Pathogenic analysis in different types of orthopedic implant infections

Background Diversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens.It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections.We aimed to investigate the frequency of different pathogens derived from orthopedic infections,and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants,especially focusing on staphylococci.Methods From January 2006 to December 2011,orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records.The sources of orthopedic infections were divided into two main groups：those associated with implants and those not associated with implants.Implants-associated infections were further subdivided into five subgroups：arthroplasty,internal fixation,external fixation,internal and external fixation,and others.We analyzed microbiological spectrum in different groups and subgroups.Antibiotic susceptibility of staphylococci was analyzed.Results Only coagulase-negative staphylococci （CoNS） was significantly more likely to be associated with implantsassociated infections （P=0.029）.The overall pathogens prevalence of arthroplasty was significantly different from other subgroups （P 〈0.05）.65% isolates from external fixation was Gram-negative bacteria.Some percentage （55%） of S.aureus and （83%） CoNS were resistant to methicillin.No resistance to glycopeptide was seen in all of staphylococci.Conclusions Staphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants.Only CoNS was implants-associated,especially for arthroplasty infection.Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.

Resident involvement in the prostatic urethral lift:implementing innovative technology in an academic setting

Adoption of the prostatic urethral lift(PUL)as a treatment for benign prostatic hyperplasia highlights the importance of training residents with novel technology without compromising patient care.This study examines the effect of resident involvement during PUL on patient and procedural outcomes.Retrospective chart review was conducted on all consecutive PUL cases performed by a single academic urologist between October 2017 and November 2019.Trainees in post-graduate year(PGY)1–3 are considered junior residents,while those in PGY 4–6 are senior residents.The International Prostate Symptom Score(IPSS)and quality of life(QOL)scores were used to measure outcomes.Simple and mixed-effects linear regression models were used to compare differences.There were 110 patients with a median age of 66.4 years.Residents were involved in 73 cases(66.4%),and senior residents were involved in 31 of those cases.Resident involvement was not associated with adverse perioperative outcomes with respect to the number of implants fired,the percentage of implants successfully placed,or the postoperative catheterization rate.After adjustment for confounding factors,junior residents were associated with significantly longer case length compared to the attending alone(+12.6 min,P=0.003)but senior residents were not(+2.4 min,P=0.59).IPSS and QOL scores were not significantly affected by resident involvement(P=0.12 and P=0.21,respectively).The presence of surgeons-in-training,particularly those in the early stages,prolongs PUL case length but does not appear to have an adverse impact on patient outcomes.