Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature.

Non-albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68-year-old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri-prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri-prosthetic tissue and materials yielded C. glabrata, as well as a methicillin-resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement-spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First-line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long-term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment.

Infected pseudoaneurysm after carotid endarterectomy: mismatch between clinical presentation and origin.

Pseudoaneurysm after carotid endarterectomy (CEA) is a rare complication, with an incidence lower than 1%. Infection as a cause of carotid pseudoaneurysm is uncommon, and is mostly caused by staphylococci. An 81-year-old woman, treated with right carotid endarterectomy 7 years earlier, presented with a diagnosis of right carotid pseudoaneurysm. The patient was neurologically asymptomatic; clinical status, laboratory, and imaging findings were negative for infection. She was referred to surgical treatment consisting of patch excision and a carotid polytetrafluoroethylene bypass grafting. During intervention a purulent fluid collection was discovered, and therefore an inverted great saphenous vein carotid bypass was performed. The postoperative course was normal. Microbiological examination on the purulent fluid collection and excised patch showed the presence of Staphylococcus epidermidis. Carotid pseudoaneurysms after CEA often arise in asymptomatic patients. Despite this common clinical presentation, an infective origin must always be taken into account before any intervention is planned.

Causative role of infection in chronic non-thromboembolic pulmonary hypertension following ventriculo-atrial shunt.

A severe complication of ventriculo-atrial (VA) shunt placement for treatment of hydrocephalus is chronic thromboembolic pulmonary hypertension (CTEPH). We report here a patient with a VA shunt for treatment of hydrocephalus who presented two consecutive episodes of VA shunt-induced infection by Staphylococcus epidermidis and who rapidly developed chronic PH. Extensive radiological investigations and normal ventilation/perfusion lung scan allowed us to rule out CTEPH. To our knowledge, no other case of chronic pulmonary hypertension (PH) related to VA shunt insertion has been reported so far. PH in this patient with VA shunt is clinically distinct from CTEPH and has been caused by VA shunt-induced S. epidermidis infection per se.

Acute and chronic Staphylococcus epidermidis post-operative endophthalmitis: The importance of biofilm production.

To report two cases of acute and chronic-onset, postoperative Staphylococcus epidermidis endophthalmitis and discuss the virulence and treatment of this saprophytic pathogen. After clinical diagnosis of endophthalmitis, prompt vitreous culture was performed with injection of intravitreal vancomycin 1 mg/0.1 mL and ceftazidime 2.25 mg/0.1 mL. With no improvement after this procedure, a pars plana vitrectomy and lensectomy were performed to further decrease microbial load and repeat the intravitreal antibiotic. The lens and large amounts of fibrotic tissue were removed, and the posterior capsule was stripped. Vitreous cultures grew S. epidermidis sensitive to vancomycin. Intraoperative findings included dense vitreous opacification with extensive vitreous bands and pus extending into the zonules. During the removal of the IOL, adherent pus filaments were removed; however, only a moderate amount of bacteria was detected on the IOL. Further intravitreal vancomycin (1 mg/0.1 mL) and ceftazidime (2.25 mg/0.1 mL) were injected. Staphylococcus epidermidis is widely reported as responsible for medical device-related sepsis. This is mainly due to the production of slime, an exopolysaccharide that eventually leads to the formation of biofilm, one of the most important virulence factors. The failure of intravitreal antibiotic treatment in our two biofilm-associated infections may be due to the considerable amount of slime and pus found extending into the zonules and adherent to the IOL during surgery.

Intraperitoneal cerebrospinal fluid pseudocyst. A rare complication of ventriculoperitoneal shunt.

The abdominal intraperitoneal cerebrospinal fluid pseudocyst is a rare but important complication in patients with ventriculoperitoneal shunts. We report a case of a 31-year-old female, in which a large abdominal pseudocyst was developed 1 year after insertion of a ventriculoperitoneal shunt for hydrocephalus. The abdominal CT scan and the ultrasonographical evaluation of the abdomen showed a well defined, cystic mass lesion with a volume of 50 cm3, in the recessus hepato-renal. The peritoneal tip of the shunt was located within the mass lesion. A distal externalization of the peritoneal catheter without excision of the pseudocyst was performed. Cerebrospinal fluid culture demonstrated a Staphylococcus epidermis infection and adequate antibiotic treatment was administrated. The previous symptoms improved 4 weeks later and a new catheter was placed intraperitoneally in a different quadrant. The postoperative course was uneventful. We suggest that chronic inflammation or subclinical peritonitis is a predisposing factor for this complication.

Polymicrobial anaerobic infection with a deep abscess in the supraspinous fossa following a subacromial corticosteroid injection.

In September 2015, a male aged 61 years with poorly controlled diabetes (his only medical problem) had left shoulder surgery that included an arthroscopic acromioplasty with debridement of suture material from a rotator cuff repair done 10 years prior. A subacromial corticosteroid injection was given 7 months later for pain and reduced motion. Three weeks later a fulminate infection was evident. Cultures grew Propionibacterium acnes Treatment included two arthroscopic debridement surgeries and 8 weeks of intravenous antibiotics (primarily daptomycin). Eight weeks after the cessation of the antibiotics, purulence recurred and tissue cultures then grew Staphylococcus epidermidis Several additional surgeries were needed to control the infection. We failed to recognise that an abscess that extended from the subacromial space across the entire supraspinous fossa. We report this case to alert clinicians that a seemingly innocuous subacromial corticosteroid injection can lead to an atypical infection and also extend into the supraspinous fossa.

Disinfection by antiseptics in management of postoperative surgical wounds in urologic operations.

The objective of this study was to confirm that frequent disinfection by antiseptics is unnecessary on surgical wounds of urologic operations. Patients who received urologic operations were divided into 3 groups that had the same surgical dressings but different frequencies of disinfection and different antiseptics used. Surgical wounds were evaluated clinically and bacteriologically for the period until removal of sutures. Of the 97 patients randomly recruited for the study, 3 developed surgical-site infection (SSI). There was no significant difference in the incidence of SSI among the 3 groups. Bacterial counts of surgical wounds increased over time after operation, to similar extents in the 3 groups. The major isolate was Staphylococcus epidermidis, one of the normal florae on the skin. This strain was found at almost equal frequencies in all groups. In conclusion, our study suggested that covering with the surgical dressing without frequent disinfection by antiseptics was effective for prevention of SSI. Thus, traditional frequent disinfection should be abandoned.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient.

Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

Angiographic arterial embolization and computed tomography-directed drainage for the management of hemorrhage and infection with abdominal pregnancy.

Hemorrhage during or after surgery, pelvic abscess, bowel obstruction, and prolonged febrile morbidity can complicate the puerperal course of the gravida after removal of an extrauterine fetus with nondisturbance of the extrauterine placenta. In this report we describe the successful angiographic arterial gelfoam embolization of the placental vascular bed to control heavy postoperative hemorrhage in a mother suffering adult respiratory distress syndrome after removal of the fetal portion of her abdominal pregnancy. Six weeks later, computed tomography (CT)-directed drainage by catheter of a placental abscess was performed. Selective angiographic transcatheter embolization with gelfoam is a useful tool for the control of hemorrhage in the gravida who is an unfavorable operative candidate or who may present technical hemostasis problems peculiar to the placenta with abdominal pregnancy. Later use of CT-directed catheter drainage of the infected residual placental mass provided a nonoperative means of treatment.

Superior vena cava syndrome and infection of pacing leads in one patient.

The superior vena cava (SVC) syndrome is an uncommon complication due to permanent transvenous pacemaker electrodes. Infection of the leads is a risk factor for its occurrence. After being treated for SVC syndrome, due to multiple pacemaker leads, with thrombolysis and coumarine therapy, our patient was diagnosed with repetitive positive blood cultures. Because of relapsing SVC syndrome all pacemaker material was surgically removed. Recovery was complete and the patient remained pacemaker-independent. Culture of the leads showed the same coagulase-negative staphylococci as in the blood cultures. The indications for pacemaker implantation should always be rigorously defined and complications thoroughly investigated and treated.

[Pott's puffy tumor]. / 'Pott's puffy tumor'.

A 26-year-old man developed a fluctuating swelling of the forehead after twice being treated with antibiotics because of persistent sinusitis complaints. This swelling, a subperiostal abcess diagnosed as 'Pott's puffy tumor', is a complication of a frontal sinusitis, and may lead to serious neurological sequelae. The patient recovered after surgical drainage, ethmoidectomy and intravenous antibiotic treatment; no ablation of affected bone was necessary.

[Bacterial ecology in a neonatal intensive care unit]. / Ecologia batterica in un reparto di patologia neonatale.

A study about bacterial colonization/infection has been performed in 523 newborn, consecutively hospitalized in the Neonatal Intensive Care Unit (NICU) of Verona. Bacteriological samples were taken routinely at the admission in all patients and selectively only in neonates at risk of infection. The obtained data revealed a significative prevalence of gram-positive organisms (particularly Staphylococcus epidermidis highly resistant to antibiotics commonly used); among gram-negative bacteria Pseudomonas spp. resulted the more frequently isolated micro-organisms. According to data obtained, antimicrobial approach to bacterial infection in our NICU is finally discussed.

[Relationship between an offensive smell given off from human foot and Staphylococcus epidermidis].

The bacteria isolated from foot skins of 17 volunteers by the swab sampling method were mostly gram-positive cocci, which were identified as Staphylococcus epidermidis by the ID-kit SP-18 (Nissui Co., Ltd). After incubation of S. epidermidis on agar plates containing oleic acid and Tween 80 for 24 h at 35 C, the smell noticed was similar to an offensive smell of human pes. However, under the same conditions, the smell of another staphylococcal species was different from that of S. epidermidis. Except for the staphylococcal species, the colonies isolated from the skins were mostly those of yeast (unidentified) and gave off no offensive smell. From these results, it was considered that the smell of human pes might be given off by S. epidermidis, and if this species is inhibited, the smell would also be inhibited. A selective bactericide for gram-positive bacteria, which is a lotion containing deoxycholic acid, was applied to the feet of the 17 volunteers. The experiments showed that the application obviously decreased the counts of colonies of S. epidermidis and inhibited the smell as compared with controls.

Descending necrotizing mediastinitis associated with spinal cord abscess.

A 58-year-old man with a history of Ludwig's angina was admitted with a spinal cord abscess at the level of C2-T1 and associated osteomyelitic destruction of vertebral bodies, spinal cord compression, and secondary quadriparesis, followed by descending mediastinitis. A right posterolateral thoracotomy and a cervicotomy drained purulent exudates. A tracheostomy was performed, and the patient was discharged after 84 days.

The use of the ASET in the diagnosis of ventriculoatrial shunt infection.

A 38-year-old man with a ventriculoatrial shunt presented with non-specific symptoms (headache, back pain, night sweats) and inconclusive laboratory results. He showed an extremely high titre of antibody to Staphylococcus epidermidis which proved diagnostic of shunt infection. This was confirmed on shunt removal and he was successfully treated.

Panophthalmitis with orbital cellulitis following glaucoma drainage implant surgery in a pediatric patient / Panoftalmite com celulite orbitária após implante de drenagem em glaucoma congênito

ABSTRACT Here we report a case of childhood glaucoma refractory to angle and trabeculectomy surgery. The patient was treated with an Ahmed™ drainage implant that was subsequently complicated by rapid-onset panophthalmitis and orbital cellulitis. Intravenous and intravitreal antibiotic therapy was initiated and the drainage tube was removed. The infectious process resolved within 3 weeks; however, phthisis bulbi developed subsequently.

RESUMO Relato de um caso de uma criança portadora de glaucoma congênito primário, refratário a cirurgias angulares e trabeculectomias prévias, submetido à implante de drenagem do tipo Ahmed®. O paciente evoluiu com panoftalmite e celulite orbitária de aparecimento súbito, sendo submetido à remoção do tubo e antibioticoterapia endovenosa e intravítrea. O processo infeccioso foi resolvido em três semanas, porém o olho evoluiu para phthisis bulbi.

Design and application of an inertial impactor in combination with an ATP bioluminescence detector for in situ rapid estimation of the efficacies of air controlling devices on removal of bioaerosols.

We proposed a rapid method to estimate the efficacies of air controlling devices in situ using ATP bioluminescence in combination with an inertial impactor. The inertial impactor was designed to have 1 mum of cutoff diameter, and its performance was estimated analytically, numerically, and experimentally. The proposed method was characterized using Staphylococcus epidermidis, which was aerosolized with a nebulizer. The bioaerosol concentrations were estimated within 25 min using the proposed method without a culturing process, which requires several days for colony formation. A linear relationship was obtained between the results of the proposed ATP method (RLU/m(3)) and the conventional culture-based method (CFU/m(3)), with R(2) 0.9283. The proposed method was applied to estimate the concentration of indoor bioaerosols, which were identified as a mixture of various microbial species including bacteria, fungi, and actinomycetes, in an occupational indoor environment, controlled by mechanical ventilation and an air cleaner. Consequently, the proposed method showed a linearity with the culture-based method for indoor bioaerosols with R(2) 0.8189, even though various kinds of microorganisms existed in the indoor air. The proposed method may be effective in monitoring the changes of relative concentration of indoor bioaerosols and estimating the effectiveness of air control devices in indoor environments.