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The Archives of Bone and Joint Surgery Apr 2022Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The purpose of this study is to evaluate the use of antibiotic... (Review)
Review
BACKGROUND
Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The purpose of this study is to evaluate the use of antibiotic impregnated calcium sulphate (AICS) beads in the management of infected tibia and femur, with regards to patient outcomes and complication rates (including reinfection rate, remission rate and union rate).
METHODS
Searches of AMED, CINAHL, EMBASE, EMCARE, Medline, PubMed and Google Scholar were conducted in June 2020, with the mesh terms: "Calcium sulphate beads" or "Calcium sulfate beads" or "antibiotic beads" or "Stimulan" AND "Bone infection" or "Osteomyelitis" or "Debridement" AND "Tibia" or "Femur". Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of interventions (ROBINS-i) tool, and quality assessed via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
RESULTS
Out of 104 relevant papers, 10 met the inclusion criteria for data extraction. Total infection remission was 6.8%, which was greater than that of polymethylmethacrylate (PMMA, 21.2%). Complication rates varied. The main issue regarding AICS use was wound drainage, which was considerably higher in studies involving treatment of tibia alone. Studies using PMMA did not experience this issue, but there were a few incidences of superficial pin tract infection following surgery.
CONCLUSION
Where AICS was used, it was consistently effective at infection eradication, despite variation in causative organism and location of bead placement. Wound drainage varied and was higher in papers regarding tibial cases alone.
PubMed: 35721593
DOI: 10.22038/ABJS.2021.53566.2661 -
PloS One 2022Diabetes foot ulcer (DFU) is a complication of diabetes mellitus. Accurate diagnosis of DFU severity through inflammatory markers will assist in reducing impact on... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetes foot ulcer (DFU) is a complication of diabetes mellitus. Accurate diagnosis of DFU severity through inflammatory markers will assist in reducing impact on quality of life. We aimed to ascertain the diagnostic test accuracy of commonly used inflammatory markers such as erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), and white cell count (WCC) for the diagnosis and differentiation between DFU grades based on the International Working Group on the Diabetic Foot classification system.
METHODS
This systematic review explored studies that investigated one or more of the above-listed index tests aiding in diagnosing infected DFU. This review was registered on PROSPERO database (ID = CRD42021255618) and searched 5 databases including an assessment of the references of included studies. Records were manually screened as per Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A total of 16 studies were included which were assessed for quality using QUADAS-2 tool and meta-analysed using Meta-Disc v1.4.
RESULTS
CRP had the greatest area under the curve (AUC) of 0.893 for diagnosing grade 2 DFU. This returned a pooled sensitivity and specificity of 77.4% (95% CI: 72% to 82%) and 84.3% (95% CI: 79% to 89%) respectively. In terms of diagnosing grade 3 DFU, procalcitonin had the highest AUC value of 0.844 when compared with other markers. The pooled sensitivity of PCT was calculated as 85.5% (95% CI: 79% to 90%) and specificity as 68.9% (95% CI: 63% to 75%).
CONCLUSION
CRP and PCT are the best markers for diagnosing grade 2 and grade 3 DFU respectively. Other markers are also valuable when used in conjunction with clinical judgement. The findings accentuate the necessity of further research to establish standardised cut-off values for these inflammatory markers in diagnosing diabetic foot ulcers.
Topics: Biomarkers; C-Reactive Protein; Calcitonin; Diabetes Mellitus; Diabetic Foot; Humans; Osteomyelitis; Procalcitonin; Quality of Life
PubMed: 35476639
DOI: 10.1371/journal.pone.0267412 -
Tomography (Ann Arbor, Mich.) Apr 2022Bezold's abscess is a deep neck abscess related to otomastoiditis. Due to the insidious clinical presentation, diagnosis can be extremely challenging, leading to delays... (Review)
Review
Bezold's abscess is a deep neck abscess related to otomastoiditis. Due to the insidious clinical presentation, diagnosis can be extremely challenging, leading to delays in treatment and possible life-threatening complications. The literature currently provides a fragmented picture, presenting only single or small number of cases. The present study aims at examining our experience and the literature findings (based on PRISMA criteria) of 97 patients with Bezold's abscess, summarizing their epidemiology, pathogenesis, clinical presentation, imaging findings, and treatments. Bezold's abscess is found at any age, with overt male prevalence among adults. The clinical presentation, as well as the causative pathogens, are strikingly heterogeneous. Otomastoiditis and cholesteatoma are major risk factors. A clinical history of otitis is commonly reported (43%). CT and MRI are the main diagnostic tools, proving the erosion of the mastoid tip in 53% of patients and the presence of a concomitant cholesteatoma in 40%. Intracranial vascular (24%) or infectious (9%) complications have also been reported. Diagnosis might be easily achieved when imaging (CT) is properly applied. MRI has a limited diagnostic role, but it might be crucial whenever intracranial complications or the coexistence of cholesteatoma are suspected, helping to develop proper treatment (prompt antibiotic therapy and surgery).
Topics: Abscess; Adult; Cholesteatoma; Humans; Male; Mastoid; Mastoiditis; Neck
PubMed: 35448708
DOI: 10.3390/tomography8020074 -
Journal of Orthopaedic Surgery and... Feb 2022Present work was aimed to gather accessible evidence on the eradication rates and related postoperative complications of antibiotic-loaded calcium sulfate (CS) as an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Present work was aimed to gather accessible evidence on the eradication rates and related postoperative complications of antibiotic-loaded calcium sulfate (CS) as an implant in the treatment of chronic osteomyelitis (COM).
METHODS
Databases including PubMed, EMBASE, Medline, Ovid and Cochrane library were searched from their dates of initiation until November 2021. Two independent authors scrutinized the relevant studies based on the effectiveness of radical debridement combined with antibiotic-loaded CS for COM; data extraction and quality assessment of the Methodological Index for Non-Randomized Studies (MINORS) criteria were also performed by the authors. In addition, clinical efficacy mainly depended on the evaluation of eradication rates and complications, and all the extracted data are pooled and analyzed by STATA 16.0.
RESULTS
A total of 16 studies with 917 patients (920 locations) were recruited, with an overall eradication rate of 92%. Moreover, the overall reoperation rate, overall refracture rate, overall delayed wound healing rate, and the rate of aseptic wound leakage were 9.0%, 2.0%, 20.0%, and 12.0%, respectively. Moreover, the choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate, and the incidence of postoperative complications in COM patients (all [Formula: see text]). The general quality of the included studies was fair.
CONCLUSIONS
Our meta-analysis indicated that the overall eradication rate of COM treated with antibiotic-loaded CS was 92%. Delayed healing is the most common postoperative complication. The choice of tobramycin-loaded CS or vancomycin combined with gentamicin-loaded CS did not affect the eradication rate and the incidence of postoperative complications in COM patients.
Topics: Anti-Bacterial Agents; Calcium Sulfate; Gentamicins; Humans; Incidence; Osteomyelitis; Postoperative Complications; Tobramycin; Vancomycin
PubMed: 35183215
DOI: 10.1186/s13018-022-02980-2 -
North American Spine Society Journal Dec 2021Pyogenic vertebral osteomyelitis is a bacterial infection of the vertebral body that is often treatable with antibiotics, but some cases require additional surgical... (Review)
Review
BACKGROUND
Pyogenic vertebral osteomyelitis is a bacterial infection of the vertebral body that is often treatable with antibiotics, but some cases require additional surgical debridement of the infected tissue. Instrumentation is often utilized for stabilization of the spine as part of the surgical treatment, but controversy remains over the relative risks and benefits of acute instrumentation performed simultaneously with debridement versus delayed instrumentation performed days or weeks after debridement. The purpose of this review was to investigate the relative effects of acute and delayed instrumentation in treatment for pyogenic vertebral osteomyelitis on patient outcomes.
METHODS
A PRISMA-compliant systematic literature review was conducted to identify studies published between January 1, 1997 and July 23, 2021. Studies were screened for pre-defined inclusion and exclusion criteria. The primary outcome of interest was reinfection. Other outcomes of interest included neurological status, pain, progression of kyphosis, fusion, hardware failure, length of hospitalization, and mortality at two years. Due to the limited multi-armed studies available that distinguish between patients with acute and delayed instrumentation, inferential statistics were not performed, and data are expressed as descriptive statistics.
RESULTS
A total of 9 studies met our inclusion criteria, comprising 299 patients, including 113 (37.8%) with surgical treatment without fixation, 138 (46.2%) with acute instrumentation, and 48 (16.1%) with delayed instrumentation. Reinfection rates were 60.0% (15/25) for surgical treatment without fixation, 28.6% (2/7) for the acute instrumentation, and 14.3% (1/7) for the delayed instrumentation group. Pain was present after surgery in 52.0% (13/25) of the surgical treatment without fixation group, 14.3% (1/7) of the acute instrumentation group, and 0% (0/7) of the delayed instrumentation group.
CONCLUSIONS
No major differences in patient outcomes were apparent between acute and delayed instrumentation groups. Further research is needed to determine whether instrumentation staging has a significant impact on patient outcomes.
PubMed: 35141648
DOI: 10.1016/j.xnsj.2021.100083 -
Annals of Palliative Medicine Dec 2021Diabetic foot ulcer (DFU) is one of the main causes of disability and death in diabetic patients, along with the continuous development of relevant research. The purpose... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetic foot ulcer (DFU) is one of the main causes of disability and death in diabetic patients, along with the continuous development of relevant research. The purpose of this paper is to study the risk factors of multidrug resistant organisms (MDROs) infection in patients with DFUs by meta-analysis.
METHODS
We searched the PubMed, EMBASE, Cochrane library, and Web of Science databases for literature related to the risk factors of MDRO infection in patients with DFUs from the date of establishment of the database to September 2021. Duplicate studies were excluded using Endnote X9 software. Stata 15.1 software was used to meta-analyze the data. Random or fixed effects models were used to combine and analyze the odds ratio (OR) and 95% confidence interval (CI) of the included risk factors. Heterogeneity was analyzed by the Q and I2 tests. Egger's linear regression method was used to evaluate the publication bias of the included articles. Sensitivity analysis was used to analyze the source of heterogeneity.
RESULTS
A total of 13 articles were included in the study. Meta-analysis was performed on 15 risk factors. Among them, hospital records before admission (OR =5.18, 95% CI: 1.45-18.51, P=0.011), antibiotic use before admission (OR =2.17, 95% CI: 1.24-3.79, P=0.006), diabetes type (OR =2.44, 95% CI: 1.29-4.64, P=0.006), ulcer type (OR =2.17, 95% CI: 1.06-4.41, P=0.033), ulcer size (OR =2.56, 95% CI: 1.53-4.28, P<0.001), osteomyelitis (OR =3.50, 95% CI: 2.37-5.16, P<0.001), vascular disease (OR =2.37, 95% CI: 1.41-3.99, P=0.001), surgical treatment (OR =4.80, 95% CI: 2.95-7.83, P<0.001), and these meta-analysis results were statistically different and could be considered as risk factors for MDRO infection.
CONCLUSIONS
The risk factors of MDRO infection in DFU patients include hospitalization records before admission, antibiotic use before admission, type of diabetes, type of ulcer, size of ulcer, osteomyelitis, vascular lesions, and surgical treatment. This study contributes to the ability of the population of DFU patients infected with MDROs to receive timely treatment at an early stage and delay disease development.
Topics: Bacterial Infections; Diabetes Mellitus; Diabetic Foot; Drug Resistance, Multiple, Bacterial; Humans; Osteomyelitis; Risk Factors
PubMed: 35016446
DOI: 10.21037/apm-21-3406 -
EFORT Open Reviews Dec 2021Bone and joint infections are difficult to treat, and increasing antibiotic resistance has only made them more challenging. This has led to renewed interest in phage... (Review)
Review
Bone and joint infections are difficult to treat, and increasing antibiotic resistance has only made them more challenging. This has led to renewed interest in phage therapy (PT). The aim of this systematic review was to determine success rate, current treatment modalities and safety of PT in bone and joint infections.A systematic search of PubMed, EMBASE and Cochrane databases as well as the journal for literature published between January 2000 and April 2021 was conducted according to PRISMA guidelines to identify all human studies assessing bacteriophages as therapy for bone and joint infections. All study designs and patient populations were eligible. The review's primary outcome was success rate.Twenty records describing a total of 51 patients and 52 treatment episodes were included. No randomized controlled studies were identified. The overall success rate was 71% ( = 37/52). Topical administration alone was the most frequent administration route (85%, = 44/52). Antibiotics were administered concomitantly with PT in the majority of treatments (79%, = 41/52), and surgery was performed for 87% ( = 45/52) of treatment episodes. Four minor adverse events related to PT were reported, representing 8% ( = 4/52) of treatment episodes.PT for bone and joint infections has not been evaluated in any randomized controlled clinical study, and current administration modalities are highly variable between case reports and case series. While publications included here show potential benefit and few adverse effects, clinical trials are warranted to assess the efficacy of PT for bone and joint infections and determine optimal treatment modalities. Cite this article: 2021;6:1148-1156. DOI: 10.1302/2058-5241.6.210073.
PubMed: 35003759
DOI: 10.1302/2058-5241.6.210073 -
Journal of Orthopaedics and... Dec 2021Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable...
BACKGROUND
Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use.
METHODS
A systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible.
RESULTS
A total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant.
CONCLUSION
Adequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted.
LEVEL OF EVIDENCE
III.
Topics: Anti-Bacterial Agents; Bone Cements; Bone Plates; Bone Wires; Fracture Fixation, Intramedullary; Humans
PubMed: 34940945
DOI: 10.1186/s10195-021-00614-7 -
PloS One 2021To compare between current evidence of novel glycopeptides against vancomycin for the treatment of gram-positive bacterial infections. (Meta-Analysis)
Meta-Analysis
Efficacy and safety of novel glycopeptides versus vancomycin for the treatment of gram-positive bacterial infections including methicillin resistant Staphylococcus aureus: A systematic review and meta-analysis.
OBJECTIVE
To compare between current evidence of novel glycopeptides against vancomycin for the treatment of gram-positive bacterial infections.
METHODOLOGY
A systematic review and meta-analysis was done. Major databases were searched for eligible randomized control trials that assessed clinical success, microbiological success and safety profile of novel glycopeptides versus vancomycin for infections caused by gram-positive bacteria.
RESULTS
This meta-analysis included eleven trials (7289 participants) comparing telavancin, dalbavancin and oritavancin with vancomycin. No differences were detected between novel glycopeptides and vancomycin for the treatment of skin and soft tissue infections (SSTIs) among modified intent-to-treat patients (OR: 1.04, CI: 0.92-1.17) as well as within the clinically evaluable patients (OR: 1.09, CI: 0.91-1.30). Data analysed from SSTIs, HAP and bacteremia studies on telavancin showed insignificant high clinical response in microbiologically evaluable patients infected with methicillin resistant Staphylococcus aureus (MRSA) (OR: 1.57, CI: 0.94-2.62, p: 0.08) and in the eradication of MRSA (OR: 1.39, CI: 0.99-1.96, P:0.06). Dalbavancin was non-inferior to vancomycin for the treatment of osteomyelitis in a phase II trial, while it was superior to vancomycin for the treatment of bacteremia in a phase II trial. Data analysed from all trials showed similar rates of all-cause mortality between compared antibiotics groups (OR: 0.67, CI: 0.11-4.03). Telavancin was significantly related with higher adverse events (OR: 1.24, CI: 1.07-1.44, P: <0.01) while dalbavancin and oritavancin were associated with significant fewer adverse events (OR: 0.73, CI: 0.57-0.94, p: 0.01; OR: 0.72, CI: 0.59-0.89, p: <0.01 respectively).
CONCLUSION
Efficacy and safety profiles of both dalbavancin and oritavancin were the same as vancomycin in the treatment of gram-positive bacterial infections in different clinical settings, while telavancin might be an effective alternative to vancomycin in MRSA infections, but caution is required during its clinical use due to the high risk of adverse events, especially nephrotoxicity.
Topics: Anti-Bacterial Agents; Glycopeptides; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Treatment Outcome; Vancomycin
PubMed: 34843561
DOI: 10.1371/journal.pone.0260539 -
Brazilian Journal of Otorhinolaryngology 2023To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine the diagnostic accuracy of Necrotizing Otitis Externa (NOE) based on radiologic studies.
METHODS
The PubMed, Cochrane, Embase, Web of Science, SCOPUS, and Google Scholar databases were searched. True-positive and false-negative results were extracted for each study. Methodological quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool.
RESULTS
The included studies contained data on 37 studies diagnosed with NOE. The sensitivity of gallium-67, technetium-99m, and Magnetic Resonance Imaging (MRI) was 0.9378 (0.7688-0.9856), 0.9699 (0.8839-0.9927), and 0.9417 (0.6968-0.9913), respectively. For Computed Tomography (CT), the positive criteria consisted of bony erosion alone and bony erosion plus any soft tissue abnormality. The sensitivity of CT based only on bony erosion was 0.7062 (0.5954-0.7971); it was higher 0.9572 (0.9000-0.9823) when based on bony erosion plus any soft tissue abnormality.
CONCLUSION
The diagnostic sensitivity of technetium-99m, gallium-67, and MRI was favorable. On CT, the presence of bony erosion may be a useful diagnostic marker of NOE, but the diagnostic sensitivity will be even higher if the criterion of any soft tissue abnormality is also included; however, care should be taken when interpreting the results. Our study demonstrates the potential utility of radiology studies for diagnosing NOE, but their lack of specificity must be considered, and standardized anatomic criteria are still needed.
LEVEL OF EVIDENCE
2A.
Topics: Humans; Otitis Externa; Technetium; Positron-Emission Tomography; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Sensitivity and Specificity
PubMed: 34799270
DOI: 10.1016/j.bjorl.2021.08.011