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Journal of Shoulder and Elbow Surgery Aug 2016Although many case series have been published on the treatment of shoulder periprosthetic joint infection (PJI), few provide direct comparison of outcomes. This... (Review)
Review
BACKGROUND
Although many case series have been published on the treatment of shoulder periprosthetic joint infection (PJI), few provide direct comparison of outcomes. This systematic review synthesizes the available English literature on shoulder PJI to quantify treatment effectiveness.
METHODS
The PubMed and Embase databases were searched in April 2014. Keywords included "shoulder replacement infection" and "shoulder arthroplasty infection." Of 663 titles, 55 manuscripts underwent full-text review after application of exclusion criteria. Thirty articles were finally included.
RESULTS
Propionibacterium acnes was most commonly reported, representing 38.9% of infections, followed by Staphylococcus species. Risk factors for shoulder PJI include previous surgery, increased age, male gender, increased body mass index, and diabetes mellitus. The average white blood cell count in 13 studies was 7472 cells/µL. Ten studies reported a mean erythrocyte sedimentation rate of 27.6 mm/h, whereas 14 studies reported a mean C-reactive protein level of 2.6 mg/dL. P. acnes in intraoperative culture specimens was an independent risk factor for failed treatment for shoulder PJI. When outcomes were pooled, no statistical difference was found in the success rates of 1-stage, 2-stage, or resection arthroplasty revision; each displayed a success rate >90%. However, single-stage revision produced the highest mean Constant score; implant retention resulted in the best range of motion.
CONCLUSIONS
Our data suggest that single-stage revision can be as effective as 2-stage or resection treatments; however, the retrospective nature of these data precluded our ability to control for confounding variables. Future studies on shoulder PJI should involve direct comparisons of 1-stage vs. 2-stage treatment while comparing cost, morbidity, and functional outcomes.
Topics: Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Arthroplasty, Replacement, Shoulder; Female; Humans; Male; Middle Aged; Propionibacterium acnes; Prosthesis-Related Infections; Range of Motion, Articular; Risk Factors; Shoulder Joint; Treatment Outcome; Young Adult
PubMed: 27012542
DOI: 10.1016/j.jse.2015.11.064 -
Spine May 2015Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To review and assess the current evidence from the literature on the potential association between disc infection with the development of symptomatic degenerative disc disease.
SUMMARY OF BACKGROUND DATA
The potential relationship between disc infection- and disc degeneration-related symptoms remains controversial, with contradictory evidence available in the literature. Several studies have demonstrated the presence of infected extruded nucleus tissue from first-time disc herniations, implicating the role of disc microbial infection as a pathway for disc degeneration. In contrast, other studies reported very low prevalence of bacterial infection in samples from patients with sciatica, quoting contamination as the predominant source. To summarize the available evidence to date, a systematic review and meta-analysis was conducted.
METHODS
A comprehensive search from 6 electronic databases was performed for studies investigating the potential relationship between disc infection as a cause for degenerative disc disease and symptomatic neck/back pain or radiculopathy. Random-effects meta-analysis of proportions and odds ratio with 95% confidence intervals was used to pool the available evidence.
RESULTS
Nine relevant studies involving 602 patients with degenerative disc disease or pain were identified. From 6 studies supporting the role of infection in the pathophysiology of disc degeneration, the pooled infection prevalence was 45.2% (34.5%-56.0%). Overall pooled prevalence in all studies was 36.2% (24.7%-47.7%). Proportion of disc infections was higher in patients with symptomatic disc disease than in patients without (37.4% vs. 5.9%; odds ratio, 6.1; 95% confidence intervals, 1.426-25.901). The majority of infections were due to Propionibacterium acnes in 59.6% (43.2%-76.1%).
CONCLUSION
From the limited evidence available, the possibility that disc infection may be linked with disc degeneration should not be ruled out. There is a need to investigate this further through larger, adequately powered multi-institutional studies with contaminant arm to control for specimen contamination.
LEVEL OF EVIDENCE
2.
Topics: Back Pain; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Degeneration; Neck Pain; Odds Ratio; Prevalence; Propionibacterium acnes; Radiculopathy; Risk Factors; Virulence
PubMed: 25955094
DOI: 10.1097/BRS.0000000000000832 -
The Cochrane Database of Systematic... 2004Approximately half of all patients with metastatic cancer develop a malignant pleural effusion which is likely to lead to a significant reduction in quality of life... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Approximately half of all patients with metastatic cancer develop a malignant pleural effusion which is likely to lead to a significant reduction in quality of life secondary to symptoms such as dyspnoea and cough. The aim of pleurodesis in these patients is to prevent re-accumulation of the effusion and thereby of symptoms, and avoid the need for repeated hospitalization for thoracocentesis. Numerous clinical studies have been performed to try to determine the optimal pleurodesis strategy, and synthesis of the available evidence should facilitate this.
OBJECTIVES
The aims of this review were to ascertain the optimal technique of pleurodesis in cases of malignant pleural effusion; to confirm the need for a sclerosant; and to clarify which, if any, of the sclerosants is the most effective.
SEARCH STRATEGY
The Cochrane Central Register of Controlled Trials was searched for studies on 'pleurodesis'. Studies for inclusion were also identified from MEDLINE (1980 to June 2002) and EMBASE (1980 to May 2002). No language restriction was applied.
SELECTION CRITERIA
RCTs of adults subjects undergoing pleurodesis for pleural effusion in the context of metastatic malignancy (or a malignant process leading to pleural effusion) were included.
DATA COLLECTION AND ANALYSIS
Two reviewers independently selected studies for inclusion in the review, and extracted data using a standard data collection form. Primary outcome measures sought were effectiveness of pleurodesis as defined by freedom from recurrence of effusions, and mortality after pleurodesis. Secondary outcomes were adverse events due to pleurodesis. Dichotomous data were meta-analysed using a fixed effect model and expressed as relative risk. The number-needed-to-treat (NNT) was calculated for pleurodesis efficacy. In addition, for adverse events, the overall percentage of patients across studies exhibiting a particular adverse effect such as fever, pain, or gastrointestinal symptoms was calculated.
MAIN RESULTS
A total of 36 RCTs with 1499 subjects were eligible for meta-analysis. The use of sclerosants (mitozantrone, talc and tetracycline combined)compared with control (instillation of isotonic saline or equivalent pH isotonic saline or tube drainage alone) was associated with an increased efficacy of pleurodesis. The relative risk (RR) of non-recurrence of an effusion is 1.20 (95% CI 1.04 to 1.38) in favour of the use of sclerosants based on five studies with a total 228 subjects. Comparing different sclerosants, talc was found to be the most efficacious. The RR of effusion non-recurrence was 1.34 (95% CI 1.16 to 1.55) in favour of talc compared with bleomycin, tetracycline, mustine or tube drainage alone based on 10 studies comprising 308 subjects. This was not associated with increased mortality post pleurodesis. The RR of death was 1.19 (95% CI 0.08 to 1.77) for talc compared to bleomycin, tetracycline, mustine and tube drainage alone based on six studies of 186 subjects. Death was not reported in all studies and, when reported, was attributed to underlying disease, only one death being reported as procedure-related. In the comparison of thoracoscopic versus medical pleurodesis, thoracoscopic pleurodesis was found to be more effective. The RR of non-recurrence of effusion is 1.19 (95% CI 1.04 to 1.36) in favour of thoracoscopic pleurodesis compared with tube thoracostamy pleurodesis utilizing talc as sclerosant based on two studies with 112 subjects. Comparing thoracoscopic versus bedside instillation (with different sized chest tubes) of various sclerosants (tetracycline, bleomycin, talc or mustine) the RR of non-recurrence of effusion is 1.68 (95% CI 1.35 to 2.10) based on five studies with a total of 145 participants.Adverse events were not reported adequately to enable meta-analysis.
REVIEWER'S CONCLUSIONS
The available evidence supports the need for chemical sclerosants for successful pleurodesis, the use of talc as the sclerosant of choice, and thoracoscopic pleurodesis as the preferred technique for pleurodesis based on efficacy. There was no evidence for an increase in mortality following talc pleurodesis.
Topics: Humans; Mitoxantrone; Pleural Effusion, Malignant; Pleurodesis; Propionibacterium acnes; Quinacrine; Randomized Controlled Trials as Topic; Sclerosing Solutions; Talc; Tetracycline
PubMed: 14973997
DOI: 10.1002/14651858.CD002916.pub2 -
Zoonoses and Public Health 2007Our objective was to use formal systematic review methods to evaluate the efficacy of interventions to reduce faecal shedding of Escherichia coli O157 in post-weaned... (Review)
Review
Our objective was to use formal systematic review methods to evaluate the efficacy of interventions to reduce faecal shedding of Escherichia coli O157 in post-weaned ruminants by increasing animal resistance. The methodology consisted of an extensive search to identify all potentially relevant research, screening of titles and abstracts for relevance to the research question, quality assessment of relevant research, extraction of data from research of sufficient quality, and qualitative summarization of results. The interventions evaluated included probiotics, vaccination, antimicrobials, sodium chlorate, bacteriophages and other feed additives. There was evidence of efficacy for the probiotic combination Lactobacillus acidophilus NP51 (NPC 747) and Propionibacterium freudenreichii and for sodium chlorate in feed or water. The effectiveness of vaccination varied among studies and among vaccine protocols and there was no consistent evidence to suggest that antibiotic use was associated with a decrease in faecal shedding of E. coli O157, or that current industry uses of antimicrobials were associated with increased faecal shedding. There were an insufficient number of studies available to address the effectiveness of bacteriophages and several other feed additives. In general, few of the primary studies evaluated the interventions under commercial housing conditions with a natural disease challenge, there were inconsistencies in the results among study designs and in some cases among studies within study designs, and a relatively large proportion of publications were excluded based on quality assessment criteria. Few studies reported on associations between the proposed intervention and production parameters, such as average daily gain and feed: gain ratio. While the results suggest that some interventions may be efficacious, there are knowledge gaps in our understanding of the efficacy of pre-harvest interventions to increase animal resistance to E. coli O157 that require further targeted research.
Topics: Animal Feed; Animal Husbandry; Animals; Antibiosis; Bacterial Vaccines; Cattle; Colony Count, Microbial; Consumer Product Safety; Disease Susceptibility; Escherichia coli Infections; Escherichia coli O157; Feces; Food Contamination; Humans; Probiotics; Weaning
PubMed: 17803515
DOI: 10.1111/j.1863-2378.2007.01059.x -
American Journal of Clinical Dermatology 2003It is well recognized that some patients with acne do not respond adequately to antibiotic therapy. It is important to distinguish antibiotic recalcitrant acne which we... (Review)
Review
It is well recognized that some patients with acne do not respond adequately to antibiotic therapy. It is important to distinguish antibiotic recalcitrant acne which we would suggest represents acne that shows a diminished response to treatment irrespective of the cause as opposed to 'antibiotic-resistant acne' which is acne that is less responsive to treatment as a direct consequence of skin colonization with resistant propionibacteria. Here we show that antibiotic-resistant acne is not just a theoretical possibility but a real phenomenon that could have important consequences for patients and prescribers. The relationship between skin colonization by antibiotic-resistant propionibacteria and treatment outcomes is a complex one that is explained at the follicular level by physiological differences affecting local drug concentrations. A systematic review of the literature on antibiotic-resistant propionibacteria revealed methodological shortcomings in studies of their prevalence and a paucity of evidence on their clinical significance. Despite the elucidation of resistance mechanisms in cutaneous propionibacteria, our continuing inability to distinguish between strains of Propionibacterium acnes means that we still do not fully understand how resistance spreads, although person-to-person transfer is most likely. Finally, we present a decision tree for acne management in an era of prudent antimicrobial prescribing that provides an alternative to existing treatment algorithms by placing topical retinoids and not antibiotics at the cornerstone of acne management.
Topics: Acne Vulgaris; Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Decision Trees; Drug Resistance, Bacterial; Gram-Positive Bacterial Infections; Humans; Propionibacterium; Propionibacterium acnes; Skin
PubMed: 14640775
DOI: 10.2165/00128071-200304120-00002 -
The Journal of the American Academy of... Jan 2022Cutibacterium acnes is a common pathogen associated with surgical site infection after shoulder surgery; current standard of care products are largely ineffective at... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cutibacterium acnes is a common pathogen associated with surgical site infection after shoulder surgery; current standard of care products are largely ineffective at reducing C acnes bacterial burden before surgery. The purpose of this systematic meta-analysis was to assess the efficacy of peroxide-containing solutions (PCS) in decreasing the C acnes burden on the shoulder.
METHODS
This was a systematic review of all level I and II studies investigating the effect of peroxidase-containing products for skin preparation. We extracted data regarding demographics, treatment details and timing, study methodology, and culture positivity. Forest plots were used to determine the pooled efficacy of peroxide solutions versus control.
RESULTS
Seven studies with 412 patients were eligible for inclusion. Notable heterogeneity was observed in the manner and timing of peroxide application. Two studies applied PCS at the time of surgery; four studies applied PCS in the 24- to 72-hour period leading up to culture acquisition. Compared with the placebo, peroxide significantly diminished C acnes culture positivity (Hazard Ratio 0.174, P = 0.009). When considering using peroxide-containing products in the period leading up to surgery or at the time of surgery, in addition to standard preparation, the addition of peroxide significantly diminished C acnes culture positivity (HR 0.467, P = 0.004). Owing to study heterogeneity, we could not make notable comparisons based on the timing or duration of benzoyl peroxides application.
CONCLUSIONS
Despite heterogeneity in study design, pooled results of high-quality data suggest that the addition of PCS can markedly reduce C acnes bioburden. This review was not able to identify the ideal regimen for the utilization of PCS for reduction of C acnes burden.
LEVEL OF EVIDENCE
Level II.
Topics: Humans; Peroxides; Propionibacterium acnes; Shoulder; Shoulder Joint; Skin
PubMed: 34437309
DOI: 10.5435/JAAOS-D-21-00457 -
Tuberculosis (Edinburgh, Scotland) Mar 2018The lung microbiota has received less attention compared to other body sites, in part because its study carries special technological difficulties related to obtaining... (Meta-Analysis)
Meta-Analysis
The lung microbiota has received less attention compared to other body sites, in part because its study carries special technological difficulties related to obtaining reliable samples as compared to other body niches. The limited number of studies on the sputum microbiota on TB patients and controls available so far have reported inconsistent, and sometimes, contradictory results. Aiming to clarify if changes in the lung microbiota composition are associated with pulmonary TB, we performed a meta-analysis of available data on microbiota of the lower respiratory tract in TB patients and healthy controls. Re-processing next generation sequencing data under uniform parameters and utilizing state-of-the-art bioinformatics analysis, we obtained distinct clusterings of microbiota between TB cases vs. controls across multiple studies. We identified Tumebacillus ginsengisoli, Propionibacterium acnes, Haemophilus parahaemolyticus as differentially abundant species signature in healthy controls while Caulobacter henricii, Actinomyces graevenitzii, Rothia mucilaginosa, in addition to Mycobacterium tuberculosis as differentially abundant species signature in TB cases, and described R. mucilaginosa as the anchoring species in a network of bacteria co-occurring with Mycobacterium tuberculosis (Mtb) infection.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Case-Control Studies; Coinfection; Female; Humans; Lung; Male; Microbiota; Middle Aged; Mycobacterium tuberculosis; Sputum; Tuberculosis, Pulmonary; Young Adult
PubMed: 29559113
DOI: 10.1016/j.tube.2018.02.006 -
Journal of Shoulder and Elbow Surgery Jun 2019Periprosthetic shoulder infection (PSI) is one of the most challenging complications after shoulder arthroplasty. Different treatments have been proposed, but the best...
BACKGROUND
Periprosthetic shoulder infection (PSI) is one of the most challenging complications after shoulder arthroplasty. Different treatments have been proposed, but the best surgical procedure remains disputed in the current literature. This systematic review investigated the outcomes of revision surgery after PSI.
METHODS
The PubMed and Scopus databases were used to search keywords in April 2018. Of 2157 titles, 34 studies were finally analyzed. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported.
RESULTS
A total of 754 patients were identified. Cutibacterium acnes (C. acnes) was the most common microorganism found both in PSI (33%) and persistent infections (40%). Preoperatively, C-reactive protein was elevated in 70% of patients with PSI. Reverse shoulder arthroplasty had a lower prevalence of infection (P < .001). The eradication rate was 96% with 1 stage, 93% with permanent spacers, 86% with 2 stages, 85% with resection arthroplasty, and 65% with irrigation and débridement. One-stage revision was the best treatment, considering postoperative flexion and abduction, compared with resection arthroplasty, permanent spacers, and 2-stage revision. One-stage revision showed fewer postoperative complications than irrigation and débridement, resection arthroplasty, and 2-stage surgery. Two-stage surgery was the most common treatment, and the functional score demonstrated no differences between 2-stage and 1-stage procedures.
CONCLUSIONS
Our review suggests that a 1-stage procedure should be recommended to treat PSI. Two-stage revision could be reserved for select cases in which the bacterium involved is unknown.
Topics: Arthroplasty, Replacement, Shoulder; Debridement; Humans; Postoperative Period; Propionibacterium acnes; Prosthesis-Related Infections; Range of Motion, Articular; Reoperation; Shoulder Joint; Treatment Outcome
PubMed: 31003887
DOI: 10.1016/j.jse.2019.02.014 -
The Cochrane Database of Systematic... Nov 2013A new review team are preparing a new protocol to replace this review. The new review is entitled 'Interventions for the management of malignant pleural effusions'.... (Meta-Analysis)
Meta-Analysis Review
A new review team are preparing a new protocol to replace this review. The new review is entitled 'Interventions for the management of malignant pleural effusions'. Publication of the full review is anticipated in early 2015. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Humans; Mitoxantrone; Pleural Effusion, Malignant; Pleurodesis; Propionibacterium acnes; Quinacrine; Randomized Controlled Trials as Topic; Sclerosing Solutions; Talc; Tetracycline
PubMed: 24259053
DOI: 10.1002/14651858.CD002916.pub3 -
The American Journal of Sports Medicine Apr 2024() is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common...
BACKGROUND
() is a commensal skin bacterium, primarily found in sebaceous glands and hair follicles, with a high prevalence in the shoulder region. It is the most common pathogenic organism in prosthetic joint infections after shoulder arthroplasty. Because of its low virulence, its diagnosis remains difficult.
PURPOSE
To evaluate the relative effects of topical preparations in reducing in shoulder surgery.
STUDY DESIGN
Meta-analysis; Level of evidence, 1.
METHODS
We searched the MEDLINE, Embase, PsychINFO, and Cochrane Library databases in March 2022. Randomized controlled trials (RCTs) comparing any form of topical preparation in arthroscopic or open shoulder surgery were included. The primary outcome was a reduction in the number of positive cultures. Secondary outcomes were adverse events related to the application of topical preparations. We performed a network meta-analysis to facilitate simultaneous comparisons between multiple preparations across studies. We calculated differences between preparations using odds ratios and their 95% CIs. The risk of bias was assessed using the Cochrane risk-of-bias tool.
RESULTS
The search yielded 17 RCTs (1350 patients), of which 9 were suitable for the network meta-analysis (775 patients). Overall, 2 RCTs were deemed as having a low risk of bias, and 15 raised "some concerns" of bias. Preparations included benzoyl peroxide (BPO), BPO combined with clindamycin, chlorhexidine gluconate, hydrogen peroxide, povidone-iodine, and water with soap. Only BPO resulted in significantly lower odds of a positive culture compared with placebo or soap and water (odds ratio, 0.12 [95% CI, 0.04-0.36]). There was no statistically significant difference with all other topical preparations. The only adverse events were skin irritation from BPO and chlorhexidine gluconate in a small number of reported cases.
CONCLUSION
BPO was the most effective topical agent in reducing the prevalence of in shoulder surgery. These results were limited by a combination of indirect and direct data. Future studies should focus on establishing the optimal frequency and duration of preoperative BPO to further reduce the burden of .
REGISTRATION
CRD42022310312 (PROSPERO).
PubMed: 38590237
DOI: 10.1177/03635465231223877