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The sensitivity of periprosthetic tissue culture is inadequate for the diagnosis of prosthetic joint infection (PJI). We investigated and compared the values of sonication fluid culture and periprosthetic tissue culture for diagnosing PJI.Included were patients whose joint prosthesis had been removed for any reason. The resulting sonication fluid and periprosthetic tissues were cultured for 14 days.Of 231 explanted prostheses, aseptic failure was diagnosed in 162 cases (70%) and PJI in 69 (30%). In PJI cases, sonication fluid culture detected 62 microorganisms and periprosthetic tissue culture detected 45. Tissue and sonication fluid cultures showed sensitivities of 61% and 81%, respectively (p0.01), with specificity of 100% and 99%, respectively. On day 1, tissue and sonication fluid cultures were positive in 13% and 28% (p = 0.013) of PJI cases respectively, and on day 2, in 26% and 48% (p = 0.002) of cases. Four anaerobes grew in sonication fluid culture after 7-13 days incubation, whereas tissue culture missed 3 of these. Prolonged incubation of sonication fluid did not detect any organisms in the cases of aseptic failure.Sonication fluid culture provides a more rapid diagnosis and detects about 30% more pathogens, although anaerobic organisms require up to 2 weeks of incubation.

To analyze the characteristics of infection, adequacy of empirical treatment and outcome of patients with community-onset healthcare-associated (HCA) urinary tract infections (UTI) and compare them with hospital (HA) and community-acquired (CA) UTI.Prospective observational cohort study performed at a university 600-bed hospital between July 2009 and February 2010. Patients with UTI requiring hospital admission were included. Epidemiological, clinical and outcome data were recorded.251 patients were included. Patients with community-onset HCA UTI were older, had more co-morbidities and had received previous antimicrobial treatment more frequently than CA UTI (p = 0.02, p = 0.01 and p0.01). ESBL-Escherichia coli and Pseudomonas aeruginosa infections were more frequent in HCA than in CA UTI (p = 0.03 and p0.01). Inadequate empirical treatment was not significantly different between community-onset HCA and CA. Factors related to mortality were P. aeruginosa infection (OR 6.51; 95%CI: 1.01-41.73), diabetes mellitus (OR 22.66; 95%CI: 3.61-142.21), solid neoplasia (OR 22.48; 95%CI: 3.38-149.49) and age (OR 1.15; 95%CI 1.03-1.28).Epidemiological, clinical and microbiological features suggest that community-onset HCA UTI is different from CA and similar to HA UTI. However, in our series inadequate empirical antimicrobial therapy and mortality were not significantly higher in community-onset HCA than in CA UTI.

Objectives To determine whether the incidence of bacteremia after transrectal ultrasound-guided prostate biopsy (TRUSGPB) significantly diminishes with the setting up of a new preventive protocol. This protocol was set up after detecting an augmented incidence of bacteremia after TRUSGPB with a high prevalence of antibiotic-resistant microorganisms. Methods Retrospective descriptive and prospective intervention study performed at a University Hospital. Participants: Patients undergoing TRUSGPB under the old preventive protocol (January 2006-February 2007), that is, amoxicillin-clavulanate 500 mg tid the day before, the day of the procedure, and 1 day after the procedure, and after setting up a new protocol (March 2007-April 2008), that is, 2 g cefoxitin 1 hour before the procedure and ciprofloxacin 750 mg p.o. bid the day before, the day of the procedure, and 3 days after the procedure; dipstick urinalysis was performed before the procedure, and patients with positive results were not biopsied. Results Incidence of bacteremia with old and new protocols: 9 of 204 procedures (4.4%) vs 2 of 207 (0.9%), (P = .03). Four isolates (44.4%) under the old protocol produced extended-spectrum beta-lactamase (ESBL). With the new protocol, 2 (0.9%) cases of non-ESBL Escherichia coli bacteremia were observed. Sixty-five (23.8%) cases were not biopsied because of positive result of dipstick urinalysis, lack of antibiotic prophylaxis adherence, or altered coagulation parameters. Conclusions Antibiotic prophylaxis for TRUSGPB should take into account local resistance patterns. Cefoxitin could be used as prophylaxis in centers with high prevalence of ESBL enterobacteriaceae. Before TRUSGPB, excluding patients with positive results of dipstick urinalysis is an advisable practice.

Fundamento El objetivo fue conocer, mediante un estudio multicentrico y con la colaboracion de clinicos, microbiologos y epidemiologos, el nivel de resistencias de Mycobacterium tuberculosis en el area de Barcelona y su relacion con datos clinicos de los pacientes para establecer posibles grupos de riesgo. Pacientes y metodo Se incluyeron las cepas de M. tuberculosis aisladas de los pacientes diagnosticados bacteriologicamente desde octubre de 1995 a septiembre de 1997, revisandose su historial clinico. Se estudio la resistencia a isoniacida, rifampicina, estreptomicina, etambutol y pirazinamida mediante el sistema Bactec 460. Los factores asociados a resistencia se analizaron mediante regresion logistica. Resultados El total de pacientes fue de 1.749 (1.535 iniciales y 214 tratados anteriormente). La resistencia primaria fue 5,7% (isoniacida, 3,8%; rifampicina, 1,0%, estreptomicina, 2,1%, etambutol, 0,3% y pirazinamida, 1,0%). La resistencia adquirida alcanzo el 20,5% (isoniacidas, 17,3%, rifampi-cina, 9,8%, etambutol, 1,9%, estreptomicina, 4,7% y pirazinamida, 6,5%). La multirresistencia primaria fue 0,9%, y la adquirida 9,3%. Las resistencias primarias totales, a isoniacida y a pirazinamida se asociaron con inmigracion y se objetivaron algunas diferencias entre laboratorios atribuibles a diferencias de poblacion. Las resistencias adquiridas totales y a isoniacida se asociaron a mas de 60 anos y al sexo femenino. Conclusiones El bajo nivel de resistencias primarias a isoniacida permite tratar los casos iniciales con 3 farmacos, salvo en determinados grupos de inmigrantes. Se recomienda realizar pruebas de sensibilidad en todas las cepas aisladas y realizar estudios de farmacorresistencia en tuberculosis basados en trabajos coordinados para evitar sesgos de poblacion.

Fundamento y objetivo Los pacientes con bacteriemia suelen requerir ingreso hospitalario, aunque en ocasiones se les remite a su domicilio por diagnostico inapropiado o rapida mejoria. En el presente estudio se describen la evolucion y las intervenciones realizadas en los pacientes con bacteriemia comunitaria remitidos a domicilio. Pacientes y metodo Estudio prospectivo realizado en un hospital de 450 camas desde marzo de 2000 hasta diciembre de 2003. El centro dispone de un equipo que controla todas las bacteriemias. Se identifico a los pacientes enviados a su domicilio desde urgencias y que recibieron tratamiento antimicrobiano inapropiado. Resultados Se diagnostico a 1.172 pacientes con bacteriemia verdadera, de los que 247 (21,1%) fueron remitidos a su domicilio. En 50 casos (20,2%) se considero necesario revaluar al paciente: 36 por tratamiento antibiotico inapropiado, 12 sin tratamiento antibiotico y 2 por falta de informacion. En 34 pacientes (64%) se instauro o modifico el tratamiento antimicrobiano y 10 (20%) requirieron ingreso hospitalario. Excluyendo a los 66 pacientes que fallecieron en las primeras 48 h, la mortalidad bruta de los pacientes remitidos a domicilio fue inferior (4%) a la de los pacientes ingresados (11,9%). Conclusiones Una quinta parte de las bacteriemias comunitarias fueron tratadas de forma ambulatoria. Con frecuencia el tratamiento antibiotico fue inapropiado. Es necesario garantizar un control adecuado de estos pacientes.