Background Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. Questions/purposes We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected. Methods We prospectively enrolled and evaluated 40 patients (29 with THAs and 11 with TKAs) who met the following inclusion criteria: older than 18 years, with suspected PJI of unknown cause, undergoing surgical revision. After arthrotomy, three tissue samples were obtained for microbiologic analysis and diagnosis, and antimicrobial prophylaxis (cefazolin 2 g intravenously) then was administered. Later during the procedure, but before débridement and irrigation, the second set of three tissue samples was obtained from the same surgical area and was cultured. Tissue concentration of prophylactic antibiotic was verified with the second set of samples. A positive culture result was defined as one or more positive cultures (growth on agar at or before 14 days). We then compared the yield on the microbiologic cultures obtained before administration of antibiotics with the yield on the cultures obtained after antibiotics were administered. An a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, and that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Valdoltra Orthopaedic Hospital, Ankaran, Slovenia. priori analysis was performed; with the numbers available, we had 98% power to detect a difference in diagnostic sensitivity of 33%. Results With the numbers available, we found no difference in the likelihood that an infection would be diagnosed between the samples obtained before and after administration of antimicrobial prophylaxis...
The concentrations of the trace elements zinc (Zn), arsenic (As), manganese (Mn), copper (Cu), chromium (Cr), nickel (Ni), cobalt (Co), cadmium (Cd), lead (Pb), mercury (Hg), and iron (Fe) were examined in Mediterranean blue mussels (Mytilus galloprovincialis) from the Northern Adriatic Sea to determine whether there were site differences and seasonal variations in metal concentrations and to evaluate the potential health risks of consumption of these mussels to humans. Mussels were collected between January and October 2015 from three Slovenian shellfish harvesting areas and from a lighthouse near Debeli Rtič. The concentrations of elements were determined using inductively coupled plasma mass spectrometry. The amount of each element decreased in the following order: Fe > Zn > (As, Mn) > (Cu, Cr) > (Ni, Co) > (Cd, Pb) > Hg. Statistical analysis revealed that time, that is, the month of sampling, significantly affected the concentrations of elements in mussels (P < 0.05). The concentrations of Cr, Mn, Fe, Ni, Hg, and Pb were highest between January and March and lowest between May and September. The concentrations of other elements in mussels were not higher or lower for several consecutive months, but occasionally (some months) lower or higher content was detected. The sampling site had a statistically significant effect only on the content of Cd, Pb, and Hg in mussels (P < 0.05). The lowest level of these elements was found in mussels from Seča, and the highest levels of Hg and Pb were found in mussels from Debeli Rtič. Debeli Rtič is, among all sampling points, closest to the outflow of the Soča River that brings heavy metals into the Northern Adriatic Sea from a closed Hg mine. Because the concentrations of Pb, Cd, and Hg in all analyzed samples were below the maximum level permitted by Commission Regulation No 1881/2006, mussels were suitable for human consumption.
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