Infecciones osteoarticulares
Epidemiología, etiología y evolución clínica en un centro de referencia nacional
Palabras clave:
INFECCIÓN OSTEO-ARTICULAR, OSTEOMIELITIS, INFECCIONES RELACIONADAS CON PRÓTESIS
Resumen
Introducción: la infección osteo-articular es una patología compleja, y su prevalencia esta en aumento. Conocer las principales características de su presentación clínica, etiología y evolución permite mejorar su abordaje.
Material y métodos: estudio observacional, retrospectivo, período 01 de enero 2020 a 31 diciembre 2020 en el Instituto Nacional de Ortopedia y Traumatología. Se incluyeron todos los pacientes adultos ingresados con diagnóstico clínico de infección osteo-articular y que fueron asistido en conjunto por Enfermedades Infecciosas y Traumatología en el período de estudio. Todos los casos contaban con uno o más cultivos microbiológicos profundos.
Resultados: hubo 132 pacientes con infección osteo-articular, la relación hombre-mujer fue 2 a 1 y una media de 53 años. La presentación clínica fue con dolor, fístula y signos fluxivos locales. Las infecciones más frecuentes fueron de fracturas y prótesis articulares. El 54% de las infecciones fue por cocos gram positivos, 31% por enterobacterias y 13% bacilos gram negativos no fermentadores. En cuanto al perfil de sensibilidad 33% de los cocos fueron meticilino resistentes y 43% de las enterobacterias multirresistentes.
Conclusión: La patología mas frecuente en 2 de cada 3 ingresos fue la infección de fracturas y la asociada a material implantado. A la complejidad habitual del tratamiento quirúrgico y antimicrobiano de esta patología se suma que 3 de cada 10 microorganismos aislados fueron resistentes.
Citas
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8) Sendi P, Morgenstern M, Metsemakers WJ, McNally M. Fracture-related infection of the long bones. En: Zimmerli W, ed. Bone and Joint Infections: from microbiology to diagnostics and treatment. 2 ed. Hoboken, NJ: Wiley, 2021:367-85. doi: 10.1002/9781119720676.ch23.
9) Karczewski D, Winkler T, Renz N, Trampuz A, Lieb E, Perka C, et al. A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections. Bone Joint J 2019; 101-B(2):132-9. doi: 10.1302/0301-620X.101B2.BJJ-2018-1056.R1.
10) Ariza J, Cobo J, Baraia-Etxaburu J, Benito N, Bori G, Cabo J, et al. Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin 2017; 35(3):189-95. doi: 10.1016/j.eimc.2016.08.012.
11) Zimmerli W, Borens O. Infectious arthritis. En: Ochsner P, Borens O, Bodler P, Broger I, Eich G, Hefti F, et al. Infections of the musculoskeletal system: basic principles, prevention, diagnosis and treatment. 2016:147-55. Disponible en: https://www.heraeus.com/en/hme/formular/order_form_infections_ebook/infections_ebook.html [Consulta: 26 octubre 2022].
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13) Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, et al. Fracture-related infection: a consensus on definition from an international expert group. Injury 2018; 49(3):505-10. doi: 10.1016/j.injury.2017.08.040.
14) McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J 2021; 103-B(1):18-25. doi: 10.1302/0301-620X.103B1.BJJ-2020-1381.R1.
15) Cardoso A, Barbosa L, Coelho AM, Correia JG, Maurício HL, Lima Á. Spondylodiscitis: a retrospective analysis of clinical, etiological, and radiological diagnosis. Int J Spine Surg 2020; 14(2):226-31. doi: 10.14444/7019.
16) Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x.
17) Alberdi F, García I, Atutxa L, Zabarte M; Grupo de Trabajo de Trauma y Neurointensivismo de SEMICYUC. Epidemiología del trauma grave. Med Intensiva 2014; 38(9):580-8. doi: 10.1016/j.medin.2014.06.012.
18) Paolillo E, Scasso A, Torres F, Barrios G, Tavares G, Ahmed Z, et al. Siniestros de tránsito, los grupos relacionados por el diagnóstico y los costos hospitalarios. Características clínicas y costos de 740 pacientes hospitalizados por siniestros de tránsito en el trienio 2012-2014 en La Asistencial Médica Departamental de Maldonado, Uruguay. Rev Méd Urug 2016; 32(1):25-35. Disponible en: http://www.scielo.edu.uy/pdf/rmu/v32n1/v32n1a04.pdf [Consulta: 24 marzo 2022].
19) Whitaker J, Denning M, O' Donohoe N, Poenaru D, Guadagno E, Leather A, et al. Assessing trauma care health systems in low- and middle-income countries, a protocol for a systematic literature review and narrative synthesis. Syst Rev 2019; 8(1):157. doi: 10.1186/s13643-019-1075-8.
20) Parvizi J, Gehrke T. Proceedings of the Second International Consensus Meeting on Musculoskeletal Infection. Philadelpia, 2018. Disponible en: https://upload.orthobullets.com/documents/temp/73c7b918-5f54-46d2-87cd-1ab75e3c3a9d50Proceedings%20of%20the%20Second%20International%20Consensus%20Meeting%20on%20Musculoskeletal%20Infection.pdf [Consulta: 26 octubre 2022].
21) Global guidelines for the prevention of surgical site infection, 2 ed. Geneva: World Health Organization, 2018. Disponible en: https://www.who.int/publications/i/item/global-guidelines-for-the-prevention-of-surgical-site-infection-2nd-ed [Consulta: 26 octubre 2022].
22) Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint J 2017; 99-B(4_Suppl_ B):3-10. doi: 10.1302/0301-620X.99B4.BJJ-2016-1212.R1.
23) Garrote-Garrote M, Del-Moral-Luque JA, Checa-García A, Valverde-Cánovas JF, Campelo-Gutiérrez C, Martínez-Martín J, et al. Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohortes. Rev Esp Quimioter 2018; 31(2):118-22.
24) Alamanda VK, Springe BD. The prevention of infection: 12 modifiable risk factors. Bone Joint J 2019; 101-B(1_Suppl_A):3-9. doi: 10.1302/0301-620X.101B1.BJJ-2018-0233.R1.
25) Huang CY, Hsieh RW, Yen HT, Hsu TC, Chen CY, Chen YC, et al. Short- versus long-course antibiotics in osteomyelitis: a systematic review and meta-analysis. Int J Antimicrob Agents 2019; 53(3):246-60. doi: 10.1016/j.ijantimicag.2019.01.007.
26) Li HK, Rombach I, Zambellas R, Walker AS, McNally MA, Atkins BL, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 2019; 380(5):425-36. doi: 10.1056/NEJMoa1710926.
27) Chang Y, Bhandari M, Zhu KL, Mirza RD, Ren M, Kennedy SA, et al. Antibiotic prophylaxis in the management of open fractures: a systematic survey of current practice and recommendations. JBJS Rev 2019; 7(2):e1. doi: 10.2106/JBJS.RVW.17.00197.
28) Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci 2019; 23(2 Suppl):258-70. doi: 10.26355/eurrev_201904_17500.
29) Glaudemans AWJM, Jutte PC, Cataldo MA, Cassar-Pullicino V, Gheysens O, Borens O, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46(4):957-70. doi: 10.1007/s00259-019-4262-x.
30) Vemu L, Sudhaharan S, Mamidi N, Chavali P. Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis. J Lab Physicians 2018; 10(1):21-5. doi: 10.4103/JLP.JLP_14_17.
31) Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O'Rourke S, et al. Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clin Microbiol Rev 2018; 31(2):e00084-17. doi: 10.1128/CMR.00084-17.
32) Carvalho VC, Oliveira PR, Dal-Paz K, Paula AP, Félix Cda S, Lima AL, et al. Gram-negative osteomyelitis: clinical and microbiological profile. Braz J Infect Dis 2012; 16(1):63-7.
33) Triffault-Fillit C, Ferry T, Laurent F, Pradat P, Dupieux C, Conrad A, et al. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect 2019; 25(3):353-8. doi: 10.1016/j.cmi.2018.04.035.
34) García del Pozo E, Collazos J, Carton JA, Camporro D, Asensi V. Factors predictive of relapse in adult bacterial osteomyelitis of long bones. BMC Infect Dis 2018; 18(1):635. doi: 10.1186/s12879-018-3550-6.
35) Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, Salles M, et al. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: role of surgery and impact of colistin administration. Int J Antimicrob Agents 2019; 53(3):294-301. doi: 10.1016/j.ijantimicag.2018.10.018.
36) Pfang BG, García-Cañete J, García-Lasheras J, Blanco A, Auñón Á, Parron-Cambero R, et al. Orthopedic implant-associated infection by multidrug resistant enterobacteriaceae. J Clin Med 2019; 8(2):220. doi: 10.3390/jcm8020220.
37) Antony SJ, Parikh MS, Soto E, Cameron C, Mody R. Extended-spectrum beta-lactamase infections in orthopedic-related devices and prosthetic joints. Orthopedics 2016; 39(4):e668-e673. doi: 10.3928/01477447-20160606-07.
38) Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, et al. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrobial Agents 2022; 59(1):106497. doi: 10.1016/j.ijantimicag.2021.106497.
39) Pouderoux C, Becker A, Goutelle S, Lustig S, Triffault-Fillit C, Daoud F, et al. Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients. J Antimicrob Chemother 2019; 74(7):2060-4. doi: 10.1093/jac/dkz104.
40) Oliveira PR, da Silva Felix C, Cordeiro de Carvalho V, Mazzini Giovani A, Suarti dos Reis R, Beraldo M, et al. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil. Braz J Infect Dis 2016; 20(3):272-5. doi: 10.1016/j.bjid.2016.03.005.
2) Walter N, Rupp M, Baertl S, Alt A. The role of multidisciplinary teams in musculoskeletal infection. Bone Joint Res 2022; 11(1):6-7. doi: 10.1302/2046-3758.111.BJR-2021-0498.
3) Ferry T, Seng P, Mainard D, Jenny JY, Laurent F, Senneville E, et al. The CRIOAc healthcare network in France: a nationwide Health Ministry program to improve the management of bone and joint infection. Orthop Traumatol Surg Res 2019; 105(1):185-90. doi: 10.1016/j.otsr.2018.09.016.
4) Fondo Nacional de Recursos. Visualizador actos médicos 2020. Disponible en: http://www.fnr.gub.uy/visualizador_realizaciones_2020 [Consulta: 26 octubre 2022].
5) Unidad Nacional de Seguridad Vial. 2021-Informe semestral de Siniestralidad Vial. Estadísticas. Disponible en: https://www.gub.uy/unidad-nacional-seguridad-vial/datos-y-estadisticas/estadisticas/2021-informe-semestral-siniestralidad-vial-0. [Consulta: 24 marzo 2022].
6) Constant C, Calabro L, Metsemakers WJ, Richards RG, Moriarty TF. Preclinical models of Infection in Bone and Joint Surgery. En: Zimmerli W, ed. Bone and Joint Infections: from microbiology to diagnostics and treatment. 2 ed. Hoboken, NJ: Wiley, 2021:99-115. doi: 10.1002/9781119720676.
7) Renz N, Margaryan D, Trampuz A. Diagnostic approach in bone and joint infections. En: Zimmerli W, ed. Bone and Joint Infections: from microbiology to diagnostics and treatment. 2 ed. Hoboken, NJ: Wiley, 2021:5-20. doi: 10.1002/9781119720676.ch2.
8) Sendi P, Morgenstern M, Metsemakers WJ, McNally M. Fracture-related infection of the long bones. En: Zimmerli W, ed. Bone and Joint Infections: from microbiology to diagnostics and treatment. 2 ed. Hoboken, NJ: Wiley, 2021:367-85. doi: 10.1002/9781119720676.ch23.
9) Karczewski D, Winkler T, Renz N, Trampuz A, Lieb E, Perka C, et al. A standardized interdisciplinary algorithm for the treatment of prosthetic joint infections. Bone Joint J 2019; 101-B(2):132-9. doi: 10.1302/0301-620X.101B2.BJJ-2018-1056.R1.
10) Ariza J, Cobo J, Baraia-Etxaburu J, Benito N, Bori G, Cabo J, et al. Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin 2017; 35(3):189-95. doi: 10.1016/j.eimc.2016.08.012.
11) Zimmerli W, Borens O. Infectious arthritis. En: Ochsner P, Borens O, Bodler P, Broger I, Eich G, Hefti F, et al. Infections of the musculoskeletal system: basic principles, prevention, diagnosis and treatment. 2016:147-55. Disponible en: https://www.heraeus.com/en/hme/formular/order_form_infections_ebook/infections_ebook.html [Consulta: 26 octubre 2022].
12) Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am 2017; 31:203-18. doi: 10.1016/j.idc.2017.01.001.
13) Metsemakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, et al. Fracture-related infection: a consensus on definition from an international expert group. Injury 2018; 49(3):505-10. doi: 10.1016/j.injury.2017.08.040.
14) McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J 2021; 103-B(1):18-25. doi: 10.1302/0301-620X.103B1.BJJ-2020-1381.R1.
15) Cardoso A, Barbosa L, Coelho AM, Correia JG, Maurício HL, Lima Á. Spondylodiscitis: a retrospective analysis of clinical, etiological, and radiological diagnosis. Int J Spine Surg 2020; 14(2):226-31. doi: 10.14444/7019.
16) Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x.
17) Alberdi F, García I, Atutxa L, Zabarte M; Grupo de Trabajo de Trauma y Neurointensivismo de SEMICYUC. Epidemiología del trauma grave. Med Intensiva 2014; 38(9):580-8. doi: 10.1016/j.medin.2014.06.012.
18) Paolillo E, Scasso A, Torres F, Barrios G, Tavares G, Ahmed Z, et al. Siniestros de tránsito, los grupos relacionados por el diagnóstico y los costos hospitalarios. Características clínicas y costos de 740 pacientes hospitalizados por siniestros de tránsito en el trienio 2012-2014 en La Asistencial Médica Departamental de Maldonado, Uruguay. Rev Méd Urug 2016; 32(1):25-35. Disponible en: http://www.scielo.edu.uy/pdf/rmu/v32n1/v32n1a04.pdf [Consulta: 24 marzo 2022].
19) Whitaker J, Denning M, O' Donohoe N, Poenaru D, Guadagno E, Leather A, et al. Assessing trauma care health systems in low- and middle-income countries, a protocol for a systematic literature review and narrative synthesis. Syst Rev 2019; 8(1):157. doi: 10.1186/s13643-019-1075-8.
20) Parvizi J, Gehrke T. Proceedings of the Second International Consensus Meeting on Musculoskeletal Infection. Philadelpia, 2018. Disponible en: https://upload.orthobullets.com/documents/temp/73c7b918-5f54-46d2-87cd-1ab75e3c3a9d50Proceedings%20of%20the%20Second%20International%20Consensus%20Meeting%20on%20Musculoskeletal%20Infection.pdf [Consulta: 26 octubre 2022].
21) Global guidelines for the prevention of surgical site infection, 2 ed. Geneva: World Health Organization, 2018. Disponible en: https://www.who.int/publications/i/item/global-guidelines-for-the-prevention-of-surgical-site-infection-2nd-ed [Consulta: 26 octubre 2022].
22) Parvizi J, Shohat N, Gehrke T. Prevention of periprosthetic joint infection: new guidelines. Bone Joint J 2017; 99-B(4_Suppl_ B):3-10. doi: 10.1302/0301-620X.99B4.BJJ-2016-1212.R1.
23) Garrote-Garrote M, Del-Moral-Luque JA, Checa-García A, Valverde-Cánovas JF, Campelo-Gutiérrez C, Martínez-Martín J, et al. Antibioterapia profiláctica en la artroplastia de cadera. Estudio de cohortes. Rev Esp Quimioter 2018; 31(2):118-22.
24) Alamanda VK, Springe BD. The prevention of infection: 12 modifiable risk factors. Bone Joint J 2019; 101-B(1_Suppl_A):3-9. doi: 10.1302/0301-620X.101B1.BJJ-2018-0233.R1.
25) Huang CY, Hsieh RW, Yen HT, Hsu TC, Chen CY, Chen YC, et al. Short- versus long-course antibiotics in osteomyelitis: a systematic review and meta-analysis. Int J Antimicrob Agents 2019; 53(3):246-60. doi: 10.1016/j.ijantimicag.2019.01.007.
26) Li HK, Rombach I, Zambellas R, Walker AS, McNally MA, Atkins BL, et al. Oral versus intravenous antibiotics for bone and joint infection. N Engl J Med 2019; 380(5):425-36. doi: 10.1056/NEJMoa1710926.
27) Chang Y, Bhandari M, Zhu KL, Mirza RD, Ren M, Kennedy SA, et al. Antibiotic prophylaxis in the management of open fractures: a systematic survey of current practice and recommendations. JBJS Rev 2019; 7(2):e1. doi: 10.2106/JBJS.RVW.17.00197.
28) Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci 2019; 23(2 Suppl):258-70. doi: 10.26355/eurrev_201904_17500.
29) Glaudemans AWJM, Jutte PC, Cataldo MA, Cassar-Pullicino V, Gheysens O, Borens O, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46(4):957-70. doi: 10.1007/s00259-019-4262-x.
30) Vemu L, Sudhaharan S, Mamidi N, Chavali P. Need for appropriate specimen for microbiology diagnosis of chronic osteomyelitis. J Lab Physicians 2018; 10(1):21-5. doi: 10.4103/JLP.JLP_14_17.
31) Kavanagh N, Ryan EJ, Widaa A, Sexton G, Fennell J, O'Rourke S, et al. Staphylococcal osteomyelitis: disease progression, treatment challenges, and future directions. Clin Microbiol Rev 2018; 31(2):e00084-17. doi: 10.1128/CMR.00084-17.
32) Carvalho VC, Oliveira PR, Dal-Paz K, Paula AP, Félix Cda S, Lima AL, et al. Gram-negative osteomyelitis: clinical and microbiological profile. Braz J Infect Dis 2012; 16(1):63-7.
33) Triffault-Fillit C, Ferry T, Laurent F, Pradat P, Dupieux C, Conrad A, et al. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect 2019; 25(3):353-8. doi: 10.1016/j.cmi.2018.04.035.
34) García del Pozo E, Collazos J, Carton JA, Camporro D, Asensi V. Factors predictive of relapse in adult bacterial osteomyelitis of long bones. BMC Infect Dis 2018; 18(1):635. doi: 10.1186/s12879-018-3550-6.
35) Papadopoulos A, Ribera A, Mavrogenis AF, Rodriguez-Pardo D, Bonnet E, Salles M, et al. Multidrug-resistant and extensively drug-resistant Gram-negative prosthetic joint infections: role of surgery and impact of colistin administration. Int J Antimicrob Agents 2019; 53(3):294-301. doi: 10.1016/j.ijantimicag.2018.10.018.
36) Pfang BG, García-Cañete J, García-Lasheras J, Blanco A, Auñón Á, Parron-Cambero R, et al. Orthopedic implant-associated infection by multidrug resistant enterobacteriaceae. J Clin Med 2019; 8(2):220. doi: 10.3390/jcm8020220.
37) Antony SJ, Parikh MS, Soto E, Cameron C, Mody R. Extended-spectrum beta-lactamase infections in orthopedic-related devices and prosthetic joints. Orthopedics 2016; 39(4):e668-e673. doi: 10.3928/01477447-20160606-07.
38) Davido B, Saleh-Mghir A, Rottman M, Jaffal K, Salomon E, Bouchand F, et al. Native bone and joint infections caused by extended-spectrum β-lactamase-producing Enterobacterales: experience of a reference centre in the Greater Paris area. Int J Antimicrobial Agents 2022; 59(1):106497. doi: 10.1016/j.ijantimicag.2021.106497.
39) Pouderoux C, Becker A, Goutelle S, Lustig S, Triffault-Fillit C, Daoud F, et al. Subcutaneous suppressive antibiotic therapy for bone and joint infections: safety and outcome in a cohort of 10 patients. J Antimicrob Chemother 2019; 74(7):2060-4. doi: 10.1093/jac/dkz104.
40) Oliveira PR, da Silva Felix C, Cordeiro de Carvalho V, Mazzini Giovani A, Suarti dos Reis R, Beraldo M, et al. Outpatient parenteral antimicrobial therapy for orthopedic infections - a successful public healthcare experience in Brazil. Braz J Infect Dis 2016; 20(3):272-5. doi: 10.1016/j.bjid.2016.03.005.
Publicado
2023-05-31
Cómo citar
1.
Tenaglia K, Sosa A, Medina J. Infecciones osteoarticulares. Rev. Méd. Urug. [Internet]. 31 de mayo de 2023 [citado 25 de abril de 2024];39(2):e205. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/1032
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