The objective was to determine most common pathogens causing periprosthetic joint infection (PJI) of major joints, to identify the tendency to antibiotic resistance over the period from 2015 to 2020. Material and methods Microbiological culture results of 354 patients with PJI of major joints treated at our department were retrospectively analyzed. The spectrum of the leading pathogens causing PJI and the antibacterial resistance were explored and the prevalence of common organisms depending on the type of PJI demonstrated. Results 354 patients were examined and 317 microbial isolates identified. Gram-positive bacteria was isolated in 70.7 % (224 microorganisms) of cases, Gram-negative bacilli isolated in 28.1 % (89 organisms) and Candida sp. identified in 1.2 % (4 isolates). Microbial associations were identified in 15% of cases. Discussion Most common pathogens causing PJI included S. aureus identified in 31.9 %; S. epidermidis, in 20.2 %; E. faecalis, in 8.5 %; P. aeruginosa, in 7.9 %; A. baumannii, in 7.3%. PJI associated MRSE strains increased from 12.1 % to 26.7 % and S. haemolyticus (MR) increased from 2 % to 11.6 %. S. aureus and Gram-negative bacilli were most common for early acute and hematogenous acute PJI. There were no significant differences in the prevalence of S. aureus and S. epidermidis in early/delayed and late chronic PJI. Enterococcus species and Gram-negative bacilli were detected less frequently with PJI. There was an increasing antibiotic resistance of A. baumannii and P. aeruginosa. Vancomycin-resistant strains and linezolid-resistant strains were newly found among Grampositive bacilli and pan drug-resistant A. baumannii strains. Conclusion The six-year microbiological monitoring showed S. aureus, S. epidermidis, P. aeruginosa, and A. baumannii as most common pathogens causing PJI. The growing antibiotic resistance of Gram-positive and Gram-negative bacilli and the increasing role of the latter in the pathogenesis of early acute PJI require changes in empirical antibiotic therapy regimens.
Objective. To analyze the leading pathogens of implant-associated infection (IAI) after spinal surgery and identification of trends in the change in the pattern of microorganisms at the stages of treatment using the negative pressure method (NPWT systems).Material and Methods. The results of microbiological cultures of 25 patients with IAI of the spine were studied. The frequency of occurrence of Gram-positive and Gram-negative pathogens was estimated. The leading pathogens in the species spectrum were identified. Changes in the structure of identified microorganisms were studied at various time intervals of treatment.Results. A total of 136 microbiological studies were performed in 25 patients at the stages of treatment with the negative pressure method, with the identification of microorganisms in 127 (93.3 %) cases. The frequency of gram-negative microflora was 50.0 %, gram-positive – 42.6 %, Candida sp. – 0.7%, in 15.4 % microbial associations with the dominance of gram-negative microflora were identified at all periods of treatment. Not only the diversity of the isolated flora was noted (E. faecalis – 16.5 %, P. aeruginosa – 14.2 %, K. pneumoniae – 11.0 %, S. aureus and A. baumannii – 9.4 % each and S. epidermidis – 8.6 %), but also changes in the spectrum of flora at the stages of treatment: on the 1st and 2nd weeks from the first debridement intervention and the installation of the NPWT system, E. faecalis was most often detected, on the 3rd and 4th weeks – P. aeruginosa and A. baumannii, during the 2nd month – E. faecalis and P. aeruginosa, later – gram-negative bacteria against the background of an increase in the incidence of K. pneumoniae. The frequency of verification of other species of microorganisms had no statistically significant differences. Microbial associations were found from the 2nd month of treatment. The change in pathogens was noted in 72 % of cases during the treatment of IAI of the spine. On average, this treatment required 7–8 NPWT dressing changes per patient. This method of treatment made it possible to achieve both negative results of microbiological examination and stable relief of the infectious process.Conclusion. IAI, which complicates surgical interventions on the spine, is characterized by a change in pathogens during treatment, which requires not only multiple debridement with the replacement of the NPWT dressing, but also adequate long-term rational (etiologically justified) antibacterial therapy, based on the control of data on both the spectrum and on microbial resistance.
Aim. To study the results of treatment of patients with fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, by the method of biomechanically grounded transosseous osteosynthesis. Materials and methods. A retrospective analysis of the results of treatment of fractures and pseudarthrosis of the humerus, including those complicated by chronic osteomyelitis, was carried out by the method of biomechanically substantiated transosseous osteosynthesis in 74 patients who were in the N.I. N.N. Priorov in the period from 2011 to 2019. Osteosynthesis with a rod-based apparatus was performed in 36 (48.6%) patients, with a spoke-rod in 38 (51.4%) patients. Results. Complete consolidation of bone fragments of the humerus and relief of the purulent-inflammatory process were achieved in all cases studied. Excellent treatment results were achieved in 25 (34%) cases, good results were obtained in 44 (60%) patients, satisfactory results were stated in 4 (6%) patients. No unsatisfactory outcomes were registered. Conclusion. The use of biomechanically based transosseous osteosynthesis in the treatment of fractures of the humerus and their consequences, including those complicated by chronic osteomyelitis, provided up to 94% of excellent and good results.
Цель исследования: изучить и оценить результаты биомеханически обоснованного чрескостного остеосинтеза у пациентов с ложными суставами бедренной кости, осложненными хроническим остеомиелитом. Материал и методы. Проведен ретроспективный анализ результатов чрескостного остеосинтеза у 72 пациентов с инфицированными ложными суставами бедренной кости методом с учетом критериев биомеханической концепции фиксации костных отломков в период с 2011 по 2017 г. Остеосинтез аппаратом гибридной компоновки выполнен 38 (52,8%) пациентам, стержневой-34 (47,2%). Результаты. Купирование гнойно-воспалительного процесса и полная консолидация костных отломков бедренной кости достигнута во всех исследуемых случаях. Отличные результаты получены у 21 (29,5%) пациента, хорошие результаты констатированы у 41 (57,7%) больного, удовлетворительные-у 7 (9,8%), неудовлетворительные результаты отмечены у 2 (3%) больных. Заключение. При инфицированных псевдоартрозах бедренной кости чрескостный остеосинтез с учетом биомеханических свойств каждого отломка обеспечивает до 97% положительных исходов. К л ю ч е в ы е с л о в а: бедро, ложный сустав, хронический остеомиелит, дефект костной ткани, биомеханическая концепция, чрескостный остеосинтез К о н ф л и к т и н т е р е с о в: авторы заявляют об отсутствии конфликта интересов И с т о ч н и к ф и н а н с и р о в а н и я: авторы не получали финансирования за данную работу
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