Case report
Acute total knee replacement infection after a cat bite and scratch: A clinical case and review of the literature
Infección aguda de prótesis total de rodilla tras mordedura y arañazo de gato: caso clínico y revisión de la bibliografía
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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A propósito de 2 casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 681 "Ancho" => 1000 "Tamanyo" => 97048 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ultrasound scan performed to guide the suspected diagnosis of massive hematoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Villalba Modol, X. Solernou Soler" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Villalba Modol" ] 1 => array:2 [ "nombre" => "X." 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Miranda, M. Angulo, J.V. Amaya" "autores" => array:3 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Miranda" ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Angulo" "email" => array:1 [ 0 => "mangulosa@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "J.V." "apellidos" => "Amaya" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección aguda de prótesis total de rodilla tras mordedura y arañazo de gato: caso clínico y revisión de la bibliografía" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Prosthetic infection is one of the most severe complications that can take place in arthroplasty surgery. The incidence of infection is 1–2% in the first 2 years after surgery, in both hip and knee arthroplasties.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> The most common pathogen is <span class="elsevierStyleItalic">Staphylococcus aureus</span>, followed by coagulase-negative staphylococci and streptococci, although Gram-negative bacilli have also been isolated in some cases.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> In the last 15 years there have been some reports of prosthetic infection by <span class="elsevierStyleItalic">Pasteurella multocida</span> (<span class="elsevierStyleItalic">P. multocida</span>) related to bites and scratches by cats and dogs (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7–13</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. multocida</span> is a Gram-negative coccobacillus. It is common in the habitual flora of wild and domestic animals, especially dogs and cats. <span class="elsevierStyleItalic">P. multocida</span> has been frequently associated with infections caused by bites and scratches from dogs and cats.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although in most cases the infection remains confined to the entry point, causing cellulitis and abscess, occasionally osteomyelitis and septic arthritis can also appear, and, more rarely, prosthetic infection. Systemically, it may lead to respiratory infections, meningitis and septicemia.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,12,13</span></a> Transmission from animals to humans after a scratch or bite can occur via hematogenous spread or local contamination, although the former is considered more common.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,13</span></a> The risk factors described for prosthetic infection by <span class="elsevierStyleItalic">P. multocida</span> include immunosuppression, advanced age, diabetes, rheumatoid arthritis, obesity, the number of previous surgeries, kidney failure, intraoperative blood loss and the number days of postoperative drainage.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7,8,11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The treatment of choice is intravenous antibiotic therapy (second or third generation cephalosporins or penicillin). A surgical intervention involving arthrotomy for joint lavage and debridement should be added in cases of prosthetic infection. If necessary, replacement of a component or removal of the prosthesis can also be carried out.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 64-year-old white male who attended the emergency unit due to symptoms including chills, dysthermia and fever of 38<span class="elsevierStyleHsp" style=""></span>°C, with 24<span class="elsevierStyleHsp" style=""></span>h evolution. Subsequently, he began to suffer severe pain in the right knee which evolved into edema and redness, as well as joint stiffness. Upon examination, he presented heat and redness in the right knee, limitation of joint movement range with severe pain upon flexion, positive patellar tap sign and intense pain upon knee palpation, especially in its medial side. He also presented a small wound on the lateral side of the distal third of his right leg, with no signs of local infection. Axillary temperature was 37.8<span class="elsevierStyleHsp" style=""></span>°C. The rest of the examination was normal, with no relevant findings.</p><p id="par0025" class="elsevierStylePara elsevierViewall">As background history, the patient reported that 10 days before attending the ER and 9 days before the onset of symptoms, he suffered the bite and scratch of a cat on his right leg, in the pretibial area, which were cured at his local health center.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In his youth he underwent intervention for a posttraumatic right patellectomy. Subsequently, at the age of 56, 7 years before the arthroplasty, he underwent valgus closure osteotomy in the right tibia, using a staple for osteosynthesis. One year before the current symptoms, the patient had undergone total knee arthroplasty on the right side (total knee prosthesis with rotating platform and cementing of all components), which evolved favorably, achieving 0° extension, 100° flexion and painless gait.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The relevant medical history also included familial hypercholesterolemia and arterial hypertension.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We performed right knee arthrocentesis under sterile conditions, obtaining an opalescent and whitish-yellow liquid. We requested a biochemical analysis and culture of the synovial fluid. We performed a blood test and requested its biochemical analysis (with determination of C-reactive protein [CRP]), hemogram, hemostasis and blood culture. These tests revealed the following results: the synovial fluid presented a cell count over 10,000/μl, with 95% of polymorphonuclear cells (PMN), and a total protein count of 4.9<span class="elsevierStyleHsp" style=""></span>g/dl. There was also leukocytosis (16.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl) with neutrophilia (93.8%) and the CRP result was 169.3<span class="elsevierStyleHsp" style=""></span>mg/l (normal range: 0–8<span class="elsevierStyleHsp" style=""></span>mg/l). In the following days we obtained the results of the culture. Blood culture was negative, but the synovial fluid culture was positive for <span class="elsevierStyleItalic">P. multocida</span> (with antibiogram susceptible to amoxicillin/clavulanate, cefotaxime, ceftriaxone, ciprofloxacin and cotrimoxazole).</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient was operated 72<span class="elsevierStyleHsp" style=""></span>h after admission at the emergency unit. The intervention included joint lavage, synovectomy and replacement of the polyethylene spacer component. The culture of synovial fluid and synovial membrane samples taken intraoperatively was positive for <span class="elsevierStyleItalic">P. multocida</span>. The patient was treated for 10 days with dual intravenous (iv) antibiotic therapy (amoxicillin–clavulanate 1<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h plus levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h). He presented a favorable evolution and oral antibiotic therapy with amoxicillin/clavulanate 875/125<span class="elsevierStyleHsp" style=""></span>mg plus levofloxacin 500<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h was maintained for 6 weeks.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ten weeks after the intervention, the patient remained asymptomatic and afebrile and laboratory parameters had become normalized (CRP 1<span class="elsevierStyleHsp" style=""></span>mg/l, leukocytes 8.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl with 42.2% neutrophils). Two years after surgery, the patient is asymptomatic, with a joint movement range of 0° extension and 90° flexion. The knee has a good external appearance; there is no joint effusion; it is neither warm nor edematous and the patient is able to walk without aids and does not require analgesia.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. multocida</span> is a Gram-negative coccobacillus which has been infrequently described as the cause of prosthetic infections. Virtually all published cases of prosthetic knee infection by <span class="elsevierStyleItalic">P. multocida</span>, including the case presented, have a documented history of scratches and bites by cats and dogs (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,7–13</span></a> It is important to perform a thorough anamnesis and question the patient about possible contact with animals upon suspicion of knee prosthesis infection. If there is a history of scratch or bite by a dog or cat and symptoms of prosthetic infection, then this etiology should be considered in order to implement antibiotic coverage until the results of cultures are obtained. Symptoms are nonspecific and similar to prosthetic knee infection by other pathogens, including fever, pain, swelling, heat and redness. These clinical data are supported by laboratory data such as an increase in C-reactive protein, erythrocyte sedimentation rate and leukocytosis, which, like the symptoms, are not only highly sensitive, but also highly unspecific.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The definitive diagnosis is obtained through the result of cultures and biochemical analysis of the synovial fluid.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It is difficult to establish the latency time between the injury and the onset of symptoms. This varies between 7 days and 2 months, thus making it difficult to diagnose, since patients may not remember the scratch or bite or may not give it any importance (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Numerous risk factors which facilitate prosthetic infection by <span class="elsevierStyleItalic">P. multocida</span> have been reported.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,11</span></a> However, if we analyze the 9 cases described in the literature in the last 15 years, only 4 presented any of these risk factors: rheumatoid arthritis,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> systemic lupus erythematosus treated with corticosteroids,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> diabetes<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and multiple surgical interventions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Despite being a risk factor, advanced age cannot be considered a differentiating factor, since most patients with knee prostheses are usually over 60 years old. Therefore, the existence of risk factors should not be a decisive factor when considering this diagnosis.</p><p id="par0070" class="elsevierStylePara elsevierViewall">When faced with acute infection of knee prostheses, empirical antibiotic treatment should be started immediately until the results of cultures and antibiograms are available, and the indication of surgery should be evaluated.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Some authors suggest that prolonged antibiotic treatment without surgery may be sufficient in selected cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Most reports indicate surgical intervention followed by antibiotic treatment, and the main discussion focuses on the choice of surgical approach option. Some cases have reported that arthroscopic debridement followed by drainage with irrigation and antibiotic therapy may be a valid treatment.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, most authors prefer joint lavage arthrotomy with aggressive debridement followed by appropriate antibiotic therapy, with or without prosthetic replacement.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5,8,9,14</span></a> Prosthetic replacement can be avoided when the following criteria are met<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>: (1) acute infection, (2) the microorganism is identified, (3) the microorganism is sensitive to oral antibiotics, (4) the antibiotics required for treatment are well tolerated by the patient, and (5) there is no loosening of the prosthetic components. In contrast, other authors argue the need for prosthetic replacement in all cases.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> One accepted option is to perform joint lavage arthrotomy and adequate debridement, and to assess the condition of the soft tissues, bone and prosthetic components.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Prosthetic replacement is necessary when there is loosening of prosthetic components or bone involvement. However, if the components have become loosened they can be preserved.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5,9,14</span></a> Moving components (polyethylene spacers) can be replaced.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> If prosthetic replacement is necessary, it can be performed in a single surgical action,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,7,14</span></a> although most authors choose to perform replacement in 2 stages.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,9,13,14</span></a> Based on our experience, we believe that the treatment of choice for suspected acute infection of knee prosthesis is to start empirical antibiotic therapy as soon as possible (an antibiotic that covers <span class="elsevierStyleItalic">P. multocida</span> should be chosen if there is a history of scratch or bite by a dog or cat), followed by joint lavage arthrotomy with aggressive debridement, as well as replacement of the polyethylene spacer if the prosthesis model allows it. After the intervention, antibiotic treatment should be maintained for 6–12 weeks, ensuring that the analytical parameters become normalized. The most commonly used antibiotics include penicillin, amoxicillin, amoxicillin–clavulanate, cefuroxime, tetracyclines and fluoroquinolones.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,13</span></a> In the event that the prosthetic components have become loosened, we believe that replacement should be carried out in 2 stages, leaving an intermediate period of 4–6 weeks with antibiotic therapy, and placing the new prosthesis in a second stage once the analytical parameters have become normalized. In our case, the infection of the knee prosthesis was very acute (24<span class="elsevierStyleHsp" style=""></span>h and the operation was performed at 72<span class="elsevierStyleHsp" style=""></span>h), which may be one of the reasons for the successful treatment through debridement, replacement of moving components and antibiotic therapy without replacement of the prosthesis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Early diagnosis is very important in cases of knee prosthesis infection. <span class="elsevierStyleItalic">P. multocida</span> should be considered as a potential pathogen causing the infection if there is a history of bite or scratch by a dog or cat. Treatment should be initiated urgently upon confirmed infection of knee prosthesis. The need for prophylactic antibiotic coverage should be considered in patients with a knee prosthesis who attend consultation due to a scratch or bite by a dog or cat.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Level of evidence</span><p id="par0080" class="elsevierStylePara elsevierViewall">Level of evidence V<span class="elsevierStyleSmallCaps">.</span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Ethical responsibilities</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Protection of people and animals</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Confidentiality of data</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Right to privacy and informed consent</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and/or subjects mentioned in the article. The author for correspondence is in possession of this document.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres273599" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec255602" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres273598" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec255601" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0030" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-03-14" "fechaAceptado" => "2013-04-12" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec255602" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Pasteurella multocida</span>" 1 => "Total knee arthroplasty" 2 => "Infection" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec255601" "palabras" => array:3 [ 0 => "<span class="elsevierStyleItalic">Pasteurella multocida</span>" 1 => "Artroplastia total de rodilla" 2 => "Infección" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In the last 15 years only a few cases of <span class="elsevierStyleItalic">Pasteurella multocida</span> (<span class="elsevierStyleItalic">P. multocida</span>) total knee arthroplasty infection have been published, mostly related to cat or dog bites or scratches. We report a case of <span class="elsevierStyleItalic">P. multocida</span> total knee arthroplasty infection in a 64-year-old patient, 10 days after being scratched and bitten by his cat. The patient was successfully treated with debridement and tibial interspacer exchange and antibiotic treatment for 6 weeks. Antimicrobial prophylaxis should be considered in cat or dog bites or scratches victims with prosthetic joints.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">En los últimos 15 años se han descrito solo unos pocos casos de infección de prótesis total de rodilla por <span class="elsevierStyleItalic">Pasteurella multocida</span> (<span class="elsevierStyleItalic">P. multocida</span>). La mayoría de estos casos están relacionados con un antecedente de mordedura o arañazo de perro o gato. Presentamos un caso de infección de prótesis de rodilla por <span class="elsevierStyleItalic">P. multocida</span> en un paciente de 64 años, que 10 días antes había sufrido heridas en la pierna por arañazos y mordeduras de su gato. El paciente fue tratado mediante artrotomía de limpieza y desbridamiento con recambio del polietileno, seguido de 6 semanas de tratamiento antibiótico con un buen resultado. La profilaxis antibiótica debería valorarse en los portadores de una prótesis que presenten una herida por mordedura o arañazo de perro o de gato.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Miranda I, Angulo M, Amaya JV. Infección aguda de prótesis total de rodilla tras mordedura y arañazo de gato: caso clínico y revisión de la bibliografía. Rev Esp Cir Ortop Traumatol. 2013;<span class="elsevierStyleBold">57</span>:300–5.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A–C: amoxicillin–clavulanate; APS: antiphospholipid syndrome; CRP: C reactive protein; ESR: erythrocyte sedimentation rate; IM: intramuscular; IV: intravenous; OR: orally; RA: rheumatoid arthritis; SLE: systemic lupus erythematosus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Animal involved \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time from bite and/or scratch until diagnosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Analytical data \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Surgical treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Antibiotic therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Time from the primary prosthesis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Risk factors \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Current case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scratch and bite by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, pain heat, redness, swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 169.3<span class="elsevierStyleHsp" style=""></span>mg/l; leukocytes 16.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl; neutrophils 93.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthrotomy, debridement and replacement of polyethylene spacer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A–C<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>levofloxacin (10 days IV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>6 weeks OR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 year \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heydemann et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scratch by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, pain, cellulitis and sero-hematic secretion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 254<span class="elsevierStyleHsp" style=""></span>mg/l; ESR 80<span class="elsevierStyleHsp" style=""></span>mm/h; leukocytes 14<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthrotomy, synovectomy and replacement of tibial spacer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ampicillin–sulbactam (4 days)<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ceftriaxone (28 days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Campoamor Serrano et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scratch by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain, swelling, heat, erythema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 220.7<span class="elsevierStyleHsp" style=""></span>mg/l; ESR 51/83<span class="elsevierStyleHsp" style=""></span>mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Joint lavage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A–C IV (3 weeks) followed by ciprofloxacin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>trimethoprim–sulfamethoxazole OR (12 weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heym et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Dog \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, pain, heat, redness, swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 277<span class="elsevierStyleHsp" style=""></span>mg/l; leukocytes 14.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arthrotomy, lavage, synovectomy and replacement of polyethylene spacer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Amoxicillin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>doxycycline (5 days IV and 2 months OR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciampolini<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scratch by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, poor general condition, heat, redness, swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 110<span class="elsevierStyleHsp" style=""></span>mg/l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthroscopy. Upon poor evolution: prosthesis replacement in 2 stages \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benzyl-penicillin IV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ciprofloxacin OR (until analytical values became normalized) followed by amoxicillin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ciprofloxacin OR (6 weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Polzhofer et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bite by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A few days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain, swelling, redness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 194<span class="elsevierStyleHsp" style=""></span>mg/l; leukocytes 16.6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arthroscopic debridement, partial synovectomy. Irrigation-suction drainage for 6 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unacid<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>clindamycin IV (3 weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 years \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stiehl et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contact with dogs and horses, does not recall any injuries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, significant intra-articular effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP 220<span class="elsevierStyleHsp" style=""></span>mg/l; ESR 121<span class="elsevierStyleHsp" style=""></span>mm/h; leukocytes 7.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthrotomy, debridement, prosthesis replacement in 2 stages. Required coverage flap \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>piperacillin–tazobactam (time and route not specified) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 years. Previous interventions due to traumatic lesions in the same knee \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Zebeede et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Scratch by cat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever swelling, pain, erythema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leukocytes 12.5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin OR 3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 years (replacement) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 years, SLE, APS, corticosteroids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Antuña et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bite by dog \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fever, heat, erythema, lymphadenopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR 45<span class="elsevierStyleHsp" style=""></span>mm/h; leukocytes 13<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthrotomy and replacement in one stage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ciprofloxacin IV (6 weeks) followed by ciprofloxacin IM 4 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 years, RA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Maradona et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1997 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bite by dog \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 days \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain, fever, swelling \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Leukocytes 16<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span>/μl \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lavage arthrotomy, debridement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Penicillin G (3 weeks) followed by ciprofloxacin (3 weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 years, diabetes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab392942.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cases of prosthetic infection by <span class="elsevierStyleItalic">P. multocida</span> described in the past 15 years.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AAOS Clinical Practice Guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. 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| Year/Month | Html | Total | |
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| 2021 May | 15 | 6 | 21 |
| 2021 April | 24 | 8 | 32 |
| 2021 March | 9 | 11 | 20 |
| 2021 February | 9 | 10 | 19 |
| 2021 January | 8 | 7 | 15 |
| 2019 May | 1 | 2 | 3 |
| 2018 February | 14 | 0 | 14 |
| 2018 January | 15 | 1 | 16 |
| 2017 December | 14 | 1 | 15 |
| 2017 November | 17 | 2 | 19 |
| 2017 October | 12 | 0 | 12 |
| 2017 September | 18 | 5 | 23 |
| 2017 August | 13 | 6 | 19 |
| 2017 July | 13 | 1 | 14 |
| 2017 June | 17 | 3 | 20 |
| 2017 May | 18 | 15 | 33 |
| 2017 April | 12 | 10 | 22 |
| 2017 March | 13 | 6 | 19 |
| 2017 February | 15 | 1 | 16 |
| 2017 January | 13 | 1 | 14 |
| 2016 December | 17 | 9 | 26 |
| 2016 November | 29 | 5 | 34 |
| 2016 October | 40 | 11 | 51 |
| 2016 September | 39 | 4 | 43 |
| 2016 August | 46 | 4 | 50 |
| 2016 July | 27 | 1 | 28 |
| 2016 June | 25 | 2 | 27 |
| 2016 May | 19 | 5 | 24 |
| 2016 April | 19 | 6 | 25 |
| 2016 March | 26 | 9 | 35 |
| 2016 February | 18 | 14 | 32 |
| 2016 January | 19 | 11 | 30 |
| 2015 December | 12 | 5 | 17 |
| 2015 November | 20 | 8 | 28 |
| 2015 October | 32 | 8 | 40 |
| 2015 September | 24 | 3 | 27 |
| 2015 August | 21 | 7 | 28 |
| 2015 July | 7 | 3 | 10 |
| 2015 June | 1 | 0 | 1 |
| 2015 April | 0 | 1 | 1 |
| 2015 February | 2 | 0 | 2 |
| 2014 May | 2 | 0 | 2 |
| 2014 April | 1 | 0 | 1 |
| 2014 March | 0 | 1 | 1 |
| 2013 October | 1 | 0 | 1 |
Show all
