 2-stage revision. There were no significant differences in patient comorbidities. Patients undergoing DAIR were diagnosed significantly earlier than those undergoing single- and 2-stage revision procedures (12.6±22.9 months vs. 49.6±48.4 vs. 25.0±26.6, P=.010). Recurrent PJI was noted in 23.1% of patients: 29.4% of DAIR patients, no single-stage patients, and 23.8% of 2-stage patients (P=.330). Patients undergoing 2-stage revision with treatment failure had a significantly higher Elixhauser Comorbidity Index (0.2±3.7 vs. 3.7±3.9, P=.027). There was no significant difference in patient-reported outcomes across groups. Patients undergoing treatment of shoulder PJI with DAIR did not have an increased rate of reinfection compared with single-stage and 2-stage revision procedures. Patients treated with DAIR were diagnosed with PJI significantly earlier than those undergoing single-stage and 2-stage revision procedures. There was no difference in complication rates between groups. This information adds to the body of work detailing outcomes after DAIR for shoulder PJI and provides encouraging data for use in this patient population. Future studies with a larger sample size may be conducted to further investigate specific pathogens, infection timelines, and antibiotic regimens that reduce the risk of treatment failure.

Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

PurposeThe treatment of periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is still under debate. Two-stage exchange arthroplasty is the most common surgical procedure performed. This study analyzed a new functional articulating hip spacer called "Spaceflex" regarding the mechanical-related complications, the recurrent/persistent infection during the interval period, the overall infection-free survivorship after reimplantation, the overall complication/reoperation after reimplantation and the evaluation of patient-reported outcome measures (PROMs) at three intervals of time: before the first stage, during the interval period, and at the final follow-up after reimplantation. MethodsA consecutive series of 56 patients with chronic hip PJI undergoing two-stage prosthetic revision using a new intraoperatively molded articulating hip spacer design implanted by the same experienced surgeons was examined from January 2017 to December 2021. The demographic and clinical characteristics of the included patients were analyzed. Specifically, PROMs before the first stage, during the interval period, and at the final follow-up after reimplantation and complications reported during the interval period and after reimplantation were examined. ResultsThe new functional articulating hip spacer was characterized by a low mechanical complication rate (5.8%) and an overall two-stage procedure success rate of 90.6% at the last follow-up. PROMs improved with the spacer during the interval period and at the final follow-up. Furthermore, the reinfection rate was in line with other case series with different spacer designs. Finally, low postoperative complication rates after reimplantation have been demonstrated. ConclusionsTwo-stage revision performed with a modular articulating spacer allows patients to preserve satisfactory functional and quality-of-life outcomes in the postoperative period, with a low risk of mechanical complications and without increasing the reinfection rate.

Water Contact, Infection and Re-Infection Rate of Urogenital Schistosomiasis in Shelleng Local Government Area, Adamawa State, Nigeria

Schistosomiasis is on the increase despite intervention by the Government, Non-Governmental Organization (NGOs) and World Health Organization (WHO) due to the method of intervention used. The research on water contact, infection and re-infection rate of urogenital schistosomiasis was carried out in Kiri dam and Shelleng water bodies. Urine samples were collected from the month of MarchApril 2019 and examined in the laboratory using urine microscopy for schistosoma parasite and from October-November 2019 for re-infection with schistosoma parasite. Results generated ten (10) days after praziquentel administration indicate that the overall prevalence rate for schistosomiasis infection was 13.3% of the 442 study participants examined. Male had the highest rate (18.0%) while female had 8.6% rate of infection. Children that refused to take praziquentel had the highest 25.0%. Participants who adopted Washing/Bathing /Swimming/Drinking (WBSD) had the highest (17.3%). The prevalence rate was low due to the administration of praziquentel. The overall prevalence rate for schistosomiasis re-infection was 52.0% of the 442 study participants examined. Male had the highest rate of 52.9% while female had 51.1%, the intensity of infection shows that male had high intensity of 12.7%. Children whose parents are fishermen had the highest infection of 72.7%, the least infection rate was recorded among children whose parents are in to business (44.9%). Those that involved in picking of snails had the highest rate of 62.6%. Participants who adopted Washing/Bathing/Swimming/Drinking (WBSD) had the highest of 65.7%. The results obtained show that there was equal exposure to the source of infection irrespective of age gender, parents’ occupation and education. It is recommended that integrated method of treatment of the water bodies and populace should be carried out simultaneously.

An ecological study on reinfection rates using a large dataset of RT-qPCR tests for SARS-CoV-2 in Santiago of Chile.

As the SARS-CoV-2 continues to evolve, new variants pose a significant threat by potentially overriding the immunity conferred by vaccination and natural infection. This scenario can lead to an upswing in reinfections, amplified baseline epidemic activity, and localized outbreaks. In various global regions, estimates of breakthrough cases associated with the currently circulating viral variants, such as Omicron, have been reported. Nonetheless, specific data on the reinfection rate in Chile still needs to be included. Our study has focused on estimating COVID-19 reinfections per wave based on a sample of 578,670 RT-qPCR tests conducted at the University of Santiago of Chile (USACH) from April 2020 to July 2022, encompassing 345,997 individuals. The analysis reveals that the highest rate of reinfections transpired during the fourth and fifth COVID-19 waves, primarily driven by the Omicron variant. These findings hold despite 80% of the Chilean population receiving complete vaccination under the primary scheme and 60% receiving at least one booster dose. On average, the interval between initial infection and reinfection was found to be 372 days. Interestingly, reinfection incidence was higher in women aged between 30 and 55. Additionally, the viral load during the second infection episode was lower, likely attributed to Chile's high vaccination rate. This study demonstrates that the Omicron variant is behind Chile's highest number of reinfection cases, underscoring its potential for immune evasion. This vital epidemiological information contributes to developing and implementing effective public health policies.

Gluteus maximus transfer for wound closure and treatment of abductor deficiency: a single-plastic surgeon series.

Due to the increasing number of total hip arthroplasties (THA), the number and complexity of revision procedures are also on the rise. For complex cases such as periprosthetic joint infections with soft tissue compromise or for abductor muscle deficiencies, one of the treatment options is a gluteus maximus flap (GMF) that covers dead space and can help restore the failed abductor mechanism. The purpose of this study is to investigate the outcomes of a single-plastic surgeon's series of GMF procedures. This retrospective review reports on 57 patients (mean follow-up 39.2months) undergoing GMF transfers for abductor insufficiency on native hip (N = 16), for abductor insufficiency in aseptic revision THA (rTHA) (N = 16), for soft tissue defects in aseptic rTHA (N = 8) and for soft tissue defects in septic rTHA (N = 17) by a single plastic surgeon over a 10-year period. Revision-free survival and complication rates were assessed and risk factors were analyzed with Cox-regression analysis. The reoperation-free survival rate of GMF for abductor insufficiency in native hips was 100%. GMF procedures for soft tissue defects in septic rTHA had the lowest cumulative revision-free survival (34.3%) and highest reinfection rates (53.9%). More than three prior surgeries (HR = 2.9, p = 0.020), presence of infection (HR = 3.2, p = 0.010) and resistant organisms (HR = 3.1, p = 0.022) significantly increased the risk of revision. GMF is a viable option for addressing abductor insufficiency in native hip joints. However, high revision and complication rates are reported for GMF in septic rTHA. This study highlights the need to clarify the circumstances for which the flap reconstruction will be indicated.

Articular Cartilage After Toe Amputation-Protective Barrier or Source of Infection?: A Retrospective Chart Review.

Digital and ray amputations are common surgical treatments for infected bone and traumatic injuries in the foot. When disarticulated, the exposed articular cartilage can be addressed by either leaving the cartilage cap as a "protective barrier" to infection or by remodeling the exposed bone, removing the cartilage to bleeding bone to better fight infection. Our objective is to provide the first study in the foot to determine whether leaving exposed articular cartilage after toe amputation results in more returns to surgery and delayed healing. We performed a review of the electronic database of patients who had undergone toe amputation and/or metatarsal head amputation with the inclusion criteria of Current Procedural Terminology codes 28825, 28820, and 28810. Excluded patients were those who had multiple osteomyelitic bones or more than one-digit amputations because of the difficulty of controlling the extent of infection. Sixty-three procedures were included in the study (group 1, n = 47; group, n = 216). The time to healing between group 1 (44.0 ± 40.6 days) and group 2 (51.7 ± 48.0 days) was not statistically significant (t test, 0.54392), with reinfection rate being low in both group 1 (8.51%) and group 2 (6.25%). Our study showed a low reinfection rate in both groups (8.51% vs 6.25%). Age, A1C, and BMI were also similar between both groups. The PAD difference (55.3% vs 81.3%) could have contributed to the time to heal (44.0 vs 51.7 days) but not to infection rate between both groups. Tobacco use did not seem to affect time to heal or infection rate between both groups. From our results, there doesn't seem to be a difference in infection rates between each group.

Serratia marcescens prosthetic joint infection: two case reports and a review of the literature

BackgroundDespite some studies on Gram-negative bacteria as difficult to treat pathogens in periprosthetic joint infections, there are no detailed analyses on Serratia periprosthetic joint infections. As such, we present two cases of Serratia periprosthetic joint infections and summarize all known cases to date in the course of a PRISMA criteria-based systematic review.Case presentationCase 1: a 72-year-old Caucasian female with Parkinson’s disease and treated breast cancer developed periprosthetic joint infection caused by Serratia marcescens and Bacillus cereus, following multiple prior revisions for recurrent dislocations of her total hip arthroplasty. Two-stage exchange was performed, and the patient remained free of Serratia periprosthetic joint infection recurrence at 3 years. Case 2: an 82-year-old Caucasian female with diabetes and chronic obstructive pulmonary disease presented with a chronic parapatellar knee fistula after undergoing multiple failed infection treatments at external clinics. After performing two-stage exchange and gastrocnemius flap plastic for combined Serratia marcescens and Proteus mirabilis periprosthetic joint infection, the patient was released without any signs of infection, but was subsequently lost to follow-up. Review: a total of 12 additional Serratia periprosthetic joint infections were identified. Merged with our two cases, the mean age of 14 patients was 66 years and 75% were males. Mean length of antibiotic therapy was 10 weeks with ciprofloxacin most commonly used (50%). Mean follow-up was 23 months. There was a total of four reinfections (29%), including one case of Serratia reinfection (7%).ConclusionsSerratia is a rare cause of periprosthetic joint infection affecting elderly with secondary diseases. While the overall reinfection rate was high, the risk of Serratia periprosthetic joint infection persistence was low. Treatment failure in patients may be attributable to the host, rather than the Serratia periprosthetic joint infection itself, thus challenging current concepts on Gram-negatives as a uniform class of difficult-to-treat pathogens.Level of evidence: Therapeutic level IV