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Journal of Clinical Microbiology Sep 2017Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial... (Review)
Review
The Effect of Preoperative Antimicrobial Prophylaxis on Intraoperative Culture Results in Patients with a Suspected or Confirmed Prosthetic Joint Infection: a Systematic Review.
Obtaining reliable cultures during revision arthroplasty is important to adequately diagnose and treat a prosthetic joint infection (PJI). The influence of antimicrobial prophylaxis on culture results remains unclear. Since withholding prophylaxis increases the risk for surgical site infections, clarification on this topic is critical. A systematic review was performed with the following research question: in patients who undergo revision surgery of a prosthetic joint, does preoperative antimicrobial prophylaxis affect the culture yield of intraoperative samples in comparison with nonpreoperative antimicrobial prophylaxis? Seven articles were included in the final analysis. In most studies, standard diagnostic culture techniques were used. In patients with a PJI, pooled analysis showed a culture yield of 88% (145/165) in the prophylaxis group versus 95% (344/362) in the nonprophylaxis group ( = 0.004). Subanalysis of patients with chronic PJIs showed positive cultures in 88% (78/89) versus 91% (52/57), respectively ( = 0.59). In patients with a suspected chronic infection, a maximum difference of 4% in culture yield between the prophylaxis and nonprophylaxis groups was observed. With the use of standard culture techniques, antimicrobial prophylaxis seems to affect cultures in a minority of patients. Along with the known risk of surgical site infections due to inadequate timing of antimicrobial prophylaxis, we discourage the postponement of prophylaxis until tissue samples are obtained in revision surgery. Future studies are necessary to conclude whether the small percentage of false-negative cultures after prophylaxis can be further reduced with the use of more-sensitive culture techniques, like sonication.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Corynebacterium; Humans; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Staphylococcus; Surgical Wound Infection
PubMed: 28659322
DOI: 10.1128/JCM.00640-17 -
International Orthopaedics Apr 2017While as many as 50% of revision shoulder arthroplasties are culture positive, a consistent, clinically useful definition of a "periprosthetic shoulder infection" is... (Review)
Review
PURPOSE
While as many as 50% of revision shoulder arthroplasties are culture positive, a consistent, clinically useful definition of a "periprosthetic shoulder infection" is lacking. We conducted a systematic review of the published literature with respect to (1) the definition of a "periprosthetic shoulder infection", (2) the pre-operative evaluation for possible infection, and (3) the harvesting and culturing of specimens at the time of surgical revision.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified 20 studies concerning infection at the time of revision shoulder arthroplasty. The review was registered in the international Prospective Register of Systematic Reviews.
RESULTS
An explicit definition of infection was not present in six studies (27%). Classification systems used for periprosthetic hip and knee infections were used in three studies (14%). Clinical signs and symptoms were used in all definitions, but most studies did not report microbiologic results or culturing practices.
CONCLUSIONS
Synthesis of the literature on failed arthroplasties with positive cultures is compromised by lack of standardization, leaving surgeons without secure evidence on which to base diagnostic and treatment decisions. These decisions would be better informed if authors used a consistent approach in the evaluation of failed arthroplasties with respect to the number and source of specimens submitted, the culture technique, the number of specimens that became culture positive, the bacteria identified, and the bacterial load recovered from the shoulder.
LEVEL OF EVIDENCE
This was a systematic review of reports of all levels.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Microbiological Techniques; Prosthesis-Related Infections; Reoperation; Shoulder Joint; Specimen Handling
PubMed: 28224190
DOI: 10.1007/s00264-017-3421-6 -
The British Journal of Dermatology Nov 2017Dysbiosis is a hallmark of atopic dermatitis (AD). The composition of skin microbiome communities and the causality of dysbiosis in eczema have not been well... (Review)
Review
Dysbiosis is a hallmark of atopic dermatitis (AD). The composition of skin microbiome communities and the causality of dysbiosis in eczema have not been well established. The objective of this review is to describe the skin microbiome profile in AD and address whether there is a causal relationship between dysbiosis and AD. The protocol is registered in PROSPERO (CRD42016035813). We searched PubMed, Embase, Scopus and ClinicalTrials.gov for primary research studies applying culture-independent analysis on the microbiome on AD skin of humans and animal models. Two authors independently screened the full text of studies for eligibility and assessed risk of bias. Because of heterogeneity no quantitative synthesis was done. Of 5735 texts, 32 met the inclusion criteria (17 published: 11 human and six animal studies). The studies varied in quality and applied different methodology. The skin in AD had low bacterial diversity (lowest at dermatitis-involved sites) and three studies showed depletion of Malassezia spp. and high non-Malassezia fungal diversity. The relative abundance of Staphylococcus aureus and Staphylococcus epidermidis were elevated and other genera were reduced, including Propionibacterium. A mouse study indicated that dysbiosis is a driving factor in eczema pathogenesis. The data are not sufficiently robust for good characterization; however, dysbiosis in AD not only implicates Staphylococcus spp., but also microbes such as Propionibacterium and Malassezia. A causal role of dysbiosis in eczema in mice should encourage future studies to investigate if this also applies to humans. Other important aspects are temporal dynamics and the influence of methodology on microbiome data.
Topics: Animals; Dermatitis, Atopic; Dermatologic Agents; Disease Models, Animal; Dogs; Humans; Mice; Microbiota
PubMed: 28207943
DOI: 10.1111/bjd.15390 -
BMC Pulmonary Medicine Nov 2016During the last few years, investigators have debated the role that infectious agents may have in sarcoidosis pathogenesis. With the emergence of new molecular biology... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
During the last few years, investigators have debated the role that infectious agents may have in sarcoidosis pathogenesis. With the emergence of new molecular biology techniques, several studies have been conducted; therefore, we performed a meta-analysis in order to better explain this possible association.
METHODS
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane collaboration guidelines. Four different databases (Medline, Scopus, Web of Science, and Cochrane Collaboration) were searched for all original articles published from 1980 to 2015. The present meta-analysis included case-control studies that reported the presence of microorganisms in samples of patients with sarcoidosis using culture methods or molecular biology techniques. We used a random effects or a fixed-effect model to calculate the odds ratio (OR) and 95% confidence intervals (CI). Sensitivity and subgroup analyses were performed in order to explore the heterogeneity among studies.
RESULTS
Fifty-eight studies qualified for the purpose of this analysis. The present meta-analysis, the first, to our knowledge, in evaluation of all infectious agents proposed to be associated with sarcoidosis and involving more than 6000 patients in several countries, suggests an etiological link between Propionibacterium acnes and sarcoidosis, with an OR of 18.80 (95% CI 12.62, 28.01). We also found a significant association between sarcoidosis and mycobacteria, with an OR of 6.8 (95% CI 3.73, 12.39). Borrelia (OR 4.82; 95% CI 0.98, 23.81), HHV-8 (OR 1.47; 95% CI 0.02, 110.06) as well as Rickettsia helvetica, Chlamydia pneumoniae, Epstein-barr virus and Retrovirus, although suggested by previous investigations, were not associated with sarcoidosis.
CONCLUSION
This meta-analysis suggests that some infectious agents can be associated with sarcoidosis. What seems clear is that more than one infectious agent might be implicated in the pathogenesis of sarcoidosis; probably the patient's geographical location might dictate which microorganisms are more involved. Future investigations and more clinical trials are need to bring these evidences to a more global level.
Topics: Humans; Mycobacterium; Mycobacterium Infections; Propionibacterium acnes; Sarcoidosis; Sensitivity and Specificity
PubMed: 27894280
DOI: 10.1186/s12890-016-0332-z -
Journal of Neurosurgical Sciences Apr 2019The aim of this paper was to systematically review the evidence linking Propionibacterium acnes (P. acnes) with the development of symptomatic degenerative disc disease.
BACKGROUND
The aim of this paper was to systematically review the evidence linking Propionibacterium acnes (P. acnes) with the development of symptomatic degenerative disc disease.
EVIDENCE ACQUISITION
Data were obtained from MEDLINE from their inception to October 2015. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they investigated the presence of P. acnes in symptomatic degenerative disc disease through intra-operative cultural examination. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale.
EVIDENCE SYNTHESIS
Overall 641 articles were retrieved with 9 cross-sectional studies being included in the review. All selected studies revealed an association between P. acnes and disc degeneration.
CONCLUSIONS
This study shows that there is a relationship between P. acnes and development of symptomatic degenerative disc disease. Despite this, we cannot support that P. acnes and development of symptomatic degenerative disc disease due to the low quality of the results according Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Topics: Adult; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc Degeneration; Propionibacterium acnes
PubMed: 27603410
DOI: 10.23736/S0390-5616.16.03842-X -
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 -
The Lancet. Infectious Diseases Mar 2016Topical and oral antibiotics are routinely used to treat acne. However, antibiotic resistance is increasing, with many countries reporting that more than 50% of... (Review)
Review
Topical and oral antibiotics are routinely used to treat acne. However, antibiotic resistance is increasing, with many countries reporting that more than 50% of Propionibacterium acnes strains are resistant to topical macrolides, making them less effective. We reviewed the current scientific literature to enable proposal of recommendations for antibiotic use in acne treatment. References were identified through PubMed searches for articles published from January, 1954, to March 7, 2015, using four multiword searches. Ideally, benzoyl peroxide in combination with a topical retinoid should be used instead of a topical antibiotic to minimise the impact of resistance. Oral antibiotics still have a role in the treatment of moderate-to-severe acne, but only with a topical retinoid, benzoyl peroxide, or their combination, and ideally for no longer than 3 months. To limit resistance, it is recommended that benzoyl peroxide should always be added when long-term oral antibiotic use is deemed necessary. The benefit-to-risk ratio of long-term antibiotic use should be carefully considered and, in particular, use alone avoided where possible. There is a need to treat acne with effective alternatives to antibiotics to reduce the likelihood of resistance.
Topics: Acne Vulgaris; Anti-Bacterial Agents; Benzoyl Peroxide; Drug Resistance, Bacterial; Humans; Propionibacterium acnes; Retinoids
PubMed: 26852728
DOI: 10.1016/S1473-3099(15)00527-7 -
Archives of Dermatological Research Nov 2015Determined efficacies of benzoyl peroxide may be affected by study design, implementation, and vehicle effects. We sought to elucidate areas that may allow improvement... (Review)
Review
Determined efficacies of benzoyl peroxide may be affected by study design, implementation, and vehicle effects. We sought to elucidate areas that may allow improvement in determining accurate treatment efficacies by determining rates of active treatment and vehicle responders in randomized controlled trials assessing the efficacy of topical benzoyl peroxide to treat acne. We conducted a systematic review of randomized vehicle-controlled trials evaluating the efficacy of topical benzoyl peroxide for the treatment of acne. We compared response rates of vehicle treatment arms versus those in benzoyl peroxide arms. Twelve trials met inclusion criteria with 2818 patients receiving benzoyl peroxide monotherapy treatment and 2004 receiving vehicle treatment. The average percent reduction in total number of acne lesions was 44.3 (SD = 9.2) and 27.8 (SD = 21.0) for the active and vehicle treatment groups, respectively. The average reduction in non-inflammatory lesions was 41.5 % (SD = 9.4) in the active treatment group and 27.0 % (SD = 20.9) in the vehicle group. The average percent decrease in inflammatory lesions was 52.1 (SD = 10.4) in the benzoyl peroxide group and 34.7 (SD = 22.7) in the vehicle group. The average percentage of participants achieving success per designated study outcomes was 28.6 (SD = 17.3) and 15.2 (SD = 9.5) in the active treatment and vehicle groups, respectively. Patient responses in randomized controlled trials evaluating topical acne therapies may be affected by clinical trial design, implementation, the biologic effects of vehicles, and natural disease progression. "No treatment" groups may facilitate determination of accurate treatment efficacies.
Topics: Acne Vulgaris; Administration, Topical; Anti-Bacterial Agents; Benzoyl Peroxide; Dermatologic Agents; Gels; Humans; Placebo Effect; Propionibacterium acnes; Randomized Controlled Trials as Topic; Research Design; Treatment Outcome
PubMed: 26048131
DOI: 10.1007/s00403-015-1568-9 -
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 -
BMC Medicine Jan 2015Recently, there has been both immense interest and controversy regarding a randomised, controlled trial which showed antibiotics to be effective in the treatment of... (Review)
Review
BACKGROUND
Recently, there has been both immense interest and controversy regarding a randomised, controlled trial which showed antibiotics to be effective in the treatment of chronic low back pain (disc herniation with Modic Type 1 change). While this research has the potential to result in a paradigm shift in the treatment of low back pain, several questions remain unanswered. This systematic review aims to address these questions by examining the role of bacteria in low back pain and the relationship between bacteria and Modic change.
METHODS
We conducted electronic searches of MEDLINE and EMBASE and included studies that examined the relationship between bacteria and back pain or Modic change. Studies were rated based on their methodological quality, a best-evidence synthesis was used to summarise the results, and Bradford Hill's criteria were used to assess the evidence for causation.
RESULTS
Eleven studies were identified. The median (range) age and percentage of female participants was 44.7 (41-46.4) years and 41.5% (27-59%), respectively, and in 7 of the 11 studies participants were diagnosed with disc herniation. Nine studies examined the presence of bacteria in spinal disc material and all identified bacteria, with the pooled estimate of the proportion with positive samples being 34%. Propionibacterium acnes was the most prevalent bacteria, being present in 7 of the 9 studies, with median (minimum, maximum) 45.0% (0-86.0) of samples positive. The best evidence synthesis found moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change with disc herniation. There was modest evidence for a cause-effect relationship.
CONCLUSIONS
We found that bacteria were common in the spinal disc material of people undergoing spinal surgery. There was moderate evidence for a relationship between the presence of bacteria and both low back pain with disc herniation and Modic Type 1 change associated with disc herniation and modest evidence for causation. However, further work is needed to determine whether these organisms are a result of contamination or represent low grade infection of the spine which contributes to chronic low back pain.
Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Female; Humans; Low Back Pain; Male; Prevalence
PubMed: 25609421
DOI: 10.1186/s12916-015-0267-x