BACKGROUND Surgical site infections following anterior cruciate ligament(ACL)reconstruction are an uncommon but potentially devastating complication.In this study,we present an unusual case of recurrent infection of t...BACKGROUND Surgical site infections following anterior cruciate ligament(ACL)reconstruction are an uncommon but potentially devastating complication.In this study,we present an unusual case of recurrent infection of the knee after an ACL reconstruction,and discuss the importance of accurate diagnosis and appropriate management,including the issue of graft preservation versus removal.CASE SUMMARY A 33-year-old gentleman underwent ACL reconstruction using a hamstring tendon autograft with suspensory Endobutton fixation to the distal femur and an interference screw fixation to the proximal tibia.Four years after ACL reconstruction,he developed an abscess over the proximal tibia and underwent incision and drainage.Remnant suture material was found at the base of the abscess and was removed.Five years later,he re-presented with a lateral distal thigh abscess that encroached the femoral tunnel.He underwent incision and drainage of the abscess which was later complicated by a chronic discharging sinus.Repeated magnetic resonance imaging revealed a fistulous communication between the lateral thigh wound extending toward the femoral tunnel with suggestion of osteomyelitis.Decision was made for a second surgery and the patient was counselled about the need for graft removal should there be intraarticular involvement.Knee arthroscopy revealed the graft to be intact with no evidence of intra-articular involvement.As such,the decision was made to retain the ACL graft.Re-debridement,excision of the sinus tract and removal of Endobutton was also performed in the same setting.Joint fluid cultures did not grow bacteria.However,tissue cultures from the femoral tunnel abscess grew Enterobacter cloacae complex,similar to what grew in tissue cultures from the tibial abscess five years earlier.In view of the recurrent and indolent nature of the infection,antibiotic therapy was escalated from Clindamycin to Ertapenem.He completed a six-week course of intravenous antibiotics and has been well for six months since surgery,with excellent 展开更多
Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients adm...Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients admitted for arthritis between 2000 and 2014, in Rheumatology department of Brazzaville university teaching hospital have been included. Among 416 patients listed as cases of arthritis, 201 answered to the inclusion criterias have been kept for analysis. The etiological diagnoses were based on criterias of classification and/or diagnosis used in Rheumatology. Results: 201 patients, 110 men (54.72%) and 91 women (45.28%) were included. The sex-ratio was 1.2, and average age was 45.5 years old (extremes: 8-86 years). Among them, 72 patients had microcrystal arthritis. Septic arthritis and those associated with HIV constituted the second etiological group of 60 patients and respectively, 32 were bacterial and 28 HIV associated arthritis. 58 remaining patients had a chronic inflammatory arthritis. Etiology distribution showed that gout was the most frequent (33.83%), followed by septic arthritis (15.92%), HIV associated arthritis (13.93%) and rheumatoid arthritis (11.94%). In 11 patients (5.5%), etiology was unknown. Conclusion: Three decades after the first publications in Brazzaville, the etiologies of arthritis remain dominated in order of frequency by gout, septic arthritis and HIV associated arthritis and rheumatoid arthritis. The frequency of indeterminate arthritis decreased significantly. Spondy-loarthropathy and autoimmune diseases are more common diagnosis.展开更多
BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of com...BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.展开更多
The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising...The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.展开更多
文摘BACKGROUND Surgical site infections following anterior cruciate ligament(ACL)reconstruction are an uncommon but potentially devastating complication.In this study,we present an unusual case of recurrent infection of the knee after an ACL reconstruction,and discuss the importance of accurate diagnosis and appropriate management,including the issue of graft preservation versus removal.CASE SUMMARY A 33-year-old gentleman underwent ACL reconstruction using a hamstring tendon autograft with suspensory Endobutton fixation to the distal femur and an interference screw fixation to the proximal tibia.Four years after ACL reconstruction,he developed an abscess over the proximal tibia and underwent incision and drainage.Remnant suture material was found at the base of the abscess and was removed.Five years later,he re-presented with a lateral distal thigh abscess that encroached the femoral tunnel.He underwent incision and drainage of the abscess which was later complicated by a chronic discharging sinus.Repeated magnetic resonance imaging revealed a fistulous communication between the lateral thigh wound extending toward the femoral tunnel with suggestion of osteomyelitis.Decision was made for a second surgery and the patient was counselled about the need for graft removal should there be intraarticular involvement.Knee arthroscopy revealed the graft to be intact with no evidence of intra-articular involvement.As such,the decision was made to retain the ACL graft.Re-debridement,excision of the sinus tract and removal of Endobutton was also performed in the same setting.Joint fluid cultures did not grow bacteria.However,tissue cultures from the femoral tunnel abscess grew Enterobacter cloacae complex,similar to what grew in tissue cultures from the tibial abscess five years earlier.In view of the recurrent and indolent nature of the infection,antibiotic therapy was escalated from Clindamycin to Ertapenem.He completed a six-week course of intravenous antibiotics and has been well for six months since surgery,with excellent
文摘Objective: To research distribution of etiologies modification of arthritis in Congo-Brazzaville, twenty years after the first reports. Methods: A cross sectional study has been achieved. Medical files of patients admitted for arthritis between 2000 and 2014, in Rheumatology department of Brazzaville university teaching hospital have been included. Among 416 patients listed as cases of arthritis, 201 answered to the inclusion criterias have been kept for analysis. The etiological diagnoses were based on criterias of classification and/or diagnosis used in Rheumatology. Results: 201 patients, 110 men (54.72%) and 91 women (45.28%) were included. The sex-ratio was 1.2, and average age was 45.5 years old (extremes: 8-86 years). Among them, 72 patients had microcrystal arthritis. Septic arthritis and those associated with HIV constituted the second etiological group of 60 patients and respectively, 32 were bacterial and 28 HIV associated arthritis. 58 remaining patients had a chronic inflammatory arthritis. Etiology distribution showed that gout was the most frequent (33.83%), followed by septic arthritis (15.92%), HIV associated arthritis (13.93%) and rheumatoid arthritis (11.94%). In 11 patients (5.5%), etiology was unknown. Conclusion: Three decades after the first publications in Brazzaville, the etiologies of arthritis remain dominated in order of frequency by gout, septic arthritis and HIV associated arthritis and rheumatoid arthritis. The frequency of indeterminate arthritis decreased significantly. Spondy-loarthropathy and autoimmune diseases are more common diagnosis.
文摘BACKGROUND Septic arthritis,whether native or prosthetic,poses a significant challenge in clinical practice due to its potentially devastating consequences.Despite its clinical importance,there remains a dearth of comprehensive studies and standardized diagnostic criteria,particularly in the Kingdom of Saudi Arabia.AIM To investigate the epidemiology,microbiological profiles,and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.METHODS Medical records of patients diagnosed with septic arthritis between January 1,2015,and December 31,2022,were retrospectively reviewed.Data regarding patient demographics,clinical presentation,microbiological cultures,treatment modalities,and outcomes were analyzed.RESULTS In a retrospective review of 52 cases of septic arthritis,a balanced gender distribution was observed(1:1 ratio),with the knee being the most commonly affected joint(80.8%).Methicillin-resistant Staphylococcus aureus predominated in native joints(24.2%),while Brucella spp.was more prevalent in prosthetic joints(21.1%).Joint preservation was achieved in most cases(84.6%),with no significant difference in clinical features between native and prosthetic joints.However,certain comorbidities were more common in native joint cases,including renal impairment(P=0.002),hemodialysis(P=0.004),heart disease(P=0.013),and chronic liver disease(P=0.048).At the same time,osteoarthritis was more prevalent in prosthetic joint cases(P=0.013).Vancomycin was the most frequently used antibiotic(26.9%),and most patients received antibiotics before joint aspiration(57.7%).Surgical intervention,predominantly arthrotomy,was required in most cases(32.7%).Notably,a significant association was found between joint type and mortality(odds ratio=0.587,P=0.048),as well as the Charlson comorbidity index and mortality(P=0.001).CONCLUSION This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.
文摘The genus Citrobacter commonly found in water and soil as well as the intestinal and urinary tracts of animals and humans.Although Citrobacter infections are infrequently diagnosed in environmental contexts,the rising incidence of nosocomial manifestations underscores the importance of considering this organism in the differential diagnosis of hospital-acquired infections.We present a case of patient with septic arthritis of the shoulder who had been originally admitted for the management of acute-on-chronic congestive heart failure exacerbation and severe sepsis.On hospital day 1,joint aspiration cultures and Gram stain confirmed the presence of Citrobacter koseri,a pathogen not commonly associated with septic arthritis,and ceftriaxone was administered to target it.On hospital day 7,antibiotic was transitioned to levofloxacin,every other day for 4 weeks.The patient was discharged to an acute rehabilitation facility after a 14-day hospital stay.This case stresses the importance of maintaining a broad differential diagnosis for any patients who present with fever and joint inflammation or swelling,especially in a postoperative setting.
