bluuebunny/crossref_metadata_2025 huggingface dataset:
Barrios convivenciales ante la emergencia climática y social. Implementación de metodologías artísticas en un proceso de eco-gestión barrial.
Authors: Morales Soler Eva , Pérez-Rendón Cristina Alba , Calderón Torres Juan Antonio
Published: November 2023

¿Podemos fortalecer nuestro ámbito local y cotidiano para adaptarlo a los retos climáticos y sociales? Nuestras viviendas y barrios son nuestro ecosistema más cercano, están deteriorados y no responden a las urgencias climáticas y sociales que tenemos ante nosotras. Esto es así sobre todo en la ciudad existente y, de manera más dramática, en los barrios de vivienda social. Tejidos urbanos con una obsolescencia edificatoria que requiere de una importante revisión tipológica, constructiva, energética, así como urbana. La regeneración de estos barrios supone pues un reto para las administraciones públicas, así como para las propias familias que las habitan que son incapaces de asumir por sí solas su adaptación y mejora, y donde estrategias colaborativas son una oportunidad para vivir de forma más eficiente y adaptables a los cambios que puedan venir. La metodología de trabajo que queremos compartir en este artículo se basa en la experiencia del proyecto Barrios Convivenciales ante la emergencia climática y social, que hemos estado desarrollando en la barriada de La Cooperativa, San Juan de Aznalfarache, con el apoyo de la Fundación Daniel y Nina Carasso. De este proyecto describimos dos ámbitos de trabajo fundamentales: dinámicas comunitarias realizadas en el barrio y actividades de seguimiento político-técnico, aproximaciones esenciales para facilitar la cogestión entre agentes. Las dinámicas comunitarias siguen diferentes líneas de acción: dinámicas teatralizadas, dinámicas para la memoria del barrio y dinámicas de bioclimática al alcance de las personas. De todas éstas, destacamos el valor que tienen las dinámicas teatralizadas, como generadoras de cohesión y facilitación de las relaciones sociales, que puede funcionar de amalgama necesaria sobre la que interactuar con la línea de bioclimática de las viviendas y memoria de vida del barrio, vinculado fundamentalmente al espacio público. Este trabajo sirve de base para fortalecer el ámbito comunitario, esencial a la hora de impulsar un proceso de cogestión entre los agentes que intervienen en la mejora habitacional, para abrir la toma de decisiones, paso esencial para la generación de otras políticas públicas de mejora barrial desde el punto de vista eco-social. Para terminar, a esta experiencia le acompaña el seguimiento e intercambio de saberes entre la universidad y el barrio, como experiencia de aprendizaje-servicio entre las realidades y problemas concretos de la sociedad y la docencia de Proyectos Arquitectónicos. Palabras claves Producción y Gestión Social del Hábitat, Sostenibilidad, Transformación Social, Participación ciudadana, Procesos artísticos, Emergencia climática y social.
Zbrojna agresja Rosji, destabilizacja Ukrainy, kryzys humanitarny i jego skutki
Authors: Kwieciński Bartosz , Kozlov Roman
Published: November 2023

The history of relations between the Russian Federation and independent Ukraine since the declaration of independence has been full of tensions, which at first were regulated diplomatically – with the participation of the international community. The pro-European turn in Ukraine’s policy has contributed to the escalation of tensions and the invasion of Ukrainian territory – resulting in territorial annexations. The seizure of Crimea, Lugansk and Donbass regions was a prelude to a full-scale war. The immediate aftermath of the war launched by the Russian Federation in Ukraine was a spectacular humanitarian and refugee crisis – the largest in Europe since World War II. Although the situation on the frontline is dynamic – it is possible to distinguish the most important areas of destructive actions of the Russian aggressor: documented war crimes against civilians, destruction of critical infrastructure, attacks on civilian objects. From the beginning of the war, Ukraine has made efforts to record crimes and material losses – establishing its own agencies to that end and reporting the destruction to international organizations. The war has contributed to the largest humanitarian and migration crisis – mostly from the regions in eastern Ukraine. The Republic of Poland became the main migration route for the war refugees – which posed a challenge to local and state authorities, and above all, mobilized largescale relief operations initiated by Polish citizens.
Świat na krawędzi: Czy projekt liberalno-konstytucyjny sprosta wyzwaniom współczesności?
Authors: Kamiński Bartłomiej , Z. Kamiński Antoni
Published: November 2023

Over two centuries, the Western liberal-constitutional order has displayed remarkable capacity to adapt and generate unprecedented levels of prosperity and social and economic development. While the conditions of human existence had hardly changed before the First Industrial Revolution, subsequent transformations – made possible by the liberal-constitutional order, which has freed human energy and innovativeness and encouraged entrepreneurship – have been enormous. Note that all breakthrough innovations that were engines of successive technological revolutions occurred in societies under this order. Moreover, despite these dramatic changes, the fundamentals underpinning the liberal-constitutional order have remained essentially intact assuring dynamic equilibrium amongst its constituent parts: state, society, and economy. To put it differently, the process of mutual adaptation of institutional systems of state, economy and society has been taking place within the parameters of the liberal-constitutional order. The question is whether it will continue to offer institutional solutions to emerging hurdles within the realms of this order. The problem is not only internal, i.e., the disintegrations of its cultural foundations, but also external stemming from China’s challenge to us hegemony.
Analysis of treatment preferences, immunosuppressant adherence and mental health disorders in kidney transplant recipients
Authors: Santacruz Juan , Llana Helena García , Oliva María López , Valeros María José Santana , García María Elena González , Gutiérrez Rafael Selgas , Martin Carlos Jiménez
Published: November 2023

This study quantifies the prevalence of mental health disorders, immunosuppressive treatment adherence and identifies the treatment preferences (medical and psychological) of kidney transplant recipients
Explore National Kidney Federation's national home dialysis peer support service
Authors: Emmerson Stephen , Warren Sharney
Published: November 2023

This article outlines the National Kidney Federation's free patient support services and the benefits of shared care
Moral courage
Authors: Ellis Peter , Ellis Hannah
Published: November 2023

This article outlines the ways in which whistleblowing and speaking out about misconduct takes courage, even when there have been substantial suspicions raised previously
Communities of practice
Authors: Jenkins Karen
Published: November 2023

In this piece, the Association of Nephrology Nurses UK provides an update on the activities of the association and the future
KAYITDIŞI ÇALIŞMA VE SURİYELİ SIĞINMACI İŞÇİLER
Authors: BAYRAKCI Onur
Published: November 2023

ÖZ: Kayıtdışı çalışma kavramı son yıllarda Suriyeli sığınmacılarla birlikte tekrar günden olan konulardan birisidir. Kayıtdışı çalışma Türkiye’de Küreselleşme ile birlikte ivme kazanmıştır. Küresel pazarlar arasında sert rekabetin oluşması sonucu işverenler mümkün olduğunca karlarını arttırmak ve rekabete karşı direnç gösterebilmek için işgücünün maliyetini düşürmeye çalışmışlar ve bu süreç sonunda da tüm dünya da olduğu gibi göçmen emek gündeme düşmüştür. Suriyeli sığınmacı sayısının 2011 yılından günümüze kadar hızlı artış göstermesi ve sığınmacıların işgücü piyasalarına dahil olması kayıtdışılık ve sığınmacılık konularını beraber ele alınmasını zorunlu hale getirmiştir. Bu çalışmada piyasalarda kayıtdışılık kavramıyla ve Suriyeli sığınmacıların işgücü piyasalarındaki konumları ve yaşadıkları sıkıntılar beraber işlenerek analiz edilecektir.
REVISION DUE TO PJI INCREASES RISK OF PERIOPERATIVE MYOCARDIAL INJURY AND DEATH IN COMPARISON TO PRIMARY AND NON-PJI REVISION ARTHROPLASTY
Authors: Stuetzle Adrian , Puelacher Christian , Morgenstern Mario , Sendi Parham , Mueller Christian , Clauss Martin
Published: November 2023

Aim

Perioperative myocardial infarction/injury (PMI) is a common complication in noncardiac surgery, contributing to postoperative morbidity and mortality. We aimed to identify the risk for PMI in periprosthetic joint infection (PJI) in comparison to primary hip (THA) and knee arthroplasty (TKA) and to non-PJI revision surgery.

Methods

Patients undergoing primary/revision THA/TKA at a University Hospital who were eligible for the institutional PMI screening and response program were prospectively included. Revision arthroplasties were divided into 2 groups (PJI revision and non-PJI revision). PJI was defined according to the EBJIS criteria, and included DAIR, one-stage and two-stage revisions. Non-PJI revisions included partial and/or complete exchange of components. The primary endpoint was PMI, secondary endpoints were major adverse cardiovascular events (MACE) and all-cause mortality within 120 days.

Results

The study population included 673 patients (443 primary THA/TKA, 119 PJI revision, 111 Non-PJI revision) enrolled from 05/2014 to 06/2018. The median age in all groups was 75 years. In primary, non-PJI and PJI revision surgery, 39%, 41% and 50%, respectively were male.

PMI occurred in 12% of patients with primary arthroplasty compared to 20% and 35% in non-PJI and PJI revision, respectively (p<0.001 overall), with PJI having a significantly elevated risk over non-PJI revisions (p=0.014). Conversely, in MACE (4% primary vs 9% non-PJI vs 12% PJI, p=0.002) an all-cause mortality (2% primary vs 4% non-PJI vs 9% PJI, p<0.001) no significant difference between PJI and non-PJI revisions was observed. We found no difference for the risk of PMI comparing DAIR vs one-/two-stage PJI revision (p=0.88).

In multivariable analysis (primary arthroplasty as reference), significant odds ratios for PMI included PJI (3, 1.7–5.3), coronary artery disease (2.9, 1.9–4.4), chronic heart faiure (1.3, 1.1–1.7) and age (1.1, 1.0–1.1 per each year age). Urgency of surgery, duration of surgery, to the presence of Staphylococcus aureus were not significant. impact on PMI.

Conclusion

In PJI, PMI and MACE were 3-times, and death 4.5 times, respectively, more frequently observed than in primary arthroplasty. Also, PJI had the highest odds for PMI (3.0). Orthopaedic surgeons should be aware of the high PMI risk when performing revision surgery. This work confirms the importance of a peri-/postpoperative PMI screening and response program in the field of septic surgery.
CLOSED-INCISIONAL NEGATIVE PRESSURE WOUND THERAPY IN POST-SURGICAL MANAGEMENT OF BONE AND JOINT INFECTIONS
Authors: De Meo Daniele , Martini Paolo , Pennarola Mariafrancesca , Candela Vittorio , Torto Federico Lo , Ceccarelli Giancarlo , Gumina Stefano , Villani Ciro
Published: November 2023

Aim

There are no studies in literature that analyze the effectiveness of closed-incisional negative pressure wound therapy (ciNPWT) in the treatment of bone and joint infections (BJI). The aim of the study was to evaluate the efficacy and the safety of the application of ciNPWT in the postsurgical wound management of patients with osteoarticular infections.

Method

We conducted a perspective single-center study on patients with BJI treated between 01/2022 and 10/2022 with ciNPWT dressing application at the end of the surgical procedure. All patients were treated by a multidisciplinary team (MDT) approach and operated by the same surgical equipe. Inclusion criteria were: presence of periprosthetic joint infection (PJI), fracture-related infection (FRI), osteomyelitis (OM), septic arthritis (SA) surgically treated, after which ciNPTW was applied over the closed surgical wound. 30 patients (19M, 11F) have been analyzed with mean age of 56,10±17,11 years old; BJIs were all localized in the lower limb (16 PJI, 12 FRI, 1 SA, 1 OM).

Results

We considered the following clinical local pre-operative parameters: presence of fistula (10 patients, 33,33%), presence of erythema (18 patients, 60%), presence of previous flap in the incisional site (7 patients, 23,33%). In 11 cases (36,67%) more than 3 previous surgical procedures were performed in the surgical site. The following surgical procedures were performed: 8 debridement and implants removal, 7 DAIR, 3 one-stage exchange, 6 two-stage exchange, 3 spacer exchange, 3 resection arthroplasty. Nineteen patients (63,34%) showed no occurrence of any local post-operative complication (erythema, hematoma, wound breakdown, wound blister, necrosis). Seven (23,33%) patients showed the presence of one or more postoperative complications that didn't require additional surgery. We observed four (13,33%) failures, defined as the need for further surgical procedures following the onset of a local complication: two patients had a wound breakdown before wound closure and two had a recurrence of infection after an uneventfully wound closure. All failures were within the group of joint infection (PJI+SA) and were affected by a multi drug resistant pathogen.

Conclusions

In our series four patients required further surgery, but only two cases were related to incisional wound problems, that is consistent with aseptic joint revision surgeries data that are available in literature (3.4%-6.9%)[1-2]. Patients affected by BJI are a group with significant high risk of failure and therefore the use of ciNPWT should be considered. However, randomized clinical trials are needed to establish the superiority of the ciNPWT dressing over the standard one.
THE ROLE OF MACROPHAGES AND INTRACELLULAR SURVIVAL OF STAPHYLOCOCCUS AUREUS: NEW INSIGHTS FROM DIRECT EVALUATION OF HUMAN TISSUE SAMPLES
Authors: Morin Benedict , Tripathi Vishwachi , Iizuka Aya , Clauss Martin , Morgenstern Mario , Baumhoer Daniel , Jantarug Krittapas , Fuentes Pablo Rivera , Kuehl Richard , Bumann Dirk , Khanna Nina
Published: November 2023

Aim

Staphylococcus aureus (SA) can cause various infections and is associated with high morbidity and mortality rates of up to 40%. Antibiotic treatment often fails to eradicate SA infections even if the causative strain has been tested susceptible in vitro. The mechanisms leading to this persistence is still largely unknown. In our work, we to reveal SA interactions with host cells that allow SA to persist at the site of infection.

Method

We established a sampling workflow to receive tissue samples from patients requiring surgical debridement due to SA bone-and joint or soft-tissue infections. We developed a multiplex immunofluorescent staining protocol which allowed us to stain for SA, leukocytes, neutrophils, macrophages, B-cells, T-cells, DAPI and cytoplasmatic marker on the same sample slide. Further, distance of SA to cell nuclei was measured. Interaction of immune cells and SA on a single cell level was investigated with high-resolution 3D microscopy. We then validated our findings applying fluorescence-activated cell sorting (FACS) on digested patient samples. Finally, we aimed to reproduce our ex vivo patient results in an in vitro co-culture model of primary macrophages and clinical SA strains, where we used live cell microscopy and high-resolution microscopy to visualize SA-immune cell interactions and a gentamicin protection assay to assess viability of SA.

Results

Here, we revealed that CD68+ macrophages were the immune cells closest to SA with a mean distance of 56μm (SD=36.4μm). Counting the amount of SA, we found in total >7000 single SA in nine patients. Two-thirds of SA were located intracellularly. Two-thirds of the affected immune cells with intracellular SA were macrophages. The distribution of intra- to extracellular SA was independent of ongoing antibiotic therapy and underlying infection type. FACS confirmed these findings. In our co-culture model, intracellular SA remained alive for the whole observation period of eight hours and resided in RAB5+ early phagosomes.

Conclusions

Our study suggests an essential role of intracellular survival in macrophages in SA infections. These findings may have major implication for future treatment strategies.
ANTIBIOTIC PROPHYLAXIS FOR ENDOPROSTHETIC REPLACEMENTS IMPLANTED FOR MUSCULOSKELETAL TUMOURS: AN INTERNATIONAL SURVEY OF PRACTICE
Authors: Azamgarhi Tariq , Warren Simon , Ghert Michelle , Gerrand Craig
Published: November 2023

Aim

Deep infection following endoprosthetic replacement (EPR) of long bones is a devastating complication occurring in 15% of musculoskeletal tumour patients. The recently published PARITY Trial demonstrated that extending antibiotic prophylaxis from 24 hours to 5 days does not reduce infection rates. However, questions remain about the optimal antibiotic choice and dose.

Method

A 23-question multiple-choice questionnaire was designed and piloted through an iterative feedback process until the final version was agreed by all authors. Open and closed-ended questions were used to gather information on practice and Likert-type scale responses were used to grade responses to ascertain surgeon perceptions and preferences. The online survey was sent to all surgeon delegates of the 34th Annual Meeting of the European Musculo-Skeletal Oncology Society in London in October 2022.

Results

Amongst 61 respondents, 43 were based in Europe and 18 outside of Europe. The majority (48/61) had been in clinical practice over 11 years.

Antibiotic choice

1st or 2nd generation cephalosporins were the first line choice practiced among 49 (80.3%) of respondents. Of these, 39 responded had a 2nd line protocol for beta-lactam allergy which was most commonly clindamycin (18), vancomycin (11) or a combination of a glycopeptide or clindamycin plus gentamicin (4). Respondents changed their first line regimen for radiotherapy in 6/61, chemotherapy in 8/61 and tumour site in 20/61.

Re-dosing

Intraoperative re-dosing intervals of 1st and 2nd generation cephalosporins ranged from 2 to 8 hourly. Re-dosing for blood loss ranged from never to when 2 litres was lost. Of the 47 respondents, 24 said intraoperative re-dosing is always reliably administered.

Duration

Six (10%) of 61 respondent routinely cover the intraoperative period only, whereas 30 (49%) give 24 hours, 16 (give 48 hours or longer and 8 continue until surgical drains are removed. 31 of 61 change duration depending on clinical situation. The most common reasons for changing were patient risk factors, soft tissue status and previous radiotherapy. 57/61 surgeons were aware of the PARITY Trial. When these respondents were asked whether they had changed practice based on PARITY, 12 said yes, 24 said no and 21 said they always give 24 hours anyway.

Conclusions

Amongst an international cohort of orthopaedic oncology surgeons there was a wide variation in practice. Further research should focus on the optimum choice and re-dosing strategy, which have not been defined.
BACTERIAL RESERVOIR IN DEEPER SKIN IS A POTENTIAL SOURCE FOR SURGICAL SITE AND BIOMATERIAL-ASSOCIATED INFECTIONS
Authors: Pérez Clara Mar Guarch , Riool Martijn , de Boer Leonie , Kloen Peter , Zaat Sebastian
Published: November 2023

Aim

The origin of surgical site and biomaterial-associated infection is still elusive. Microorganisms contaminating the wound may come from the air, the surgical team, or from the skin of the patient. Prior to surgery the skin of patients is disinfected, but bacteria deeper in the skin (e.g. in sweat glands or sebaceous glands), may not be reached. This study aims to assess a potential role of this intracutaneous bacterial reservoir in biomaterial-associated infection.

Method

To study if cutaneous microbiota colonize the wound when released from the skin upon cutting, we isolated, quantified and identified aerobic and anaerobic bacteria from the skin of 99 patients undergoing trauma surgery, before and after skin disinfection, from the knife blades and from the wound directly after the first cut.

Results

Ninety-nine percent of the patients were culture-positive before disinfection with chlorhexidine. Of these, 40% were still culture-positive after disinfection. Of these, 54% had a positive culture of the wound after the skin cut. Twenty percent of the patients with a negative culture after disinfection, nevertheless had a positive wound culture after cutting the skin. Staphylococcus epidermidis and Cutibacterium acnes were the most often cultured bacterial species. In 9%, more than 100 bacterial colonies were cultured from the wound, a dose that may cause biomaterial-associated infections.

Conclusions

Bacteria residing in the skin and not eradicated by disinfection may enter the surgical wound upon cutting, resulting in contamination which may cause a biomaterial-associated infection. Use of two knifes likely reduces the risk of wound contamination.
RISK FACTORS AND OUTCOME OF POLYMICROBIAL PROSTHETIC JOINT INFECTIONS COMPARED TO MONO MICROBIAL: A SINGLE-INSTITUTION REVISION OF 536 PATIENTS
Authors: Martín Ignacio Ortiz , Ortiz Salvador Peñarrubia , Sádaba Estibaliz Torrecilla , García Antonio Blanco , Moreno Jaime Esteban , Rubio Alvaro Auñon
Published: November 2023

Aim

To describe the risk factors, microbiology and treatment outcome polymicrobial prosthetic joint infections (PJI) compared to monomicrobial PJI.

Methods

Between January 2011 and December 2021, a total of 536 patients were diagnosed with PJI at our institution. Clinical records were revised, and 91(16.9%) had an isolation of two or more pathogens. Age, sex, previous conditions, Charlson comorbidity score, previous surgery, PJI diagnosis and surgical and antibiotic treatment, from the index surgery onwards were reviewed and compared between groups.

Results

Polymicrobial PJI success rate was 57.1%, compared to 85.3% of the monomicrobial PJI(p=0.0036). There were no statistically significative differences between acute and chronic infections. In terms of related risk factors, revision surgery(p=0.0002), fracture(p=0.002), tobacco(p=0.0031) and Body Mass Index (BMI) between 20–25(p=0.0021) were associated to monomicrobial PJI, whereas overweight(p=0.005) and obesity(p=0.02) were linked to polymicrobial PJI. Regarding pathogens, the most common microorganism isolated in monomicrobial was S.aureus (33.5%), followed by S. epidermidis(20%) and gram negative bacilli (12.2%); while S. epidermidis(56%), gram negative bacilli (41.8%) and E.colli (30.8%) were the most frequent in the polymicrobial PJI. Enterococci(p=0.0008), S. epidermidis(p=0.007), E.colli (p=0.0008), gram negative bacilli (p=0.00003) and atypical bacteria (p=0.00001) statistically significative linked to polymicrobial PJI; while S.aureus (p=0.018) was related to monomicrobial PJI

Conclusion

Polymicrobial PJI showed worse outcome compared to monomicrobial PJI in our cohort. In terms of risk factors, overweight, obesity and some pathogens like gram negative bacilli, atypical bacteria, enterococci, S. epidermidis and E.colli were associated with Polymicrobial PJI
STRUGGLING WITH A CEFAZOLIN IMPREGNATION PROTOCOL OF BONE CHIPS: THE EFFECT OF THE TIMING OF THE IMPREGNATION AND GAMMA IRRADIATION ON THE CEFAZOLIN RELEASE
Authors: Dendoncker Karen , Putzeys Guy , Cornu Olivier , Nieuwenhuizen Tara , Bertrand Manon , Valster Henriëtte , Croes Kathleen
Published: November 2023

Aim

Local antibiotics released through a carrier is a commonly used technique to prevent infection in orthopaedic procedures. An interesting carrier in aseptic bone reconstructive surgery are bone chips impregnated with AB solution. Systemically administered Cefazolin (CFZ) is used for surgical site infection prophylaxis however in vitro study showed that fresh frozen and processed bone chips impregnated with CFZ solution completely release the CFZ within a few hours. On the other hand irradiated freeze-dried bone chips, treated with supercritical CO2 (scCO2) have been shown to be an efficient carrier for the antibiotics vancomycine or tobramycine.

With this pilot study we wanted to investigate if CFZ solution impregnation of bone chips treated with scCO2 shows a more favorable release pattern of CFZ.

Method

The bone chips were prepared using the standard scCO2 protocol and were impregnated with 100 mg/ml cefazolin at different timepoints during the process: before freeze drying (BC type A), after freeze drying (BC type B) and after gamma-irradiation. 0.5g of the impregnated bone grafts were incubated with 5ml of fetal calf serum (FCS) at 37°C. At 2, 4, 6, 8 and 24h of incubation 200µl of eluate was taken for analysis. After 24h the remaining FCS was removed, bone grafts were washed and new FCS (5ml) was added. Consecutive eluate samples were taken at 48, 72 and 96h of incubation.

The concentration of CFZ in the eluates was measured with the validated UPLC-DAD method. Analysis was performed in triplicate.

Results

The mean concentration of CFZ in the eluate obtained from BC type A incubated for 2h was higher compared to BC type B, respectively 581 mg/l and 297 mg/l. However, the elution profile is the same for both types: the CFZ concentration in the eluates drops within the first 24h from 581 mg/l to 365 mg/l (37%) for BC type A and from 297 mg/l to 132 mg/l (56%) for BC type B. After 24h no further significant CFZ release is seen.

Impregnation of the bone chips before or after gamma irradiation did not affect this elution profile.

Conclusions

Bone chips treated with scCO2 show a comparable elution pattern compared to non-scCO2 treated bone chips. AB release depends on the properties of the AB, making it impossible to copy the same impregnation protocol for different antibiotics. The stability of CFZ in solution at 37°C and its release are a major concern when establishing an impregnation protocol with CFZ.
MONITORING AND GUIDANCE OF PATIENTS WITH PROLONGED ANTIMICROBIAL THERAPY: FILLING THE GAP TO IMPROVE QUALITY OF CARE
Authors: Veerman Karin , Vos Fidel , Spijkers Karin , Goosen Jon , Telgt Denise
Published: November 2023

Aim

Bone and joint infection requires antimicrobial treatment for 6 to 12 weeks. When patients are well prepared and instructed regarding their therapy, they are more likely to have less side effects and improved compliance. Although side effects are common, this coaching is often not routinely performed when oral treatment is given. We developed a monitoring and guidance program for our outpatients who are on long term antimicrobial therapy, in which we can early signal side effects and treatment failure and coach the patients in their journey of infection treatment.

Method

In our tertiary referral centre for orthopaedic infections, we started the outpatient monitoring of antimicrobial treatment (OMAT)- team for patients who will receive antimicrobial therapy for >2 weeks. Before discharge, our trained nurse gives instruction to the patient. Within 3 days after hospital discharge the patient is contacted by phone to, if necessary, clarify ambiguities in monitoring set up. During this contact, the nurse checks for side effects, addresses logistic problems regarding laboratory monitoring or future appointments and coaches patients for other questions. The patient is instructed how to recognize and who to contact in case of red flags and problems possibly related to the treatment. This is repeated after every laboratory check-up. Supervision is performed by an infectious disease specialist in close collaboration with the patient's surgeon.

Results

The OMAT-team started in October 2020 and consists of 3 trained nurses and 3 ID specialist. In one year, 453 patients were proactively monitored for a mean of 11 weeks. Routinely, laboratory measurements were performed 1 week after the start of therapy and every 3–4 weeks thereafter, which resulted in 2711 contacts per year. In total, 64% of the patients reported side effects and 13% needed one or more extra laboratory measurement. This led to 40 additional outpatient consultations by the ID specialist because of complications of treatment and a switch of the antimicrobial agent in 31% of the patients.

Conclusions

OMAT seems to improve the early signalling of complications regarding treatment, which is likely to improve compliance. The OMAT-team serves as a easy to access team to discuss any problem regarding antimicrobial therapy. Being proactive, the OMAT-team intervenes in an early stage of problems regarding side effects, logistics of the treatment and possible treatment failure. Future analysis of our data will show to what extend this will lead to prevention of re-hospitalization and improvement of success rate.
USE OF DALBAVANCIN TO FACILITATE DISCHARGE IN THE TREATMENT OF BONE AND JOINT INFECTIONS
Authors: Azamgarhi Tariq , Perez-Sanchez Cristina , Warren Simon , Scobie Antonia , Karunaharan Natasha , Houghton Rebecca , Hassan Salma , Kershaw Hannah , Sendi Parham , Saeed Kordo
Published: November 2023

Aim

Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections.

Method

All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included.

Data collected through a standardised data collection form included:

Clinical and microbiological characteristics.

Hospital length of stay.

Complications.

Patient suitability for hypothetical treatment options, such as Outpatient Parenteral

Antibiotic Team (OPAT)

Clinical outcome.

Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference.

Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol.

Results

Thirty-six patients were included: 20 males and 16 females, with a median age of 53 (IQR 43–73): Thirteen were septic arthritis, twelve were prosthetic joints, seven were spondylodiscitis and five were other orthopaedic-related implant infections. In twenty cases the infecting organism was Staphylococcus aureus, fourteen were due to coagulase-negative staphylococci and two no cultured organism.

Reasons for dalbavancin

The reasons for choosing dalbavancin over alternatives were due to either:

Necessity due to poor adherence (21), or lack of viable OPAT options due to antibiotic resistance or intolerance (7)

OR

Convenience to avoid the need for OPAT (8)

Dalbavancin was initiated at 1500mg after a median of 12 days (IQR 6–17) of in-hospital antimicrobial therapy. Subsequent dalbavancin doses were based on clinical decisions and ranged from 1000mg to 1500mg.

Healthcare benefits

Switching to dalbavancin reduced treatment costs by a median of £3526 (IQR 1118 - 6251) compared with the preferred theoretical alternatives. A median of 31 hospital days (IQR 23–47) was avoided among patients who would have required a prolonged inpatient stay.

Outcome

Overall, 20 patients (55.6%) were successfully treated after a median follow-up of 8 months (IQR, 5.8 – 18.4). No patients developed an adverse drug reaction.

Conclusions

Dalbavancin can safely facilitate outpatient treatment in patients with limited oral options and in whom OPAT is unsuitable. Dalbavancin is cost-effective compared with the alternative of an inpatient stay.
MICROBIOLOGICAL PROFILE CHANGES IN SEQUENTIAL REVISION HIP AND KNEE ARTHROPLASTY FOR PROSTHETIC JOINT INFECTION
Authors: McCulloch Robert , Martin Alex , Kendrick Ben , Jeys Lee , Alvand Abtin , Young Bernadette , Taylor Adrian , Stevenson Jonathan , Palmer Antony
Published: November 2023

Introduction

A proportion of patients with hip and knee prosthetic joint infection (PJI) undergo multiple revisions with the aim of eradicating infection and improving quality of life. The aim of this study was to describe the microbiology cultured from multiply revised hip and knee replacement procedures to guide antimicrobial therapy at the time of surgery.

Patients and Methods

Consecutive patients were retrospectively identified from databases at two specialist orthopaedic centres in the United Kingdom between 2011 and 2019. Patient were included who had undergone repeat revision total knee replacement (TKR) or total hip replacement (THR) for infection, following an initial failed revision for infection.

Results

106 patients were identified, of which 74 underwent revision TKR and 32 underwent revision THR. Mean age at first revision was 67 years (SD 10). Charlson Comorbidity Index was <2 for 31 patients, 3–4 for 57 patients, and >5 for 18 patients. All patients underwent >2 revisions, 73 patients received 3, 47 patients received 4, 31 patients received 5, and 21 patients received >6. After six revisions, 90% of patients cultured different organisms than the initial revision, and 53% of organisms were multi-drug resistant species. The most frequent organisms at each revision were coagulase negative Staphylococcus (36%) and Staphylococcus aureus (19%). Fungus was cultured from 3% of revisions and 21% of infections were polymicrobial.

Conclusion

Patients undergoing multiple revisions for PJI are highly likely to experience a change in organisms and sensitivities with each subsequent revision. It is important to administer empirical antibiotics at each subsequent revision, appreciating known drug resistance from previous cultures. Our results do not support routine use of empirical antifungals.
DOES IMPROVEMENT IN PREANALYTICS LEAD TO INCREASED CULTURE YIELD IN PATIENTS WITH PERIPROSTHETIC INFECTIONS?
Authors: Käschner Juliane , Theil Christoph , Gosheger Georg , Schaumburg Frieder , Schwarze Jan , Puetzler Jan , Moellenbeck Burkhard
Published: November 2023

Aims

The microbiological detection of microorganisms plays a crucial role in the diagnosis as well as in the targeted systemic and local antibiotic therapy of periprosthetic infections (PJI). Despite extensive efforts to improve the sensitivity of current culture methods, the rate of culture-negative infections is approximately 10–20% of all PJI. This study investigates an preanalytical algorithm (culture collection and direct processing in the OR) to potentially increasing culture yield in patients with PJI.

Methods

Patients undergoing staged revision arthroplasty for PJI in our hospital between October 2021 and 2022 were included in this prospective pilot study. Intraoperatively twenty tissue samples were collected and distributed among 4 groups. Tissue samples were prepared according to standard without medium and in thioglycolate medium at 3 different temperatures (room temperature, 4°C, 37° for 24h before transport to microbiology) directly in the OR. The removed implants were sonicated. Cultures were investigated on days 1, 3, 7, 12, 14 for possible growth. All grown organism, the number of positive samples and the time to positivity were recorded and compared.

Results

71 patients were included (age, gender). Compared to the standard procedure the thioglycolate broth at 37°C was significantly more often culture-negative (p=0.031). No significant differences in the frequency of culture-negative samples were detected in the other groups.

8.4% (6/71) patients were culture negative in the standard culture but positive in the thioglycolate samples. In contrast, 7% (5/71) were culture negative in the thioglycolate samples but had bacterial detection in the standard approach. In 4.7% (3/63) of the patients, only the sonication showed growth, whereas 25.4% (16/63) had no growth in sonication fluid but in one of the cultures.

For S. caprae, there was a significantly different distribution (p=0.026) with more frequent detection in the group with thioglycolate at 37°C.

The standard procedure (p=0.005) and sonication (p=0.023) showed a shorter time to positivity of the culture compared to the thioglycolate approach at 4°C.

Conclusions

No general differences could be shown between the standard preparation and the thioglycolate preparation; in particular, storage at different temperatures does not seem to result in any difference. For individual cases (8% in this study), bacterial growth was detected in the thioglycolate group that would have been culture-negative otherwise. There might be organism dependent differences in growth in different media.
MOLECULAR EPIDEMIOLOGY OF COMMUNITY-ONSET METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS CAUSING SKIN AND MUSCULOSKELETAL INFECTIONS: AN ALARMING ANTIMICROBIAL RESISTANCE SCENARIO
Authors: Prebianchi Stefânia Bazanelli , Santos Ingrid Nayara Marcelino , Brasil Isabelle , Charf Patricia , Cunha Carolina Coelho , Seriacopi Lais Sales , Durigon Thomas Stravinkas , Rebouças Maria Augusta , Pereira Daniel Litardi Castorino , Dell Aquila Adriana Macedo , Salles Mauro
Published: November 2023

Aim

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is commonly associated with serious cases of community-onset skin and musculoskeletal infections (Co-SMSI). Molecular epidemiology analysis of CA-MRSA recovered from skin and soft tissues specimens is lacking in Latin America. This study aimed to identify phenotypic and genotypic features of MRSA isolates recovered from patients presenting Co-SMSI.

Methods

Consecutive MRSA isolates recovered from Co-SMSI of patients admitted from March 2022 to January 2023 in a Brazilian teaching hospital were tested for antimicrobial resistance and characterized by their genotypic features. Identification was carried out by automated method and through MALDI-TOF MS. Antimicrobial susceptibility was tested by disk diffusion, broth microdilution and E-test strips for determination of the minimal inhibitory concentration (MIC) according to recommendations from the Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). Gene mecA characterization and Sccmec typing were performed by multiplex polymerase chain reaction (PCR) assay, and gene lukF detection by single PCR. Patients were prospectively followed up for two months, in order to determine their clinical characteristics and outcomes.

Results

Overall, 48 Staphylococcus aureus isolates were obtained from 68 samples recovered from patients with Co-SMSI. Twenty two (42%) were phenotypically characterized as MRSA, although mecA gene was only identified in 20 of those samples. Sccmec was untypable in 12 isolates, Sccmec was type II in 4 isolates and 2 were classified as type IVa. LukF gene was identified in 5 isolates. Antimicrobial resistance profile showed that all isolates were susceptible to linezolid and vancomycin with MIC = 1 and MIC = 2 in 66,7% and 33.3%, respectively. Susceptibility to quinolones was worryingly low and none of the isolates were sensitive to usual doses of ciprofloxacin and levofloxacin, and showed increased rates of resistance to increased exposure to these drugs, as well. Isolates were both susceptible to gentamicin and tetracycline in 85% and resistance to also Sulfamethoxazole/Trimethoprim occurred in only 2 isolates. Mortality rate evaluated within 1 month of the initial evaluation was 10% among MRSA isolates.

Conclusions

Our results showed that CA-MRSA isolates causing Co-SMSI demonstrated an alarming pattern of multidrug resistance, including to β-lactam and quinolones, which have been commonly prescribed as empirical therapy for patients with skin, soft tissue and musculoskeletal infections.
SYNOVIAL FLUID VISCOSITY WITH SYNOVIAL FLUID CELL COUNT: A HIGHLY SENSITIVE AND SPECIFIC DIAGNOSTIC TOOL OF PROSTHETIC JOINT INFECTIONS
Authors: Roskar Samo , Mihalic Rene , Trebse Rihard
Published: November 2023

Aim

Prosthetic joint infection (PJI) represents the second most frequent complication of total joint arthroplasty (TJA) with up to 20% of low-grade PJI treated as aseptic failure. Sensitive diagnostic criteria have been provided by EBJIS. However, to date there is no single test to reliably diagnose all PJIs. Studies of Mazzucco et al. and Fu et al. suggest that synovial fluid (SF) viscosity could be considered as an important marker for PJI. The primary aim of our study was to determine if SF viscosity is a more reliable diagnostic criterion of PJI than the SF cell count with differential (CCD), and the combined diagnostic value of SF viscosity and CCD.

Method

We prospectively analysed the viscosity of SF samples obtained during TJA of hip and knee revisions. We sampled 2.5–5mL of SF for viscosity and CCD. Intraoperatively, 1mL of the sample was analysed for the CCD. The remaining SF was centrifuged for 4min at 7000rpm. The viscosity of the supernatant was determined on Ostwald viscometer as the time required to pass the viscometer at 20°C. During each surgery at least 5 microbiological and multiple histopathological samples were harvested, and explant sonication was performed. The diagnosis was based on EBJIS definition. The viscosity threshold for detecting PJI was set at 65 seconds.

Results

Between December 2020 and January 2023, we analysed 65 knee and 47 hip TJA revision procedures. There were 55 septic and 57 aseptic diagnoses. As a diagnostic marker of PJI, SF viscosity achieved 100% sensitivity and 82.5% specificity, with area under the receiver operating characteristic curve (AUC) of 0.832 (95% CI 0.739, 0.925). The specificity and sensitivity of SF CCD were 98.2% and 78.2%, respectively, with AUC of 0.921 (95% CI 0.869, 0.974). Of the 10 cases incorrectly diagnosed as aseptic based on SF viscosity, 2 were acute traumas and 8 metalloses. The SF CCD in all these cases was <0.5. Of the 12 cases incorrectly diagnosed as aseptic based on SF CCD, 6 cases were culture negative, 4 C. acnes and 2 S. epidemidis isolates in microbiology. Taken together, SF viscosity and CCD achieved a combined AUC of 0.953 (95% CI 0.919, 0.987).

Conclusions

Our study is the first to report that SF viscosity is more sensitive but slightly less specific for PJI than SF CCD. The study demonstrates diagnostic value of combining SF viscosity with CCD in decision making in TJA revision surgery.
THE VALUE OF PREOPERATIVE ULTRASOUND-DETERMINED FLUID FILM AND JOINT ASPIRATION IN REVISION HIP ARTHROPLASTY
Authors: Mitterer Jennyfer A , Frank Bernhard J.H. , Guger Matthias , Schoefberger Lukas , Simon Sebastian , Huber Stephanie , Autherith Maximilian , Hofstätter Jochen
Published: November 2023

Background

Data regarding the diagnostic value of ultrasound (US)-determined fluid film and joint aspiration prior to revision total hip arthroplasty (THA) for suspected periprosthetic joint infections (PJIs) is limited. This study aimed to analyse (1) the value of US-determined fluid film, (2) characterisation of the pre- and intraoperative microbiological spectrum and resistance patterns and (3) the concordance between preoperative synovial fluid and intraoperative culture results.

Methods

We analysed 366 US-examinations from 340 patients prior to revision THA. Selected cases were categorized into clearly infected, non-infected and inconclusive, according to the International Consensus Meeting (ICM) 2018 Criteria. If US-determined fluid film was <1mm, no aspiration was performed based on our institutional standard protocol. Patients were grouped into no-aspiration (144/366;[39.3%]), dry-tap (21/366;[5.7%]) and a successful-tap (201/366;[54.9%]). The microbiological spectrum and antibiotic resistance patterns were determined and differences were compared between pre- and intraoperative results.

Results

The absence of US-determined fluid film showed no correlation with the presence of hip PJI. Overall, 29.9% cases of the no-aspiration-group had a confirmed PJI. Discrepancies were found in 43.2% between successful taps and intraoperative cultures. The most prevalent microorganisms in preoperative synovial fluid were Staphylococcus epidermidis (20.9%), Staphylococcus aureus (20.9%) and Enterococcus faecalis (9.3%). The most prevalent microorganisms in intraoperative cultures were Staphylococcus epidermidis, Cutibacterium acnes and other coagulase-negative Staphylococci (14.2%). Additional microorganisms were identified in 43.8% intraoperatively. Staphylococcus aureus was more often detected preoperatively (20.9% vs. 5.8%;P=0.003), and Cutibacterium acnes intraoperatively (2.3% vs. 14.4%;P=0.01). There were no differences between the antibiotic resistance patterns of pre- and intraoperative concordant microorganisms.

Conclusion

Absence of US-determined fluid film cannot rule out the presence of hip PJI. US-guided joint aspirations is a well-established technique. However, the preoperative analysis of synovial fluid shows high discrepancies especially in Cutibacterium acnes and other rare gram-positive microorganisms compared to intraoperative cultures.
IMPROVING THE DIAGNOSIS OF BONE AND JOINT INFECTIONS: EVALUATION OF 16S RRNA METAGENOMICS
Authors: Roussel-Gaillard Tiphaine , Bouchiat-Sarabi Coralie , Souche Aubin , Ginevra Christophe , Dauwalder Olivier , Benito Yvonne , Salord Hélène , Vandenesch François , Laurent Frederic
Published: November 2023

Aim

While 16S rRNA PCR - Sanger sequencing has paved the way for the diagnosis of culture-negative bacterial infections, it does not provide the composition of polymicrobial infections. We aimed to evaluate the performance of the Nanopore-based 16S rRNA metagenomic approach using partial-length amplification of the gene, and to explore its feasibility and suitability as a routine diagnostic tool for bone and joint infections (BJI) in a clinical laboratory.

Method

Sixty-two clinical samples from patients with BJI were sequenced on MinION* using the in-house partial amplification of the 16S rRNA gene. BJI were defined based on the ICM Philly 2018 and EBJIS 2021 criteria. Among the 62 samples, 16 (26%) were culture-positive, including 6 polymicrobial infections, and 46 (74%) were culture-negative from mono- and polymicrobial infections based on Sanger-sequencing. Contamination, background noise definition, bacterial identification, and time-effectiveness issues were addressed.

Results

Results were obtained within one day. Setting a threshold at 1% of total reads overcame the background noise issue and eased interpretation of clinical samples. The partial 16S rRNA metagenomics approach had a greater sensitivity compared both to the culture method and the Sanger sequencing. All the 16 culture-positive samples were confirmed with the metagenomic sequencing. Bacterial DNA was detected in 32 culture-negative samples (70%), with pathogens consistent with BJI. The 14 Nanopore negative samples included 7 negative results confirmed after implementation of other molecular techniques and 7 false-negative MinION results: 3 Kingella kingae infections detected after targeted-PCR only, 2 Staphylococcus aureus infections and 2 Pseudomonas aeruginosa infections sterile on agar plate media and detected only after implementation of blood culture media, advocating for the very low inoculum.

Conclusions

The results discriminated polymicrobial samples, and gave accurate bacterial identifications compared to Sanger-based results. They confirmed that Nanopore technology is user-friendly as well as cost- and time-effective. They also indicated that 16S rRNA targeted metagenomics is a suitable approach to be implemented for routine diagnosis of culture-negative samples in clinical laboratories.

* Oxford Nanopore Technologies